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Background Despite wide availability of patient lift equipment in hospitals to promote worker and patient safety, nursing staff do not consistently use equipment. Objective To determine the influence of factors on the use or non-use of lift equipment during patient lifts/transfers. Design Prospective observational cohort study. Setting One university teaching hospital and two community hospitals in a large health system in southeastern United States. Participants 77 nurses and nursing care assistants with patient handling duties in critical care, step-down and intermediate care units. Methods Participants recorded information about all patient lifts/transfers during their shifts during a 1 week period per month for three months: type of lift/transfer, equipment use, type of equipment, and presence of 20 factors at the time of the lift/transfer. With the patient lift/transfer as the unit of analysis, the association (risk ratios (RR) and 95% confidence intervals (CI)) between factors and equipment use was examined using multivariate Poisson regression with generalized estimating equations. Results Seventy-seven participants (465 person-shifts) reported 3246 patient lifts/transfers. Frequent lifts/transfers included bed-to-toilet (21%), toilet-to-bed (18%), bed-to-chair (13%), chair-to-bed (13%), chair-to-toilet (6%), and toilet-to-chair (6%). Equipment was used for 21% of lifts/transfers including powered floor based dependent lift (41%), powered sit-to-stand lift (29%), non-powered sit-to-stand lift (17%), air-assisted lateral transfer device (6%), ceiling lift (3%), and air-assist patient lift (3%). Factors associated with equipment use included: availability of equipment supplies (RR = 9.61 [95%CI: 6.32, 14.63]), staff availability to help with equipment (6.64 [4.36, 10.12]), staff preference to use equipment (3.46 [2.48, 4.83]), equipment required for patient condition (2.38 [1.74, 3.25]), patient inability to help with lift/transfer (2.38 [1.71, 3.31]), equipment located in/by patient room (1.82 [1.08, 3.06]), sling already under patient (1.79 [1.27, 2.51]), and patient size/weight (1.38 [0.98, 1.95]). Lower patient mobility score (3.39 [2.19, 5.26]) and presence of physical or mental impairments (2.00 [1.40, 2.86]) were also associated with lift equipment use. Factors associated with non-use of equipment included: patient/family preference (0.31 [0.12, 0.80]), staff assisting with lift did not want to use equipment 0.34 ([0.17, 0.68]), patient condition (0.48 [0.20, 1.20]), and patient almost fell (0.66 [0.45, 0.97]). Conclusions Patient, worker, equipment, and situational factors influence whether nursing staff used equipment to lift/transfer a patient. Quantifying and understanding these factors associated with lift equipment use and non-use provides specific information for hospitals and safety professionals to enhance effectiveness of future organizational and ergonomic intervention efforts to prevent work-related patient-handling injuries.

Context: Health care workers have high rates of musculoskeletal injuries, but many of these injuries go unreported to workers' compensation and national surveillance systems. Little is known regarding the work-related injuries of certified athletic trainers (ATs). Objective: To determine the 12-month incidence and prevalence of work-related injuries and describe injury-reporting and -management strategies. Design: Cross-sectional study. Setting: Population-based online survey. Patients or Other Participants: Of the 29 051 ATs currently certified by the Board of Certification, Inc, who “opted in” to research studies, we randomly selected 10 000. Of these, 1826 (18.3%) ATs currently working in the clinical setting were eligible and participated in the baseline survey. Main Outcome Measure(s): An online survey was e-mailed in May of 2012. We assessed self-reported work-related injuries in the previous 12 months and management strategies including medical care, work limitations or modifications, and time off work. Statistics (frequencies and percentages) were calculated to describe injury rates per 200 000 work hours, injury prevalence, injury characteristics, and injury-reporting and -management strategies. Results: A total of 247 ATs reported 419 work-related injuries during the previous 12 months, for an incidence rate of 21.6 per 200 000 hours (95% confidence interval = 19.6, 23.7) and injury prevalence of 13.5% (95% confidence interval = 12.0%, 15.1%). The low back (26%), hand/fingers (9%), and knee (9%) were frequently affected body sites. Injuries were most often caused by bodily motion/overexertion/repetition (52%), contact with objects/equipment/persons (24%), or slips/trips/falls (15%). More than half of injured ATs (55.5%) sought medical care, 25% missed work, and most (77%) did not file a workers' compensation claim for their injury. Half of injured ATs were limited at work (n = 125), and 89% modified or changed their athletic training work as a result of the injury. Conclusions: More than half of AT work-related injuries required medical care or work limitations and were not reported for workers' compensation. Understanding how ATs care for and manage their work-related injuries is important given that few take time off work.

Background Devices to lift, transfer, and reposition patients are recommended for healthcare workers' and patients' safety, but their intended use has yet to be fully realized. Objective The aim of this study was to describe hospital nursing staff use of lift/transfer devices and the presence of factors at the time of lifts/transfers with potential to influence whether devices are used. Methods Participants were 108 US nursing staff in a university-based medical center and two community hospitals. A self-completed questionnaire was used to collect demographic and work characteristics, typical frequency of patient lifts/transfers, training in and typical use of lift equipment, and specific factors that could influence use. Proportional distributions of lifting/transferring and repositioning frequencies in a typical shift, amount of equipment use, and factors present were examined overall and across worker and work-related characteristics. Results Although trained in equipment use, only 40% used equipment for at least half of lifts/transfers. During lifts/transfers, factors often present included patient unable to help with lift/transfer (91.3%) or of a size/weight where participant needed assistance to help lift/transfer (87.5%); availability of others who could assist with manual lift (86.3%) or use of lift equipment (82.4%); and equipment functioning properly (86.4%), having supplies available (82.5%), and being easy to retrieve from storage (81.6%). During repositioning tasks, physical assistance was "always/almost always" provided from coworkers (83.3%) and often perceived as "very helpful" (92.6%) in reducing physical demands. Physical assistance from patients was less common (14.0% "always/almost always") yet perceived as "very helpful" by 66.3%. One fifth always used friction-reducing devices. Discussion Despite training in their use, nursing staff use of available lift equipment and assistive devices is limited. Factors present at the time of lifts/transfers that may influence equipment/device use reflect a complex mix of patient, worker, equipment, and situational characteristics.

OBJECTIVETo use a unique multicomponent administrative data set assembled at a large academic teaching hospital to examine the risk of percutaneous blood and body fluid (BBF) exposures occurring in operating rooms.DESIGNA 10-year retrospective cohort design.SETTINGA single large academic teaching hospital.PARTICIPANTSAll surgical procedures (n=333,073) performed in 2001–2010 as well as 2,113 reported BBF exposures were analyzed.METHODSCrude exposure rates were calculated; Poisson regression was used to analyze risk factors and account for procedure duration. BBF exposures involving suture needles were examined separately from those involving other device types to examine possible differences in risk factors.RESULTSThe overall rate of reported BBF exposures was 6.3 per 1,000 surgical procedures (2.9 per 1,000 surgical hours). BBF exposure rates increased with estimated patient blood loss (17.7 exposures per 1,000 procedures with 501–1,000 cc blood loss and 26.4 exposures per 1,000 procedures with >1,000 cc blood loss), number of personnel working in the surgical field during the procedure (34.4 exposures per 1,000 procedures having ≥15 personnel ever in the field), and procedure duration (14.3 exposures per 1,000 procedures lasting 4 to CONCLUSIONSResults largely support other studies found in the literature. However, additional research should investigate differences in risk factors for BBF exposures associated with suture needles and those associated with all other device types.Infect. Control Hosp. Epidemiol. 2015;37(1):80–87

Introduction A rate-based understanding of home care aides’ adverse occupational outcomes related to their work location and care tasks is lacking. Methods Within a 30-month, dynamic cohort of 43 394 home care aides in Washington State, injury rates were calculated by aides’ demographic and work characteristics. Injury narratives and focus groups provided contextual detail. Results Injury rates were higher for home care aides categorized as female, white, 50 to

OBJECTIVE:: We evaluated work-related injuries involving a hand or fingers and associated costs among a cohort of 24,830 carpenters between 1989 and 2008. METHODS:: Injury rates and rate ratios were calculated by using Poisson regression to explore higher risk on the basis of age, sex, time in the union, predominant work, and calendar time. Negative binomial regression was used to model dollars paid per claim after adjustment for inflation and discounting. RESULTS:: Hand injuries accounted for 21.1% of reported injuries and 9.5% of paid lost time injuries. Older carpenters had proportionately more amputations, fractures, and multiple injuries, but their rates of these more severe injuries were not higher. Costs exceeded $21 million, a cost burden of $0.11 per hour worked. CONCLUSIONS:: Older carpenters' higher proportion of serious injuries in the absence of higher rates likely reflects age-related reporting differences. Language: en

Background Individuals who work in the construction industry are at high risk of occupational injury. Robust surveillance systems are needed to monitor the experiences of these workers over time. Methods We updated important surveillance data for a unique occupational cohort of union construction workers to provide information on long-term trends in their reported work-related injuries and conditions. Combining administrative data sources, we identified a dynamic cohort of union carpenters who worked in Washington State from 1989 through 2008, their hours worked by month, and their workers' compensation claims. Incidence rates of reported work-related injuries and illnesses were examined. Poisson regression was used to assess risk by categories of age, gender, time in the union, and calendar time contrasting medical only and paid lost time claims. Results Over the 20-year study period, 24,830 carpenters worked 192.4 million work hours. Work-related injuries resulting in medical care or paid lost time (PLT) from work occurred at a rate of 24.3 per 200,000 hr worked (95% CI: 23.5–25.0). Medical only claims declined 62% and PLT claims declined 77%; more substantive declines were seen for injuries resulting from being struck and falls to a lower level than from overexertion with lifting. Differences in risk based on union tenure and age diminished over time as well. Conclusions Significant declines in rates of reported work-related injuries and illnesses were observed over the 20-year period among these union carpenters. Greater declines were observed among workers with less union tenure and for claims resulting in PLT. Am. J. Ind. Med. 56:381–388, 2013. © 2012 Wiley Periodicals, Inc.

Little is known about the work-related injury and illnesses experienced by certified athletic trainers (AT).The incidence and characteristics of injury/illness claims filed in two workers' compensation systems were described from 2001 to 2011. Yearly populations at risk were estimated from National Athletic Trainers' Association membership statistics. Incidence rate ratios (IRR) were reported by job setting.Claims were predominantly for traumatic injuries and disorders (82.7%: 45.7% sprains/strains, 12.0% open wounds, 6.5% bruises) and at these body sites (back 17.2%, fingers 12.3%, and knee 9.6%) and over half were caused by body motion and overexertion (51.5%). Compared with school settings, clinic/hospital settings had modestly higher claim rates (IRR = 1.29, 95% CI: 1.06-1.52) while other settings (e.g., professional or youth sport, nursing home) had lower claim rates (IRR = 0.63, 95% CI: 0.44-0.70).These first known estimates of work-related injuries/illnesses among a growing healthcare profession help identify occupational tasks and settings imposing injury risk for ATs. Am. J. Ind. Med. 59:1156-1168, 2016. © 2016 Wiley Periodicals, Inc.

Under-reporting of type II (patient/visitor-on-worker) violence by workers has been attributed to a lack of essential event details needed to inform prevention strategies.Mixed methods including surveys and focus groups were used to examine patterns of reporting type II violent events among ∼11,000 workers at six U.S. hospitals.Of the 2,098 workers who experienced a type II violent event, 75% indicated they reported. Reporting patterns were disparate including reports to managers, co-workers, security, and patients' medical records-with only 9% reporting into occupational injury/safety reporting systems. Workers were unclear about when and where to report, and relied on their own "threshold" of when to report based on event circumstances.Our findings contradict prior findings that workers significantly under-report violent events. Coordinated surveillance efforts across departments are needed to capture workers' reports, including the use of a designated violence reporting system that is supported by reporting policies. Am. J. Ind. Med. 59:853-865, 2016. © 2016 Wiley Periodicals, Inc.

OBJECTIVETo explore whether surgical teams with greater stability among their members (ie, members have worked together more in the past) experience lower rates of sharps-related percutaneous blood and body fluid exposures (BBFE) during surgical procedures.DESIGNA 10-year retrospective cohort study.SETTINGA single large academic teaching hospital.PARTICIPANTSSurgical teams participating in surgical procedures (n=333,073) performed during 2001–2010 and 2,113 reported percutaneous BBFE were analyzed.METHODSA social network measure (referred to as the team stability index) was used to quantify the extent to which surgical team members worked together in the previous 6 months. Poisson regression was used to examine the effect of team stability on the risk of BBFE while controlling for procedure characteristics and accounting for procedure duration. Separate regression models were generated for percutaneous BBFE involving suture needles and those involving other surgical devices.RESULTSThe team stability index was associated with the risk of percutaneous BBFE (adjusted rate ratio, 0.93 [95% CI, 0.88–0.97]). However, the association was stronger for percutaneous BBFE involving devices other than suture needles (adjusted rate ratio, 0.92 [95% CI, 0.85–0.99]) than for exposures involving suture needles (0.96 [0.88–1.04]).CONCLUSIONSGreater team stability may reduce the risk of percutaneous BBFE during surgical procedures, particularly for exposures involving devices other than suture needles. Additional research should be conducted on the basis of primary data gathered specifically to measure qualities of relationships among surgical team personnel.Infect Control Hosp Epidemiol 2016;37:512–518

BACKGROUND: In the high-risk construction industry little is known about the prevalence or effects of programs offering rewards for workers and/or their supervisors for improved safety records or those that punish workers in some way for injury. METHODS: We conducted an anonymous survey of 1,020 carpenter apprentices in three union training programs to document prevalence of their exposure to such efforts. We explored associations between perceptions of the reporting of work-related injury and elements of these programs. RESULTS: Fifty-eight percent (58%; n = 592) reported some safety incentive or negative consequence of work-related injuries on their current jobsite. Reporting of work-related injuries was 50% less prevalent when workers were disciplined for injury experiences. Otherwise, we saw minimal evidence of association between injury reporting practices and safety incentive programs. However, considerable evidence of fear of reprisal for reporting injuries was revealed. Less than half (46.4%) reported that work-related injuries were reported in their current workplace all or most of the time; over 30% said they were almost never or rarely reported. CONCLUSIONS: There are multiple layers of disincentives to the reporting of work-related injuries that hamper understanding of risk and pose threats to workplace safety and productivity. These pressures do not arise in a vacuum and are likely influenced by a host of contextual factors. Efforts that help us understand variation across jobsites and time could be enlightening; such inquiries may require mixed methodologies and should be framed with consideration for the upper tiers of the public health hierarchy of hazard control. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc. Language: en

Using an observational research design and robust surveillance data, we evaluated rates of musculoskeletal (MS) injuries, days away from work, and restricted work days among patient care staff at a medical center and community hospital in the United States over 13 years, during which time a "minimal manual lift" policy and mechanical lift equipment were implemented.Workers' compensation claims data were linked to human resources data to define outcomes of interest and person-time at risk to calculate rates. Poisson and negative binomial regression with lagging were used to compare outcome rates in different windows of time surrounding the intervention. Patterns of MS injuries associated with patient-handling were contrasted to patterns of other MS injuries that would not be affected by the use of mechanical lift equipment.At the medical center, no change in the patient-handling MS injury rate followed the intervention. A 44% decrease was observed at the community hospital. At both hospitals, the rate of days away declined immediately - before it was reasonable for the intervention to have been adopted.Institutional-level changes at the time of the intervention likely influenced observed results with findings only partially consistent with an intervention effect. Observational studies can be useful in assessing effectiveness of safety interventions in complex work environments. Such studies should consider the process of intervention implementation, the time needed for intervention adoption, and the dynamic nature of work environments.

Background Interventions to reduce patient-handling injuries in the hospital setting are often evaluated based on their effect on outcomes such as injury rates. Measuring intervention adoption could address how and why observed trends in the outcome occurred. Methods Unit-level data related to adoption of patient lift equipment were systematically collected at several points in time over 5 years on nursing units at two hospitals, including hours of lift equipment use, equipment accessibility, and supply purchases and availability. Results Various measures of adoption highlighted the adoption process' gradual nature and variability by hospital and between units. No single measure adequately assessed adoption. Certain measures appear well-correlated. Conclusion Future evaluation of primary preventive efforts designed to prevent patient-handling injuries would be strengthened by objective data on intermediate measures that reflect intervention implementation and adoption. Am. J. Ind. Med. 54:935–945, 2011. © 2011 Wiley Periodicals, Inc.

A Lift Assist Team (LAT) was created on three units at a medical center where nursing staff were at high risk for patient-handling injuries. LAT members were drawn from the hospital's pool of patient transporters. Using qualitative and quantitative data, this case study summarizes the development, implementation, and experiences of the LAT. Nursing staff valued the LAT, reporting increased staff safety and improved patient care. LAT members reported greater job satisfaction and a newfound sense of assimilation into the nursing group compared to when their role was patient transport only. However, over time, their job responsibilities expanded beyond those officially designated for LAT members. Active, ongoing surveillance of the LAT's exposures and outcomes is warranted to understand whether patient-handling injury risk is shifting from nursing personnel to LAT members.

Background Work in poultry-processing plants is physically demanding, and a number of studies have documented the effects of such work on the physical health of workers. Few studies, however, have examined the potential effects on mental health. Methods Longitudinal data were collected on 223 women who worked in two poultry-processing plants in northeastern North Carolina. Effects on depressive symptoms of demographic variables, work tenure at baseline, musculoskeletal pain, psychosocial job characteristics, coping style, and health-related quality of life were examined using mixed models. Results Psychosocial job characteristics were not associated with depressive symptoms as measured by the Center for Epidemiologic Studies Depression scale (CES-D) in this cohort of workers. CES-D scores decreased with increasing work tenure at the plant, which suggests a healthy worker survivor effect (HWSE). Conclusions These exploratory analyses draw attention to the need to more carefully explore the possibility that the HWSE may extend to mental health outcomes as well as physical ones. Am. J. Ind. Med. 54:791–799, 2011. © 2011 Wiley-Liss, Inc.

BACKGROUND: There is a growing recognition that common occupational injury surveillance systems in the US fail to reflect true injury risk; this failure limits efforts to accurately monitor efforts to prevent work-related injuries on a national level. METHODS: Data from the National Electronic Injury Surveillance System occupational supplement (NEISS-Work) were used to describe fall-related injuries treated in US emergency departments among workers in the construction industry (1998-2005). These data do not require workers' compensation as the payer in order to be classified as work-related. RESULTS: Based on NEISS-Work estimates, a total of 555,700 (95% confidence interval (CI): 390,700-720,800) non-fatal work-related injuries among workers in the construction industry were the result of a fall, resulting in an annual rate of 70 (95% CI: 49-91) per 10,000 full-time equivalents. Younger workers had higher rates of falls, whereas older workers were more likely to suffer serious injuries. The majority of the injuries (70%) were precipitated by falls to a lower level from roofs, ladders, and scaffolding. CONCLUSIONS: The patterns of fall-related injuries identified in these data are consistent with other reports. In contrast to the declining rates of falls requiring days away from work reported through the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses, construction industry fall-related injury rates estimated through NEISS-Work remained unchanged from 1998 to 2005 providing another perspective on this serious cause of morbidity in the construction industry. Language: en

OBJECTIVE: We describe medical care received through workers' compensation (WC) and union-provided insurance surrounding work-related back injuries and examine relationships between care provided and time off work among a large cohort of carpenters. METHODS AND PARTICIPANTS: Union records identified a cohort of 20,642 carpenters working in Washington State from 1989-2003 and their private health insurance claims. These data were linked to workers' compensation files from this state-run program including records of medical care. RESULTS: Over 74,000 WC medical encounters resulted from 2959 work-related back injuries. Eleven percent received private care for musculoskeletal back pain within 90 days of work-related injury; this proportion increased with increasing lost days. Delay to physical therapy was more prevalent among those out of work longest. The proportion of claimants with care from both systems and from private utilization only increased after the first 90 days and, for the subset with at least one paid lost work day, after return to work. CONCLUSIONS: Examination of medical care through both systems versus solely in workers' compensation provides a more complete understanding of back injury care while also demonstrating complexity. Differences in outcomes based upon treatment shortly after injury are worthy of further exploration. Language: en

Falls from heights in residential construction are common, especially among inexperienced workers.We conducted a comprehensive needs assessment to determine gaps in the school-based apprentice carpenters' fall prevention training. A team of carpenter instructors and researchers revised the fall prevention training to fill these gaps. Apprentice evaluation and feedback guided ongoing curricular improvements.Most apprentice carpenters performed work tasks at heights prior to training and fall protection techniques were not commonly used at residential construction sites. Priorities of the revised school-based training included safe ladder habits, truss setting, scaffold use, guarding floor openings, and using personal fall arrest systems. New apprentices were targeted to ensure training prior to exposure at the workplace. We used adult learning principles to emphasize hands-on experiences. A framed portion of a residential construction site was fabricated to practice fall protection behaviors in a realistic setting. The revised curriculum has been delivered consistently and apprentice feedback has been very favorable.Integration of needs assessment results was invaluable in revising the school-based carpenters apprentice fall prevention curriculum. Working closely with the instructors to tailor learning experiences has provided preliminary positive results.The fall safety of the residential construction industry continues to lag behind commercial construction and industrial settings. The National Occupational Research Agenda includes a Strategic Goal to strengthen and extend the reach of quality training and education in the construction industry via mechanisms such as construction safety and health training needs assessments. This study demonstrates how a structured process can be used to identify and remedy gaps and improve training effectiveness. We encourage others to take steps to assess and increase the impact of training efforts directed at all residential construction professionals; including both union and non-union workers. The implications are even greater in the non-union sector where most U.S. residential work is done.

Background Occupational injuries are common among nursing personnel. Most epidemiologic research on nursing aides comes from long-term care settings. Reports from acute care settings often combine data on nurses and aides even though their job requirements and personal characteristics are quite different. Our objective was to assess risk of work-related injuries in an acute care setting while contrasting injuries of aides and nurses. Methods A retrospective cohort of aides (n = 1,689) and nurses (n = 5,082) working in acute care at a large healthcare system between 1997 and 2004 were identified via personnel records. Workers' compensation filings were used to ascertain occupational injuries. Poisson regression was used to estimate rate ratios (RR) and 95% confidence intervals (95% CI). Results Aides had higher overall injury rates than nurses for no-lost work time (RR = 1.2, 95% CI: 1.1–1.3) and lost work time (RR = 2.8, 95% CI: 2.1–3.8) injuries. The risk of an injury due to lifting was greater among aides compared to nurses for both non-lost work time and lost work time injuries. Injury rates among aides were particularly high in rehabilitation and orthopedics units. Most of the injuries requiring time away from work for both groups were related to the process of delivering direct patient care. Conclusions Our findings illustrate the importance of evaluating work-related injuries separately for aides and nurses, given differences in injury risk profiles and injury outcomes. It is particularly important that occupational safety needs of aides be addressed as this occupation experiences significant job growth. Am. J. Ind. Med. 52:953–964, 2009. © 2009 Wiley-Liss, Inc.

The objective of this research was to determine the association between LBP that limited or interrupted fishing work and ergonomic low back stress measured by (1) self-reported task and (2) two ergonomic assessment methods of low back stress.Eligible participants were from a cohort of North Carolina commercial fishermen followed for LBP in regular clinic visits from 1999 to 2001 (n = 177). Work history, including crab pot and gill net fishing task frequency, was evaluated in a telephone questionnaire (n = 105). Ergonomic exposures were measured in previous study of 25 fishermen using two methods. The occurrence rate of LBP that limited or interrupted fishing work since last visit (severe LBP) was evaluated in a generalized Poisson regression model.Predictors of severe LBP included fishing with crew members and a previous history of severe LBP. Among crab pot and gill net fishermen (n = 89), running pullers or net reels, sorting catch, and unloading catch were associated with an increased rate of LBP. Percent of time in forces20 lb while in non-neutral trunk posture, spine compression3,400 N, and National Institute of Occupational Safety and Health lifting indices3.0 were associated with LBP.Tasks characterized by higher (unloading boat and sorting catch) and lower (running puller or net reel) ergonomic low back stress were associated with the occurrence of severe LBP. History of LBP, addition of crew members, and self-selection out of tasks were likely important contributors to the patterns of low back stress and outcomes we observed. Based on the results of this study, a participatory ergonomic intervention study is currently being conducted to develop tools and equipment to decrease low back stress in commercial crab pot fishing.

INTRODUCTION: Nail guns are responsible for a significant injury burden in residential construction. Risk, based on hours of work, is particularly high among apprentice carpenters due in part to more frequent exposure to tool use. METHODS: Nail gun injuries were evaluated over 3 years among carpenters enrolled in two apprenticeship programs in the Midwest (2.3 million residential work hours observed) following initiation of training and a voluntary ANSI standard change calling for safer sequential triggers on framing nailers. Injury rates, based on hours of tool use, were calculated yearly. Rates and adjusted rate ratios were calculated with Poisson regression. Attributable risk percent (AR%) and population attributable risk (PAR%) were calculated yearly for modifiable independent risk factors for injury including lack of training in tool use and type of trigger mechanism on tools being used. RESULTS: As apprentices received training and safer trigger mechanisms became more widespread, injury rates decreased significantly (31%). While school training and hands-on mentoring were both important, injury rates were lowest among apprentices who received both. Although injury rates changed over the observation period, the relative risk comparing trigger mechanisms did not; contact trip triggers consistently carried a twofold risk. CONCLUSIONS: Although training and safer trigger use both increased, because of the relative prevalence of training and trigger exposures in this population, the engineering solution consistently had the potential to make more difference in population risk. Our findings demonstrate the utility of observational methods including measures of population-based risk in monitoring intervention effectiveness and making recommendations that lead to injury reduction. Language: en

There are challenges in evaluating physical demands of commercial fishing, including identifying sources of exposure variability. Low back biomechanical stresses associated with crab pot and gill net fishing were estimated; the variability was partitioned between and within fishing type, crew size, job title, and worker to improve understanding of risk factors for low back injury. The authors observed 162 person-hours of work among 25 North Carolina commercial fishermen on 16 crews. Postures and forces during fishing tasks were measured through direct and indirect observation using two methods to determine the percentage of time fishermen were exposed to high levels of low back stress. A multilevel linear model estimated exposure variability for the dependent variables by four nesting variables: fishing type, crew size, job title, and worker. Fishermen set and pulled crab pots or gill nets for 80% of the workday. Twenty-five percent of that time was spent handling gear. For both fishing types, handling heavy loads produced high peak compression values (3586 N to 5315 N) and high NIOSH lifting index values (3.3 to 5.4), but these tasks represent a small percentage of the overall work time (0 to 14%). The majority of exposure variation in non-neutral trunk posture and/or force9 kg, handling materials, NIOSH Lifting Index1, and Lumbar Motion Monitor probability of high-risk group membership70% was accounted for by fishing type (range 60 to 91%). Crew size was not an important source of variability for these six variables when fishing type and job title were accounted for in the model; but in the model restricted to crab pot fishing, crew size accounted for 51 to 88% of the variability in low back stress. For both models, job title comprised the majority of exposure variability for NIOSH Lifting Index3.0 (46 and 65%) and worker comprised the majority of variability for spine compression3400 N (54 and 65%). The magnitude and duration of musculoskeletal loads experienced by fishermen vary by the type of fishing and the tasks performed by the worker. Understanding this variability may help researchers target ergonomic interventions for this work population.

BACKGROUND: The purpose of this study was to investigate the incidence of work-related musculoskeletal (MSK) injuries and disorders among a dynamic cohort of health care workers, including direct care providers and support services, employed at a tertiary care medical center. METHODS: Human resources data were used to define the cohort and time at risk. Workers' compensation (WC) records (1997-2003) were utilized to identify work-related MSK claims. Poisson regression was used to generate gender specific rate ratios and 95% confidence intervals (CI) of MSK injuries among workgroups. RESULTS: MSK injuries resulted equally ( approximately 30% each) from lift/push/pull of equipment, patient handling, and slip/trip/falls. Injury rates and their mechanisms varied substantially by occupational group, gender, and race. Even with declining injury rates over time, black workers had rates 2.5 times higher than other workers and women had rates 1.8 times higher than men. Male and female nurses' aides, housekeepers, and radiology technicians had among the highest rates of injury, while lost workdays rates were highest for male and female nurses' aides, female housekeepers, and male patient transporters. CONCLUSIONS: Differential risk associated with work tasks in highly segregated work populations can contribute to disparities in health, and the patterns we observed partly reflect the high concentration of female and black workers in occupations with increased physical demands. While the greatest public health impact will be achieved by implementing prevention strategies among large workgroups with high injury rates, public health efforts must not ignore smaller, often segregated, workgroups identified in this study as high risk. Language: en

Background Concern has been expressed in North Carolina that solid waste facilities may be disproportionately located in poor communities and in communities of color, that this represents an environmental injustice, and that solid waste facilities negatively impact the health of host communities. Objective Our goal in this study was to conduct a statewide analysis of the location of solid waste facilities in relation to community race and wealth. Methods We used census block groups to obtain racial and economic characteristics, and information on solid waste facilities was abstracted from solid waste facility permit records. We used logistic regression to compute prevalence odds ratios for 2003, and Cox regression to compute hazard ratios of facilities issued permits between 1990 and 2003. Results The adjusted prevalence odds of a solid waste facility was 2.8 times greater in block groups with ≥50% people of color compared with block groups with < 10% people of color, and 1.5 times greater in block groups with median house values < $60,000 compared with block groups with median house values ≥$100,000. Among block groups that did not have a previously permitted solid waste facility, the adjusted hazard of a new permitted facility was 2.7 times higher in block groups with ≥50% people of color compared with block groups with < 10% people of color. Conclusion Solid waste facilities present numerous public health concerns. In North Carolina solid waste facilities are disproportionately located in communities of color and low wealth. In the absence of action to promote environmental justice, the continued need for new facilities could exacerbate this environmental injustice.

We report on the prevalence of self-reported depressive symptoms and associated factors among women employed in a poultry processing plant and a community comparison group of other employed women in northeastern North Carolina in the southern United States. The rural area is poor and sparsely populated with an African American majority. The largest employer of women in the area is a poultry processing plant. The goals of the analyses were 1) to evaluate whether women employed in poultry processing had a higher prevalence of depressive symptoms than other working women from the same geographic area, and 2) to evaluate factors which might be associated with depression among all of these working women, including specific characteristics of their work environment. Recruitment of participants (n=590) and data collection were by community-based staff who were also African American women. Depressive symptoms were measured using the Center for Epidemiologic Studies Depression Scale (CES-D). Work organization factors were measured with the Job Content Questionnaire (JCQ). Log-binomial regression was used to calculate crude and adjusted prevalence ratios. The prevalence of depressive symptoms, based on a CES-D measure of sixteen or more, was 47.8% among the poultry workers and 19.7% among the other working women (prevalence ratio=2.3). After adjusting for socioeconomic variables, health-related quality of life and coping style, the prevalence of depressive symptoms remained 80% higher among the poultry workers. The prevalence of symptoms was also higher among those who perceived low social support at work, hazardous work conditions, job insecurity, and high levels of isometric load. These factors were all more common among the women employed in the poultry plant. The concentration of this low-wage industry in economically depressed rural areas illuminates how class exploitation and racial discrimination may influence disparities in health among working women.

BACKGROUND: Falls remain a serious source of morbidity and mortality in residential construction despite considerable knowledge of risk factors and prevention strategies. While training is universally viewed as positive, we know little about its effectiveness in preventing residential falls. METHODS: A series of focus groups were conducted with union apprentice carpenters (n = 36) at varied levels of training to elicit input on factors that might influence the effectiveness of residential fall prevention training, including hazard awareness, timing of elements of formal instruction, jobsite mentoring, and workplace norms. RESULTS: While apprentices identified many residential fall hazards, they voiced little concern about work near unprotected vertical or horizontal openings such as stairwells, window openings or leading edges. On residential jobs, apprentices worked at heights immediately and were often exposed to hazards they had not yet been trained to handle. The quality of mentoring varied tremendously, and things they had been taught in school were often not the norm on these small worksites. Use of fall arrest equipment was uncommon. Job insecurity in this fast-paced work environment influenced behaviors even when apprentices reported knowledge of safe procedures; this was more of a problem for less experienced apprentices. CONCLUSIONS: These data provide compelling evidence that apprentices often do not apply safety principles they have been taught in school in the actual work environment, illuminating how attempts to empower workers through training alone can fall short. The findings have policy implications and demonstrate the importance of measuring more than knowledge when evaluating effectiveness of training. Language: en

Hospital sitters provide continuous observation of patients at risk of harming themselves or others. Little is known about sitters' occupational safety and well-being, including experiences with patient/visitor-perpetrated violence (type II).Data from surveys, focus groups, individual interviews at six U.S. hospitals were used to characterize the prevalence of and circumstance surrounding type II violence against sitters, as well as broader issues related to sitter use.Sitter respondents had a high 12-month prevalence of physical assault, physical threat, and verbal abuse compared to other workers in the hospital setting. Sitters and other staff indicated the need for clarification of sitters' roles regarding patient care and sitter well-being (e.g., calling for assistance, taking lunch/restroom breaks), training of sitters in personal safety and de-escalation, methods to communicate patient/visitor behaviors, and unit-level support.The burden of type II violence against hospital sitters is concerning. Policies surrounding sitters' roles and violence prevention training are urgently needed.

An elevated risk of patient/visitor perpetrated violence (type II) against hospital nurses and physicians have been reported, while little is known about type II violence among other hospital workers, and circumstances surrounding these events.Hospital workers (n = 11,000) in different geographic areas were invited to participate in an anonymous survey.Twelve-month prevalence of type II violence was 39%; 2,098 of 5,385 workers experienced 1,180 physical assaults, 2,260 physical threats, and 5,576 incidents of verbal abuse. Direct care providers were at significant risk, as well as some workers that do not provide direct care. Perpetrator circumstances attributed to violent events included altered mental status, behavioral issues, pain/medication withdrawal, dissatisfaction with care. Fear for safety was common among worker victims (38%). Only 19% of events were reported into official reporting systems.This pervasive occupational safety issue is of great concern and likely extends to patients for whom these workers care for.

Musculoskeletal symptoms and disorders (MSDIs) are common reasons for visits to medical providers in the general population and they are common work-related complaints. Prior reports raise concerns as to whether declines in workers' compensation (WC) rates represent true improvement in occupational health and safety or shifting of care to other payment systems.By linking administrative records, we compared patterns of WC claims and private health care utilization for disorders of the upper extremity (UE) and knee among a large cohort of union carpenters over a 20-year period.As WC claim rates declined, private health care utilization increased. The increase was muted somewhat but sustained when adjusting for other patterns of health care utilization.Findings suggest the decline of WC claim rates do not solely represent improved occupational safety in this population, but also a considerable shifting of care to their private insurance coverage over time.

Nail guns increase productivity in residential building but with a corresponding increase in worker injuries. They are also easily accessible, at low cost, to consumers.Data from the occupational supplement to the National Electronic Injury Surveillance System (NEISS-Work) were used to calculate national estimates of work-related injuries from nail guns between 2006 and 2011. These were compared to estimates of consumer injuries obtained through online access to the Consumer Product Safety Commission's (CPSC) NEISS data.Approximately 25,000 ED-treated work-related and consumer nail gun injuries were estimated each year. During the construction economy collapse, injuries among workers declined markedly, closely following patterns of reduced residential employment. Reduction in consumer injuries was much more modest.Current nail gun injury patterns suggest marked blurring of work and home exposures. A united effort of CPSC, NIOSH, and OSHA is warranted to address these preventable injuries.

Numerous aspects of construction place workers at risk of musculoskeletal disorders and injuries (MSDIs). Work organization and the nature of MSDIs create surveillance challenges.By linking union records with workers' compensation claims, we examined 20-year patterns of MSDIs involving the upper extremity (UE) and the knee among a large carpenter cohort.MSDIs were common and accounted for a disproportionate share of paid lost work time (PLT) claims; UE MSDIs were three times more common than those of the knee. Rates declined markedly over time and were most pronounced for MSDIs of the knee with PLT. Patterns of risk varied by extremity, as well as by age, gender, union tenure, and predominant work. Carpenters in drywall installation accounted for the greatest public health burden.A combination of factors likely account for the patterns observed over time and across worker characteristics. Drywall installers are an intervention priority.

Acute nail gun injuries can be controlled significantly by using tools with sequential triggers and training. Concern has been raised that sequential triggers, which require that the nose piece of the gun be depressed prior to pulling the trigger, could increase risk of musculoskeletal problems.We conducted active injury surveillance among union carpenter apprentices to monitor acute injuries and musculoskeletal disorders between 2010 and 2013.Acute injury risk was 70% higher with contact trip rather than sequential triggers. Musculoskeletal risk was comparable (contact trip 0.09/10,000 hr (95% CI, 0.02-0.26); sequential 0.08/ 10,000 hr (95% CI 0.02-0.23)).Concern about excess risk of musculoskeletal problems from nail guns with sequential triggers is unwarranted. Both actuation systems carry comparable musculoskeletal risk which is far less than the risk of acute injury; there is clearly no justification for failure to prevent acute injuries through use of the safer sequential trigger.

Declining work injury rates may reflect safer work conditions as well as under-reporting.Union carpenters were invited to participate in a mailed, cross-sectional survey designed to capture information about injury reporting practices. Prevalence of non-reporting and fear of repercussions for reporting were compared across exposure to behavioral-based safety elements and three domains of the Nordic Safety Climate Questionnaire (NOSACQ-50).The majority (75%) of the 1,155 participants felt they could report work-related injuries to their supervisor without fear of retribution, and most felt that the majority of injuries on their jobsites got reported. However, nearly half indicated it was best not to report minor injuries, and felt pressures to use their private insurance for work injury care. The prevalence of non-reporting and fear of reporting increased markedly with poorer measures of management safety justice (NOSACQ-50).Formal and informal policies and practices on jobsites likely influence injury reporting.

We describe an ongoing collaboration that developed as academic investigators responded to a specific request from community members to document health effects on black women of employment in poultry-processing plants in rural North Carolina. Primary outcomes of interest are upper extremity musculoskeletal disorders and function as well as quality of life. Because of concerns of community women and the history of poor labor relations, we decided to conduct this longitudinal study in a manner that did not require involvement of the employer. To provide more detailed insights into the effects of this type of employment, the epidemiologic analyses are supplemented by ethnographic interviews. The resulting approach requires community collaboration. Community-based staff, as paid members of the research team, manage the local project office, recruit and retain participants, conduct interviews, coordinate physical assessments, and participate in outreach. Other community members assisted in the design of the data collection tools and the recruitment of longitudinal study participants and took part in the ethnographic component of the study. This presentation provides an example of one model through which academic researchers and community members can work together productively under challenging circumstances. Notable accomplishments include the recruitment and retention of a cohort of low-income rural black women, often considered hard to reach in research studies. This community-based project includes a number of elements associated with community-based participatory research.

Objective: To describe the epidemiology of work related injury in a group of small scale, independent commercial fishers. Design: Cross sectional survey (baseline instrument of a prospective cohort study). Setting and subjects: Commercial fishers in eastern North Carolina. Results: A cohort of 219 commercial fishers was established and 215 subjects completed an injury questionnaire. The main types of fishing conducted by the cohort were finfishing (159/215) and crabbing (154/215). Of the 215 fishers, 83 reported that they had suffered an injury event in the previous 12 months, a retrospective recall incidence proportion of 38.6 per 100 workers (95% confidence interval 32.1 to 45.1). The 83 injury events resulted in 94 injuries; 47% were penetrating wounds and 24% were strains/sprains. Half of injuries were to the hand/wrist/digits and 13% were to the back. Of the penetrating wounds, 87% were to the hand/wrist/digits, 32% became infected, and 80% were caused by contact with finfish, shellfish, or other marine animal. Of the strains/sprains, 48% were to the back and 26% were to the shoulder. Seventy percent of strains/sprains were caused by moving heavy objects, mainly either while hauling in nets, pots, or lines or loading/unloading the boat. Conclusion: In this group of small scale, independent fishers, the most common reported injuries were penetrating wounds to the hand/wrist/digits from marine animals and strains/sprains to the back while moving heavy objects.

BACKGROUND: Detailed information about factors contributing to construction injury is important to support design of safety programs directed at particular risks. METHODS: We linked over 4,000 injury reports, including text describing injury events, with an administrative workers' compensation (WC) database, and, using Haddon's matrix as a framework, classified factors contributing to injury during construction of Denver International Airport (DIA). RESULTS: Patterns of contributing factors varied according to injury mechanism and type of work: environmental factors contributed more than any other factor to slip/trip injuries, and building materials contributed to more than 40% of injuries to workers in carpentry, concrete construction, glass installation, and roofing. Rates at which factors contributed to injury also varied among types of work: environmental factors contributed at relatively high rates to injuries in glass installation, metal/steel installation and iron/steel erection >/= 2 stories, and victim factors contributed at high rates to conduit construction and metal/steel installation injuries. WC payment rates for different factors varied widely, ranging from $0.53/$100 payroll to $3.08/$100. DISCUSSION: This approach allows systematic analysis of classes of injuries, contributing factors, types of work, and other variables to assist in setting prevention priorities.

Background Understanding job tasks and estimating occupational exposures is difficult for self-employed or autonomous workers, who tend to be dispersed, with no fixed workplace, employment records, or historical exposure measurements. Methods We used ethnographic methods to collect work information for southern commercial fishermen. Major activities were mapped using the seasonal round, an anthropological tool that records activities of groups whose lifeways depend on natural cycles. Results Fishermen's work schedules depended on boat size, gear, market fluctuations, and regulations, as well as season. The seasonal round guided the analysis of qualitative data on annual cycles of activities increasing understanding of exposures and their variation. Conclusions Combined with detailed exposure information this framework for organizing and categorizing seasonal activities could improve accuracy of exposure information and guide quantitative analysis in work settings that challenge standard exposure assessment methods. Am. J. Ind. Med. 46:23–31, 2004. © 2004 Wiley-Liss, Inc.

Workers' compensation records for residential contractors were combined with hours worked provided by the union to examine injury rates and costs among union carpenters between 1995 and 2000. Brief text descriptions were reviewed to describe more costly injuries. Costs per hour worked decreased over 6 years, largely because of declines in rates and mean costs for falls from elevations. Higher costs were associated with injuries from falls, raising framed walls, setting steel I-beams, and pneumatic nail guns. Prevention priorities should include fall protection; methods to safely set steel beams, raise and brace framed walls; and steps to prevent injuries from pneumatic tools. Cost data provide an important measure that is useful in focusing prevention; combined with even limited descriptions of injuries target areas for intervention can be identified based on frequency or severity.

Background Falls are a leading cause of morbidity and mortality in the construction trades. Methods We identified a cohort of 16,215 active union carpenters, hours worked, and their workers' compensation claims for a 10-year period. The data on this well-defined cohort were used to describe their work-related falls; to define rates of injury and the associated costs; and to identify high-risk groups. Results Same level falls occurred at a rate of 1.8/200,000 hours worked; falls from elevations at a rate of 2.3/200,000 hours worked. These injuries resulted in direct payments of $0.30 per hour of work or $2.40 per 8-hr day. Mean costs per fall increased with increasing age. Age was not associated with risk of falls from elevations; younger carpenters had modestly reduced rates of falls from the same level. Rates of falls decreased with increasing time in the union. Carpenters whose usual work involved drywall installation or residential work were at highest risk. Conclusions Falls are a significant public health risk for carpenters and they are responsible for a significant burden of work-related injury costs. While there is a need for prevention of falls from elevations—through training, enforcement of fall protection regulations, improved safety climate, or engineering changes—there is also the need to prevent falls from lower elevations. Differences in risk likely reflect varying exposures and safety practices in different areas of carpentry, as well as training, experience, and job assignments based on longevity in the union. Am. J. Ind. Med. 44:148–156, 2003. © 2003 Wiley-Liss, Inc.

Findings are reported on the first two years of an active injury surveillance project designed to test the utility of active injury investigations in identifying causes of injury among a large cohort of carpenters who did residential building and drywall installation. Occupational Safety and Health Administration recordable injuries were reported by participating contractors. Injured union carpenters were interviewed by experienced journeymen trained in a standard questionnaire protocol. Enumeration of workers and hours worked were provided by the union. These data allowed the definition of a dynamic cohort of 4429 carpenters, their hours worked, detailed information on the circumstances surrounding recordable injuries, and possible preventive measures from the perspectives of the injured worker and an experienced journeyman investigator. The overall estimated injury rate (16.9 per 200,000 hours worked) was considerably higher than recent Bureau of Labor Statistics rates despite less than complete ascertainment of injuries. Injuries most commonly involved being struck by or against something, manual materials handling injuries, and falls. Manual materials handling injuries often involved very heavy objects or tasks and were injuries carpenters most often reported needs for adequate help and coordinated team work to prevent. Falls from heights occurred from a variety of surfaces and were not just injuries of inexperience. Carpenters reported the need for more attention to common fall protection practices, such as the use of more toe boards and guardrails. Poor housekeeping was involved in the majority of same level falls, as well as some manual materials handling injuries.

Objective: To describe circumstances surrounding injuries involving nail guns among carpenters, calculate injury rates, identify high risk groups and preventive measures. Methods and setting: Active injury surveillance was used to identify causes of injury among a large cohort of union residential and drywall carpenters. Injured carpenters were interviewed by experienced journeymen; enumeration of workers and hourworked were provided by the union. The combined data allowed definition of a cohort of carpenters, their hours worked, detailed information on the circumstances surrounding injuries, and identification of preventive measures from the perspectives of the injured worker and an experienced investigator. Results: Nail guns were involved in 14% of injuries investigated. Ninety percent of these injuries were the result of the carpenter being struck, most commonly by a nail puncturing a hand or fingers. The injury rate among apprentices was 3.7 per 200 000 hours worked (95% confidence interval (CI) 2.7 to 4.9) compared with a rate of 1.2 among journeymen (95% CI 0.80 to 1.7). While not always the sole contributing factor, a sequential trigger would have likely prevented 65% of the injuries from tools with contact trip triggers. Conclusions: Training, engineering, and policy changes in the workplace and manufacturing arena are all appropriate targets for prevention of these injuries. Use of sequential triggers would likely decrease acute injury rates markedly. Over 70% of injuries among residential carpenters were associated with through nailing tasks (such as nailing studs or blocks, trusses or joists) or toe nailing (angled, corner nailing) as opposed to flat nailing used for sheathing activities; this provides some indication that contact trip tools could be used solely for flat nailing.

Background Persons in the construction trades in the US have high rates of alcohol and substance abuse. We had the unique opportunity to evaluate health care utilization through private insurance and workers' compensation for a group of carpenters at high risk of injury and substance abuse. Methods We identified a cohort of union carpenters. Their claims for medical care through union insurance and workers' compensation, and appropriate measures of time at risk were documented. Using methods of indirect standardization, we compared utilization and costs between carpenters with and without alcohol and substance-abuse related diagnoses (ASRD). Results Through private insurance, those with ASRD had 10% higher outpatient utilization and 2.1 times higher rates of hospitalizations for injury care; 2.6 times higher rates of outpatient care; and 2.9 times higher inpatient admissions for non-injury care. Individuals with ASRD had only modestly increased rates (10%) of outpatient utilization through workers' compensation. Conclusions These findings support the need for alcohol and drug abuse prevention and treatment services for this workforce. Operationalizing this among highly mobile workforces, such as the construction trades, is a challenge. While not intending to minimize the problems of alcohol or substance abuse on the job among carpenters, the focus of prevention should not necessarily be in the workplace. Am. J. Ind. Med. 43: 120–131, 2003. © 2003 Wiley-Liss, Inc.

Clinical findings for 38 community residents who complained of symptoms they attributed to exposure to air emissions from nearby fiber processing and polyurethane foam manufacturing facilities are reported. Common complaints included headache, mucosal irritation, shortness of breath, chest tightness, and wheezing. Airway hyperreactivity, measured by methacholine challenge, was observed in 8 individuals (22% of those tested), who also reported temporal relationships between exposure to visible emissions or odors and symptoms consistent with environmentally induced asthma. Six individuals (18.2%) had antibodies to at least 1 of the 3 common industrial diisocyanates. The number of individuals with antibodies to diisocyanates, coupled with the absence of other diisocyanate exposure, was highly suggestive of environmental exposure. The findings raised concern that some residents may have become sensitized to toluene diisocyanate.

We describe the evaluation of a community-based program designed to facilitate access to care and return to work for injured workers in a rural, medically underserved area in upstate New York. Providers are recruited to provide easily accessible care and are oriented to concepts of transitional duty and rapid return to work as medically appropriate; companies are recruited with the agreement to provide transitional work for injured employees. Registered nurses, hired by the local hospital, serve as case coordinators to facilitate care and coordinate communications among all parties. Over 3000 injured workers received care through the program in the first 56 months, with a decline in the number of transitional days over time. The number of days that the cases remain open has steadily declined, and the number of return-to-work cases has increased. The success of this initiative provides an excellent background for continued improvement in delivery of care to injured workers and proactive efforts at improving workplace safety and health in a rural area.

Falls from height (FFH) are a longstanding, serious problem in construction.We report workers' compensation (WC) payments associated with FFH among a cohort (n = 24,830; 1989-2008) of carpenters. Mean/median payments, cost rates, and adjusted rate ratios based on hours worked were calculated using negative-binomial regression.Over the 20-year period FFH accounted for $66.6 million in WC payments or $700 per year for each full-time equivalent (2,000 hr of work). FFH were responsible for 5.5% of injuries but 15.1% of costs. Cost declines were observed, but not monotonically. Reductions were more pronounced for indemnity than medical care. Mean costs were 2.3 times greater among carpenters over 50 than those under 30; cost rates were only modestly higher.Significant progress has been made in reducing WC payments associated with FFH in this cohort particularly through 1996; primary gains reflect reduction in frequency of falls. FFH that occur remain costly.

Drywall installers are at high risk for work-related falls from height (FFH).We defined a 20-year (1989-2008) cohort of 5,073 union drywall carpenters in Washington State, their worker-hours, and FFH. FFH rate patterns were examined using Poisson regression.Drywall installers' FFH rates declined over time and varied little by worker age and time in the union. However, among FFH involving drywall sheets, workers with10 union years were at high risk. Narratives consistently described the surface from which workers fell, commonly scaffolds (33%), ladders (21%), and stilts (13%). Work task, height fallen, protective equipment use, work speed, weather, influence of other workers/workgroups, and tool/equipment specifics were not often reported.In addition to continued efforts to prevent falls from scaffolds and ladders, efforts should address stilt use and less experienced workers who may have greater exposure. Consistency in reported narrative elements may improve FFH risk factor identification and prevention effort evaluation.

While violence can adversely affect mental health of victims, repercussions of violence against workers is not as well characterized.We explored relationships between workplace violent events perpetrated by patients or visitors (Type II) against hospital employees and the employee use of psychotropic medications or mental health services using a data system that linked violent events with health claims.Significant associations were observed between reported Type II workplace violent events and employee prescription claims for anti-depressants and anxiolytics combined (RR = 1.45, 95% CI = 1.01-2.33) and anti-depressants alone (RR = 1.65, 95% CI = 1.10-2.48). No significant association between reported violent events and health claims for treatment of depression or anxiety was observed.Type II violence experienced by hospital workers may lead to increased use of psychotropic drugs, particularly anti-depressants but also anxiolytics. Our results suggest an important role of employee assistance programs in mitigating the psychological consequences of workplace violent events.

Objective—To describe injuries of teens employed in the residential construction industry and to assess whether their injury experiences are significantly different from those of adults in this high risk industry. Methods and setting—North Carolina homebuilders workers' compensation data for a 41 month period were analyzed. Injuries of teens were identified and described by body part injured, nature, and cause of injury. Proportionate injury ratios were used to summarize and compare the injury experience of teens with those of adult construction workers. Results—Teens had proportionately more injuries to the eye and foot and fewer injuries to the back than adults. They had more cuts and scratches and fewer sprains and strains. They also had proportionately fewer injuries from falls from elevations and overexertion, injuries that account for a significant cost burden in construction. Consistent with these findings, teens had significantly fewer injuries resulting in medical costs or lost time costs of $1000 or more. Conclusions—The analyses indicate that injuries of teens are less serious than those of adults. This finding may indicate that their work exposures are less dangerous than those of adults in comparable broad categories of construction. However, the data also provide documentation of injuries to teens resulting from work at heights, use of power tools, and motor vehicles with the majority of more expensive claims involving one of these exposures. Construction is dangerous work and these results add to the documentation of the need for additional measures to prevent work related injuries among all workers—teens and adults—in this industry.

OBJECTIVE: The objective of this review was to describe the effectiveness of interventions designed to prevent work-related eye injuries in construction, manufacturing, and agricultural industries. Two types of interventions were of interest: (1) effectiveness of different types of eye protection and/or environmental controls in the workplace, and (2) evaluation of behavioral interventions focused on increasing the use of eye protection among at-risk workers. METHODS: Cochrane Collaboration search strategies were used to identify reports of the effectiveness of interventions designed to prevent eye injuries. To be included, a measurable outcome (change in eye injury rates, use of eye protection or costs for eye injury care) had to be reported. Studies that focused on exposures to lasers, radiation or microwaves were not included. RESULTS: Seven reports met inclusion criteria-all from industrial settings. None of the studies was a controlled trial and only one involved a comparison group. CONCLUSIONS: Although there is some evidence that policy changes are effective in changing behaviors and reducing eye injuries in manufacturing settings either in conjunction with a broader program focused on eye safety or by policy alone, there is limited scientific literature about the effectiveness of eye injury prevention interventions. There is a need for systematic evaluation of interventions designed to prevent eye injuries and to change the overall safety culture.

Records from the Office of the North Carolina Chief Medical Examiner were used to describe 3955 deaths, both on and off the job, between 1988 and 1994 from external causes of injury (E-codes) among individuals whose usual occupation was in the construction trades. For the calculation of rates, population sizes were estimated using 1980 and 1990 census data. Deaths from injuries occurred at an average rate of 226 per 100,000 population; 213 per 100,000 for non-work-related fatalities and 13 per 100,000 for work-related fatalities. Overall, deaths were most often from guns or motor vehicle accidents. Work-related deaths were most often caused by motor vehicles (21%); falls (20%), most commonly from roofs or scaffolds; and machinery (15%), electrocutions (14%), and falling objects (10%). Three major causes of work-related motor vehicle accidents were identified including injuries to pedestrians in highway work zones and in backovers on construction sites, and injuries to drivers caused by shifting loads while transporting construction materials. The circumstances surrounding deaths involving scaffolding document the need for training and safety procedures for erecting, moving, and disassembling scaffolds, but also for safe work practices on scaffolds. Training and safety procedures to avoid electrocutions must involve workers who are not in the electrical trades, as these deaths often occurred among individuals who were not electricians or linemen. Significant differences were observed in the proportion of victims having elevated blood-alcohol levels depending on whether the injury was work-related; 57 percent of victims were impaired at the time of fatal non-work-related injuries compared to 5 percent of work-related injuries. Interventions to treat and prevent alcohol abuse among construction workers could have a significant public health impact in the prevention of premature death from injury, particularly outside the workplace.