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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.

An interview was conducted with a morbidly obese registered nurse who was also a patient in a nursing home. He describes his experience during an admission to a large acute care hospital. Needed areas of improvement identified by the patient and his wife included better staff-to-staff communication about effective ways to handle the patient, acknowledgment of the patient's capacity to handle himself, conversations with the family about care and expectations, as well as knowledge and use of available equipment.

Background Evidence regarding the unequal burden of occupational injuries between workers employed by temporary agencies and those in standard employment arrangements is unclear. Studies range from no significant differences in risk to substantial increased risk for temporary workers. The purpose of this study is to compare the workers' compensation experience of a large cohort of temporary agency employed workers with those in standard forms of employment. Methods Washington State Fund workers' compensation data were obtained for claims with injury dates from January 1, 2003 to June 30, 2006, resulting in 342,540 accepted claims. General descriptive statistics, injury rates (per 10,000 FTE), and rate ratios (temp agency/standard employer) were computed by injury type and industry. Results Temporary agency employed workers had higher rates of injury for all injury types, and higher median time loss (40 vs. 27 days) but lower time loss costs (median $1,224 vs. $1,914, P

The purpose of this article was to assess validity of the regional Disabilities of Arm, Shoulder, and Hand (QuickDASH) and Short-Form 12 (SF-12) for surveillance purpose. We compared the predictive, discriminate, and concurrent validity of the QuickDASH and SF-12 among 231 workers with specific clinical diagnoses of neck or upper extremity musculoskeletal disorders (UEMSDs) and 175 workers with symptoms only. Compared to those with symptoms only, the odds of being any neck or UEMSD case were 1.45 (95% confidence interval [95% CI]: 1.24-1.70) and 0.66 (95% CI: 0.48-0.91) with every 10-point increase in QuickDASH disability and physical component scale (PCS-12) scores, respectively. The clinical cases had significantly higher QuickDASH disability (23.0 vs. 14.3, p

PROBLEM: The trucking industry experiences one of the highest work-related injury rates. Little work has been conducted previously in the United States to assess the hazards, needs, and injury prevention priorities in trucking. Method: Two separate industry-wide surveys of 359 trucking companies and 397 commercial truck drivers were conducted in Washington State. Results: Trucking companies and drivers both ranked musculoskeletal and slip, trip, fall injuries as the top two priorities. Controlling heavy lifting, using appropriate equipment, and addressing slippery surfaces were frequently listed as solutions. There appears to be a gap in safety climate perception between workers and employers. However, driver and company priorities agreed with industry workers' compensation claims. There is room for safety program management improvement in the industry. The study findings detail opportunities for prioritizing and reducing injuries. Impact on Industry: This information can be used to focus and design interventions for the prevention of work-related injuries while improving industry competitiveness. Language: en

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.

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.

The Strain Index (SI) has been developed to evaluate the risk for developing a distal upper extremity disorder. The objective of this study is to determine if the SI predicts incidence cases of work-related lateral, medial, or any epicondylities (LEPI, MEPI, and EPI).Six hundred seven workers were followed for up to 3.5 years, 70 developed EPI on the dominant side (44 LEPI, 13 MEPI, and 13 both). Survival analyses were conducted adjusting for demographic, psychosocial, and work organizational factors, with the SI as time-dependent variable.High exposure (SI5), older age, and self-perceived poor general health were associated with incidence of LEPI and EPI, but not MEPI. There was a significant relationship between higher scores of SI and LEPI, hazard ratio (HR) 2.00 (95% CI 1.04-3.87) for SI 5.1-12, HR 2.12 (95% CI 1.11-4.05) for SI12.The SI can effectively identify jobs with increased risk of developing incidence of LEPI.

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.

Falls from height (FFH) continue to cause significant morbidity and mortality across the construction industry.By linking data on work hours with workers' compensation records, rates of work-related injuries resulting from FFH and associated days away from work were evaluated among a large cohort (n = 24,830) of union carpenters in Washington State from 1989 to 2008. Using Poisson regression we assessed rates of FFH over the 20-year period while adjusting for temporal trend in other work-related injuries. Patterns of paid lost days (PLDs) were assessed with negative binomial regression.Crude rates of FFH decreased 82% over the 20-year period. Reductions were more modest and without demonstrable change since 1996 when adjusting for the temporal reduction in other injuries. Younger workers had higher injury rates; older workers lost more days following falls. Rates of PLDs associated with falls decreased over time, but there was not a consistent decline in mean lost days per fall.These patterns are consistent with decreased FFH for several years surrounding state (1991) and then federal (1994) fall standards; the decline during this time period exceeded those seen in injury rates overall in this cohort. While crude rates of FFH have continued to decline, the decline is not as substantial as that seen for other types of injuries. This could reflect a variety of things including more global efforts designed to control risk (site planning, safety accountability) and changes in reporting practices.

Acute work-related trauma is a leading cause of death and disability for U.S. workers but it is difficult to obtain information about injured workers not covered by workers' compensation (WC). This study aimed to: (1) describe trends in expected payer and linkage to WC claims, (2) compare characteristics of injured workers who did and did not have a linked WC claim, and (3) describe variation in expected payer and linkage to WC claims by ethnicity and injury severity.Data for injuries occurring from 1998 through 2008 were obtained from the Washington State Trauma Registry and linked to WC claims.We found that 27% of work-related traumatic injuries did not have WC listed as a payer, while 37% did not link to a WC claim. Among those with WC listed as a payer, the odds of having a linked WC claim were 57% lower for workers with other non-WC insurance compared with the otherwise uninsured. Latinos were more likely to have a linked WC claim compared with non-Latinos, but there was no significant difference after partially controlling for WC-covered employment and other insurance.This study demonstrated the importance of considering differential access to other insurance coverage and adaptation by health care settings to financial pressures when assessing trends in occupational injury incidence and reporting, especially when using WC as a proxy for work-relatedness. The addition of occupation, industry, and work status to trauma registries and hospital discharge databases would improve surveillance, research, policy and prevention efforts.

Objective: To test the inter-rater reliability of physical examinations for upper extremity musculoskeletal disorders. Methods: A total of 111 subjects were examined by both an occupational medicine physician and a physical therapist, who were blinded to each others' tests results and subjects' current symptoms and health histories. Results: Inter-rater reliability was moderate to excellent (0.52 to 0.88) for shoulder tests but required the inclusion of symptoms for increased inter-rater reliability of fair to excellent (0.27 to 0.57) for the elbow and hand/wrist tests. Conclusions: With the lack of "gold standard" tests, it is important that epidemiologic field studies conduct and report inter-rater reliability testing results between study examiners. It is important for researchers to report the results of inter-rater reliability, so that practitioners can weigh the results of study findings to improve both their diagnosis and treatment of these costly injuries.

Background Workers in the United States with limited English proficiency likely perform more hazardous work, experience higher rates of work-related injury and illness, and have worse disability outcomes. Methods We conducted a descriptive study of employment characteristics, timeliness and utilization of workers' compensation (WC) insurance benefits, cost and occupational health outcomes for Washington State WC state fund, non-traumatic low back disorders (LBD) claimants by language preference. Results A greater proportion of Spanish language preferring (SLP) LBD claims filed were accepted and resulted in lost work time than English language preferring (ELP) LBD claims. There were significant differences in the demographic, employment, and occupational characteristics between the SLP and ELP compensable claimant populations. The SLP LBD compensable claimants had greater time loss duration, greater medical and total claim costs, more use of physical therapy and vocational services than the ELP LBD compensable claimants. With the exception of the timeliness for providing the first time loss payment, the time periods for provision of insurance benefits did not differ between the SLP and ELP populations. SLP compensable claimants received less back surgery and had comparable permanent partial disability payments to the ELP population. Employers were more likely to protest the acceptance of a SLP compensable than one in an ELP LBD compensable claim. Conclusion For those injured workers accessing the Washington State WC system, we observed differences based on language preference for pre-injury, and workers compensation outcomes. Further research is needed to explain the observed differences. Am. J. Ind. Med. 53:204–215 2010. © 2009 Wiley-Liss, Inc.

Objectives The aim was to explore whether ”adjustment” for gender masks important exposure differences between men and women in a study of rotator cuff syndrome (RCS) and carpal tunnel syndrome (CTS) and work exposures. Methods This cross-sectional study of 733 subjects in 12 healthcare and manufacturing workplaces used detailed individual health and work exposure assessment methods. Multiple logistic regression analysis was used to compare gender stratified and adjusted models. Results Prevalence of RCS and CTS among women was 7.1% and 11.3% respectively, and among men 7.8% and 6.4%. In adjusted (gender, age, body mass index) multivariate analyses of RCS and CTS, gender was not statistically significantly different. For RCS, upper arm flexion ≥45° and forceful pinch increased the odds ratio (OR) in the gender-adjusted model (OR 2.66, 95% CI 1.26-5.59) but primarily among women in the stratified analysis (OR 6.68, 95% CI 1.81-24.66 versus OR 1.45, 95% CI 0.53-4.00). For CTS, wrist radial/ulnar deviation ≥4% time and lifting ≥4.5 kg ＞3% time, the adjusted OR was higher for women (OR 4.85, 95% CI 2.12-11.11) and in the gender stratified analyses, the odds were increased for both genders (female OR 5.18, 95% CI 1.70-15.81 and male OR 3.63, 95% CI 1.08-12.18). Conclusions Gender differences in response to physical work exposures may reflect gender segregation in work and potential differences in pinch and lifting capacity. Reduction in these exposures may reduce prevalence of upper extremity disorders for all workers.

Background Shoulder injuries are a common cause of pain and discomfort. Many work-related factors have been associated with the onset of shoulder symptoms. The psychosocial concepts in the demand–control model have been studied in association with musculoskeletal symptoms but with heterogeneous findings. The purpose of this study was to assess the relationship between the psychosocial concepts of the demand–control model and the incidence of shoulder symptoms in a working population. Methods After following 424 subjects for approximately 1 year, 85 incident cases were identified from self-reported data. Cox proportional hazards modeling was used to assess the associations between shoulder symptoms and demand–control model quadrants. Results Cases were more likely to be female and report other upper extremity symptoms at baseline (P

This paper presents a conceptual model for the pathogenesis of work-related musculoskeletal disorders. The model contains sets of cascading exposure, dose, capacity, and response variables, such that response at one level can act as dose at the next. Response to one or more doses can diminish or increase the capacity for responding to successive doses. The model is used as a framework for discussing the development of work-related muscle, tendon, and nerve disorders. It is intended as a beginning, to be modified to explain new findings as they become available. In research, it can help to identify areas needing additional data for the development and expression of work-related musculoskeletal disorders. Researchers can use it to design laboratory and field studies. In practice, it demonstrates the relationship between common exposure factors and different responses. This information can be used to evaluate and design jobs for the prevention of work-related musculoskeletal disorders.

This roundtable discussion will be devoted to the proposed OSHA Standard related to Ergonomics which is scheduled to be published the first week in October. The discussion will be timely and important. This is a very controversial topic. The participants have been selected from different backgrounds and opinions. Barbara Silverstein is the head of the standard writing team and is on leave at OSHA in Washington, D.C. from her regular employment with the State of Washington Department of Labor and Industries. Deborah Berkowitz is the Director of Safety and Health of a national labor union (United Food and Commercial Workers) and has been actively pushing for better ergonomic accommodation for workers. Gregory Worrell is the Corporate Ergonomics Director of a major meatpacking company (Monfort Inc.) and has extensive experience in establishing and conducting Ergonomics programs. Thomas Albin is a corporate level Ergonomist for 3M and is responsible for a considerable part of that company's Ergonomics effort and has extensive experience in establishing and conducting Ergonomics programs. Todd Brown is a Senior Research Engineer with the Association of American Railroads who has considerable experience in funding and conducting ergonomic research for application in the railroad environment. William Marras is a leading researcher and practitioner in the field of Ergonomics, Biomechanics, and Cumulative Trauma Disorders. Thomas Armstrong is a pioneer in the research and practice in the fields of Ergonomics and Biomechanics as they relate to Cumulative Trauma Disorders. These are talented, well respected people in their areas of expertise and will bring the latest thinking to this roundtable. This roundtable will not be a rehash of old stale ideas. The proposed standard is new and very important to the field of Ergonomics and to industry.

Surveillance for musculoskeletal disorders of the upper extremity in industry is in its infancy. Research efforts to elucidate the causal factors of these disorders often rely on either the analysis of existing medical records, worker compensation records (passive surveillance), or the surveying of workers with questionnaire and physical examination (active surveillance). The use of either type of data for routine surveillance presents several difficulties illustrated with the results presented in this paper. The analysis of existing records is generally less costly but the reliability of the data is difficult to assess. Standardized questionnaire and physical examinations can be as sensitive as the use of unusually thorough existing occupational medical records; however, it is unclear whether the additional cost of an active surveillance system will deter the routine use of such systems.

Carpal tunnel syndrome (CTS) is the most commonly reported nerve entrapment syndrome. The prevalence of CTS among 652 active workers in jobs with specific hand force and repetitiveness characteristics was estimated. The prevalence of CTS ranged from 0.6% among workers in low force-low repetitive jobs to 5.6% among workers in high force-high repetitive jobs. When controlling for potential confounders, the odds ratio for the high force-high repetitive jobs was more than 15 (p less than .001) compared to the low force-low repetitive jobs. High repetitiveness appears to be a greater risk factor than high force (odds ratio of 5.5 p less than .05 versus 2.9 and not statistically significant).

After 1 year of an on-job exercise program to control musculoskeletal symptoms in the neck and upper limb, there were no statistically significant differences in localized postural discomfort scores or in the proportion of those whose discomfort decreased based on exercise participation. Although no clear reduction in discomfort was achieved by the exercise program alone, at least 67% of respondents who participated in the exercise program reported that the program made them feel better.

A survey of the prevalence of chronic soft tissue disorders of the hand and wrist was conducted 3 years after an initial survey of workers in a midwestern investment casting plant. The second survey of 136 (90%) of the original participants disclosed that (1) approximately 25% had different jobs in 1986, (2) 35% of those who had different jobs in 1986 reported transfers because of disorders, and (3) of those workers with the same job during both surveys, 11% reported temporary job changes due to disorders in the preceding 3 years. Workers with hand-wrist disorders in high-force and high-repetitive jobs tended to transfer out of these jobs more frequently than those in low-force-low-repetitive jobs. We failed to detect a relationship between ergonomic changes and change in prevalence of chronic hand-wrist disorders. This may be because the changes did not substantially alter the force and repetitiveness characteristics of the jobs.

Mortality analyses were carried out for 278 male hourly workers who were employed for at least 10 years at a gray iron foundry and who died between January 1, 1970 and December 31, 1981. Statistically significant excess proportional mortality due to non-malignant respiratory disease (SPMR = 177), lung cancer (SPMR = 148), and leukemia (SPMR = 284) was found among the 221 white males. Among nonwhite males there was a significant excess in proportional mortality due to circulatory diseases (SPMR = 143). White males in the Finishing classification experienced a significant excess of proportional mortality due to nonmalignant respiratory disease (SPMR = 279) and lung cancer (SPMR = 179). White males in the Core Room classification experienced an excess of proportional mortality due to nonmalignant respiratory disease (SPMR = 321). Case-control studies demonstrated a significant association between nonmalignant respiratory disease and the Finishing classification after controlling for the effects of age, prior occupations in coal mining or foundries, and smoking. A positive but nonsignificant association between lung cancer and Finishing was also found after controlling for age, prior work history, and smoking in case control studies.

The objectives of this article are to present (1) a historical perspective on hand and wrist tendinitis in workers, (2) new data that demonstrate a relationship between the repetitiveness and forcefulness of manual work and the prevalence of tendinitis, (3) possible biomechanical factors in tendinitis, and (4) possible job modifications for the prevention of tendinitis. Numerous studies during the last 100 years show that tendinitis is a major cause of worker suffering and workers' compensation in intensive hand work. Epidemiologic data show that the risk of hand and wrist tendinitis in persons who perform highly repetitive and forceful jobs is 29 times greater than in persons who perform jobs that are low in repetitiveness and force. A possible factor in this relationship is viscous deformation of the tendons and adjacent tissues. Although these data suggest that the risk of tendinitis among workers can be reduced by reduction of the repetitiveness and the forcefulness of the work, this hypothesis has not yet been fully tested.