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Ensuring the safety and health of workers in this country, who are employed at millions of workplaces presenting a dizzying array of hazards, is beyond daunting. And yet, it is exceptionally important, because the lives and well-being of countless workers, and their families, hang in the balance. Every day, workers are maimed or die of their workplace injuries or occupational illnesses. These outcomes are unacceptable. Agencies must use all the means at their disposal to keep workers safe and healthy in their workplaces. This paper addresses this challenge through the lens of strategic enforcement, with the goal of maximizing enforcement effectiveness to save lives and limbs.First, we examine how, under the Occupational Safety and Health Act, federal and state enforcement schemes are designed to interact. Next, we dive into the impressive array of strategic enforcement tools that are available to federal, state, and local enforcers, and we observe that many of them are either unrecognized or underutilized. We emphasize that these are all significant, because, given our limited enforcement resources, we need to use every tool we can muster-from strategic targeting, to enterprise-wide enforcement, to heightening deterrence through more robust penalty assessments and publicity, to valuing and making the most of partnerships and coenforcement efforts with a wide range of organizations and agencies. And we need to engage in a process of continual evaluation and improvement of our tools and assets, always striving to maximize our enforcement leverage in aid of worker safety and health. Finally, we examine an impressive list of initiatives state and local governments have taken, beyond what the OSH Act mandates, in their efforts to go the extra mile for the safety of the workers in their states and cities. These examples are intended to inspire federal, state and local agencies to do the same, or, hopefully, even better. The stakes are high. Workers deserve to work in safe and healthy environments. This paper is intended to provide practical ways in which state and local agencies can better-and potentially far better-satisfy that obligation., Competing Interests: Declaration of Conflicting InterestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: Declaration of Conflicting InterestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

For public interest advocates engaged on issues of worker health and safety and environmental protections, regulatory cost-benefit analysis has long been seen as an obstacle to meaningful progress. In November 2023, the Biden administration overhauled Circular A-4, which provides guidance to agencies on how to perform cost-benefit analyses for their rules. The reforms seek to make cost-benefit analysis less biased against worker safety, public health, environmental, and other protective safeguards. As such, the new version of Circular A-4 offers important new levers to agencies to justify more stringent protections. By extension, those in the public interest community can use agency implementation of the new Circular A-4 as part of their advocacy efforts for specific rules they are tracking. This article seeks to support this tactic by providing a roadmap for advocates on how to incorporate into their comments critiques of agencies' cost-benefit analyses based on the Circular A-4 revisions., Competing Interests: Declaration of Conflicting InterestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

This paper describes the work-related information collected in several important U.S. national health and behavior surveys, to highlight data gaps that prevent identifying responses by vulnerable workers in the gig economy, with emphasis on the growing digital platform sector of the work force. The national information systems used to understand health status and health behaviors, including drug use, rely on outdated census categories for self-employed workers. This paper describes the importance of understanding the needs of this growing part of the labor sector and describes how some of the most well-known and utilized national surveys fail to meet this need. For the agencies conducting national health and behavior surveys, we propose revisions to the categories used to classify type of worker and recommend adoption of a new Worker-Employer Relationship Classification model., Competing Interests: Declaration of Conflicting InterestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objective: Quad bikes are a leading cause of death and incident-related injury on farms, yet little is understood about rules used by farmers to ensure their safe operation. This study explored rules about quad bikes set by those who live or work on farms. Through the case of quad bikes, this study sought to understand how rules are determined and implemented at the farm level., Setting: A mix of farm types and locations in rural Australia including Queensland, South Australia, and New South Wales., Participants: Eight farmers were interviewed and recruited from information sheets at farmers' markets, through a local health organisation, and a media release., Design: Thematic analysis was used to transform data from eight semi-structured interviews with farmers in rural Australia., Results: Data were distilled into two themes - "Rule content" described the explicit rules farmers had set on their properties, while the theme "Underlying rule principles" explored the values and norms which underpinned the creation and implementation of these rules., Conclusions: Through the case of quad bike rules, this study illustrated how rules are determined and implemented at the farm level. Perceptions of risk were tied to farmers being experts in their own environment and therefore able to mitigate risk. In contrast to injury data, reckless use of quad bikes was perceived to cause incidents, and this was the basis of rules for adults and children.

Background: Studies on the impact of workplace safety inspections on work injuries have found mixed effectiveness. Most studies are from the United States, examining Occupational Health and Safety Administration (OSHA) regulatory inspections in manufacturing firms with more than 10 employees. This study examines whether regulatory inspections in Alberta, Canada, result in reductions in workers' compensation claims rates for inspected firms relative to comparable non-inspected firms., Methods: Firm and claim-level data from the Workers' Compensation Board of Alberta were linked with regulatory enforcement data from the Government of Alberta for construction, manufacturing, and transportation firms with at least one full-time employee for 37 consecutive months. A matched difference-in-differences study design was used to estimate changes in lost-time claim rates for work-related injuries and musculoskeletal diseases of inspected and comparable non-inspected firms between the year pre-inspection and 2 years, post-inspection, controlling for firm-level characteristics., Results: Inspections were not effective in reducing firm-level claim rates, with the exception of transportation firms with more than one inspection experiencing a 28% decrease in their claim rate in the second year post-inspection, relative to the change in non-inspected firms. In construction, inspected firms experienced a 12% increase in their claim rate in the first year post-inspection. No effect was observed in the manufacturing sector., Conclusions: Regulatory workplace safety inspections in Alberta generally do not result in greater reductions in firm-level claim rates in the construction, manufacturing, and transportation sectors. Inspections alone may not be sufficient to induce compliance or hazard management changes that lead to reductions in firm-level injuries., (© 2024 The Authors. American Journal of Industrial Medicine published by Wiley Periodicals LLC.)

Occupational health and safety (OHS) policies in healthcare institutions must be well managed, because healthcare practice involves many physical, biological, ergonomic, chemical, and psychosocial hazards that can affect the health of healthcare workers. In addition, their work performance may be affected by the so-called organisational myopia. In this context, the aim of our study was to determine how organisational myopia affects OHS practices in healthcare institutions and whether it increases the risk of occupational accidents. The study population consisted of a convenience sample of 420 healthcare professionals working throughout Turkey who completed a questionnaire addressing these three domains: organisational myopia, OHS practices, and risk of occupational accidents. Their responses were analysed with exploratory factor analysis, reliability analysis, and Spearman's correlation to assess the adequacy of measurement tools and identify relationships between variables, followed by mediation analysis. We found that OHS practices mitigate organisational myopia and the risk of occupational accidents. We also found no significant effect of organisational myopia on the risk of occupational accidents. Our findings underscore the importance of OHS practices in healthcare institutions and that organisational myopia should be evaluated in special contexts such as working time, experience, or routinisation., (© 2024 Hasan Sadık Tatli et al., published by Sciendo.)

Objective: to develop and validate the content and technical aspects of a web software program for promoting mental health in the workplace., Method: applied methodological study and technological development, carried out in three stages: 1) Umbrella review development; 2) Web software development; 3) Content and technical validation carried out by 14 judges. The data was submitted to descriptive statistical analysis and calculation of the content validity index., Results: based on the guidelines' recommendations, information was defined and extracted in order to develop the web software consisting of the following dimensions: mental health education, support among coworkers, promotion strategies and mental health self-assessment. For the technical development, the objectives, general functions and technological infrastructure were defined. After development and functional testing, the version was made available for content and technical validation by judges. The overall content validity index was 0.98 and for the technical aspects it was 0.97., Conclusion: the agreement between the judges in relation to the content and technical aspects, as well as the suggestions incorporated, demonstrated the potential for using web software to promote mental health in the workplace.

Objectives: to adapt and validate the content of the Healthy Work Environment Assessment Tool for Brazilian culture, and evaluate the practical aspects of its application., Methods: methodological study that followed six stages: translation; synthesis; back translation; content validation by a group of experts, pre-testing and approval of the process by the author of the original instrument., Results: the first three stages were carried out by contracted companies. In the committee, two items and the title of a subscale were evaluated in a second round, when consensus was reached among experts. In the pre-test, more than 93% of professionals agreed that the tool was easy to understand. The average completion time was 8.53 minutes. The American Association of Critical-Care Nurses authorized publication of the results., Conclusions: the adaptation of the tool to Brazilian culture was completed following the adopted framework. In addition to the evidence of content validity, the tool appears promising for managerial use.

Force Health Protection programs in the U.S. Air Force endeavor to sustain the operational readiness of the warfighters. We have previously identified hundreds of chemical substances of interest and toxicity reference value (TRV) knowledge gaps that constrain risk based-decision-making for potential exposures. Multiple approaches to occupational TRV estimation were used to generate possible guideline values for 84 compounds (18% of the substances of interest). These candidate TRVs included values from international databases, chemical similarity (nearest neighbor) approaches, empirical adjustments to account for duration differences, quantitative activity relationships, and thresholds of toxicological concern. This present work describes derivation of provisional TRVs from these candidate values. Rodent bioassay-derived long-term worker Derived No-Effect Levels (DNELs) were deemed presumptively the most reliable, but only 19 such DNELs were available for the 84 substances with TRV gaps. In the absence of DNELs, the quality of the approaches and consistency among candidate values were key elements of the weight of evidence used to select the most suitable guideline values. The use of novel nearest-neighbor approaches, empirical adjustment of short term TRVs, and occupational exposure bands were found to be options that would allow occupational TRV estimation with reasonable confidence for nearly all substances evaluated., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Lisa M. Sweeney reports financial support was provided by Air Force Research Laboratory. Teresa R. Sterner reports financial support was provided by Air Force Research Laboratory. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Ensuring workplace safety for healthcare workers is vital considering the important role they play in various societies which is to save life. Healthcare workers face different risks when performing tasks in various departments within hospitals, hence there is a need to assess work safety analysis procedures among healthcare workers. As a result, this study aims to assess the effectiveness of work safety analysis procedures among healthcare workers at Muvonde and Driefontein Sanatorium rural hospitals in Chirumanzu district. The research applied the descriptive cross-sectional design, combining quantitative and qualitative data collection methods. A questionnaire with both closed and open ended questionnaire was used for data collection among 109 healthcare workers at Muvonde hospital and 68 healthcare workers at Driefontein Sanatorium hospital. Secondary data sources, observations and interviews were also included as data collection methods. Quantitative data collected during the study was analysed using SPSS version 25. Braun and Clarke (2006)'s six phase framework was applied for qualitative data analysis. Ethical approval form was obtained from the District Medical Officer and Midlands State University. Findings of the study indicated that risks identified at Muvonde and Driefontein Sanatorium rural hospitals are classified as ergonomic, physical, chemical, psychosocial and biological risks. Respondents specified that these risks occur as a result of inadequate equipment, poor training, negative safety behaviour, poor management and pressure due to high workload. Safety inspection, safety workshops and monitoring of worker's safety behaviour were mentioned as measures to manage risks. However, the strengths and weaknesses of the current safety procedures need to be assessed to highlight areas for improvement to reduce occurrence of risks within the hospitals., (© 2024. The Author(s).)

Introduction: Australia's remote health sector has chronic understaffing issues and serves an isolated, culturally diverse population with a high burden of disease. Workplace health and safety (WHS) impacts the wellbeing and sustainability of the remote health workforce. Additionally, poor WHS contributes to burnout, high turnover of staff and reduced quality of care. The issue of poor WHS in Australian very remote primary health clinics was highlighted by the murder of remote area nurse (RAN) Gayle Woodford in 2016. Following her death, a national call for change led by peak bodies and Gayle's family resulted in the development of many WHS recommendations and strategies for the remote health sector. However, it is unclear whether they have been implemented. The aim of this study is to identify which WHS recommendations have been implemented, from the perspective of RANs., Methods: A cross-sectional online survey of 173 RANs was conducted during December 2020 and January 2021. The survey was open to all RANs who had worked in a very remote (MM 7 of the Modified Monash (MM) Model) primary health clinic in Australia more recently than January 2019. A convenience sampling approach was used. The survey tool was developed by the project team using a combination of validated tools and remote-specific workplace safety recommendations. Broad recommendations, such as having a safe clinic building, safe staff accommodation, local orientation, and 'never alone' policy, were broken down into specific safety criteria. These criteria were used to generate workplace safety scores to quantify how well each recommendation had been met, and clustered into the following domains: preparation of staff, safe work environment and safe work practices. Descriptive statistics were used and the safety scores between different states and territories were also compared., Results: Overall, the average national workplace safety score was 53% (standard deviation (SD) 19.8%) of recommendations met in participants' most recent workplace, with median 38.5% (interquartile range (IQR) 15.4-61.5%) of staff preparation recommendations, median 59.4% (IQR 43.8-78.1%) of safe work environment recommendations, and median 50.0% (IQR 30.0-66.7%) of safe work practices recommendations met. Within domains, some recommendations had greater uptake than others, and the safety scores of different states/territories also varied. Significant variation was found between the Northern Territory (57.5%, SD 18.7%) and Queensland (41.7%, SD 16.7%) (p<0.01), and between South Australia (74.5%, IQR 35.9%) and Queensland (p<0.05). Last, many RANs were still expected to attend after-hours call-outs on their own, with only 64.1% (n=107/167) of participants reporting a 'never alone' policy or process in their workplace., Conclusion: The evidence from this study revealed that some recommended safety strategies had been implemented, but significant gaps remained around staff preparation, fatigue management and infrastructure safety. Ongoing poor WHS likely contributes to the persistently high turnover of RANs, negatively affecting the quality and continuity of health care in remote communities. Variation in safety scores between regions warns of a fragmentation of approaches to WHS within the remote health sector, despite the almost identical WHS legislation in different states/territories. These gaps highlight the need to establish and enforce a national minimum standard of workplace safety in the remote health sector.

Aim: To explore Remote Area Nurses' experiences of the implementation of workplace health and safety policies and risk mitigation strategies in Australian very remote primary health clinics., Design: This qualitative study used online semi-structured interviews, with participants purposively sampled to maximize variation in work location and service type. Data were analysed using a reflexive thematic analysis approach. Coding was carried out inductively, with NVivo 12 aiding data management., Setting: The interviews were conducted from 24 Februrary 2021 to 06 March 2021 with Remote Area Nurses from very remote primary health clinics in Australia., Participants: Fifteen Remote Area Nurses participated in the study., Results: Thematic analysis revealed varied approaches to workplace safety among the different health services and regions. While the spread of 'never alone' policies in many clinics addressed one of the significant risks faced by Remote Area Nurses, gaps remained even for hazards specifically highlighted in existing work health and safety legislation. Meaningful collaboration with staff and the community, local orientation, preparation for the role and providing quality care were protective factors for staff safety. Understaffing, unsafe infrastructure and inadequate equipment were common concerns among Remote Area Nurses., Conclusion: Health services need to prioritize workplace safety and take a continuous quality improvement approach to its implementation. This will include ensuring safety strategies are appropriate for the local context, improving infrastructure maintenance, and establishing sustainable second responder systems such as a pool of drivers with local knowledge., Implications for the Profession: Poor personal safety contributes to burnout and high turnover of staff. Nurses' insights into the barriers and enablers of current workplace safety strategies will aid policymakers and employers in future improvements., Reporting Method: COREQ reporting guidelines were followed., Pipe Statement: A panel of six Remote Area Nurses collaborated in the development of this project., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

Ensuring the safety and health of workers in this country, who are employed at millions of workplaces that present a dizzying array of hazards, is daunting. Every day, workers are maimed or die from workplace injuries or occupational illnesses. Hence, government agencies must use all available means to ensure the laws intended to keep workers safe and healthy in their workplaces are maximally effective in accomplishing that purpose. This paper addresses this challenge through the lens of strategic enforcement . It examines how federal and state authority are designed to interact to ensure worker protection in this space, and focuses on what tools for deterring violations - many unrecognized or underutilized by worker safety agencies - are available to leverage the limited resources that inevitably constrain the agencies' reach. The forthcoming Part II will, among other things, showcase a number of noteworthy state and local initiatives that exceed the federal standard., Competing Interests: Declaration of Conflicting InterestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Environmental and occupational noise has the potential to result in health risks. The presence of high noise levels aboard ships can cause substantial hazards that affect the well-being of those employed in the maritime industry. The study and implementation of occupational noise reduction aboard ships are of the highest priority for ensuring the well-being of marine workers, compliance with regulatory standards, protection of the environment, and improvement of overall operational efficiency and safety within the maritime sector. A scoping study was conducted to collect and summarize the existing scientific literature about approaches to preventing occupational noise in vessel operations. We searched electronic databases for papers published up to June 2024. Initially, 94 articles were identified for screening, and the present research produced 16 studies, which were finally analyzed. Resultantly, noise control may begin with elimination, substitution, engineering, administrative, and hearing protection (ear plugs or muffs). Noise control innovation would be started with engineering techniques. Hearing protection devices (HPDs) could be used to reduce noise and as an instrument of communication between sailors. More research needs to be carried out in order to find the best ways for maritime vessels to reduce noise at work and to see how well they work in lowering the risks that come with noise for workers on board.

This study looks into the effectiveness of the authorisation procedure as a regulatory instrument within the framework of the European REACH regulation. It highlights its impact on enhancing occupational safety and health for both applicants and companies utilising the substances. This procedure encompasses manufacturers, importers, and downstream users of substances, as well as representatives of foreign manufacturers who are also eligible to seek authorisation. When applying for authorisation, the ECHA Risk Assessment Committee (RAC) assesses the risks associated with the intended uses of the substance, including the appropriateness and effectiveness of the Occupational Conditions (OCs) and Risk Management Measures (RMMs) described in the application and the risks posed by potential alternatives. If the RAC determines that the OCs/RMMs are inadequate for managing or controlling the risk, or if the measures to protect workers are deemed insufficient, it may recommend additional measures to enhance occupational safety and health or environmental protection. The 398 processed Applications for Authorisation (AfA) that have been submitted to date were examined to determine these recommended measures, categorised as Conditions for use, Monitoring arrangements, and Recommendations for Review Reports. Overall, a significant improvement concerning occupational safety and health seems necessary, as indicated by the large number of measures recommended by the ECHA Committee for Risk Assessment (RAC) and ECHA Committee for Socio-economic Analysis (SEAC) or supplemented by the European Commission. In addition to the proposed measures, a short assessment provided by the committees as to whether the operational conditions and risk management measures are adequate in controlling the risks is also included in the study., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Occupational Hygiene Society.)

Land grant universities in the Northeast (e.g. Delaware, Maryland, New York) have seen changes in their faculty or Extension level positions: Agricultural safety specialist positions have been left vacant or have been merged with another position with other responsibilities, which reduces the amount of time available to address safety. In response to the resulting support gap, Penn State Ag Safety and Health and the Northeast Center for Occupational Health and Safety (NEC) launched the Northeast Agricultural Safety and Health Coalition (NEASHC) in 2014. NEASHC provides extension staff and other individuals interested in safety trainings (e.g. insurers, Farm Bureau staff) with opportunities to network and learn about best practices in agricultural health and safety training. Recognizing the importance of NEASHC's role in filling this service gap in the Northeast, the NEC included support for NEASHC in its last 5-year grant cycle (2016-2022) and has continued its support for the Coalition in their current five-year center grant (2022-2027). The NEC center grant is funded by National Institute for Occupational Health and Safety (NIOSH) Grant #2 U54OH007542. NEASHC is an important component of the NEC's unified approach to worker health and safety, which is based in part on G. Sorensen's conceptual model for integrated approaches to the protection and promotion of worker safety. 1 The goals for NEASHC through 2027 are as follows: expand the Coalition's reach by adding states and members; provide professional development to members; (3) offer mini-grants for outreach projects and activities; (4) develop and disseminate new resources; and (5) provide occupational safety and health (OSH) updates for agricultural populations.

The agriculture industry lacks novel techniques for analyzing risks facing its workers. Although injuries are common in this field, existing datasets and tools are insufficient for risk assessment and mitigation for two primary reasons: they provide neither immediate nor long-term risk mitigation advice, and they do not account for hazards which fluctuate daily. The purpose of Demeter is to collect safety data about hazards on farms and produce risk analysis and mitigation reports. This application uses a combination of formula-based risk calculations and state-of-the-art graph neural networks (GNNs) to perform risk analysis and reduction. The formula-based risk calculations had a mean absolute error (MAE) of 0.2110, and the GNN had an accuracy of 94.9%, a precision of 0.3521, and a recall of 0.8333. Demeter has the potential to reduce the number of injuries and fatalities among agriculture workers by alerting them to risks present in their daily workflow and suggesting safety precautions.

The Ghanaian construction industry faces challenges in managing safety, especially for small and medium-sized enterprises (SMEs) that need more resources. This research addressed the critical need for a positive safety culture framework specifically designed for SMEs in Ghana. The study adopts the Delphi research approach, which involves a series of questionnaire 'rounds' to gather and refine information and develop a collaborative safety culture framework with SME stakeholders. The study employed a mixed-methods strategy, harnessing quantitative and qualitative data to meet the research goals. The critical components of the developed framework included safety commitment, adaptability, information, awareness, culture, and performance. The research offered evidence-based recommendations for effective positive safety practices across Ghana's SMEs by analysing the relationship between these interventions and safety outcomes. Applying the framework should reduce workplace accidents and foster a positive safety culture that aligns with international best practices.

Objective: Occupational Safety and Health (OSH) professionals increasingly need to assess and mitigate a broad scope of worker safety, health, and well-being concerns that extend beyond traditional OSH training curricula. Work-related and non-work-related psychosocial hazards, chronic physical and mental health conditions, and changing work arrangements call for an integrative, public health approach to occupational risk management; this approach has been called, "Total Worker Health®" by United States public health authorities (Schulte et al. 2019). OSH professionals need education to ensure that Total Worker Health (TWH) practice approaches are consistently and effectively applied. This study sought to develop a valid, reliable scale that could be used to assess TWH skills gaps that can be addressed with tailored, competency-based curricula., Method: We developed a survey scale to assess professional competency for specific TWH practice approaches described in prior literature (Lee et al. 2016; Punnett et al. 2020). The scale contained 11 statements and used a 5-point scale (not skilled to highly skilled) to rate the level of competency. We pre-tested and refined the statements for face validity then administered the scale with a convenience sample of 258 professionals from mixed OSH disciplines. A total of 210 OSH professionals (31% safety, 17% industrial hygiene, 12% occupational nurses, 11% occupational physicians, 29% other) who completed 50% or more of the questions were included in the analysis. Scale reliability was assessed with a Cronbach's alpha test. Scale validity and structure were assessed with exploratory factor analysis (EFA)., Results: The 11-item scale had high internal consistency (Cronbach's α = 0.92). The initial EFA solution suggested 2 factors that explained 65.3% of variance, with one cross-loaded question. A final 10-item, 2-factor scale was developed that accounted for 66.0% of variance with no cross-loaded items (Cronbach's alpha α = 0.91). Factor 1 (6 items) contributed to 55.5% of the variance and captured skills related to TWH program leadership (e.g. leader commitment, integrating program systems, engaging with other program leaders and workers). Factor 2 (4 items) contributed to 10.5% of the variance and captured technical skills related to hazard identification and control (e.g. identifying hazards, designing work to reduce hazards). Internal consistency was very good for both TWH program leadership (Cronbach α = 0.89) and TWH risk assessment and control (Cronbach α = 0.80) subscales., Conclusion: A novel 10-item TWH skill scale to assess specific TWH practice approaches was developed with very good reliability. Factor analysis revealed 2 latent constructs: TWH leadership skills and TWH risk assessment and control skills. This study offers an evidence-based tool to assess competency for specific TWH practices among OSH professionals. The results of this study contribute to the broader research base needed to formalize a TWH competency framework, as advocated by other scholars interested in TWH workforce education (Newman et al. 2020)., (© The Author(s) 2024. Published by Oxford University Press on behalf of the British Occupational Hygiene Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.)

In modern conditions of maritime navigation, protection of lives of crew members plays key role for their health and quality of life. The practice testifies that shipowners underestimate real statistics of occupational injuries, since procedure for its management and investigation of accidents on ships are not sufficiently regulated in international and national legislation. Besides, approaches of shipowners to implementation of existing standards also have different levels of responsibility that leaves measures preventing such incidents unreasonably underestimated. This situation results in increasing of occupational injuries on ships and allows shipowners or insurance companies to avoid proper payments to injured sailor or his family members in case of one's death. The complexity of implementation of "belated" medical expertise to determine cause of death or injury of crew member also makes it difficult to obtain positive result of recognition of disability or death of sailor as result of occupational traumatism. All the described above testifies importance and actuality of stated research topic. The article examines in detail normative acts regulating protection of labor and life and medical care of sailors. Also are considered causes, factors and types of occupational traumatism on ships. The accident statistics and procedure of their investigation are analyzed in relation to maritime practice. The issues of medical expertise are studied and main problematic issues are identified. The recommendations for their solution are formulated.

Objective: Research involving working populations can pose unique ethical and risk evaluation challenges. The purpose of this benchmarking project was to assess how federal agencies and academic institutions approach the interpretation and application of key risk evaluation concepts in research involving workers in their places of employment., Methods: Key informant interviews were conducted to ascertain current practices related to assessing soundness of research design, determining risk reasonableness and research relatedness of risks, and evaluating the risk of noninvasive clinical tests in occupational settings., Results: There were noteworthy commonalities among the approaches described to review and address critical aspects of risk evaluation for occupational safety and health research involving human participants., Conclusions: The insights gleaned may help guide institutional review boards and Human Research Protection Programs as they consider the ethical issues of human subjects research in occupational settings., Competing Interests: Conflict of interest: None declared., (Copyright © 2024 American College of Occupational and Environmental Medicine.)

Objectives: Due to their mechanism of action, most classical cytostatic drugs have carcinogenic, mutagenic and/or reprotoxic properties. Therefore, occupational exposure of healthcare staff to these drugs should be prevented. Our objective was to lay out European legislation on this topic and reflect on the process of revising the European CM-directive. We summarise independent European and Dutch studies, and give a concise set of basic recommendations for safe working with cytotoxic drugs in healthcare facilities., Methods: We were directly involved in the process of revising the CM-directive: first, through an EU commissioned workshop in the Netherlands, and after that by contributing to the pan-European stakeholder symposium. For this aim, we had to gather the relevant study data from the Netherlands and from Europe. We analysed all relevant industry-independent studies and collated a set of basic recommendations., Results: Independent studies show that the development of measures in recent years can lead to a safe work environment. Standardising the cleaning process leads to a significant improvement in environmental contamination in the majority of hospitals. In the Netherlands, exposure of workers was shown to be well beneath the limit value of 0.74 µg cyclophosphamide per week, therefore showing that the measures taken in recent years are adequate., Conclusions: The safety of healthcare workers is of the utmost importance. Current practice in the Netherlands show that measures taken in recent years are adequate. European legislation should be based on independent scientific research and practice. The first goal should be to bring countries with less safe working levels to a higher level instead of introducing measures that only increase healthcare budgets but not healthcare safety., Competing Interests: Competing interests: None declared., (© European Association of Hospital Pharmacists 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Occupational health and safety management systems (OHSMS) are the foundation of occupational health and safety activities within an organization. An important element of these systems is audits. However, OHSMS auditors often lack confidence in conducting occupational health audits compared with their proficiency in conducting occupational safety audits. For occupational health to be effectively managed by OHSMS, the sampling competence of auditors engaged in third-party audits should be improved. Therefore, we conducted this study to identify appropriate sampling targets for occupational health related to International Organization for Standardization (ISO) 45001., Methods: We adopted a mixed methods approach to identify appropriate sampling targets. This involved conducting focus group discussions with experts in occupational health and performing systematic text condensation analysis. The validity of our findings was further reinforced through confirmation by external auditors who specialize in ISO 45001., Results: In the qualitative phase, 6 occupational health sampling targets were identified, and of these, 5 were subsequently validated in the quantitative phase: (1) Health issues, legal requirements, and occupational health goals identified by the organization; (2) Occupational health risk assessment and control processes; (3) Processes related to occupational health and documented information showing the results of efforts; (4) Organizational roles and functions of occupational health professionals and opportunities for their professional development; and (5) Processes to ensure commitment to occupational health issues and objectives., Conclusion: To ensure effective and comprehensive occupational health audits, auditors should review these targets. This study will enhance the competence of auditors by identifying appropriate occupational health sampling targets., (© The Author(s) [2024]. Published by Oxford University Press on behalf of Journal of Occupational Health.)

Background: Readymade garment workers globally experience distinctive vulnerabilities at the workplace. The situation is worse in many developing countries. However, there is a lack of scientific evidence about the health and safety of garment workers in the workplace., Objective: The objective of this study was to examine the patterns of illness and injury of garment workers, factory level health safety policies and programs, and views and perception of management staff at factories in Bangladesh., Methods: This mixed-method study was conducted among garment workers and management level staff between January 2018 and April 2019. We extracted 4000 health records of the workers who attended primary health care centers of the factories and conducted 11 key informant interviews using qualitative method from different management-level staff., Results: Half of the workers (51.0%) were working in the sewing section following 12.8% in quality control and 12.3% in the laundry section. A review of the medical records showed that peptic ulcer diseases (PUDs) (19.2%), fever (11.7%), loose motion (10.3%), and headache (9.4%). Needle injury was uncommon for taking medical care. Occupational safety and health management, safe drinking water, access to maternity leave and other facilities were better in large and medium factories compared with those in small factories., Conclusions: Although the readymade garments sector is one of the largest sources of foreign currency revenue earnings in Bangladesh, occupational health and safety issues of workers remain a big concern. Thus, support from the government needs more focus on the health and safety of workers.

Background: Quantitatively analyzing the impact of UV radiation and noise during welding operations is essential to assess the exposure, identify potential hazards, and develop targeted safety protocols to ensure worker safety and adherence to safety regulations, especially in developing countries with inadequate adherence to safety standards and resources., Objectives: This study employs machine learning for predicting ultraviolet radiation and noise levels during welding, emphasizing worker safety. The focus is on the Indian foundry sector to gauge actual exposure vis-á-vis safety standards., Materials and Methods: Ultraviolet radiation and noise emitted during the welding of a ferrous alloy were collected from three foundries in Agra, India. Five machine learning (ML) algorithms were applied for data analysis and prediction of UV radiation and noise levels, and a relative performance comparison was carried out on the compiled data against safety standards., Results: Out of all the ML algorithms applied, the Support Vector Machine regression algorithm (RMSE = 356.93) obtained the best performance on UV radiation data, and the Random Forest algorithm (RMSE = 11.4) was found to give the best results for the noise level prediction task., Conclusions: This work represents the first known application of machine learning techniques for predicting UV radiation and noise levels in arc welding processes. The results show the efficacy of algorithms such as SVM regression and Random Forest for the problem. Further, the datasets and ML algorithms implemented in the work will be made openly available to support further research endeavors in this and related areas.

TECHNICAL ABSTRACT Background : Commercial drones are rapidly transforming business operations, however there is a paucity of research evaluating occupational hazards and risks associated with drone deployment in the workplace. Purpose: We aimed to identify challenges of human-drone collaborations and assess drone pilot perceptions of workplace safety. Methods: An online questionnaire was generated and sent to 308 drone pilots working in different industries. A total of 75 of responses were included for data analysis. Descriptive statistics, principal component analysis, and association rule mining were employed to extract knowledge from the obtained data. Results: Our results indicate that human factors are the main contributors to workplace drone mishaps. Poor communication, information display, and control modes were found to be chief obstacles to effective human-drone collaboration. Drone pilots indicated a propensity for complying with and participating in safety practices. Following safety procedures, receiving technical training, and flying outdoors may all be associated with a lower risk of drone mishaps. Conclusions: Offering professional training to pilots and following safety procedures could decrease the risks associated with occupational drones.

Background: Safety design covers proactive actions as it analyzes accident risks early in the enterprise life cycle, and considers the designer acting on accident prevention as a member of the construction team., Objective: This paper proposes an accident investigation to establish links between accident causes and design to support Prevention through Design (PtD) tools., Methods: This article analyzed more than a thousand severe and fatal accident cases in the construction sector. A systematic analysis method was structured based on descriptions of accident causes and measures that could be taken to avoid accidents., Results: Analyzing the severe and fatal accidents, the safety measures implemented in the project design could avoid at least 23.6% of the events. As a result, the architectural and structural designs were more effective in accident prevention. The reference percentages and the design types that are more effective in preventing accidents are analyzed through a representative sample of the analysis of the accident., Conclusions: This research contributes to applying safety guidelines in design projects, directly assisting in project and construction management.

Background: Like other things, psychological safety has a too-much-of-a-good-thing effect on the risk prevention process. There are warranted systematic and theoretical discussions on both positive and negative influences of psychological safety, which provide useful guides to handling potential risks for workers., Objective: This study focuses on the psychological safety analysis of work safety for workers in high-risk industries through the construction of a theoretical model, illustrating that a higher level of psychological safety is not better., Method: This study explores the impact of workers' psychological safety on the potential risk of work safety by conducting a comprehensive analysis of relevant literature and employing inductive reasoning and analogy methodology., Results: We systematically reviewed the research background and several hypotheses of psychological safety, described the relationship between psychological safety and risk prevention from three levels, and constructed the threshold initial, special, and extended model of psychological safety to reveal the importance of workers' psychological safety when handling potential risks., Conclusion: This research effectively describes the influence of high, moderate, and low levels of psychological safety on the risk prevention of work safety, which provides a psychological model guide to developing measures for the improvement of work safety management.

This article explores stakeholders’ perceptions of the quality of occupational health service (OHS) delivery in South Africa. Using a purposive sampling technique, 11 focus group discussions (FGDs) were conducted in three provinces. Focus group participants (n = 69) were recruited through professional organizations of occupational physicians and occupational health nurses as well as employer representatives of major industries in South Africa. Transcriptions of FGDs were analyzed using thematic content analysis. South Africa has diverse models of OHS delivery with varying quality. Focus group participants criticized the outsourced model of service delivery and the excessive focus on physical examinations to achieve legal compliance. These problems are exacerbated by a perceived lack of employer emphasis on occupational health, insufficient human and financial resources, and lack of specific quality of care standards for occupational health. Improvement in the quality of OHS delivery is essential to realize South Africa’s quest for universal health coverage. [ABSTRACT FROM AUTHOR]

The current umbrella review aimed to assess and summarise evidence on universal, selective and indicated interventions for mental health at the workplace. This umbrella review forms one of the evidence reviews which were commissioned by the WHO to develop global guidelines on mental health at work. We conducted systematic searches in five bibliographic databases (PubMed, Embase, PsycINFO, Cochrane and Global Medicus Index) and included meta-analyses of randomised trials examining psychosocial, physical activity and lifestyle interventions delivered to all general workers (universal interventions), at-risk workers (selective interventions) and workers already experiencing symptoms of mental disorders (indicated interventions). We included outcomes from seven domains: symptoms of mental health conditions, positive mental health, quality of life, work-related outcomes, substance use, suicide-related outcomes and potential adverse effects. We identified 16 meta-analyses producing 66 pooled effect sizes of the examined interventions, mostly on symptoms of mental health conditions (n=43 pooled effect sizes) (eg, burnout, insomnia, stress) and positive mental health (n=15) (eg, well-being). Most of the evidence on universal, selective and indicated interventions was focused on psychosocial interventions, showing small to moderate effects across the various outcomes. Certainty levels according to GRADE (Grading of Recommendations Assessment, Development and Evaluation) were low to very low in almost all of the examined outcomes. The results of existing meta-analyses are promising for the use of preventative and early treatment interventions in the workplace. However, the quality and certainty of the evidence were very modest, and further research on the effectiveness of these interventions is warranted., Competing Interests: Competing interests: None declared., (© World Health Organization 2023. Licensee BMJ.)

To meet the requirement from the economy and society, China's emergency rescue has been developing towards specialization and professionalization. The working environment for emergency responders is special accompanying with tremendous challenges and uncertainties. To promote the research on occupational health and personal protection is an important guarantee for the workers in China to realize the goal of "decent work". This paper reviews the hazards that affect the occupational health of emergency rescue workers, the research progress of adverse outcomes caused from exposure to these hazards, and the related development issues of personal protection. In order to ensure the safety and health of emergency rescue workers, the direction of further research on occupational health of emergency rescue workers is put forward.

Objectives: This cohort study including essential workers, assessed the risk and incidence of SARS-CoV-2 infection during the second surge of COVID-19 according to baseline serostatus and occupational sector., Methods: Essential workers were selected from a seroprevalence survey cohort in Geneva, Switzerland and were linked to a state centralised registry compiling SARS-CoV-2 infections. Primary outcome was the incidence of virologically confirmed infections from serological assessment (between May and September 2020) to 25 January 2021, according to baseline antibody status and stratified by three predefined occupational groups (occupations requiring sustained physical proximity, involving brief regular contact or others)., Results: 10 457 essential workers were included (occupations requiring sustained physical proximity accounted for 3057 individuals, those involving regular brief contact, 3645 and 3755 workers were classified under 'Other essential occupations'). After a follow-up period of over 27 weeks, 5 (0.6%) seropositive and 830 (8.5%) seronegative individuals had a positive SARS-CoV-2 test, with an incidence rate of 0.2 (95% CI 0.1 to 0.6) and 3.2 (95% CI 2.9 to 3.4) cases per person-week, respectively. Incidences were similar across occupational groups. Seropositive essential workers had a 93% reduction in the hazard (HR of 0.07, 95% CI 0.03 to 0.17) of having a positive test during the follow-up with no significant between-occupational group difference., Conclusions: A 10-fold reduction in the hazard of being virologically tested positive was observed among anti-SARS-CoV-2 seropositive essential workers regardless of their sector of occupation, confirming the seroprotective effect of a previous SARS-CoV2 exposure at least 6 months after infection., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: To evaluate the health status of healthcare workers (doctors and nurses) compared to those in the general population based on the National Health Insurance Service database and the cause of death data from Statistics Korea., Methods: The subjects of this study were 104,484 doctors and 220,310 nurses working in healthcare facilities from 2002 to 2017, and who had undergone at least one general medical examination. Based on the subject definition, the subject data were extracted from the National Health Insurance healthcare facility database and qualification database. We collected medical use details included in the research database, general medical examination results, medical history included in the health examination database, and additional data on the cause of death from the National Statistics database to analyze the main cause of death and mortality., Results: In terms of the major causes of death and mortality among healthcare workers, the mortality rate associated with intentional self-harm, injury, transportation accident, heart disease, addiction, and falling was significantly higher than that in the general population. Further, the prevalence of respiratory and gastrointestinal diseases was high. When analyzing the proportional mortality ratio (PMR) by cause of death for healthcare workers, the PMR values for death related to malignant neoplasm was the highest. In terms of diseases, both doctors and nurses had higher rates of infectious diseases such as maternal sepsis, rubella, and measles., Conclusion: The health status of healthcare workers differs from that of the general population. Thus, it is important to consider the occupational characteristics of healthcare personnel. This study is unique in that it was conducted based on medical use indicators rather than survey data., Competing Interests: The authors have no potential conflicts of interest to disclose., (© 2022 The Korean Academy of Medical Sciences.)

The utility of chest x-ray examination (CXR) in mandatory annual health examinations for occupational health is debatable in Japan. This study aimed to provide basic data to consider future policies for mandatory annual health examinations in the workplace. A nationwide descriptive survey was performed to determine the rate of detection of tuberculosis, lung cancer, and other diseases through CXR in organizations associated with National Federation of Industrial Health Association. The rate of finding on CXR conducted during annual health examinations in FY2016 was evaluated. Data regarding diagnosis based on follow-up examination findings were obtained and compared with the national statistics. In addition, CXR findings were compared with the results of low-dose lung computed tomography performed at the Hitachi Health Care Center. From 121 surveyed institutions, 88 institutions with 8,669,403 workers were included. For all ages, 1.0% of examinees required follow-up examination. Among 4,764,985 workers with diagnosis data, the tuberculosis detection rate was 1.8-5.3 per 100,000 persons. For Lung cancer, 3,688,396 workers were surveyed, and 334 positive cases were detected. The lung cancer detection rate using CXR was 9.1-24.4 per 100,000 persons. From 164 cases with information regarding the clinical stage, 72 (43.9%) had Stage I lung cancer. From 40,045 workers who underwent low-dose computed tomography multiple times, 31 lung cancer cases, all with Stage I disease, were detected (detection rate: 77.4 per 100,000 persons). Our findings suggest that CXR plays a little role in the detection of active tuberculosis. With regard to LC screening, the detection rate of LC by CXR was lower, approximately 50%, than the expected rate (41.0 per 100,000 persons) of LC morbidity based on the age-sex distribution of this study population. However, the role of CXR for LC screening cannot be mentioned based on this result, because assessment of mortality reduction is essential to evaluate the role., Competing Interests: The all authors have declared that no competing interests exist. Y.W., T.N., T.Ho., and T.Ha. are employees of Hitachi Health Care Center. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

The use of pharmaceutical drugs has provided a cure for many diseases. However, unintended exposure to drugs in the manufacturing workplace can cause significant health hazards to workers. It is important to protect the workforce from these deleterious effects by limiting exposure to an acceptable level, the occupational exposure limit (OEL). OEL is defined as airborne concentrations (expressed as a time-weighted average for a conventional 8-h workday and a 40-h work week) of a substance to which nearly all workers may be repeatedly exposed (for a working lifetime) without adverse effects. Determination of OELs has become very challenging over time, requiring an overall assessment of the preclinical and clinical data of the drug being manufactured. Previously, to derive OEL values, toxicologists used animal no-observed-adverse-effect level (NOAEL) data, which have been replaced with the overall assessment of animal and human data, placing a higher emphasis on human health-based data. A major advantage of working with human pharmaceuticals is that sufficient clinical data are available for them in most cases. The present manuscript reviews the latest knowledge regarding the derivation of occupational exposure limits as health-based exposure limits (HBELs) for pharmaceuticals. We have provided examples of OEL calculations for various drugs including levofloxacin (CAS No. 100986-85-4), dienogest (CAS no. 65928-58-7), and acetylsalicylic acid (ASA, CAS no. 50-78-2) using human data. This report will benefit professionals in the OEL domain in understanding this highly important, growing, and challenging field., (© 2021 John Wiley & Sons, Ltd.)

Background: Healthcare workers are disproportionately affected by COVID-19. In low- and middle- income countries, they may be particularly impacted by underfunded health systems, lack of personal protective equipment, challenging working conditions and barriers in accessing personal healthcare., Methods: In this cross-sectional study, occupational health screening was implemented at the largest public sector medical centre in Harare, Zimbabwe, during the "first wave" of the country's COVID-19 epidemic. Clients were voluntarily screened for symptoms of COVID-19, and if present, offered a SARS-CoV-2 nucleic acid detection assay. In addition, measurement of height, weight, blood pressure and HbA1c, HIV and TB testing, and mental health screening using the Shona Symptom Questionnaire (SSQ-14) were offered. An interviewer-administered questionnaire ascertained client knowledge and experiences related to COVID-19., Results: Between 27th July and 30th October 2020, 951 healthcare workers accessed the service; 210 (22%) were tested for SARS-CoV-2, of whom 12 (5.7%) tested positive. Clients reported high levels of concern about COVID-19 which declined with time, and faced barriers including lack of resources for infection prevention and control. There was a high prevalence of largely undiagnosed non-communicable disease: 61% were overweight or obese, 34% had a blood pressure of 140/90mmHg or above, 10% had an HbA1c diagnostic of diabetes, and 7% had an SSQ-14 score consistent with a common mental disorder. Overall 8% were HIV-positive, with 97% previously diagnosed and on treatment., Conclusions: Cases of SARS-CoV-2 in healthcare workers mirrored the national epidemic curve. Implementation of comprehensive occupational health services during a pandemic was feasible, and uptake was high. Other comorbidities were highly prevalent, which may be risk factors for severe COVID-19 but are also important independent causes of morbidity and mortality. Healthcare workers are critical to combatting COVID-19; it is essential to support their physical and psychological wellbeing during the pandemic and beyond., Competing Interests: The authors have declared that no competing interests exist.

Background: Current literature lacks recommendations regarding the ideal organization of the smoke evacuation system to minimize inhalation of surgical smoke., Objective: This study determines optimal parameters of the smoke evacuation system with respect to the surgical field., Materials and Methods: This study was conducted in an outpatient surgical facility at a tertiary care center. After 30 seconds of continuous electrocautery of tissue, particulate measurements were recorded using the TSI DustTrak Aerosol Monitor 8520 (>2.5 μm particles) and the TSI P-Trak Ultrafine Particle Counter 8525 (<1 μm particles) while changing the angle and distance of the smoke evacuation system., Results: Particulate matter measurements were lower when suction angle was at 45° than at 90°. For both small-sized and large-sized particles, the lowest particulate matter was recorded when the evacuator was maintained at a 45° angle, 2 to 4 inches away from the cauterizing procedure. Particulate matters dramatically increased after increasing the distance of the smoke evacuator beyond 8 inches from the procedural site., Conclusion: In an effort to reduce smoke inhalation, the authors recommend that smoke evacuation should be placed at a 45° suction angle, no further than 8 inches away from the surgical site, while preserving the surgeon's field of vision., (Copyright © 2021 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)

COVID-19 is around the world. We attempt to apply three-step method in ISO/IEC Guide 51: 2014 to COVID-19 infection control in the workplace. The results show that the COVID-19 infection control measures include the eradication of the virus, the destruction of infectivity, the detoxification and weakening and the elimination of opportunities for infection as "Inherently Safe Design Measures", the avoidance of contact as "Safeguarding and Complementary Protective Measures" and the reduction of contact and the avoidance of seriousness as "Information for Use". Among these specific measures, the New Normal, especially in the manufacturing industries, would be "telecommuting" and "unmanned workplaces", which are part of the elimination of opportunities for infection, and "changes in flow lines" and "changes in airflow", which are part of the avoidance of contact. Where "telecommuting" and "unmanned workplaces" are feasible, they should be implemented as much as possible, and where they are not, attempts should be made to minimize human-to-human contact by "changes in flow lines". In addition, in the area of "changes in airflow", there are high expectations for future research on how to establish a ventilation design for COVID-19, in which but also the source would be workers themselves, not only combustible gases and toxic gases.

Despite the well-documented need for nurse-focused efforts on health and wellness, too few healthcare organizations have made a meaningful impact on this issue. Nurse health should be integrated into the strategic and operational workings of the organization. Environments of health and wellness require attention, accountability, action, and accessibility. Although individual choice is the starting point, true success will be achieved when nurse health is a nonnegotiable outcome consistent with quality, safety, finance, and patient experience., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

The safety of our patients and our workforce is paramount to elevating the health and wellness of the global communities we serve. The health and well-being of our frontline staff directly influences the environment of care, and it is our job as healthcare leaders to address workplace bullying, incivility, and lateral and horizontal violence. From patient to provider violence, to peer-peer bullying, these acts of incivility erode at the core of the care environment and impact an organization's culture of safety, influence nursing engagement scores, negatively impact patient outcomes, and decrease overall retention. Magnet® organizations help to elevate the practice of nursing and ensure world-class interprofessional care. Therefore, the Commission on Magnet has included new language in the 2023 Magnet Application Manual in the Organizational Overview (OO7), which directly addresses the organization's structure and processes aimed at addressing workplace violence, bullying, and incivility., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objectives: To assess the reporting quality of randomisation and allocation methods in occupational health and safety (OHS) trials in relation to Consolidated Standards of Reporting Trials (CONSORT) requirements of journals, risk of bias (RoB) and publication year., Methods: We systematically searched for randomised controlled trials (RCTs) in PubMed between 2010 and May 2019 in 18 OHS journals. We measured reporting quality as percentage compliance with the CONSORT 2010 checklist (items 8-10) and RoB with the ROB V.2.0 tool (first domain). We tested the mean difference (MD) in % in reporting quality between CONSORT-requiring and non-requiring journals, trials with low, some concern and high RoB and publications before and after 2015., Results: In 135 articles reporting on 129 RCTs, average reporting quality was at 37.4% compliance (95% CI 31.9% to 43.0%), with 10% of articles reaching 100% compliance. Reporting quality was significantly better in CONSORT-requiring journals than non-requiring journals (MD 31.0% (95% CI 21.4% to 40.7%)), for studies at low RoB than high RoB (MD 33.1% (95% CI 16.1% to 50.2%)) and with RoB of some concern (MD 39.8% (95% CI 30.0% to 49.7%)). Reporting quality did not improve over time (MD -5.7% (95% CI -16.8% to 5.4%)., Conclusions: Articles in CONSORT-requiring journals and of low RoB studies show better reporting quality. Low reporting quality is linked to unclear RoB judgements (some concern). Reporting quality did not improve over the last 10 years and CONSORT is insufficiently implemented. Concerted efforts by editors and authors are needed to improve CONSORT implementation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ.)