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[BACKGROUND: Although landscape and horticultural services workers have high injury and illness rates, little is known about fatalities in this industry. METHODS: Census of Fatal Occupational Injuries and Current Population Survey data were analyzed to determine fatality rates and causes of landscaping deaths from 1992 to 2001. RESULTS: There were 1,101 fatalities during the 10-year period and the average fatality rate was 13.50 deaths per 100,000 full-time employees. In 2001, the landscaping fatality rate was 3.33 (95% CI 2.84-3.91) times the all industry rate. The leading causes of death were transportation incidents (27%), contact with objects or equipment (27%), falls (24%), exposure to harmful substances and environments (18%), and assaults and violent acts (4%). The fatality rate for African American landscapers was 1.51 (95% CI 1.25-1.83) times the rate for white workers. Fatalities were also common among self-employed, small business, and young landscapers. CONCLUSIONS: Landscaping workers are at increased risk of fatal injury. Further research is needed to characterize industry hazards. Language: en

Endocrine-disrupting chemicals, including pesticides, may be associated with weight gain. This is the first longitudinal study to examine a potential association between weight gain and pesticides using data on 8,365 male pesticide applicators from the Agricultural Health Study (AHS) cohort established in 1993. The relationship between total cumulative days of exposure to pesticide functional/chemical classes and to the four most frequently used individual pesticides was studied in relation to body mass index (BMI) at the time of 5-yr follow-up (beginning in 1998) with the length of the exposure period dating back to age 20 yr. Multiple regression, Spearman correlation, ordinal logistic regression, and logistic regression models all utilized a Bonferroni-adjusted p value, were adjusted for relevant covariates, and were stratified by state of residence (Iowa/North Carolina) and presence/absence of weight-related health conditions. Adjusted multiple regression yielded statistically significant positive parameter estimates for the study sample and Iowa subgroups with consistent findings for triazine herbicides and atrazine: Change in BMI per 100 cumulative pesticide exposure days ranged from 0.07 to 0.11 for triazine herbicides and from 0.10 to 0.19 for atrazine. Ordinal logistic regression compared normal weight with overweight and with obese using the zero exposure category as referent. Statistically significant adjusted odds ratios identified for the study sample and both state subgroups for the highest level of atrazine exposure ranged from 1.4 to 1.7. Further investigation is warranted to evaluate the associations identified here.

Emergency medical services (EMS) personnel treat 22 million patients a year in the United States, yet little is known of their injury risks.To describe the epidemiology of occupational injuries among EMS personnel, calculate injury rates, and compare the findings with those for other occupational groups.This was a retrospective review of injury records kept by two urban agencies. The agencies submitted all 617 case reports for three periods between January 1, 1998, and July 15, 2002. The agency personnel worked an estimated 2,829,906 hours during the study periods. Cases were coded according to U.S. Department of Labor (DOL) criteria.Four hundred eighty-nine cases met the DOL inclusion criteria. The overall injury rate was 34.6 per 100 full-time (FT) workers per year (95% confidence interval [CI] 31.5-37.6). "Sprains, strains, and tears" was the leading category of injury; the back was the body part most often injured. Of the 489 cases, 277 (57%) resulted in lost workdays, resulting in a rate of 19.6 (95% CI 17.3-21.9) per 100 FT workers; in comparison, the relative risks for EMS workers were 1.5 (95% CI 1.35-1.72) compared with firefighters, 5.8 (95% CI 5.12-6.49) compared with health services personnel, and 7.0 (95% CI 6.22-7.87) compared with the national average.The injury rates for EMS workers are higher than rates reported by DOL for any industry in 2000. Funding and additional research are critical to further defining the high risks to EMS workers and developing interventions to mitigate this serious problem.

Occupational heat-related mortality is not well studied and risk factors remain largely unknown. This paper describes the epidemiological characteristics of heat-related deaths among workers in the US 2000-2010.Fatality data were obtained at the Bureau of Labor Statistics from the confidential on-site Census of Fatal Occupational Injuries database. Fatality rates and risk ratios with 95% confidence intervals were calculated by year, sex, age group, ethnicity, race, state, and industry.Between 2000 and 2010, 359 occupational heat-related deaths were identified in the U.S., for a yearly average fatality rate of 0.22 per 1 million workers. Highest rates were found among Hispanics, men, the agriculture and construction industries, the state of Mississippi, and very small establishments.This study provides the first comprehensive national profile of heat-related deaths in the U.S. workplace. Prevention efforts should be directed at small businesses and at industries and individuals with the highest risk.

This article describes non-fatal injuries among Hispanic construction workers treated at an emergency department from 1990 to 1998. Medical and interview data were analyzed to evaluate and explain the workers' apparently inflated risk of injury. The majority of the injured Hispanic workers were employed in the less-skilled trades. Compared with other injured workers, Hispanics had a higher proportion of serious injuries and were disadvantaged in terms of training and union status. With the exception of union status, these differences largely disappeared after controlling for trade. The physical, financial, and emotional consequences were more apparent 1 year later for injured Hispanics, even after controlling for trade. These observations suggest that minority status is a predictor of trade and that trade is a predictor of injury risk. In addition to reducing injury hazards, interventions should address the limited employment and union membership options that are available to minority workers in the construction industry.

OBJECTIVE AND METHODS--This historical cohort study investigated causes of death among car and mobile equipment mechanics in the District of Columbia's Department of Public Works. Men who were employed for at least one year between 1977 and 1989 were eligible for inclusion in the cohort; follow up was up to the end of 1991. Three cases of leukaemia (index cases) had been reported among these workers before the inception of this study. This research was undertaken to estimate the relative risk of haematological cancer among mechanics working for the District of Columbia. RESULTS--Among the 335 male fleet maintenance workers, the all cause standardised mortality ratio (SMR) was 0.50 (33 observed deaths, 95% confidence interval (95% CI) 0.35-0.70), and the all cancer SMR was 0.55 (nine deaths, 95% CI 0.25-1.05). Three deaths from lymphatic and haematopoietic cancer were observed; the SMR was 3.63 (95% CI 0.75-10.63). In the subgroup with highest potential for exposure to fuels and solvents, the SMR for leukaemia and aleukaemia was 9.26 (two deaths, 95% CI 1.12-33.43), and the SMR for other lymphatic and haematopoietic neoplasms was 2.57 (one death from malignant lymphoma, 95% CI 0.06-14.27). All three lymphatic and haematopoietic cancer deaths were among car and mobile equipment mechanics (one was an index case). The two additional index cases were a fourth mechanic who died of leukaemia in 1992, after mortality follow up ended, and a fifth mechanic who was diagnosed with leukaemia in 1988 and is still alive. CONCLUSION--Many garage mechanics in this cohort regularly used petrol to clean parts and to wash their hands; some workers would occasionally siphon petrol by mouth. Benzene, a recognised cause of haematological cancer, is a component of petrol. Previous research indicates that garage mechanics may be at risk of leukaemia and other haematological cancers, presumably due to exposure to petrol; this study supports those findings.

We report results of two pilot studies of the relationship between musculoskeletal disorders and work tasks in sheet metal workers. These two studies were undertaken as pilot investigations to determine if symptoms of carpal tunnel syndrome or other work-related musculoskeletal symptoms are present in sheet metal workers, and to determine if we could begin to identify the factors in sheet metal work that cause them. In the first study, telephone interviews were conducted with 18 disabled sheet metal workers; the second survey entailed self-administered questionnaires completed by 47 active and retired sheet metal workers. Among the disabled workers, rotator cuff cases reported the greatest percent of time spent hanging duct, an overhead task commonly carried out during field work. Carpal tunnel cases reported more hand tool use than the rotator cuff cases. The questionnaire survey of active and retired workers found the proportion of time spent in a sheet metal shop (contrasted with field work) to be positively associated with hand symptoms; sheet metal workers who spent at least 65% of their time in the shop had an odds ratio of 3.4 for symptomatic hand cumulative trauma disorder (CTD) (p = 0.12). The proportion of time spent hanging duct was positively associated with both neck and shoulder symptoms, with odds ratios of 7.9 (p = 0.08) and 2.7 (p = 0.16), respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

To learn more about the causes of nonfatal construction worker injuries, and to identify injury cases for further work-site investigations or prevention programs, an emergency department-based surveillance program was established. Construction workers with work-related injuries or illnesses were identified by reviewing the medical records of all patients treated at the George Washington University Emergency Department between November 1, 1990 and November 31, 1992. Information regarding the worker, the injury, and the injury circumstances were abstracted from medical records. Information was obtained on 592 injured construction workers from numerous trades. Lacerations were the most commonly treated injuries among these workers, followed by strains and sprains, contusions, and eye injuries. Injuries were most commonly caused by sharp objects (n = 155, 26%), falls (n = 106, 18%), and falling objects (n = 70, 12%). Thirty-five percent of injuries were to the hands, wrists, or fingers. Among the twenty-eight injuries severe enough to require hospital admission, eighteen (64%) were caused by falls. Laborers and Hispanic workers were overrepresented among these severe cases. Emergency Department records were a useful surveillance tool for the initial identification and description of work-related injuries. Although E codes were not that useful for formulating prevention strategies, detailed review of injury circumstances from Emergency Department records was valuable and has helped to establish priorities for prevention activities. Language: en

This study ascertained the presence of musculoskeletal symptoms among electricians, in order to evaluate the prevalence of cumulative trauma disorders (CTD) in this population. We adapted the CTD surveillance questionnaire used by National Institute for Occupational Safety and Health (NIOSH) to assess the prevalence of neck, shoulder, elbow, hand/wrist, back, and knee symptoms in the year prior to the survey. Questionnaires were completed by 308 apprentices and journeymen enrolled in training classes at the local union hall. The participants were relatively young individuals, and 86% of the participants were currently working as electricians. Participants reported a high prevalence of symptoms which occurred more than three times during the past year or which lasted more than 1 week. Back symptoms and hand/wrist symptoms were experienced most frequently, by about half the population, while elbow symptoms were reported by only 15% of participants. Symptom prevalence was lower, but still notable, when defined as symptoms which had occurred at least once a month or lasted more than a week in the past year. Eighty-two percent of participants reported at least one musculoskeletal symptom using the most inclusive definition, while 57% reported two or more symptoms. This survey highlights that: 1) low back discomfort is common in young construction workers, and resulted in medical care, missed work, or light duty for almost 35% of the participants; 2) neck discomfort is also very common and required doctor visits or work modification for almost one quarter of the participants; 3) these construction workers continued to work with symptoms that are classifiable as a CTD; and 4) history of injury is correlated with the subsequent prevalence of musculoskeletal symptoms.

Mine Safety and Health Administration (MSHA) surveillance data were analyzed to elucidate mine characteristics or injury characteristics that distinguished mines with high rates of transport-related injuries from mines with lower transport injury rates. The results showed that most high-rate mines are small, high-rate mines have a disproportionate number of injuries involving young and less experienced workers, and injuries in high-rate mines are proportionally more severe. Further analyses of the MSHA injury data showed that smaller mines have a greater share of fatal and permanently disabling injuries, whereas larger mines have a greater share of injuries involving no lost time. Based on these results, we explored two explanations for the small mine injury risk: (1) a suggestion that differences in injury reporting between large and small mines may contribute to an apparent small mine injury risk, and (2) identification of factors contributing to a true difference in transport-related injury risk between small and large mines. Whereas it was true that most high injury rate mines were small, most small mines were actually zero-rate, having reported employment but no injuries to MSHA. An analysis employing binomial probability theory showed that a substantial proportion of small mines reported zero injuries when it was statistically probable that injuries would have occurred. This indicated that small mines may underreport injuries relative to larger mines. The possibility that reporting bias affected the associations found in this study was explored by eliminating the least severe injuries from the data set and evaluating changes in associations. This "adjustment" for reporting bias did not change previously observed relationships. Finally, MSHA injury data were analyzed in concert with mining population data collected by the Bureau of Mines. With such denominator information, the results indicated a disproportionately high risk of injury among workers in their first year at a mine and indicated that higher injury risk in small mines might be explained by the fact that workers at small mines have substantially less experience than workers at large mines. An effect of age was not found in these analyses. These results suggest the potential importance of targeted training programs for newly hired miners. Results also point to the need to explore specific factors contributing to the small mine injury risk, and to the necessity for complete and accurate reporting of injury data.

This study assessed agreement between workers' and observers' daily estimates of exposure to construction work tasks. The ultimate aim was to develop a valid method and instrument for the collection of self-reported data on duration of exposure to a priori identified work tasks for use in characterizing exposure in settings with substantial task variability. Forty-nine shop workers and 52 construction site sheet metal workers were observed for up to 3 full workdays. Observers sampled approximately 25% of each worker's day, recording the work performed from a prespecified list of tasks. Each participant completed a daily questionnaire, indicating the tasks he or she performed that day and time spent on each task. Shop workers tended to specialize in particular tasks, while at the construction site, the workers' tasks reflected substantial day-to-day variability. Agreement between worker and observer estimates was generally better for major shop tasks (with intraclass correlation coefficients [ICCs] ranging from 0.52 to 0.85), than for major construction site tasks (with ICCs ranging from 0.36 to 0.64). Workers tended to overestimate the amount of time spent at tasks of longer duration and to underestimate time spent at short-duration tasks. Rank order analysis of time spent on task revealed fairly high agreement. Agreement was acceptable for shop-based work, which has less day-to-day variability than construction site work. Overall, however, the data suggest that, for highly variable work, the use of task as the unit of exposure does not improve recall over assessment approaches focusing on questions about posture and material handling.

Previous research has found that the location, type and mechanisms of injuries in lacrosse players vary by gender. The patterns and risk factors of injuries in lacrosse players are still not well known. The study population consists of lacrosse players who utilised the accident medical insurance provided to US Lacrosse members. Cluster analysis was used to explore the aetiology of lacrosse-related injuries. Between 2002 and 2006 there were 593 game injuries, 496 in men and 97 in women. There were six clusters of injuries in women and five clusters of injuries in men. Play scenarios resulting in injury differed by the position played. In all the five injury clusters in males, the primary injury mechanism was by contact, either with another player, a stick or a ball. In women, body-to-body and stick-to-body, and no contact were the most common injury mechanisms. In both genders, the majority of injuries occurred during legal play. These results provide a picture of high-risk situations that lead to injuries in male and female lacrosse players. Future efforts should be made to confirm these results through epidemiologic studies. Further research should also address the effectiveness of interventions that could reduce the risk of injury in these situations.

BACKGROUND: To assess the intersection of work demands, chronic medical and musculoskeletal conditions, aging, and disability, we initiated a longitudinal study of construction roofers who were current union members between the ages of 40 and 59. METHODS: Participants were asked about the presence of medical conditions and musculoskeletal disorders; the Work Limitations Questionnaire, the SF-12, and other validated assessments of social and economic impact of injury were included. RESULTS: Factors at baseline that predicted leaving for a health-related reason were older age, lower physical functioning, work limitations, and having missed work. Those who left roofing for a health-related reason were much more likely to have a lower economic score at the 1 year interview. CONCLUSIONS: Medical and musculoskeletal conditions are strongly associated with work limitation, missed work, and reduced physical functioning; these factors are also associated with premature departure from the workforce. Language: en

Objectives This study investigated the relationships between work demands, chronic medical and musculoskeletal conditions, aging, and the ability to remain on the job in a longitudinal study of 979 construction roofers between the ages of 40 and 59 years. Methods In a phone interview at baseline and 1 year later, the participants were asked about the presence of medical conditions and musculoskeletal disorders, work limitations and work accommodations, and social and economic functioning. Results Among the workers for whom a musculoskeletal disorder was their most serious condition at baseline, 8% left roofing due to a health condition during the first year of follow-up. A comparison between those who left and those who stayed identified older age and lower physical functioning as statistically significant predictors of leaving the trade. Workers with a musculoskeletal disorder and who, in the baseline interview, reported receiving some type of job accommodation for their musculoskeletal disorder had an odds ratio of 0.24 (P=0.07) for leaving work by the time of the 1-year follow-up when compared with workers with a musculoskeletal disorder and no job accommodation. The workers with three or more work limitations were also more likely to leave roofing, but this association disappeared after adjustment for other factors. Conclusions Musculoskeletal conditions among roofers are strongly associated with work limitation, missed work, and reduced physical functioning, factors that are predictive of premature departure from the workforce. Job accommodation was provided for 31% of the roofers with a musculoskeletal disorder, and it was associated with a reduced likelihood of subsequently leaving roofing for health-related reasons.

To investigate the intersection of aging with work limitations, chronic medical and musculoskeletal conditions, and physical functioning we undertook a cross-sectional study of U.S. construction roofers who were current union members between the ages of 40 and 59.Participants were asked about the presence of medical conditions and musculoskeletal disorders (MSDs); the Work Limitations Questionnaire, the SF-12, and other validated assessments of social and economic impact of injury were included.Sixty-nine percent had at least one of these conditions in the previous two years; 31% missed work. Workers with medical and musculoskeletal conditions were older, had the highest prevalence of work activity limitations, and had the lowest SF-12 scores.Older age was associated with the presence of a medical condition, and with reduced physical functioning. Medical and musculoskeletal conditions were strongly associated with work limitation, missed work, and reduced physical functioning. Older workers may be at higher risk of disability retirement compared to younger workers with similar medical conditions and work limitations.

This study evaluated risk factors for injurious and noninjurious slips, trips, and falls among painters and investigated the hypothesis that exposure to solvents influenced the risk of such accidents. The data were collected longitudinally over an 11 month period. Weekly self-administered questionnaires detailed paint solvent exposure; work-related slips, trips, and falls (STFs); and potentially hazardous job tasks and environmental conditions. An initial questionnaire ascertained personal data, such as age, solvent exposure history, and alcohol consumption. During the study, 2,088 person-weeks of data were collected. Some participants provided many weeks of data, while others responded sporadically. Exposure to potentially hazardous environmental conditions was significantly related to the occurrence of STFs during a week. Several measures of solvent exposure were evaluated for their effect on STFs. Low solvent exposure during a week significantly increased the occurrence of slips, trips, and falls compared to no exposure. Moderate and high weekly exposure were not associated with increased risk, however. Week-to-week variability in the amount of solvent exposure was a strong positive predictor of STFs. Further analysis showed that both increases and decreases in solvent exposure between the preceding 2 weeks and the week of the STF were positively related to the risk of such events. The strongest effect was observed for exposure increases over the preceding 2 weeks. Overall, the results suggest that solvent exposure variability may increase accident risk, and possible explanations are explored. Language: en

The aim of this study was to profile construction workers' injuries for more information about the causes of nonfatal construction worker injuries and identify injury trends for further investigations and prevention programs.An injury-tracking program for emergency departments was established in 1990 to gather the data needed for the study. Profiles were obtained for 2916 construction workers' injuries that were identified on hospital registration forms at the George Washington University Emergency Department in Washington, DC, from November 1990 through October 1997. Laborers and construction workers who did not specify a trade were combined, and together they made up the largest group--29% of the injured workers.The leading cause of injury was contact with cutting or piercing objects-most often pieces of metal, razors, knives, power tools, and nails. Workers striking against objects or being struck by objects (including falling objects) accounted for the second-largest group of injuries, and the third leading injury circumstance was falling--either from a height or on the same level. Detailed injury statistics are presented by trade, showing patterns of injury that reflect tasks of these trades and which injuries predominated in each trade. Although many previous reports have described construction workers' injuries, very few have provided detailed data by trade.The details presented in this analysis allow for a better understanding of the injury circumstances and provide a starting point for injury prevention programs.

As water flows from treatment plants to the tap, chlorine, used to disinfect surface water meant for residential use, reacts with residual organic and inorganic matter, creating chlorine disinfection by-products. In recent years, these by-products have been scrutinized as a potential reproductive and developmental hazard. This study examined whether exposure to the four total trihalomethanes or the five haloacetic acids (two major subgroups of chlorine disinfection by-products) was related to an increased risk of intrauterine growth retardation in four regions of a Maryland county from 1998 to 2002. Maternal exposure to each by-product was evaluated for each trimester as well as over the entire pregnancy. The authors were not able to demonstrate any consistent, statistically significant effect on intrauterine growth retardation associated with any of the chlorine disinfection by-products, nor did they find any indication of a dose-response relation. However, they did find some potential for a slightly elevated risk of intrauterine growth retardation during the second and third trimesters for both total trihalomethanes and five haloacetic acids when comparing increasing quintiles of exposure to constituents of total trihalomethanes and five haloacetic acids.

Study objective: We estimate the occupational fatality rate among emergency medical services (EMS) personnel in the United States. Methods: We undertook descriptive epidemiology of occupational fatalities among EMS providers. Analysis was conducted by using data from 3 independent fatality databases: the Census of Fatal Occupational Injuries (1992 to 1997), the National EMS Memorial Service (1992 to 1997), and the National Highway Traffic Safety Administration's Fatality Analysis Reporting System (1994 to 1997). These rates were compared with the occupational fatality rates of police and firefighters and with the rate of all employed persons in the United States. Results: The Census of Fatal Occupational Injuries database documented 91 EMS provider occupational fatalities. The National EMS Memorial Service database contained 70 fatalities, and the Fatality Analysis Reporting System identified 8 ground-transportation EMS occupational fatalities. There was also wide variation in fatality counts by cause of injury. Using the highest cause-specific count from each of the databases, we estimate that there were at least 67 ground transportation-related fatalities, 19 air ambulance crash fatalities, 13 deaths resulting from cardiovascular incidents, 10 homicides, and 5 other causes, resulting in 114 EMS worker fatalities during these 6 years. We estimated a rate of 12.7 fatalities per 100,000 EMS workers annually, which compares with 14.2 for police, 16.5 for firefighters, and a national average of 5.0 during the same time period. Conclusion: This study identifies an occupational fatality rate for EMS workers that exceeds that of the general population and is comparable with that of other emergency public service workers. [ Ann Emerg Med. 2002;40:625-632.]

Occupational eye injuries are both common and preventable. About 20% of occupational eye injuries occur in construction. To investigate the nature of eye injuries among construction workers, we analyzed a large data set of construction worker injuries. In addition, we interviewed 62 workers with eye injuries to further explore circumstances of eye injury and workers' attitudes and behavior toward the use of eye protection. Eleven percent (363 cases) of the 3,390 construction workers in our data set were treated for eye injuries. Welders, plumbers, insulators, painters/glaziers, supervisors, and electricians had a higher proportion of all injuries due to eye injuries than other trades. Nearly half of the diagnoses were abrasions (46%) followed by foreign objects or splash in the eye (29%), conjunctivitis (10%), and burns (5%). In the interviews with 62 workers, we found that employers very frequently required eye protection for all tasks or for high-risk tasks, and workers report wearing eye protection regularly. However, most did not wear eye protection with top and side shields; if we believe the injuries occurred because a particle or liquid passed between the glasses and the workers' faces, increased use of goggles or full shields would have prevented two-thirds of this group of injuries.

Construction is one of the largest industries in the United States, employing over 7.5 million people. It accounts for 3 times as many accidents as might be expected on a per capita basis. Laborers represent one of 15 job classifications participating in this industry. They have a higher risk of death or injury from a number of causes than do other construction workers.

Hearing loss affects many workers including those in the military and may be caused by noise, medications, and chemicals. Exposures to some chemicals may lead to an increase in the incidence of hearing loss when combined with hazardous noise. This retrospective study evaluated the risk for hearing loss among Air Force Reserve personnel exposed to occupational noise with and without exposures to toluene, styrene, xylene, benzene, and JP-8 (jet fuel). Risk factors associated with hearing loss were determined using logistic and linear regression. Stratified analysis was used to evaluate potential interaction between solvent and noise exposure. The majority of the subjects were male (94.6%) and 35 years or older on the date of their first study audiogram (66%). Followed for an average of 3.2 years, 9.2% of the study subjects had hearing loss in at least one ear. Increasing age (odds ratio [OR] = 1.03 per year of age) and each year of follow-up time (OR = 1.23) were significantly associated with hearing loss. Low and moderate solvent exposures were not associated with hearing loss. Linear regression demonstrated that hearing loss was significantly associated with age at first study audiogram, length of follow-up time, and exposure to noise. Hearing decreased by 0.04 decibels for every decibel increase in noise level or by almost half a decibel (0.4 dB) for every 10 decibel increase in noise level.