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Increasing intensification in swine production has led to new and specialized technologies, but the occupational health and safety impacts are rarely quantified in the business plans for adoption. Needle-less injection has potential to increase productivity and eliminate needle stick injury in workers, but it is not clear whether these benefits offset high capital investment and potential increases in musculoskeletal loads. This economic evaluation employed probabilistic scenario analysis using injury, cost, and production data gathered from interviews with swine producers in Manitoba and Saskatchewan. After adoption of needle-less injection, rates of needle-stick injury went down with no measureable effect on upper limb musculoskeletal disorders, resulting in lower health and safety costs for needle-less injectors. Needle-less injection duration was 40% faster once workers acclimatized, but large start-up costs mean economic benefits are realized only after the first year. The incremental benefit cost ratio promoted adoption of needle-less injectors over conventional needles for the base case of a 1200 sow barn; the conventional method is beneficial for barns with 600 sows or less. Findings indicate that well-designed technologies have the potential to achieve the dual ergonomics goals of enhancing human wellbeing and system performance. We anticipate that the economic and decision models developed in this study can be applied to other new technologies in agriculture and animal production., Competing Interests: The authors have declared that no competing interests exist.

Workplace illnesses can be difficult for physicians and patients because some take years to develop and frequently are masked or mimicked by other illnesses. Such a disease may not show itself until decades after the patient has left the job that caused the problem. By then, the illness may be so far along that little can be done. That time lag between exposure and illness is just one of several difficulties Texas physicians face in tackling workplace illnesses. Because Texas does not have a federally-approved plan for developing and enforcing workplace health and safety standards, the state defers to OSHA on this responsibility.

Introduction: Heat stress is an occupational hazard. Exposed workers may suffer heat-related illness, disease exacerbation, increased injuries, and reduced productivity. Response strategies include mitigation policies and preparedness., Methods: Frequency of heat-related illness and workers' compensation costs before and after implementation of a voluntary Heat Stress Awareness Program were evaluated retrospectively in outdoor workers from 2009 to 2017. The program consisted of training, acclimatization, and medical monitoring as outlined in NIOSH's Criteria for a Recommended Standard: Occupational Exposure to Heat and Hot Environments., Results: Of the 604 workers assessed, those with two or more risk factors reported a heat-related illness at greater frequency, which decreased after program implementation. Median workers' compensation costs decreased by 50%., Discussion: Heat-related illness prevention programs can be effective in reducing the frequency and severity of these occupational injuries as well as associated costs.

Objective: The purpose of this paper is to describe and evaluate a web-based, educational Health Risk Calculator that communicates the value of investing in employee health and well-being for the prevention of work-related injuries, illnesses, and fatalities., Methods: We developed and evaluated the calculator following the RE-AIM framework. We assessed effectiveness via focus groups (n = 15) and a post-use survey (n = 33) and reach via website analytics., Results: We observed evidence for the calculator's usability, educational benefit, and encouragement of action to improve worker health and safety. Website analytics data demonstrated that we reached over 300 users equally in urban and rural areas within 3 months after launch., Conclusion: We urge researchers to consider the ways in which they can communicate their empirical research findings to their key stakeholders and to evaluate their communication efforts.

Objective: This study aimed to quantify the burden of fatal and workers' compensation-related injuries on the dairy sector in Australia and to assess current financial inputs for work health and safety actions., Methods: The first and second phases entailed a review of the financial costs associated with fatal (2001-2013) and workers' compensation cases (2008-2009 to 2012-2013). The third element was a case-study approach focusing on actual production and cost data from a small sample of dairy farms (n = 6) to ascertain an estimate for current financial inputs to work health and safety., Results: The estimated financial impact was approximately AUD$12.4 million each year, comprising AUD$6.8 million for fatalities and AUD$5.6 million for compensable injuries. All sample businesses were investing in health and safety initiatives; however, this was modest and on average represented 0.4% of total expenditure (AUD$4,472) or

The following is Part II of a three-part paper presenting holistic models of determining impairment and occupational disability with respect to common "own occupation" and "any occupation" definitions, especially in the motor vehicle accident (MVA) context. This segment of the paper is for the purpose of educating readers regarding pertinent case law and related evolving judicial/arbitral interpretations surrounding the Post 104-week income replacement entitlement within the Ontario MVA insurance system. Best practices in disa- bility assessment methodology and analysis are supported in the context of holistic occupational disability assessment models in relation to the relevant case law. Comparative analysis was also utilized to inform the reader of the emphasis upon the quality of activity engagement across pre- and post- 104 week spheres. Beyond the MVA sphere, medically-legally, the reviewed case law and related clinical best practices are fully germane to the long term disability and WSIB (workers' compensation) sectors. A specific area emphasized by authors is that the assessment of pain is more complex than is generally acknowledged in many disability assessments. Research on the impact of pain on individuals with disabilities and impairments arising from injuries sustained, clearly demonstrates that traditional pain measurements are often inadequate to fully determine the disability arising from pain. Finally, particularly in the context of In- surance Examinations (lEs and Independent Medical Assessments for LTD), the principle of competitive employability is often not considered as it should be in accordance with the existing case law.

Objectives: The aims of this study were to describe predictors of sustained return to work (RTW) among a cohort of workers with compensated work-related mental health conditions (MHCs); and to examine predictors of subsequent absences due to the same condition., Methods: This study was a retrospective analysis of compensation claims data in Victoria, Australia. We selected workers with an accepted wage replacement claim due to a work-related MHC from 1 January 2002 to 31 December 2009, with two years of follow-up data., Results: We identified 8358 workers meeting our inclusion criteria. The median age of workers was 44 years (Interquartile range (IQR): 36-51) and 56% were female. In a multivariable Cox regression analysis, older age, being from a small organisation, working in some specific industry segments, consulting a psychiatrist or psychologist, using medications, and having a previous claim were all associated with a delayed RTW. Workers experiencing work pressure, assault/workplace violence or other mental stress factors, working in the public administration and safety industry and having a medical incapacity certification between 3-4 days and 5-7 days had a higher rate of multiple RTW attempts., Conclusion: This study identified a number of risk factors associated with a delayed RTW and multiple attempts at RTW. Predictors may help identify high-risk groups and facilitate the RTW process of workers with MHCs., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background: Occupational health and safety (OHS) information is often complex, diverse and unstructured and suffers from a lack of integration which usually precludes any systemic insight of the situation., Aims: To analyse to what extent the use of geographical information systems (GISs) can help to integrate, analyse and present OHS data in a comprehensive and communicable way relevant for surveillance purposes., Methods: We first developed a 'macro-approach' (from national to local level), mapping data related to economic activity (denominator of active workers displayed by activity sectors), as well as work-related ill-health (numerators of workers suffering from work-related ill-health). The latter data are composed of compensated occupational diseases on the one hand and work-related diseases investigated by specialized clinics on the other hand. Then, a 'micro-approach' was worked out, integrating at a plant level, using computer-aided drawing, occupational risks data and OHS surveillance data (e.g. use of medication and sickness absence data)., Results: At the macro-level, microelectronics companies and workers were mapped at different scales. For the first time, we were able to compare, up to the enterprise level, complementary data showing different pictures of work-related ill-health, allowing a better understanding of OH issues in this sector. At the micro-level, new information arose from the integration of risk assessment data and medical data., Conclusions: This work illustrates to what extent GIS is a promising tool in the OHS field, and discusses related challenges (technical, ethical, biases and interpretation) and research perspectives., (© The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oup.com.)

Informal workers in Thailand lack employee status as defined under the Labor Protection Act (LPA). Typically, they do not work at an employer's premise; they work at home and may be self-employed or temporary workers. They account for 62.6 percent of the Thai workforce and have a workplace accident rate ten times higher than formal workers. Most Thai Labor laws apply only to formal workers, but some protect informal workers in the domestic, home work, and agricultural sectors. Laws that protect informal workers lack practical enforcement mechanisms and are generally ineffective because informal workers lack employment contracts and awareness of their legal rights. Thai social security laws fail to provide informal workers with treatment of work-related accidents, diseases, and injuries; unemployment and retirement insurance; and workers' compensation. The article summarizes the differences in protections available for formal and informal sector workers and measures needed to decrease these disparities in coverage., (© The Author(s) 2015.)

Background: Federal Employees' Compensation Act injury rates and claim costs benefit from injury prevention and case management efforts. The Department of Labor Protecting Our Workers and Ensuring Reemployment data on lost time injuries and illnesses do support injury prevention and case management activities., Methods: The management efforts of the Department of Defense, Veterans Administration, and Department of Labor were examined to determine whether more is needed to support injury prevention and case management efforts., Results: Data on Protecting Our Workers and Ensuring Reemployment goal 3 metrics should be provided to safety and occupational health (SOH) personnel to support injury prevention and case management efforts., Discussion: Injury prevention and case management data need to be made available to SOH team members to prevent injuries and lower claims costs., Conclusion: Actionable information must be provided to SOH that will facilitate case management and injury prevention programs and lower costs.

Background: This study evaluated the effectiveness of a program in which a workers' compensation (WC) insurer provided matching funds to insured employers to implement safety/health engineering controls., Methods: Pre- and post-intervention WC metrics were compiled for the employees designated as affected by the interventions within 468 employers for interventions occurring from 2003 to 2009. Poisson, two-part, and linear regression models with repeated measures were used to evaluate differences in pre- and post-data, controlling for time trends independent of the interventions., Results: For affected employees, total WC claim frequency rates (both medical-only and lost-time claims) decreased 66%, lost-time WC claim frequency rates decreased 78%, WC paid cost per employee decreased 81%, and WC geometric mean paid claim cost decreased 30% post-intervention. Reductions varied by employer size, specific industry, and intervention type., Conclusions: The insurer-supported safety/health engineering control program was effective in reducing WC claims and costs for affected employees., (© 2014 Wiley Periodicals, Inc.)

This study aims to investigate the impact of heatwaves on worker's health and safety; to identify workers at higher risk of prevalent illnesses and injuries due to heatwaves; and to provide evidence for policy-makers and service providers. South Australian workers' compensation claims data for 2001-2010 were transformed into time series format, merged with meteorological data and analysed using generalized estimating equation (GEE) models. For total injury claims there was no significant difference detected between heatwave and non-heatwave periods. However, for outdoor industries, daily claims increased significantly by 6.2% during heatwaves. Over-represented in hot weather were male labourers and tradespersons aged ≥ 55 years, and those employed in 'agriculture, forestry and fishing' and 'electricity, gas and water'. Occupational burns, wounds, lacerations, and amputations as well as heat illnesses were significantly associated with heatwaves. Similarly, moving objects, contact with chemicals, and injuries related to environmental factors increased significantly during heatwaves, especially among middle-aged and older male workers. With the predicted increase of extremely hot weather, there is a need for relevant adaptation and prevention measures at both practice and policy levels for vulnerable work groups., (Copyright © 2014 Elsevier Inc. All rights reserved.)

To allocate available resources as efficiently as possible, decision makers need information on the relative economic merits of occupational health and safety (OHS) interventions. Economic evaluations can provide this information by comparing the costs and consequences of alternatives. Nevertheless, only a few of the studies that consider the effectiveness of OHS interventions take the extra step of considering their resource implications. Moreover, the methodological quality of those that do is generally poor. Therefore, this study aims to help occupational health researchers conduct high-quality trial-based economic evaluations by discussing the theory and methodology that underlie them, and by providing recommendations for good practice regarding their design, analysis, and reporting. This study also helps consumers of this literature with understanding and critically appraising trial-based economic evaluations of OHS interventions.

Purpose: To estimate the employer costs associated with employee obesity., Design: The study used cross-sectional analysis of employee health-risk assessment, disability, workers' compensation, and medical claims data from 2006 to 2008., Setting: The study took place in the United States from 2006 to 2008., Subjects: A panel database with 29,699 employees drawn from a panel of employers and observed for 3 years each (N = 89,097) was used., Measures: Workdays lost owing to illness and disability; the cost of medical, short-term disability, and workers' compensation claims; and employees' adjusted body mass indices (BMI) were measured., Analysis: We model the number and probability of workdays lost from illness, short-term disability, and workers' compensation events; short-term disability and workers' compensation payments; and health care spending as a function of BMI. We estimate spline regression models and fit results using a third-degree fractional polynomial., Results: Probability of disability, workers' compensation claims, and number of days missed owing to any cause increase with BMI above 25, as do total employer costs. The probability of a short-term disability claim increases faster for employees with hypertension, hyperlipidemia, or diabetes. Normal weight employees cost on average $3830 per year in covered medical, sick day, short-term disability, and workers' compensation claims combined; morbidly obese employees cost more than twice that amount, or $8067, in 2011 dollars., Conclusion: Obesity is associated with large employer costs from direct health care and insurance claims and indirect costs from lost productivity owing to workdays lost because of illness and disability.

Introduction: Acute work-related trauma is a leading cause of death and disability among U.S. workers. Occupational health services researchers have described the pressing need to identify valid injury severity measures for purposes such as case-mix adjustment and the construction of appropriate comparison groups in programme evaluation, intervention, quality improvement, and outcome studies. The objective of this study was to compare the performance of several injury severity scores and scoring methods in the context of predicting work-related disability and medical cost outcomes., Methods: Washington State Trauma Registry (WTR) records for injuries treated from 1998 to 2008 were linked with workers' compensation claims. Several Abbreviated Injury Scale (AIS)-based injury severity measures (ISS, New ISS, maximum AIS) were estimated directly from ICD-9-CM codes using two software packages: (1) ICDMAP-90, and (2) Stata's user-written ICDPIC programme (ICDPIC). ICDMAP-90 and ICDPIC scores were compared with existing WTR scores using the Akaike Information Criterion, amount of variance explained, and estimated effects on outcomes. Competing risks survival analysis was used to evaluate work disability outcomes. Adjusted total medical costs were modelled using linear regression., Results: The linked sample contained 6052 work-related injury events. There was substantial agreement between WTR scores and those estimated by ICDMAP-90 (kappa=0.73), and between WTR scores and those estimated by ICDPIC (kappa=0.68). Work disability and medical costs increased monotonically with injury severity, and injury severity was a significant predictor of work disability and medical cost outcomes in all models. WTR and ICDMAP-90 scores performed better with regard to predicting outcomes than did ICDPIC scores, but effect estimates were similar. Of the three severity measures, maxAIS was usually weakest, except when predicting total permanent disability., Conclusions: Injury severity was significantly associated with work disability and medical cost outcomes for work-related injuries. Injury severity can be estimated using either ICDMAP-90 or ICDPIC when ICD-9-CM codes are available. We observed little practical difference between severity measures or scoring methods. This study demonstrated that using existing software to estimate injury severity may be useful to enhance occupational injury surveillance and research., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Objective: To examine trends in the proportion of work-related emergency department visits not expected to be paid by workers' compensation during 2003-2006, and to identify demographic and clinical correlates of such visits., Data Source: A total of 3,881 work-related emergency department visit records drawn from the 2003-2006 National Hospital Ambulatory Medical Care Surveys., Study Design: Secondary, cross-sectional analyses of work-related emergency department visit data were performed. Odds ratios and 95 percent confidence intervals were modeled using logistic regression., Principal Findings: A substantial and increasing proportion of work-related emergency department visits in the United States were not expected to be paid by workers' compensation. Private insurance, Medicaid, Medicare, and workers themselves were expected to pay for 40 percent of the work-related emergency department visits with this percentage increasing annually. Work-related visits by blacks, in the South, to for-profit hospitals and for work-related illnesses were all more likely not to be paid by workers' compensation., Conclusions: Emergency department-based surveillance and research that determine work-relatedness on the basis of expected payment by workers' compensation systematically underestimate the occurrence of occupational illness and injury. This has important methodological and policy implications., (© Health Research and Educational Trust.)

Aim: The aim of this article is to describe the physical challenges that ageing nurses experience and the facility design features that can promote healthy work environments to motivate nurses to continue working., Background: Older nurses are working longer and beyond the usual retirement age. They often experience chronic fatigue and the usual physical and cognitive changes associated with aging. Nursing is a physically demanding profession and many older nurses work in pain while providing direct patient care. The literature is replete with studies focusing on the organisational factors that retain older nurses, but little research addresses design factors that facilitate nurses working longer and more safely in direct patient care., Evaluation: Electronic databases in medicine, nursing, psychology, and architecture were searched and evidence-based, non-evidence-based, and review articles and government and organisational newsletters were evaluated., Key Issues: Hospital design can help address the physical work challenges that older nurses experience., Conclusions: Older nurses have a wealth of knowledge and expertise, and the design of nursing units can optimize their work experience., Implications for Nursing Management: Nurse Managers must participate in design efforts and advocate designs that support aging nurses., (© 2013 John Wiley & Sons Ltd.)

Objective: To investigate the incentive for primary and secondary prevention associated with experience rating in a retrospective workers' compensation program., Methods: Panel data on 21,558 firms from 1998 to 2007 were used to estimate the relationship between the degree of experience rating and seven measures of workplace occupational health and safety outcomes. We focused on the impact of a policy change in 2004 in which the degree of experience rating was substantially increased for all firms., Results: The 2004 increase in experience rating was associated with a reduction in the total, lost-time, no-lost-time, benefit days, permanent impairment, musculoskeletal disorder, and acute trauma claim rates. These observed changes follow secular trends., Conclusion: The association of experience rating with some claim outcomes and not others in some time periods suggests that firms may focus on claims and cost management practices.

This article reports the experiences of women aged 55 to 75 with mobility impairments who attributed aspects of their limitations to workplace injuries and provides insight into worker's compensation policies. The study sample includes Mexican American (MA) and non-Hispanic White (NHW) women aged 55 to 75 who participated in a 4-year ethnographic study of disablement. Ninety-two of the 122 participants in the study attributed aspects of their functional limitations to employment, and their experiences were analyzed using data from 354 meetings. Using Lipscomb and colleagues' conceptual model of work and health disparities, the women's experiences were grouped into three categories according to type of injury, assistance gained, and the consequences of a workplace injury; the results have broad implications for policies that influence aging outcomes. Workplace injuries causing permanent functional limitations compound the effects of age and gender on employment outcomes. Policies addressing health disparities should consider work related influences.

An international body of scientific research indicates that growth of job insecurity and precarious forms of employment over the past 35 years have had significant negative consequences for health and safety. Commonly overlooked in debates over the changing world of work is that widespread use of insecure and short-term work is not new, but represents a return to something resembling labor market arrangements found in rich countries in the 19th and early 20th centuries. Moreover, the adverse health effects of precarious employment were extensively documented in government inquiries and in health and medical journals. This article examines the case of a large group of casual dockworkers in Britain. It identifies the mechanisms by which precarious employment was seen to undermine workers and families' health and safety. The article also shows the British dockworker experience was not unique and there are important lessons to be drawn from history. First, historical evidence reinforces just how health-damaging precarious employment is and how these effects extend to the community, strengthening the case for social and economic policies that minimize precarious employment. Second, there are striking parallels between historical evidence and contemporary research that can inform future research on the health effects of precarious employment.

Background: Studies of regulatory effectiveness have shown mixed evidence of impact of inspections on injury rates. We examine changes in workers compensation claims rates and costs for Washington employers having either an inspection, with or without citation, or a voluntary consultation activity., Method: We merge 10 years of enforcement and consultation activity with workers compensation records at the individual workplace level for stable firms with a single business location and at least 10 full-time employees. The change in claims incidence rates (CIRs) was estimated, controlling for workplace claims rate history, size, and industry. Separate analyses were performed for non-musculoskeletal and musculoskeletal (MSD) CIRs, claims costs and for enforcement activities with citation and without citation., Results: Enforcement activities are associated with a significant reduction in CIRs and costs. Similar results may also be attributable to consultations. Inspections were associated with a 4% decline in time-loss claims rates relative to uninspected workplaces. The effect strengthens when MSD claims are excluded. Citations for non-compliance are associated with a 20% decline in non-MSD CIRs relative to uninspected workplaces. There is also some evidence for a reduction in MSD claims rates beginning in the second year following inspection. Enforcement and consultation activity is associated with substantial decreases in claims costs., Conclusions: Enforcement activities make a significant contribution to reducing CIRs and costs. Similar results following consultations may also exist. Inspections with citations are more effective than those without. Claims rates for non-MSD injuries, related to hazards covered by specific standards, are more affected in the year following the visit, while those for MSDs take longer to begin falling., (Copyright © 2012 Wiley Periodicals, Inc.)

Objective: Examine uses of US workers' compensation (WC) data for occupational safety and health purposes., Methods: This article is a summary of the proceedings from an invitational workshop held in September 2009 to discuss the use of WC data for occupational safety and health prevention purposes., Results: Workers' compensation data systems, although limited in many ways, contain information such as medical treatments, their costs and outcomes, and disability causes that are unavailable from national occupational surveillance sources., Conclusions: Despite their limitations, WC records are collected in a manner consistent with many occupational health and safety surveillance needs. Reports are available on the use of WC data for surveillance and research purposes such as estimating the frequency, magnitude, severity, and cost of compensated injuries. Inconsistencies in WC data can limit generalization of research results.

This article intends to discuss the interfaces of Decree No. 6042 and the adoption of its guidelines as a strategy to reduce the occupational hazards.

This study aims to describe workers who were hospitalized with work-related burn injuries and their psychiatric sequelae in Washington State. Psychiatric sequelae of interest were depression, posttraumatic stress disorder, and other anxiety disorders. Workers' compensation claims meeting a definition for a hospitalized burn patient from Washington State from January 2001 through April 2008 were analyzed. The resulting claims were searched for the presence of certain psychiatric diagnoses or treatment codes, and descriptive analyses performed. In Washington State during the time period, the prevalence of claims with psychiatric diagnoses after hospitalization with burn injury was 19%. Claims with psychiatric diagnoses had higher medical costs and more days of time loss than those without these diagnoses. Workers with electrical burns in the construction industry and in construction and extraction occupations had a higher proportion of psychiatric sequelae. Burns are devastating yet preventable injuries. Workers who were hospitalized with work-related burn injuries, particularly those in certain industries and occupations and those with electrical burns, are at high risk for developing serious psychiatric sequelae with major costs to both the individual and the society.

A recent meeting of leading workers' compensation (WC) researchers was held in Washington, DC to consider ways of improving the use of WC data for injury and illness prevention. Participants identified specific deficiencies that limit the application of WC data for research purposes. For example, commercial insurers are often reluctant to provide claims records to research organizations. Unlike many other countries, the Unites States lacks a comprehensive national system for compiling and analyzing WC data, or mechanisms for linking WC data with other health care, employment, and disability records. Many of these deficiencies can be traced to historical circumstances surrounding the early development of WC laws in the United States. Inconsistencies among states developed in the absence of a federal WC system. Opportunities exist for using WC data more broadly to support public health research aimed at improving the health of populations and communities.

Objective: Obesity has become a major public health concern in the United States, and has ultimately affected occupational health, including Workers' Compensation. Obesity has been determined to contribute to work-related injury. This analysis examined weight change post-injury during the Workers' compensation rehabilitation process, and specifically how it relates to perceived mental health need, perceived dietary habits, food stamp usage, and the amount of time since the work injury., Methods: Archival data analysis was conducted examining Workers' Compensation claimants over a four year period., Participants: Data was collected from 1,864 valid Workers' Compensation claims and analyzed using descriptive statistics and a backwards elimination multiple regression analysis to examine predictive relationships between the variables of interest., Results: Approximately 2/3 of the sample reported weight gain post-injury, with the additional 1/3 reporting weight loss or no change. Both perceived benefit from mental health services and perceived healthy dietary habits were significantly predictive of weight gain., Conclusions: Clinical psychological distress, such as depression and anxiety, may be contributory factors to weight gain, and poor perceptions in food quality and caloric estimations may also relate to this problem. Suggestions for future research, including intervention studies, are also included.

Objective: To assess the relationship between self-assessed employee health risk status and future workers' compensation (WC) and short-term disability (STD) claims., Methods: A historical cohort study linking Health Risk Assessment (HRA) survey data with subsequent WC and STD claims. HRA participants who developed a WC or STD claim in the subsequent 12 months were identified as cases and compared with HRA participants who did not develop a claim in the subsequent 12 months., Results: High-risk participants had higher odds of filing a WC claim, when compared with low-risk participants (OR: 2.99, 95% CI: 1.22 to 7.32) despite adjustment for demographic factors including job type. Medium-risk participants had 1.5 times higher odds, when compared with low-risk participants to file for STD (OR: 1.45, 95% CI: 1.15 to 1.82). Other relationships trended similarly but did not reach statistical significance., Conclusion: Self-assessed personal health risk does impact future lost productivity in WC and STD claims even after adjustment for demographic, health factors, and job type (WC only). Employers wishing to reduce the impact of lost productivity should consider a worker's personal health risks as predictors of future lost productivity and may want to address this in broad risk reduction programs.

Objective: The objective of this study was to investigate the effectiveness of an integrated workplace-based program to reduce musculoskeletal injuries (MSIs) and the impact of those injuries in healthcare workers., Methods: A pre-/postintervention with concurrent control study design was applied-3 years of data before the program with 1 year of data during the program., Results: Time-loss (TL) MSIs increased at the intervention site during the intervention year. However, the program returned injured employees back to work in a shorter time and, compared with average historical data, reduced compensation costs and healthcare costs associated with TL MSIs during the first year., Conclusion: The findings that MSI-associated TL and compensation costs were significantly lower during the program illustrates the effectiveness of this program and demonstrates that increased reporting of MSIs need not be associated with increased claims costs.

The decision of the Virginia Supreme Court in Fairfax County Fire & Rescue Department v. Mottram (2002) has important implications for Workers' Compensation claims for posttraumatic stress disorder, particularly those involving emergency services personnel. A firefighter/paramedic who developed chronic, disabling PTSD after responding to a fatal fire was denied benefits because he had previously reported symptoms of the disorder, whereas the statute recognized a single traumatic incident only. The court held that PTSD resulting from multiple traumatic stressors may be considered a compensable occupational disease analogous to dermatitis developed by a flower shop employee with chronic exposure to irritating stimuli. The decision, which constitutes legal recognition of work-related cumulative PTSD in rescue workers, provides benefits for treatment and encourages earlier treatment of traumatic stress in this group.

Background: Work-related upper limb amputations account for a significant number of occupational injuries. This study analyzes the nationwide incidence of work-related amputations of upper limbs in Taiwan by using the workers' compensation database., Methods: A total of 2,950 cases were retrieved and analyzed from the database of workers' compensatory disability claims between the years 1999 and 2001., Results: The cases were workers with an average age of 39.1 years, of whom 23.0% were female, the highest percentage of cases was in the 30-49 age group, but the incidence based on insured population was the highest for those under 20 years old. About 96% of the cases involved finger amputation, and 85% of all amputations were related to common powered machines. The average annual incidence of disability claims due to occupational amputation of upper extremities was 12.5 per 100,000 workers. Claims were most prevalent among manufacturing workers and male workers. The male to female risk ratios ranged from 2.62 for manufacturing workers to 9.05 for transport, storage and communication workers by the Poisson regression analysis., Conclusions: Young male manufacturing workers were at high risk of occupational amputation of upper extremities in Taiwan. These results provide an epidemiological base for developing a prevention strategy.

This study estimated injury and illness rates, risk factors, and costs associated with construction work in Oregon from 1990-1997 using all accepted workers' compensation claims by Oregon construction employees (N = 20,680). Claim rates and risk estimates were estimated using a baseline calculated from Current Population Survey data of the Oregon workforce. The average annual rate of lost-time claims was 3.5 per 100 workers. More than 50% of claims were by workers under 35 years and with less than 1 year of tenure. The majority of claimants (96.1%) were male. There were 52 total fatalities reported over the period examined, representing an average annual death rate of 8.5 per 100,000 construction workers. Average claim cost was $10,084 and mean indemnity time was 57.3 days. Structural metal workers had the highest average days of indemnity of all workers (72. 1), highest average costs per claim ($16,472), and highest odds ratio of injury of all occupations examined. Sprains were the most frequently reported injury type, constituting 46.4% of all claims. The greatest accident risk occurred during the third hour of work. Training interventions should be extensively utilized for inexperienced workers, and prework exercises could potentially reduce injury frequency and severity.

American businesses face huge costs for work-related musculoskeletal pain. Work-related musculoskeletal pain is not new or unique to the population of the United States. Many historic manifestations of workplace pain have been related to innovation and technology changes. Incidence rates and severity of symptoms have had an interesting relationship to the public concern and governmental decisions. In 1999, a National Academy of Sciences study found total costs to be more than US dollar 1 trillion per year and concluded that effective prevention of workplace pain through active intervention is not only possible, but results in a significant cost savings for the employer while reducing the disability experienced by the employee. Employers have been reluctant to embrace the benefits of workplace prevention for work-related musculoskeletal pain. The purpose of this review is to examine (1). what is know about prevention of work-related musculoskeletal pain and workplace musculoskeletal disorders, (2). a brief description of several prevention preventing behaviors, (3). an analysis of how these preventing behaviors are maintained, and (4). suggestions on how to reverse these prevention preventing behaviors.

Introduction: A retrospective analysis evaluated the effectiveness of an insurance carrier's flexible loss control service strategy in reducing workers' compensation policyholders' reported injury and illness claims., Objectives: To assess the effects of a loss control service strategy on workers' compensation claim frequency rates, on medical-only claim rates, on severity-claim rates, and on claim cost among a group of California employers., Methods: Eighty-two small- and medium-sized companies with workers' compensation policies expiring in 1999 were randomly selected from a population of policyholders assigned to loss control consultants for two or more years. Claim performance data were obtained for each company's first expired in-force policy year and its 1999 expired policy year. The retrospective design was combined with a control component based on a randomly selected comparison group of 45 companies whose first policy year with the insurer expired in 1999 and who received safety services from the loss control staff., Results: The flexible loss control consultation service strategy was associated with lower average claim rates and costs. Companies assigned to a loss control consultant for two or more years (the "outcome group") had an average claim rate of 1.24 per $10,000 premium, compared with a rate of 1.62 in the "initial group" and a rate of 1.60 in the "comparison group." The average severity-claim rate of the outcome group was 0.32, compared with the initial-year and comparison-group means of 0.48 and 0.46, respectively. The average medical-only claim rate was 0.92, compared with the initial- and comparison-group means of 1.14 and 1.14. The outcome group's average loss ratio was over 10% lower than that of the initial and comparison groups. Statistical analysis indicated that differences among the groups' claim rates and severity-claim rates were [F=(2,206) 4.938, P=0.008] and [F=(2,206) 8.208, P<0.001], respectively., Conclusions: A loss control service strategy that provides service flexibility and develops partnership between employer and consultant can help reduce the frequency and severity of workers' compensation claims. Barriers to consultation service flexibility, both internal and external, should be identified and removed to enhance service efficacy.

Work related back injuries among hospital personnel account for high volume, high cost workers' compensation claims. These injuries can be life altering experiences, affecting both the personal and professional lives of injured workers. Lifting must be viewed as a skill involving specialized training and mandated use of mechanical equipment, rather than as a random task performed by numerous health care providers. The use of a lift team specially trained in body mechanics, lifting techniques, and the use of mandated mechanical equipment can significantly affect injury data, financial outcomes, and employee satisfaction. The benefits of a lift team extend beyond the effect on injury and financial outcomes--they can be used for recruitment and retention strategies, and team members serve as mentors to others by demonstrating safe lifting techniques. Ultimately, a lift team helps protect a valuable resource--the health care worker.

The article covers first published main parameters of management and practical activities of national system for mandatory social insurance of workmen's occupational risks within a Federal Law No 125-FL "On mandatory social insurance against occupational accidents and diseases". The authors present dynamics of insurers (employers) registration, values of allocation rates, dynamics and structure of insurance payments, results of investigations on traumatism and occupational diseases. The suggestions are ways to improve the existing system from occupational medicine viewpoint.

Australia is a developed country with a high standard of living, small population and large land area. Manufacturing is currently the largest economic contributor, although mining and agriculture are also significant industries. There are around 10 million employees in total, with retail trade and manufacturing being the largest employers. Manufacturing currently has the highest incidence of workplace injury, although around 5% of all Australian workers suffer from some kind of occupational disease or injury every year. Occupational Health and Safety (OHS) legislation is individually managed and enforced by the 8 states and territories. Training and registration for OHS professionals varies between the speciaities and usually requires a combination of academic qualifications and workplace experience. Non-medical personnel constitute a large proportion of OHS professionals in Australia.

The purpose of this study was to evaluate the effect of four common types of mandatory state-level workplace safety regulations on injury severity rates during the period 1992 to 1997 for the manufacturing sector. The full Poisson regression model showed safety committee regulations to have a highly significant reducing effect on injury rates, chi 2 (1, n = 3286) = 10.1774, P = 0.0014. Safety program regulations were significant at the alpha = 0.10 level, chi 2 (1, n = 3286) = 3.5676, P = 0.0589. The effect of insurance carrier loss control regulations in the full model was nonsignificant. However, insurance carrier loss control regulations were highly significant (alpha = 0.01) in the final reduced model. Targeting initiatives were nonsignificant in both the full and reduced models (alpha = 0.05). The study results are important to state and federal agencies considering adopting workplace safety regulations that are similar to the four types evaluated in this study.

Major areas considered under the rubric of health and productivity management (HPM) in American business include absenteeism, employee turnover, and the use of medical, disability, and workers' compensation programs. Until recently, few normative data existed for most HPM areas. To meet the need for normative information in HPM, a series of Consortium Benchmarking Studies were conducted. In the most recent application of the study, 1998 HPM costs, incidence, duration, and other program data were collected from 43 employers on almost one million workers. The median HPM costs for these organizations were $9992 per employee, which were distributed among group health (47%), turnover (37%), unscheduled absence (8%), nonoccupational disability (5%), and workers' compensation programs (3%). Achieving "best-practice" levels of performance (operationally defined as the 25th percentile for program expenditures in each HPM area) would realize savings of $2562 per employee (a 26% reduction). The results indicate substantial opportunities for improvement through effective coordination and management of HPM programs. Examples of best-practice activities collated from on-site visits to "benchmark" organizations are also reviewed.

A review of national statistics and recent studies strongly suggests that current administrative and medical systems, when applied to managing workers' compensation claims and other disability-related benefit programs, are often ineffective and costly, and can even promote disability. With numerous medical and occupational health articles published daily, it is difficult to develop practical strategies for daily management of disability claims that make use of current information. It is the authors' view that a comprehensive, dynamic model for management exists within the military's "Forward Treatment" methodology. This model, originally published in The Journal of Occupational Rehabilitation, has been expanded to include those methods demonstrated in literature to both reduce claims and deal with them in an efficient, fair, and timely manner. Because military personnel and employed individuals are similarly entitled, the military's proven model can be effective in reducing claim rates and costs associated with workers' compensation as well as short- and long-term disability programs. The model, given the acronym S.P. I.C.E., includes five components: Simplicity, Proximity, Immediacy, Centrality, and Expectancy.