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Objective: To evaluate the effectiveness of roadway policies for lighting and marking of farm equipment in reducing crashes in Illinois, Iowa, Kansas, Minnesota, Missouri, Nebraska, North Dakota, South Dakota and Wisconsin., Methods: In this ecological study, state policies on lighting and marking of farm equipment were scored for compliance with standards of the American Society of Agricultural and Biological Engineers (ASABE). Using generalized estimating equations negative binomial models, we estimated the relationships between lighting and marking scores, and farm equipment crash rates, per 100 000 farm operations., Results: A total of 7083 crashes involving farm equipment was reported from 2005 to 2010 in the Upper Midwest and Great Plains. As the state lighting and marking score increased by 5 units, crash rates reduced by 17% (rate ratio=0.83; 95% CI 0.78 to 0.88). Lighting-only (rate ratio=0.48; 95% CI 0.45 to 0.51) and marking-only policies (rate ratio=0.89; 95% CI 0.83 to 0.96) were each associated with reduced crash rates., Conclusions: Aligning lighting and marking policies with ASABE standards may effectively reduce crash rates involving farm equipment., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective: To investigate occupational risk of musculoskeletal (MSK) and mental injury among ambulance officers and paramedics, and compare with nurse professionals, social and welfare professionals, and carers and aides in Victoria, Australia, using workers' compensation (WC) claims statistics., Methods: Data were retrieved from the Victorian Compensation Research Database (CRD). Analysis was restricted to claims received between 1 July 2003 and 30 June 2012. WC claim rates were calculated using labour force statistics, and expressed per 1000 full-time equivalent workers. Adjusted HRs with 95% CIs for injury risk were estimated using multivariable regression modelling., Results: Ambulance officers and paramedics had an upward trend in WC claim rates for all injuries and the highest rates for MSK and mental injury, in comparison with other healthcare workers during the study period. In the 2009-2012 time period, ambulance officers and paramedics' risk of lower back MSK and mental injury was approximately 13 times higher than nurse professionals, HRs 57.6 vs 4.4 and 17.77 vs 1.29, respectively. Social and welfare professionals had the second highest risk of mental injury, which was up to threefold greater than in nurses. Carers and aides and nurse professionals had similar HRs overall for all injury categories., Conclusions: Differential patterns of MSK and mental injury exist among healthcare occupational groups in Victoria, Australia. Given the significant findings, especially the high risks among ambulance personnel, future research should focus on the circumstances of injury to improve understanding and inform prevention programmes., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objectives: (1) To identify work-related fatal and non-fatal hospitalised injuries using multiple data sources, (2) to compare case-ascertainment from external data sources with accepted workers' compensation claims and (3) to investigate the characteristics of work-related fatal and hospitalised injuries not captured by workers' compensation., Methods: Work-related fatal injuries were ascertained from vital statistics, coroners and hospital discharge databases using payment and diagnosis codes and injury and work descriptions; and work-related (non-fatal) injuries were ascertained from the hospital discharge database using admission, diagnosis and payment codes. Injuries for British Columbia residents aged 15-64 years from 1991 to 2009 ascertained from the above external data sources were compared to accepted workers' compensation claims using per cent captured, validity analyses and logistic regression., Results: The majority of work-related fatal injuries identified in the coroners data (83%) and the majority of work-related hospitalised injuries (95%) were captured as an accepted workers' compensation claim. A work-related coroner report was a positive predictor (88%), and the responsibility of payment field in the hospital discharge record a sensitive indicator (94%), for a workers' compensation claim. Injuries not captured by workers' compensation were associated with female gender, type of work (natural resources and other unspecified work) and injury diagnosis (eg, airway-related, dislocations and undetermined/unknown injury)., Conclusions: Some work-related injuries captured by external data sources were not found in workers' compensation data in British Columbia. This may be the result of capturing injuries or workers that are ineligible for workers' compensation, or the result of injuries that go unreported to the compensation system. Hospital discharge records and coroner reports may provide opportunities to identify workers (or family members) with an unreported work-related injury and to provide them with information for submitting a workers' compensation claim., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objectives: The current study examines and compares the relationship between both macroeconomic and industry-specific business cycle indicators, and work-related injuries among construction workers in Denmark using emergency department (ED) injury data and also officially reported injuries to the Danish Working Environment Authority (WEA)., Methods: The correlations between ED and WEA injury data from the catchment area of Odense University Hospital during the period 1984-2010 were tested separately for variability and trend with two general macroeconomic indicators (gross domestic product and the Danish unemployment rate) and two construction industry-specific indicators (gross value added and the number of employees)., Results: The results show that injury rates increase during economic booms and decrease during recessions. However, the regression coefficients were generally weak for both the ED (range 0.14-0.20) and WEA injuries (range 0.13-0.36). Furthermore, although there is some variability in the strength of the relationship of the different business cycle indicators, the relationships are generally not stronger for the WEA injuries than for the ED injuries, except for general unemployment. Similarly, no substantial differences in strength of relation between industry-specific and macroeconomic indicators were identified., Conclusions: The study shows that there was no difference in the relationship between business cycle indicators, and WEA and ED injury data. This indicates that changes in reporting behaviour do not seem to play a major role in the relation between the business cycle and workplace injuries in a Danish context., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objectives: An amputation is one of the most serious injuries an employee can sustain and may result in lost time from work and permanent limitations that restrict future activity. A multidata source system has been shown to identify twice as many acute traumatic fatalities as one relying only on employer reporting. This study demonstrates the value of a multidata source approach for non-fatal occupational injuries., Methods: Data were abstracted from medical records of patients treated for work-related amputations at Michigan hospitals and emergency departments and were linked to workers' compensation claims data. Safety inspections were conducted by the Michigan Occupational Safety and Health Administration for selected cases., Results: From 2006 through 2012, 4140 Michigan residents had a work-related amputation. In contrast, the Survey of Occupational Injury and Illness conducted by the Bureau of Labor Statistics (BLS) estimated that there were 1770 cases during this period. During the 7-year period, work-related amputation rates decreased by 26%. The work-related amputation rate for men was more than six times that for women. Industries with the highest work-related amputation rates were Wood Product Manufacturing and Paper Manufacturing. Power saws and presses were the leading causes of injury. One hundred and seventy-three safety inspections were conducted as a result of referrals from the system. These inspections identified 1566 violations and assessed $652 755 in penalties., Conclusions: The system was fairly simple to maintain, identified more than twice as many cases than either BLS or workers' compensation alone, and was useful for initiating inspection of high-risk worksites., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objectives: To provide an overview of the epidemiology of work-related traumatic brain injury (wrTBI) in the state of Victoria, Australia. Specifically, we investigated sex differences in incidence, demographics, injury characteristics, in addition to outcomes associated with wrTBI., Methods: This study involved secondary analysis of administrative workers' compensation claims data obtained from the Victorian WorkCover Authority for the period 2004-2011. Sex-specific and industry-specific rates of wrTBI were calculated using denominators derived from the Australian Bureau of Statistics. A descriptive analysis of all variables was conducted for the total wrTBI population and stratified by sex., Results: Among 4186 wrTBI cases identified, 36.4% were females. The annual incidence of wrTBI was estimated at 19.8/100 000 workers. The rate for males was 1.43 (95% CI 1.35 to 1.53) times that for females, but the gap between the two sexes appeared to have narrowed over time. Compared to males, females were older at time of injury and had lower preinjury income. Males had higher rates than females across most industry sectors, with the exception of education/training (RR 0.77, 95% CI 0.64 to 0.93) and professional/scientific/technical services (RR 0.64, 95% CI 0.44 to 0.93). For both sexes, the most common injury mechanism was struck by/against, followed by falls. WrTBI among males was associated with longer duration of work disability and higher claim costs compared to females., Conclusions: This study found significant sex differences in various risk factors and outcomes of wrTBI. Sex/gender should be taken into consideration in future research and prevention strategies., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objective: To investigate the short-term effect of air temperature on outdoor occupational injuries (out_OI) in Central Italy, also by taking different geographical factors and employment sectors of workers into account., Methods: Out_OI for all of Tuscany (Central Italy), from 2003 to 2010 (n=162,399), were provided by the National Institute of Insurance for Occupational Illness and Injury. Representative daily meteorological data of the geographical area under study were obtained from the European Reanalysis-interim climatological reanalysis archive. Relationships between short-term changes in air temperature and out_OI were studied through Generalised Additive Models., Results: The exposure-response curves of out_OI and short-term changes in air temperature generally showed significant out_OI increases when cold conditions occurred. The air temperature breakpoint corresponded to the 10th centile (-0.8°C) of the air temperature time series used in this study: a 1°C decrease in temperature below the 10th centile corresponded to a 2.3% (CI 1.3% to 3.3%) increase of out_OI throughout all of Tuscany. The cold effect was strongest in plain areas, especially when out_OI occurred in vehicles other than cars. No relationships of injuries with temperature extremes were observed in workers who generally spend half or most of their time outdoors, such as construction, land and forestry workers. However, these latter outdoor workers showed significant linear associations of injuries with typical (far-from-extreme) temperatures., Conclusions: This large population-based study highlights the significant and independent effects of short-term air temperature changes (especially cold) in triggering out_OI. These findings represent the first step towards developing a geographically differentiated, operative outdoor-temperature-occupational-health warning system aimed at preventing outdoor work injuries., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objective: To compare work injuries treated in an emergency department (ED) and injuries reported to the Danish Working Environment Authority (DWEA)., Methods: Work injuries of the ED, Odense University Hospital, and injuries from the geographical catchment area reported to the DWEA between 2003 and 2010 were included. The injuries included in both datasets were identified by merging the ED file and the DWEA file using the civil registry number and injury date information as key., Results: Approximately 50 000 work injuries occurred in the catchment area of the ED. The intersection between the two injury registration systems was 16%. A major discordance concerned the type of injuries, as some injuries were seen frequently in the ED but not reported to the DWEA to any significant extent, for example 'eye injuries' and 'superficial lacerations or wounds'. On the other hand, some injuries are rarely seen in the ED, but often reported to the DWEA, for example 'low back pain'. Additionally, younger workers visit the ED more often than older workers, and injuries in the high risk sectors have the lowest reporting proportion., Conclusions: Neither the ED nor DWEA injury files alone give a complete picture of work injuries. But merged, they represent a significant number of injuries, taking into account differences in data sources, for example concerning uneven distribution of age, sex, type of injury and type of industry. Obviously, not all serious work related ED injuries resulting in lost work time are reported to the DWEA.

Objectives: Electric shocks have been suggested as a potential risk factor for neurological disease, in particular for amyotrophic lateral sclerosis. While actual exposure to shocks is difficult to measure, occurrence and variation of electric injuries could serve as an exposure proxy. We assessed risk of electric injury, using occupational accident registries across Europe to develop an electric shock job-exposure-matrix (JEM)., Materials and Methods: Injury data were obtained from five European countries, and the number of workers per occupation and country from EUROSTAT was compiled at a 3-digit International Standard Classification of Occupations 1988 level. We pooled accident rates across countries with a random effects model and categorised jobs into low, medium and high risk based on the 75th and 90th percentile. We next compared our JEM to a JEM that classified extremely low frequency magnetic field exposure of jobs into low, medium and high., Results: Of 116 job codes, occupations with high potential for electric injury exposure were electrical and electronic equipment mechanics and fitters, building frame workers and finishers, machinery mechanics and fitters, metal moulders and welders, assemblers, mining and construction labourers, metal-products machine operators, ships' decks crews and power production and related plant operators. Agreement between the electrical injury and magnetic field JEM was 67.2%., Conclusions: Our JEM classifies occupational titles according to risk of electric injury as a proxy for occurrence of electric shocks. In addition to assessing risk potentially arising from electric shocks, this JEM might contribute to disentangling risks from electric injury from those of extremely low frequency magnetic field exposure.

Objective: The objective of this study was to compare the incidence of work-related injury and illness presenting to Ontario emergency departments to the incidence of worker's compensation claims reported to the Ontario Workplace Safety & Insurance Board over the period 2004-2008., Methods: Records of work-related injury were obtained from two administrative data sources in Ontario for the period 2004-2008: workers' compensation lost-time claims (N=435,336) and records of non-scheduled emergency department visits where the main problem was attributed to a work-related exposure (N=707,963). Denominator information required to compute the risk of work injury per 2,000,000 work hours, stratified by age and gender was estimated from labour force surveys conducted by Statistics Canada., Results: The frequency of emergency department visits for all work-related conditions was approximately 60% greater than the incidence of accepted lost-time compensation claims. When restricted to injuries resulting in fracture or concussion, gender-specific age differences in injury incidence were similar in the two data sources. Between 2004 and 2008, there was a 14.5% reduction in emergency department visits attributed to work-related causes and a 17.8% reduction in lost-time compensation claims. There was evidence that younger workers were more likely than older workers to seek treatment in an emergency department for work-related injury., Conclusions: In this setting, emergency department records available for the complete population of Ontario residents are a valid source of surveillance information on the incidence of work-related disorders. Occupational health and safety authorities should give priority to incorporating emergency department records in the routine surveillance of the health of workers.

Background: Occupational noise might increase the risk of workplace injury through a variety of mechanisms, including interference with communication and increased stress., Objectives: The purpose of this study was to assess the effect of chronic noise exposure on serious workplace injury, and how the timing of exposure influenced risk., Methods: The authors examined a cohort of 26 000 workers, who worked between 1950 and 1989. Cases were those hospitalised for a work-related injury (ICD-9 codes 800-999, and E codes E800-E999), from April 1989 to December 1998. Cumulative exposure levels were estimated for subjects based on a quantitative retrospective exposure assessment. An internal comparison of cumulative noise exposure and subchronic durations of noise exposure and injury was conducted using Poisson regression. There were 163 cases for the cumulative and 161 cases for the subchronic analysis., Results: Cumulative noise exposure were associated with a decreased risk for injuries, with the risk generally decreasing as cumulative noise levels increased, while most durations of subchronic exposure were associated with an increased risk for injury. An inverse U-shaped trend was observed with the time period of 90 days to 1 year demonstrating the most elevated RR compared with 0-1 days of exposure., Conclusions: Workers highly exposed to noise, or exposed for long periods of time, might develop effective methods of communicating the risk and preventing injuries when exposed to noise.

Objectives: Given the tendency for young people to show elevated work injury rates, this study sought to examine trends in young worker and adult compensation claim rates in a Canadian province., Methods: Workers' compensation records and labour force survey data from 1991 to 2007 were used to compute claim rates by age group. To examine the contribution of work-related factors to claim rates by age group, multivariate analyses included industry and job tenure., Results: Descriptive analysis showed that age groups had different rates of declines over the time period. Multivariate analyses showed that claim rate declines for older adults were greatest prior to 1999. Young workers showed the largest declines after 1999. There was no indication that changes in industry or job tenure accounted for the trends in claim rates among older or younger workers., Conclusions: This study is one of the first to show a convergence in youth and adult workers' compensation claims in a North American jurisdiction. Ruling out work-related factors increases the possibility that systemic interventions may have contributed to the convergence. This provides policy makers in occupational health and safety with empirical data to guide targeting of resources.

Objectives: To evaluate work experiences among teens enrolled in school-sponsored work (SSW) programs and compare the findings to other-working teens. This study, the first to assess work-related safety and health for teens in SSW programs, includes teens working one job and teens working multiple jobs., Methods: A survey was conducted among 6810 teens in school districts in five public health regions in Wisconsin. Information on demographics, work characteristics, injury and school performance was collected., Results: Of 3411 high school teens (14-18 years old) working during the school year, 461 were enrolled in SSW programs. SSW teens were more likely to hold multiple jobs, work over 40 h per week, and work 2 or more days per week before 8:00 h compared with other-working teens. SSW teens working only one job were no more likely to be injured than other-working teens. However, SSW teens working multiple jobs were significantly more likely to be severely injured compared to other-working teens (AOR 3.49; 95% CI 1.52 to 8.02)., Conclusions: SSW programs were created to prepare youth for transition into the workforce after high school. This first study suggests that students in SSW programs working only one job are no more likely to be injured at work compared with other-working teens. However, being enrolled in SSW programs is not protective against work injury, which would have been expected based on the philosophy of these programs. Furthermore, when students work multiple jobs, those enrolled in SSW programs are more likely to be severely injured. Possible explanations are provided.

Objectives: This nested case-crossover study examined the association between rushing, distraction and walking on a contaminated floor and the rate of slipping, and whether the effects varied according to weekly hours worked, job tenure and use of slip-resistant shoes., Methods: At baseline, workers from 30 limited-service restaurants in the USA reported average work hours, average weekly duration of exposure to each transient risk factor and job tenure at the current location. Use of slip-resistant shoes was determined. During the following 12 weeks, participants reported weekly their slip experience and exposures to the three transient exposures at the time of slipping. The case-crossover design was used to estimate the rate ratios using the Mantel-Haenszel estimator for person-time data., Results: Among 396 participants providing baseline information, 210 reported one or more slips with a total of 989 slips. Rate of slipping was 2.9 times higher when rushing as compared to working at a normal pace (95% CI 2.5 to 3.3). Rate of slipping was also significantly increased by distraction (rate ratio (RR) 1.7, 95% CI 1.5 to 2.0) and walking on a contaminated floor (RR 14.6, 95% CI 12.6 to 17.0). Use of slip-resistant shoes decreased the effects of rushing and walking on a contaminated floor. Rate ratios for all three transient factors decreased monotonically as job tenure increased., Conclusion: The results suggest the importance of these transient risk factors, particularly floor contamination, on rate of slipping in limited-service restaurant workers. Stable characteristics, such as slip-resistant shoes, reduced the effects of transient exposures.

Objectives: Slips and falls are a leading cause of injury at work. Few studies, however, have systematically examined risk factors of slipping outside the laboratory environment. This study examined the association between floor surface characteristics, slip-resistant shoes, floor cleaning frequency and the risk of slipping in limited-service restaurant workers., Methods: 475 workers from 36 limited-service restaurants from three major chains in six states in the USA were recruited to participate in a prospective cohort study of workplace slipping. Kitchen floor surface roughness and coefficient of friction (COF) were measured in eight working areas and then averaged within each restaurant. The use of slip-resistant shoes was determined by examining the participant's shoes and noting the presence of a 'slip-resistant' marking on the sole. Restaurant managers reported the frequency of daily kitchen floor cleaning. Participants reported their slip experience and work hours weekly for up to 12 weeks. The survey materials were made available in three languages: English, Spanish and Portuguese. The associations between rate of slipping and risk factors were assessed using a multivariable negative binomial generalised estimating equation model., Results: The mean of individual slipping rate varied among the restaurants from 0.02 to 2.49 slips per 40 work hours. After adjusting for age, gender, BMI, education, primary language, job tenure and restaurant chain, the use of slip-resistant shoes was associated with a 54% reduction in the reported rate of slipping (95% CI 37% to 64%), and the rate of slipping decreased by 21% (95% CI 5% to 34%) for each 0.1 increase in the mean kitchen COF. Increasing floor cleaning frequency was significantly associated with a decreasing rate of slipping when considered in isolation but not after statistical adjustment for other factors., Conclusion: These results provide support for the use of slip-resistant shoes and measures to increase COF as preventive interventions to reduce slips, falls and injuries.

Objective: The purpose of this study was to describe occupational exposures and the incidence of non-fatal injuries among a group of southeastern US small-scale fishermen., Methods: Participants (n=219) were enrolled in a prospective cohort study and followed from August 1999 to May 2002. Demographic information was obtained at baseline, and weekly and biweekly telephone interviews elicited information on number of days worked, fishery, fishing gear used, maintenance work, glove use and any work-related injury events. Incidence rate ratios (IRR) and 95% CIs were calculated with Poisson regression for each factor and multivariate models controlled for potential confounders., Results: Over a third of participants (81/217) reported 125 injury events over 46 153 work-days for rate of 2.74 per 1000 work-days (95% CI 2.19 to 3.41). The majority of injuries were penetrating wounds to the hand, thumb and finger (35%) or back sprains and strains (8%); most required no medical care or time off work (67%). Injury rates were similar for on and off the water work (1.9 per 1000 work-days). Injury rates differed by fishery, water location and month. Factors associated with an increased injury rate included working on someone else's boat and maintenance work. Glove use was protective., Conclusion: Similar injury characteristics were observed in small-scale fishing as compared to large-scale. For small-scale fishermen, off and on the water work locations, and particularly maintenance work, were important predictors of injury. Despite the protective association for glove use, penetrating wounds to the hand, thumb and finger were common.

Objective: To examine whether switching to and from Daylight Saving Time (DST)-1 h shift forward in the spring and 1 h shift back in the autumn-is associated with an increase in work injuries., Method: Data on work-related injuries were obtained from compensation claim records from the Ontario Workplace Safety & Insurance Board for the period 1993-2007. A Poisson regression model was run separately comparing the number of no lost time claims and lost time claims during the week of DST change with the week following DST change, and the week preceding DST change. We also examined if differences in the relationship between DST and work injury claims were present across industry, age, gender and job tenure groups., Results: The results of our regression model did not show an increase in the incidence of work injury claims in the days immediately following the spring shift to DST. There was a significant decrease in the number of claims on Thursday, Friday and Saturday following the spring transition to DST. However, this decline was solely due to the years when Good Friday occurred during DST week (1993, 1998 and 2004) when fewer people are at work. For the autumn transition from DST, no evidence was found that the gain of 1 h sleep results in a decrease or increase in work injury claims., Conclusion: Our findings show that the shift to and from DST had no detrimental effects on the incidence of claims for work injuries in Ontario, Canada.

Objectives: Meatpacking remains a hazardous and largely unexamined industry. Despite prevention efforts, laceration injuries, among others, remain high. We estimated the magnitude of associations between transient exposures such as equipment malfunction, performing an unusual work task, rushing, and occurrence of laceration injuries., Methods: Injured workers were recruited from two pork-processing plants, one in Iowa and one in Nebraska. A telephone interview was conducted within 7 days of the injury, on average to collect information on fixed and transient exposures preceding the injury event. Case-crossover methodology was used to evaluate case and control data within the same subject, thus controlling for between-subject confounding. A Mantel-Haenszel estimator for person-time data was used to estimate the relative risks of injury and transient exposures of interest., Results: Of the 362 workers with lacerations between April 2006 and October 2007, 153 (42%) were interviewed (74% male, 41% Hispanic). Forty-eight per cent were injured by a knife or a knife-like object such as scissors or a band saw. Other sources of lacerations included sharp edges and hooks. Tool sharpening was associated with the highest RR of laceration (RR 8.4, 95% CI 5.4 to 12.8) followed by slipping (RR 74.8, 95% CI 30.5 to 183.3), equipment malfunction (RR 3.8, 95% CI 2.8 to 5.3), and performing an unusual task (RR 3.7, 95% CI 2.6 to 5.2). Being tired, distracted, or rushing were not significant risk factors for a laceration., Conclusions: Aspects of the physical environment and work practices appear to be significant risk factors for laceration injury in meatpacking. Personal risk factors were less significant in this study.

Objectives: Riding thoroughbred racehorses is a hazardous occupation. In this study, we investigated risk factors associated with falls by licensed thoroughbred racing jockeys participating in flat races conducted in Australia., Methods: Data on race-day falls were extracted from stewards' reports. Denominator data were provided by Racing Information Services Australia on races conducted in Australia from August 2002 until July 2006. Incidence rate ratios (IRRs) were estimated using Poisson regression. Analyses were stratified by race grade (maiden, class, open/restricted)., Results: In multivariable analyses, factors associated with falls were female sex of jockey (IRR 1.11; 95% CI 1.00 to 1.23), being an apprentice jockey (IRR 1.51; 95% CI 1.39 to 1.63), being an amateur jockey (IRR 1.44; 95% CI 1.11 to 1.86), drier tracks (p<0.001), younger horse age (p<0.001), shorter race distance (p<0.001), lower field size (p=0.013) and lower race grade (p<0.001). The IRRs for five factors associated with falls differed by category of race grade: those for apprentice jockey (interaction p=0.003), higher prize money (interaction p<0.001) and shorter race distance (interaction p=0.041) were greater in lower race grades, while those for fewer previous rides this meeting (interaction p=0.027) and drier track rating (interaction p=0.035) were greater in higher race grades. Female jockeys had a significantly higher incidence of falls when riding horses under 4 years of age in open and restricted races (interaction p=0.038), and the effects of lower field size in maiden races, and of shorter races, were more pronounced for falls occurring before the race., Conclusions: We identified a range of factors associated with falls to thoroughbred racing jockeys riding in flat races that adds to the evidence base for formulating strategies to improve occupational health and safety standards in the thoroughbred racing industry.

Background: Health and injury surveillance data of the highest achievable quality are needed in order to appropriately allocate scarce resources at the local and national levels., Methods: This is the first reported surveillance study of injury using a complete community sample in Viet Nam. Workplaces in Xuan Tien Commune most likely to benefit from intervention were identified and ranked by the magnitude of the problem (or highest injury count), the risk (highest incidence rates) and the burden (the effect of injuries on the livelihoods of workers)., Results: 591 injuries occurring in the month prior to survey administration were recalled, which satisfied the injury case criteria of this study (the annualised incidence rate (IR) was 681 per 1000 residents). 482 were attributed to work activities (82%), yielding an annualised IR of 1001/1000 full time employee equivalents (FTE). The highest number of injuries occurred in the manufacturing sector (n=299), followed by agriculture with far fewer injuries (n=70). The highest rate of injury was in the transport, storage and communications sector (annualised IR 1583/1000 FTE), followed by manufacturing (1235/1000 FTE) and agriculture (844/1000 FTE)., Conclusion: This study identified patterns of risk which, because data collection reflected work culture, are believed to be more reliable than those from previous studies. Interventions in the manufacture of machinery and equipment sector (the largest industry in the commune) would have the most impact in reducing occupational injuries. Despite the trend towards manufacturing, agriculture is still a high priority with a continuing substantial impact.

Objectives: Because work-related injuries are common and yet the mechanisms through which various types of injuries relate to age, length of service and job remain unknown, this study assessed the role of age, length of service and job in work-related injury., Methods: Prospective study of all 164,814 permanently employed male workers at the French national railway company during 1998-2000, based on the company's injury database: 446,120 person-years, 15,195 injuries with working days lost, coded using the company's injury classification, which is derived from that of the French health insurance scheme. We investigated the incidence of 10 types of injury: fall on same level, fall to lower level, handling materials/machine parts during assembly, handling objects, lifting/handling equipment, collision with/by moving objects, collision with/by vehicles, operating machines/equipment, using hand tools and other injuries. Data were analysed using negative binomial regression., Results: Workers aged <25 years were subject to a higher injury risk from handling materials/machine parts during assembly, and collision with/by moving objects or vehicles. Older workers, especially those aged 50-55 years, were subject to a higher risk of fall and injury resulting from lifting/handling materials/equipment/objects or from collision with/by moving objects/vehicles. Using hand tools was a risky task for workers aged <30 or > or =40 years. The relative risk decreased steadily with increasing length of service with the company, from 2.6 for 1 year to 1.0 for > or =30 years, and the slope of the trend is stronger for fall to lower level, lifting/handling materials/equipment and collision with/by moving objects., Conclusion: Younger and older ages and shorter length of service are at risk for various types of injuries. Preventive measures should improve working conditions, especially for younger/older ages, provide knowledge through specific training during the first years in a job and help workers to be more aware of risks associated with their age, years of employment and job.

Objectives: Poisson regression is now widely used in epidemiology, but researchers do not always evaluate the potential for bias in this method when the data are overdispersed. This study used simulated data to evaluate sources of overdispersion in public health surveillance data and compare alternative statistical models for analysing such data. If count data are overdispersed, Poisson regression will not correctly estimate the variance. A model called negative binomial 2 (NB2) can correct for overdispersion, and may be preferred for analysis of count data. This paper compared the performance of Poisson and NB2 regression with simulated overdispersed injury surveillance data., Methods: Monte Carlo simulation was used to assess the utility of the NB2 regression model as an alternative to Poisson regression for data which had several different sources of overdispersion. Simulated injury surveillance datasets were created in which an important predictor variable was omitted, as well as with an incorrect offset (denominator). The simulations evaluated the ability of Poisson regression and NB2 to correctly estimate the true determinants of injury and their confidence intervals., Results: The NB2 model was effective in reducing overdispersion, but it could not reduce bias in point estimates which resulted from omitting a covariate which was a confounder, nor could it reduce bias from using an incorrect offset. One advantage of NB2 over Poisson for overdispersed data was that the confidence interval for a covariate was considerably wider with the former, providing an indication that the Poisson model did not fit well., Conclusion: When overdispersion is detected in a Poisson regression model, the NB2 model should be fit as an alternative. If there is no longer overdispersion, then the NB2 results may be preferred. However, it is important to remember that NB2 cannot correct for bias from omitted covariates or from using an incorrect offset.

Objectives: To investigate modifiable risk and preventive factors of work-related eye injuries., Methods: A case-crossover study conducted to explore the associations between transient risk factors and work-related eye injuries. Patients seen at seven medical centres in Taiwan with work-related eye injuries over a 4-year period were enrolled in the study. Clinical information was collected from medical charts and detailed information on exposure to eight potentially modifiable factors during the 60 minutes prior to the occurrence of each injury, as well as during the same time interval on the last work day prior to the injury, were obtained using questionnaire surveys. Matched-pair interval analysis was adopted to assess the odds ratios (ORs) for work-related eye injuries given exposure to the eight modifiable factors., Results: A total of 283 subjects were interviewed. Most of these injured workers were young, male, and self-employed or small enterprise workers. The most common injury type was photokeratitis (33.2%), mainly caused by welding (30.4%). The OR for a work-related eye injury was increased with the performance of an unfamiliar task (57.0), operation of a faulty tool or piece of equipment (48.5), distractions (24.0), being rushed (13.0), or fatigued (10.0), and a poor work environment (4.3). Wearing eye protection devices was found to have a significant protective effect on workers who might otherwise have been exposed to eye injuries (OR = 0.4; 95% CI 0.2 to 0.7)., Conclusion: Potential modifiable risk and preventive factors for work-related eye injuries were identified using a case-crossover study. This information should be helpful in the development of preventive strategies.

Objectives: To examine the burden of work-related injuries among immigrants to Canada compared to Canadian-born labour force participants., Methods: Using data from the 2003 and 2005 Canadian Community Health Surveys (n = 99,115), two nationally representative population samples, we examined the risk of self-reported, activity limiting work-related injuries among immigrants with varying time periods since arrival in Canada. Models were adjusted for hours of work in the last 12 months as well as various demographic and work-related variables., Results: Immigrant men in their first 5 years in Canada reported lower rates of activity limiting injuries compared to Canadian-born respondents. Surprisingly, the percentage of injuries that required medical attention was much higher among recent immigrants compared to Canadian-born respondents, resulting in an increased risk of activity limiting injuries requiring medical attention among immigrant men compared to Canadian-born labour force participants. No excess risk was found among female immigrants compared to Canadian-born female labour market participants., Conclusions: Immigrant men in their first 5 years in Canada are at increased risk of work-related injuries that require medical attention. A similar risk is not present among immigrant women. Further, given differences in the number of activity limiting injuries requiring medical attention across immigrant groups, we believe this excess risk among immigrant men may be underestimated in the current data source. Future research should attempt to fully capture the barriers faced by immigrants in obtaining safe employment, the number of injuries that are sustained by immigrants while working, and the consequences of these injuries.

Objective: To identify risk factors for serious farm work related injury among men., Methods: A case-control study was conducted in Victoria, Australia. Eligible cases (n = 252) were males aged > or =16 years injured while working on a farm and scoring 2 or higher on the Abbreviated Injury Scale. Non-fatal injury cases were identified on presentation to hospital. Fatal cases (next of kin) were recruited via the Coroner's Office. Two age-matched controls per case were recruited by telephone. Data were collected with a structured telephone questionnaire. Logistic regression was used to compare risk factors between cases and controls, adjusting for design factors and average weekly hours worked., Results: The most common external causes of injury were machinery (26%), falls (19%), transport (18%), animals (17%) and being struck by an object (11%). Increased injury risk was observed for being an employee/contractor (odds ratio 1.8, 95% CI 1.2 to 2.7), not having attended farm training courses (1.5, 95% CI 1.0 to 2.1), absence of roll-over protective structures on all/almost all tractors (2.5, 95% CI 1.7 to 3.8), absence of personal protective equipment for chemical use (4.7, 95% CI 1.6 to 13.9) and a low average annual farm income of AUD$5000 or less (2.7, 95% CI 1.3 to 5.6). Decreased injury risk was observed for several health related characteristics and some farm characteristics., Conclusion: We identified some risk factors possibly relevant to farm injury prevention programs. However, other factors were not associated with farm work injury suggesting these may not be as important as previously hypothesised.

Objectives: Our main purpose was to investigate any relationship between noise exposure levels in the workplace, degree of hearing loss (HL), and the relative risk of accident (OR of single or multiple events)., Methods: We conducted a retrospective study of 52 982 male workers aged 16-64 years with long-standing exposures to occupational noise over a 5-year period, using "hearing status" and "noise exposure" from the registry held by the Quebec National Institute of Public Health. Information on work-related accidents was obtained from the Quebec Workers' Compensation Board. Hearing threshold level measurements and noise exposures were regressed on the numbers of accidents after adjusting for age., Results: Exposure to extremely noisy environments (L(eq8h) (equivalent noise level for 8 h exposure) > or =90 dBA) is associated with a higher relative risk of accident. The severity of hearing impairment (average bilateral hearing threshold levels at 3, 4 and 6 kHz) increases the relative risk of single and multiple events when threshold levels exceed 15 dB of hearing loss. The relative risk of multiple events (four or more) is approximately three times higher among severely hearing-impaired workers who are exposed to L(eq8h) > or =90 dBA., Conclusion: Single and multiple events are associated with high noise exposure and hearing status. This suggests that reducing noise exposure contributes to increased safety in noisy industries and prevents hearing loss. Hearing-impaired workers assigned to noisy workstations should be provided with assistive listening devices and efficient communication strategies should be implemented.

Aims: To describe incident and recurrent work-related back injuries among union carpenters, describe the hazard function for each and associated risk factors, and explore predictors of subsequent musculoskeletal back injury based on different definitions of the initial injury., Methods: This study identified a dynamic cohort of 18 768 carpenters who worked in the State of Washington 1989-2003, their hours worked each month, and their work-related back injuries and medical claims for treatment including ICD-9 codes. Using Poisson regression we calculated rates and rate ratios (RRs) of incident and recurrent injury adjusting for age, gender, union tenure and type of carpentry work. Predictors of subsequent musculoskeletal back injury were explored based on different definitions of the incident injury, as were time periods of greatest risk following return to work., Results: Recurrent back injuries occurred at a rate 80% higher than initial injuries. Survival curves were significantly different for incident and recurrent injuries, but patterns of relative risk were similar. Individuals with greatest union tenure were at lowest risk, likely reflecting a healthy worker effect or lower physical exposures with seniority. Individuals with long periods of work disability with their first injury were at particularly high risk of subsequent musculoskeletal injury compared with those with no prior history (RR 2.3; 95% CI 2.0 to 2.7), as were individuals with degenerative diagnoses (RR 2.0; 95% CI 1.5 to 2.6). Risk for second injury peaked between 1000 and 1500 h after return to work and then gradually declined., Conclusions: Carpenters with long periods of work disability following back injury warrant accommodation and perhaps better rehabilitation efforts to avoid re-injury. Challenges to workplace accommodation and limited ability to clearly define readiness to return to work following injury demonstrate the need for primary prevention of back injuries through attention to engineering solutions among carpenters involved in strenuous work.

Objectives: Previous studies estimate hand and wrist injuries are common in commercial fishing. Risk factors including working with catch, handling gear and slips or falls, have been identified from activity and injury contact reports, but no studies have examined the influence of transient risk factors, or triggers. This case crossover study design was conducted to investigate triggers for acute hand trauma in commercial fishing., Methods: A case crossover study was nested within a previously established prospective cohort of 217 southeastern United States commercial fishermen followed from April 1999 through October 2001. Hand injury cases and controls were matched using three control selection strategies. Odds ratios (OR) and 95% confidence intervals (95% CI) were calculated to determine if transient risk factors such as glove use, engaging in more than one type of fishing, maintenance activities and other covariates of interest increased the risk of occupational traumatic hand/wrist/digit injuries., Results: 21% (46/217) of fishermen reported one or more hand/wrist/digit injuries, yielding 65 eligible cases. Performing maintenance work (any vs none) (OR 3.1, 95% CI 1.8 to 5.5) and using multiple types of fishing equipment in comparison to using only one type (OR 1.9, 95% CI 0.9 to 3.8) were associated with increased risk of hand/wrist/digit injury. There was no evidence glove use was protective (any vs none) for hand/wrist/digit injury (OR 0.9, 95% CI 0.5 to 1.7)., Conclusions: The case crossover design is a useful method to determine triggers of commercial fishing-related hand/wrist/digit injuries. Maintenance work was strongly associated with hand/wrist/digit injury for these fishermen.

Objectives: The Survey of Occupational Injuries and Illnesses (SOII), based on Occupational Safety and Health Administration (OSHA) logs, indicates that the number of occupational injuries and illnesses in the US has steadily declined by 35.8% between 1992-2003. However, major changes to the OSHA recordkeeping standard occurred in 1995 and 2001. The authors assessed the relation between changes in OSHA recordkeeping regulations and the trend in occupational injuries and illnesses., Methods: SOII data available from the Bureau of Labor Statistics for years 1992-2003 were collected. The authors assessed time series data using join-point regression models., Results: Before the first major recordkeeping change in 1995, injuries and illnesses declined annually by 0.5%. In the period 1995-2000 the slope declined by 3.1% annually (95% CI -3.7% to -2.5%), followed by another more precipitous decline occurring in 2001-2003 (-8.3%; 95% CI -10.0% to -6.6%). When stratifying the data, the authors continued to observe significant changes occurring in 1995 and 2001., Conclusions: The substantial declines in the number of injuries and illnesses correspond directly with changes in OSHA recordkeeping rules. Changes in employment, productivity, OSHA enforcement activity and sampling error do not explain the large decline. Based on the baseline slope (join-point regression analysis, 1992-4), the authors expected a decline of 407 964 injuries and illnesses during the period of follow-up if no intervention occurred; they actually observed a decline of 2.4 million injuries and illnesses of which 2 million or 83% of the decline can be attributed to the change in the OSHA recordkeeping rules.

Objectives: To describe the risk of work injury by socioeconomic status (SES) in hospital workers, and to assess whether SES gradient in injury risk is explained by differences in psychosocial, ergonomic or organisational factors at work., Methods: Workforce rosters and Occupational Safety and Health Administration injury logs for a 5-year period were obtained from two hospitals in Massachusetts. Job titles were classified into five SES strata on the basis of educational requirements and responsibilities: administrators, professionals, semiprofessionals, skilled and semiskilled workers. 13 selected psychosocial, ergonomic and organisational exposures were assigned to the hospital jobs through the national O*NET database. Rates of injury were analysed as frequency records using the Poisson regression, with job title as the unit of analysis. The risk of injury was modelled using SES alone, each exposure variable alone and then each exposure variable in combination with SES., Results: An overall annual injury rate of 7.2 per 100 full-time workers was estimated for the two hospitals combined. All SES strata except professionals showed a significant excess risk of injury compared with the highest SES category (administrators); the risk was highest among semiskilled workers (RR 5.3, p<0.001), followed by nurses (RR 3.7, p<0.001), semiprofessionals (RR 2.9, p = 0.006) and skilled workers (RR 2.6, p = 0.01). The risk of injury was significantly associated with each exposure considered except pause frequency. When workplace exposures were introduced in the regression model together with SES, four remained significant predictors of the risk of injury (decision latitude, supervisor support, force exertion and temperature extremes), whereas the RR related to SES was strongly reduced in all strata, except professionals., Conclusions: A strong gradient in the risk of injury by SES was reported in a sample population of hospital workers, which was greatly attenuated by adjusting for psychosocial and ergonomic workplace exposures, indicating that a large proportion of that gradient can be explained by differences in working conditions.

Objectives: To investigate the incidence, nature and determinants of non-fatal occupational injuries in British agriculture., Methods: As part of a postal survey, data on lifetime histories of work in agriculture and occupational accidents were obtained from men born between 1933 and 1977 and residing in three rural areas of England and Wales. Incidence rates for different categories of accident were compared with those derived from statutory reporting. Associations with risk factors were explored by Poisson regression, and summarised by incidence rate ratios (IRRs)., Results: Of the 10 765 responders (response rate = 31%), 3238 (30%) reported at least one occupational accident at the ages of 14-64 years, leading to absence from work for >or=3 days, including 1492 accidents that could be linked to a specific job listed in the history of agricultural work. The reported incidence of injuries in agriculture was markedly higher than that derived from statutory reporting, particularly for self-employed farmers. During 1996-2003, the highest rates of agricultural accidents were from handling, lifting or carrying (4.9/1000 person-years), falls from a height (4.6/1000 person-years) and injury by animals (3.4/1000 person-years). After adjustment for calendar period and age, the risk of accidents was elevated in men who had only recently entered agricultural work (IRR 3.7, 95% CI 2.7 to 5.1 for men who had worked in agriculture for up to 1 year relative to those who had entered the industry >25 years earlier), and in those who carried out forestry (IRR 1.7, 95% CI 1.5 to 1.9)., Conclusion: Our findings confirm the substantial underascertainment of serious accidental injuries in agriculture through statutory reporting, particularly for the self-employed. The risk of accidents is highest in new recruits to the industry and in those undertaking forestry, and these groups should be a target for further preventive action.

Objectives: To identify the remediable transient risk factors of occupational hand injuries in Hong Kong in order to guide the development of prevention strategies., Methods: The case-crossover study design was adopted. Study subjects were workers with acute hand injuries presenting to the government Occupational Medicine Unit for compensation claims within 90 days from the date of injury. Detailed information on exposures to specific transient factors during the 60 minutes prior to the occurrence of the injury, during the same time interval on the day prior to the injury, as well as the usual exposure during the past work-month was obtained through telephone interviews. Both matched-pair interval approach and usual frequency approach were adopted to assess the associations between transient exposures in the workplace and the short-term risk of sustaining a hand injury., Results: A total of 196 injured workers were interviewed. The results of the matched-pair interval analysis matched well with the results obtained using the usual frequency analysis. Seven significant transient risk factors were identified: using malfunctioning equipment/materials, using a different work method, performing an unusual work task, working overtime, feeling ill, being distracted and rushing, with odds ratios ranging from 10.5 to 26.0 in the matched-pair interval analysis and relative risks ranging between 8.0 and 28.3 with the usual frequency analysis. Wearing gloves was found to have an insignificant protective effect on the occurrence of hand injury in both analyses., Conclusions: Using the case-crossover study design for acute occupational hand injuries, seven transient risk factors that were mostly modifiable were identified. It is suggested that workers and their employers should increase their awareness of these risk factors, and efforts should be made to avoid exposures to these factors by means of engineering and administrative controls supplemented by safety education and training.

Objectives: Functional capacity evaluations (FCEs) are commonly used to determine return-to-work readiness and guide decision making following work related injury, yet little is known of their validity. The authors examined performance on the Isernhagen Work Systems' FCE as a predictor of timely and sustained recovery in workers' compensation claimants with upper extremity disorders. A secondary objective was to determine whether FCE is more predictive in claimants with specific injuries (that is, fracture) as compared to less specific, pain mediated disorders (that is, myofascial pain)., Methods: The authors performed a longitudinal study of 336 claimants with upper extremity disorders undergoing FCE. FCE indicators were maximum performance during handgrip and lift testing, and the number of tasks where performance was rated below required job demands. Outcomes investigated were days receiving time-loss benefits (a surrogate of return to work or work readiness) in the year following FCE, days until claim closure, and future recurrence defined as whether benefits restarted, the claim reopened, or a new upper extremity claim was filed. Cox and logistic regression were used to determine the prognostic effect of FCE crudely and after controlling for potential confounders. Analysis was performed separately on claimants with specific and pain mediated disorders., Results: Most subjects (95%) experienced time-loss benefit suspension within one year following FCE. The one year recurrence rate was 39%. Higher lifting performance was associated with faster benefit suspension and claim closure, but explained little variation in these outcomes (r2 = 1.2-11%). No FCE indicators were associated with future recurrence after controlling for confounders. Results were similar between specific injury and less specific groups., Conclusions: Better FCE performance was a weak predictor of faster benefit suspension, and was unrelated to sustained recovery. FCE was no more predictive in claimants with specific pathology and injury than in those with more ambiguous, pain mediated conditions.

Objective: To determine whether observed higher risks of occupational injury among temporary workers are due to exposure to hazardous working conditions and/or to lack of job experience level., Methods: Data systematically recorded for 2000 and 2001 by the Spanish Ministry of Labour and Social Affairs on fatal and non-fatal traumatic occupational injuries were examined by type of employment and type of accident, while adjusting for gender, age, occupation, and length of employment in the company. In the study period there were 1500 fatal and 1 806 532 non-fatal traumatic occupational injuries that occurred at the workplace. Incidence rates and rate ratios (RR) were estimated using Poisson regression models., Results: Temporary workers showed a rate ratio of 2.94 for non-fatal occupational injuries (95% CI 2.40 to 3.61) and 2.54 for fatal occupational injuries (95% CI 1.88 to 3.42). When these associations were adjusted by gender, age, occupation, and especially length of employment, they loose statistic significance: 1.05 (95% CI 0.97 to 1.12) for non-fatal and 1.07 (95% CI 0.91 to 1.26) for fatal., Conclusions: Lower job experience and knowledge of workplace hazards, measured by length of employment, is a possible mechanism to explain the consistent association between temporary workers and occupational injury. The role of working conditions associated with temporary jobs should be assessed more specifically.

Objectives: There is growing evidence that occupational injuries influence workers' emotional and physical wellbeing, extending healthcare use beyond what is covered by the Workers' Compensation Board (WCB)., Methods: The authors used an administrative database that links individual publicly funded healthcare and WCB data for the population of British Columbia (BC), Canada. They examined change in service use, relative to one year before the injury, for workers who required time off for their injuries (lost time = LT) and compared them to other injured workers (no lost time = NLT) and individuals in the population who were not injured (non-injured = NI)., Results: LT workers increased physician visits (22%), hospital days (50%), and mental healthcare use (43% physician visits; and 70% hospital days) five years after the injury, relative to the year before the injury, at a higher rate than the NI group. For the NLT workers, the level of increased use following the injury was between that of these two groups. These patterns persisted when adjusting for registration in the BC Medical Service Plan (MSP) and several workplace characteristics., Conclusions: Although the WCB system is the primary mechanism for processing claims and providing information about workplace injury, it is clear that the consequences of workplace injury extend beyond what is covered by the WCB into the publicly funded healthcare system.

Objectives: To identify and describe work related serious injuries among sawmill workers in British Columbia, Canada using hospital discharge records, and compare the agreement and capturing patterns of the work related indicators available in the hospital discharge records., Methods: Hospital discharge records were extracted from 1989 to 1998 for a cohort of sawmill workers. Work related injuries were identified from these records using International Classification of Disease (ICD-9) external cause of injury codes, which have a fifth digit, and sometimes a fourth digit, indicating place of occurrence, and the responsibility of payment schedule, which identifies workers' compensation as being responsible for payment., Results: The most frequent causes of work related hospitalisations were falls, machinery related, overexertion, struck against, cutting or piercing, and struck by falling objects. Almost all cases of machinery related, struck by falling object, and caught in or between injuries were found to be work related. Overall, there was good agreement between the two indicators (ICD-9 code and payment schedule) for identifying work relatedness of injury hospitalisations (kappa = 0.75, p < 0.01). There was better concordance between them for injuries, such as struck against, drowning/suffocation/foreign body, fire/flame/natural/environmental, and explosions/firearms/hot substance/electric current/radiation, and poor concordance for injuries, such as machinery related, struck by falling object, overexertion, cutting or piercing, and caught in or between., Conclusions: Hospital discharge records are collected for administrative reasons, and thus are readily available. Depending on the coding reliability and validity, hospital discharge records represent an alternative and independent source of information for serious work related injuries. The study findings support the use of hospital discharge records as a potential surveillance system for such injuries.

Aims: This study examined the relation between months on the job and lost-time claim rates, with a particular focus on age related differences., Methods: Workers' compensation records and labour force survey data were used to compute claim rates per 1000 full time equivalents. To adjust for potential confounding, multivariate analyses included age, sex, occupation, and industry, as well job tenure as predictors of claim rates., Results: At any age, the claim rates decline as time on the job increases. For example, workers in the first month on the job were over four times more likely to have a lost-time claim than workers with over one year in their current job. The job tenure injury associations were stronger among males, the goods industry, manual occupations, and older adult workers., Conclusions: The present results suggest that all worker subgroups examined show increased risk when new on the job. Recommendations for improving this situation include earlier training, starting workers in low hazard conditions, reducing job turnover rates in firms, and improved monitoring of hazard exposures that new workers encounter.

Aims: To analyse the impact of overtime and extended working hours on the risk of occupational injuries and illnesses among a nationally representative sample of working adults from the United States., Methods: Responses from 10,793 Americans participating in the National Longitudinal Survey of Youth (NLSY) were used to evaluate workers' job histories, work schedules, and occurrence of occupational injury and illness between 1987 and 2000. A total of 110,236 job records were analysed, encompassing 89,729 person-years of accumulated working time. Aggregated incidence rates in each of five exposure categories were calculated for each NLSY survey period. Multivariate analytical techniques were used to estimate the relative risk of long working hours per day, extended hours per week, long commute times, and overtime schedules on reporting a work related injury or illness, after adjusting for age, gender, occupation, industry, and region., Results: After adjusting for those factors, working in jobs with overtime schedules was associated with a 61% higher injury hazard rate compared to jobs without overtime. Working at least 12 hours per day was associated with a 37% increased hazard rate and working at least 60 hours per week was associated with a 23% increased hazard rate. A strong dose-response effect was observed, with the injury rate (per 100 accumulated worker-years in a particular schedule) increasing in correspondence to the number of hours per day (or per week) in the workers' customary schedule., Conclusions: Results suggest that job schedules with long working hours are not more risky merely because they are concentrated in inherently hazardous industries or occupations, or because people working long hours spend more total time "at risk" for a work injury. Strategies to prevent work injuries should consider changes in scheduling practices, job redesign, and health protection programmes for people working in jobs involving overtime and extended hours.

Background: The number of people taking prescribed medication for anxiety and depression has increased greatly, but little is known of how this medication impacts on safety at work., Aims: To examine the relation between anxiety and depression, prescribed medication, performance, and safety in the workplace., Methods: The research involved nine focus groups with sufferers of anxiety and depression to investigate experiences of mental health problems and the impact of psychotropic drugs. A further three focus groups were conducted with staff in human resources, personnel, occupational health, and health and safety departments, to explore organisational perspectives. The sample comprised 74 individuals drawn from a wide range of occupational sectors. Finally, the results were presented to a panel of experts from occupational medicine, general practice, psychology, health and safety, and psychiatry, to consider the implications for practice., Results: Workers reported that both the symptoms and the medication impaired work performance. Participants described accidents which they attributed to their condition or to the medication. Workers with responsibilities for others, such as teachers, healthcare workers, and managers appeared to present a particular safety risk. Healthcare workers believed that they placed themselves and their patients at risk when carrying out medical procedures., Conclusions: Respondents in this study felt that their symptoms of anxiety and depression and the medication they took to treat these conditions placed them at risk with respect to safety in the workplace. Drawing on the results, the authors outline areas for improvement in the management of mental health problems at work.

Aims: To study morbidity among active seafarers in the merchant navy in order to clarify possible work related morbidity and the morbidity related to work and lifestyle where possible preventive measures may be initiated., Methods: From a register in the Danish Maritime Authority a cohort of Danish merchant seafarers who had been actively employed at sea in 1995 was identified. For each seafarer, information on all employment periods at sea, charge aboard, and ship was available. The cohort was linked with the National In-patient Register in Denmark. Standardised hospitalisation ratios (SHRs) were calculated for all major diagnostic groups using all gainfully employed as reference., Results: Seafarers were shown to be inhomogeneous, with significant differences in SHRs for the same disease groups between different groups of seafarers depending on charge and ship type. SHRs for lifestyle related diseases were high, although rates for acute conditions, such as acute myocardial infarction, were low, probably due to referral bias, as acute conditions are likely to cause hospitalisation abroad, and thus are not included in the study. SHRs for injury and poisoning were high, especially for ratings and officers aboard small ships., Conclusion: Despite pre-employment selection, a large proportion of the seafarers constitute a group of workers with evidence of poor health probably caused by lifestyle. The subgroups with high risk of hospitalisation due to lifestyle related diseases also had an increased risk of hospitalisation due to injury and poisoning.

Aims: To describe the decline in injury rates between 1990 and 2000 within occupations stratified across three levels of physical demands and gender, adjusting for industry, in Canada's largest province., Methods: Records of injury compensation claims were obtained from the Ontario Workplace Safety & Insurance Board. The population likely to be insured by the Ontario Workplace Safety & Insurance Board was estimated from Statistics Canada's Labour Force Survey. Injury rates were calculated by three broad levels of physical demands, separately for men and women., Results: Injury rates decreased across each grouping of lower physical demands at work for both men and women, with the largest absolute differences in manual occupational groups (high physical demands). Occupations classified as manual (high physical demands) and mixed (moderate physical demands) showed larger differences in injury rates between genders than did non-manual (low physical demands), although the directions of these differences were not always consistent across different natures of injury classification., Conclusions: The absolute reduction in injury rates in Ontario between 1990 and 2000 was dominated by the reduction in injury rates for men and women in manual and mixed occupations. However, not all types of injury have declined to the same extent. A large proportion of differences in injury rates between men and women can be attributed to the differential labour force participation across occupations and industries, as well as the differential tasks within occupational groups.

Background: Little information exists on injury and factors associated with injury in working youth aged 10-14 years. Most studies do not involve children younger than 15., Methods: A cross-sectional anonymous survey was administered to middle school students in five school districts and one large urban school in October 2001., Results: Of the 3189 working middle school students who responded to the survey, the majority were employed in informal job settings, such as working for someone in a home, newspaper delivery, and working on family farms or in family businesses. Overall, 18% of children reported being injured at work. Of those injured, 26% reported that their injury was severe enough to affect their activities for more than three days. Variables that were associated with injury included having a "near-miss" incident at work (AOR 6.61, 95% CI 4.92 to 8.89), having a co-worker injured (AOR 2.65, 95% CI 1.95 to 3.60), and being asked to do something dangerous (AOR 2.25, 95% CI 1.61 to 3.14)., Conclusions: Children are working and being injured in jobs that are not covered by existing child labour laws. Injury rates in non-covered occupations are high, warranting review of current laws.

Aims: To investigate psychiatric disorders, somatic health, and professional effects in French train drivers having experienced a "person under train" accident, and somatic health and professional effects., Methods: A total of 202 train drivers were evaluated several times: immediately after the event, three months later, and one, two, and three years later. These drivers were compared with 186 train drivers not exposed to that psychotraumatic shock. The evaluations relied primarily on the GHQ-28 and MINI questionnaires., Results: In the exposed group, at the first evaluation, the prevalence of post-traumatic stress was 4%; scores > or =5 on the GHQ-28 were significantly higher than in the non-exposed group (32% versus 6%), for both the overall result and three sub-scores (somatic symptoms, anxiety and sleep, and psychosocial functioning). All these differences disappeared within a year. Vulnerability factors concerned prior traumas, acute and lasting life events, and the particular occupational situation where the driver is not accompanied but drives the train away alone in the aftermath of the accident. Over 95% of subjects had no short, medium, or long term impairment of their occupational fitness., Conclusions: Most of the psycho-behavioural disorders were observed in the immediate aftermath of the accident and disappeared within a year. The driver's occupational future does not seem to be affected by the "person under train" accident. Consideration of a traumatic accident as a job related risk and close psychological support of drivers after an accident probably increase the subject's ability to recover from the event.

Aims: To focus on one possible predictor of reported work related injuries--the role of living in building-site camps versus daily commuting from home to construction sites., Methods: A cohort of construction workers was collected, based on personnel files from contractors involved in the building of the Great Belt Bridge. The files included information on employment periods and whether or not the employees lived in building-site camps. The cohort was followed up for injuries reported to the National Work Environment Authority., Results: Construction workers living in camps reported 217 accidents, of which 24 were serious or fatal. Among those not living in camps we found 262 accidents, of which 29 were serious or fatal. The relative risk for all accidents for camp versus non-camp was 0.84 (95% CI 0.69 to 1.00). The respective figure for serious or fatal accidents was RR = 0.85 (95% CI 0.47 to 1.52)., Conclusion: Results suggest that high accident rates at large construction sites may be reduced, if commuting is replaced by living on-site.