Global estimates of the burden of injury and illness at work in 2012

Can Workplace Rest Breaks Prevent Work-Related Injuries Related to Long Working Hours?

OBJECTIVE

This study examined the relationship between long working hours, rest breaks, and work-related injuries.

METHODS

A total of 25,439 employees were examined from the 4th Korean Working Conditions Survey. Rest breaks were divided into two groups and working hours were divided into four groups. Multiple logistic regression was conducted to estimate the relationship between long working hours, rest breaks, and work-related injuries.

RESULTS

Work-related injuries were significantly associated with long working hours. Stratified by rest breaks, the risk of work-related injuries increased with increasing working hours in a dose-response pattern among those with insufficient rest breaks, while the risk was not significant among those with sufficient rest breaks.

CONCLUSION

It is important to provide sufficient rest breaks to prevent work-related injuries among workers with long working hours.

Predisposing factors influencing occupational injury among frontline building construction workers in Ghana

OBJECTIVE

This study aims to examine the predisposing factors influencing occupational injuries among frontline construction workers in Ghana. A cross-sectional survey was carried out with 634 frontline construction workers in Kumasi metropolis of Ghana using a structured questionnaire. The study was conducted from December 2016 to June 2017 using a household-based approach. The respondents were selected through a two-stage sampling approach. A multivariate logistics regression model was employed to examine the association between risk factors and injury. Data was analyzed employing descriptive and inferential statistics with STATA version 14.

RESULTS

The study found an injury prevalence of 57.91% among the workers. Open Wounds (37.29%) and fractures (6.78%) were the common and least injuries recorded respectively. The proximal factors (age, sex of worker, income) and distal factors (e.g. work structure, trade specialization, working hours, job/task location, and monthly off days) were risk factors for occupational injuries among frontline construction workers. The study recommends that policymakers and occupational health experts should incorporate the proximal and distal factors in the design of injury prevention as well as management strategies.

A psychosocial theory of sick leave put to the test in the European Working Conditions Survey 2010-2015

PURPOSE

In the present investigation a psychosocial theory of sick leave is proposed which integrates work-related determinants, health effects of particular work characteristics, and workers' health status. In addition, the theory explicitly formulates a series of mediators and moderators of the associations between work-related determinants and sick leave. On the basis of the theoretical assumptions and previous research findings, a series of research hypotheses are investigated with survey data.

METHODS

The study is based on data from the European Working Conditions Survey 2010 and 2015 (n = 59,790). The research hypotheses are investigated by means of generalised linear mixed models within the framework of hierarchical Bayesian regression models and Markov Chain algorithms. The theory is assessed by estimating three so-called hurdle models, which take into account the excess zeros usually observed in sick leave rates.

RESULTS

In general, the findings provide evidence of the adequacy of the theory explaining the observed variation of sick-leave rates. Several biomechanical and psychosocial characteristics of the working environment, occupation, age, and the subjective assessment of health status were found to be strongly associated with both the likelihood of being in sick leave and the length of sick-leave spells.

CONCLUSIONS

The theory and the findings of the present study may serve as a basis for the development and implementation of occupational health interventions aiming to reduce sick-leave rates in organisations.

How is safety climate formed? A meta-analysis of the antecedents of safety climate

The purpose of this meta-analysis was to provide a comprehensive quantitative review of research to date on the antecedents of psychological and organizational safety climate. Building upon and expanding Zohar’s conceptual model, antecedents were organized into three broad categories: situational factors, interpersonal interactions, and personal factors. Data were gleaned from 136 primary studies to calculate effect sizes for 38 antecedents and the relative importance of each antecedent within the three categories. Antecedent effect sizes were generally homologous for psychological and organizational safety climate, with the strongest effect sizes for interpersonal interactions followed by organizational climate and leadership. The magnitude of the safety climate antecedent effect sizes tended to be stronger in health-care industry studies and varied inconsistently as a function of the industry-specific nature of the safety climate measure. This meta-analysis provides a much needed summary of the research to date in an effort to guide future research and practice on the development and improvement of safety climate in organizations.

The Cost of Managing Occupational Injuries Among Frontline Construction Workers in Ghana

BACKGROUND

The cost burden of occupational injuries has significant effects on the social well-being of workers. Although there seems to be growing evidence on the cost burden on other public health issues, little is known about occupational injuries, especially in low- to middle-income countries including Ghana.

OBJECTIVE

This study, therefore, sought to estimate the cost burden of managing occupational injuries among frontline construction workers.

METHODS

A prevalence-based cost of illness approach was used to estimate the cost burden of construction injuries. A structured questionnaire was used to collect cost-related data from 640 frontline construction workers. Descriptive statistics were used to estimate direct and indirect cost of injuries using Microsoft Excel and STATA version 14.

RESULTS

Overall, a worker spends an average of GHC 104.84 ($24.52) and GHC 180.89 ($42.31) as direct and indirect costs, respectively. Compared with other injuries, fracture had the highest average cost, GHS 343.33 ($80.30), and concussion and internal injury recorded the lowest cost. Also, compared with other trade specialties, carpenters had the highest average cost burden and laborers had the lowest burden.

CONCLUSION

There is high direct and indirect cost for managing occupational injury among construction workers. Advocacy and awareness about workplace insurance and regulatory policies should adequately be strengthened and prioritized through periodic monitoring and evaluations.

Occupational health and safety practices among contractors in Malawi: a generic overview

The construction industry accounts for a high percentage of occupational accidents, leading to violation of workers’ human dignity and labour rights. The situation is critical in developing countries owing to occupational health and safety (OHS) interventions being in their infancy and inadequacy in systematic implementation of OHS programmes. This study was concerned with obtaining a generic overview of implementation of selected OHS practices by construction companies in Malawi in order to identify underlying motivations for their implementation or non-implementation and determine OHS management techniques for improvement. A questionnaire was used to collect data, which were analysed using a combination of frequency distribution and categorisation of OHS implementation levels. The results revealed inadequacies in the provision of OHS facilitation services and training practices on construction sites and to construction workers, respectively. Further, the findings revealed workers’ negativity towards OHS practices and reporting of construction accidents to insurance companies despite a legal mandate to notify the OHS directorate. The study supports the notion that developing countries are poor at establishing and implementing OHS legislation and programmes. If properly utilised, the study may guide interventions for improving OHS management at company and national levels.

Mortality and Years of Life Lost Due to Occupational Injury in Iran (2012-2016)

BACKGROUND

Occupational injury is a cause of premature mortality, mainly in low- and middle-income countries. Occupational injuries estimated to kill more than 300,000 workers worldwide every year. We estimated the years of life lost (YLL) of fatal unintentional occupational injuries in Iran for the five years of 2012-2016.

STUDY DESIGN

A cross-sectional study.

METHODS

To estimate the YLL, registered deaths due to occupational unintentional injury were identified from the Iranian Legal Medicine Organization. Estimated YLL was calculated according to Global Burden of Disease 2010 guideline. Population life expectancy in each corresponding years was retrieved from the national health database. All data collected entered into Excel software for calculations.

RESULTS

In 2012-2016, fatal unintentional occupational injuries were the cause of 8,606 deaths in Iran, resulting in 4.6 prematurely lost life yr per 1000 males and 0.3 yr per 1000 females among workers, every year. 98.7% of the deaths occurred in males. Males from 15 to 19 yr of age and females from 10 to 14 yr of age showed the highest YLL rates. The rate of YLLs per 1,000 workers per year was 3.99 overall, 4.6 in males, and 0.4 in females.

CONCLUSION

Premature mortality due to occupational injury is still a serious problem in the Iranian population. Our findings may be useful from a health policy perspective for designing and prioritizing interventions focused on the prevention of premature loss of life. Known prevention strategies need to be implemented widely to diminish avoidable injuries in the workplace.

Estimation of work-related injury and economic burden attributable to heat stress in Guangzhou, China

BACKGROUND

Climate change has exacerbated the health effects of high ambient temperatures on occupational health and safety; however, to what extent heat stress can induce workplace injuries and economic costs is poorly studied. This study aimed to quantify the attributable fractions of injury claims and subsequent insurance payouts using data from work-related injury insurance system in Guangzhou, China.

METHODS

Individual workers' injury claims data were collected for the period of 2011-2012, including demographic characteristics and work-related information. Daily maximum wet bulb globe temperature (WBGT, °C) was calculated from meteorological data. To examine the association between WBGT index and work-related injury, we fit a quasi-Poisson regression with distributed lag non-linear model. Then we calculated the numbers of injury claims and costs of insurance compensations attributable to days with WBGT above the heat stress limit according to the national occupational health standards.

RESULTS

There were 9550 work-related injury claims, resulting in an insurance payout of 282.3 million Chinese Yuan. The risks of injury claims increased with rising WBGT. 4.8% (95% eCI: 2.9%-6.9%) of work-related injuries and 4.1% (95% eCI: 0.2%-7.7%) of work-related injury insurance payouts were attributed to heat exposure for WBGT threshold above the heat stress limit. Male workers, those in small enterprises and with low educational attainment were especially sensitive to the effects of heat exposure.

CONCLUSIONS

Heat stress can contribute to higher risk of work-related injury and substantial economic costs. Quantified the impacts of injuries and related economic costs should be considered to develop targeted preventive measures in the context of climate change.

Comparing fatal occupational accidents in Denmark and Sweden 1993–2012

Background

Denmark and Sweden are in many respects two very similar countries with similar welfare state systems and work environment authorities. Nevertheless, marked differences in the incidence of fatal occupational accidents have been found in earlier comparisons of the two countries.

Aims

To investigate differences in the incidence of fatal occupational accidents in the period from 1993 to 2012 to establish to what extent characteristics of the deceased can explain some of the difference between the two countries.

Methods

Analyses of the accident registers of the two countries’ national work environment authorities with supplemental linkages to official registers on employment status are used to determine the incidence of fatal occupational accidents for different groups. The analysis is based on 2375 accidents (1068 in Denmark and 1307 in Sweden) over the period of 20 years. Poisson regression is used to derive incidence rates over time for specific groups.

Results

In the study period, the incidence of fatal occupational accidents decreased in both countries (incidence rate ratio [IRR]: 0.95), although the incidence was on average higher in Denmark (IRR: 1.20) and grew larger over time. This difference did not disappear after adjusting for age, sex and industry among the deceased (IRR: 1.12).

Conclusions

The incidence of fatal occupational accidents was slightly higher in Denmark in the entire period. The difference could not be explained completely by sociodemographic differences or differences related to the labour market structure in the two countries, i.e. other factors (e.g. cultural) may play a role in producing the difference.

The recording of fatal work-related injuries in information systems in Brazil

This study aims to identify information systems having fatal work-related (ATF) data in Brazil, describing their characteristics, flows and barriers to information quality. Using a documental research approach, we found: the Mortality Information System (SIM), the Hospital Admission Register from the Unified Health System (SIH-SUS), the Notifiable Diseases Information System (SINAN) and the Violence and Injuries Surveillance Program (VIVA) from the Health Ministry; the Work-related Injuries Reporting System (SISCAT) of the Ministry of Social Insurance; and the Annual Report of Social Information (RAIS), Ministry of Labour and Employment. A lack of key common variables limits the construction of a single database composed by all ATF recorded cases. From several barriers identified, the most relevant for data quality was the lack of work-relatedness recognition and recording, a task performed by the health team.

Recovery Within Injury Compensation Schemes: A System Mapping Study

Purpose Many industrialised nations have systems of injury compensation and rehabilitation that are designed to support injury recovery and return to work. Despite their intention, there is now substantial evidence that injured people, employers and healthcare providers can experience those systems as difficult to navigate, and that this can affect injury recovery. This study sought to characterise the relationships and interactions occurring between actors in three Australian injury compensation systems, to identify the range of factors that impact on injury recovery, and the interactions and inter-relationships between these factors. Methods This study uses data collected directly from injured workers and their family members via qualitative interviews, analysed for major themes and interactions between themes, and then mapped to a system level model. Results Multiple factors across multiple system levels were reported by participants as influencing injury recovery. Factors at the level of the injured person's immediate environment, the organisations and personnel involved in rehabilitation and compensation processes were more commonly cited than governmental or societal factors as influencing physical function, psychological function and work participation. Conclusions The study demonstrates that injury recovery is a complex process influenced by the decisions and actions of organisations and individuals operating across multiple levels of the compensation system. Changes occurring 'upstream', for instance at the level of governmental or organisational policy, can impact injury recovery through both direct and diffuse pathways.

Incidence, patterns and associated factors for occupational injuries among agricultural workers in a developing country

Background: Injuries are common among agricultural workers, and a large section of the population is employed in agriculture worldwide. We aimed to determine the incidence, patterns and associated risk factors of occupational injuries among the agricultural workers in a developing country.

Methods: A cross-sectional study in Hyderabad, Pakistan was conducted from December 2012 to February 2013. Information was collected about incidence, pattern and associated risk factors of occupational injuries from 472 agricultural workers. Injury incidence and patterns for place, severity, type, agent, parts of body affected and work activity were calculated. Analysis was performed using SPSS version 19.0. Multivariate logistic regression was performed to calculate the adjusted odds ratio (OR) with 95% confidence interval, to identify the putative risk factors for occupational injuries.

Results: Incidence of occupational injuries was 35.0 per 100 per year (95% CI: 28.9 - 42.7). Cuts (70%) and hand tools (71%) were the most common type and agent for injury, respectively. Majority of injuries occurred during harvesting (55%). Increasing age [AOR 1.03 (95% CI: 1.01 - 1.05)], income <6000PKR/month [AOR 2.27 (95% CI: 1.08 - 4.76)] and driving tractor [AOR 2.58 (95% CI: 1.25 -5.33)] increase the risk for injuries.

Conclusion: There was a high burden of injuries among the agricultural workers in Pakistan. Large-scale studies are required to further characterize the risk of injuries and develop preventive strategies to protect agricultural workers.

Estimating the population prevalence of traditional and novel occupational exposures in Federal Region X

OBJECTIVE

Federal Region X is an administrative region in the northwestern United States comprised of the states of Alaska (AK), Idaho (ID), Oregon (OR), and Washington (WA). Quantifying the number of workers in this region exposed to harmful circumstances in the workplace, and projected changes over time will help to inform priorities for occupational health training, risk reduction, and research.

METHODS

State data for WA, ID, OR, and AK were used to estimate number of workers by occupation, in 2014 and 2024. These data were merged with a Canadian job-exposure matrix (CANJEM) which characterizes chemical exposures, and O*NET, which ranks occupations with particular physical, ergonomic, and psychosocial exposures.

RESULTS

Of the exposures considered, psychosocial and ergonomic exposures were the most prevalent among the regional workforce, though traditional chemical exposures are still common and increasing.

CONCLUSIONS

Exposure surveillance will inform prioritization of risk reduction strategies, ultimately leading to a decrease in occupational injury and illness. Findings from this analysis will help to prioritize occupational health training and research in the region.

Cumulative stigma among injured immigrant workers: a qualitative exploratory study in Montreal (Quebec, Canada)

Purpose: This paper presents the phenomenon of stigmatisation among injured immigrant and ethnocultural minority workers experiencing a long-standing disability. Stigmatisation was one of the main findings of our study, the aim of which was to gain insight into the work rehabilitation process in the context of intercultural relations in Quebec. Various categories of stakeholders took part in the study, which sought to describe their experiences and perspectives and to identify the constraints, barriers, facilitators, and specific needs they encounter in terms of intercultural competencies.Methods: A purposive sample of 40 individuals was selected and divided into four groups: workers (N = 9), clinicians (N = 15), workers' compensation board rehabilitation experts (N = 14), and workplace representatives (N = 2). Semi-structured interviews were conducted using the critical incident technique, combined with an "explicitation" interviewing technique. Data collection and analysis procedures were based on grounded theory.Results: This study shows that immigrant and ethnocultural minority workers may experience stigmatisation as a cumulative process involving different concomitant parts of their "identity": age, gender, social class, ethnicity, mental health, and occupational injuries. Cumulative stigma may aggravate personal distress and feelings of shame, rejection, and disqualification from full social acceptance. Negative anticipatory judgements made by practitioners may undermine the therapeutic relationship and breach mutual trust and confidence.Conclusions: The phenomenon of stigmatisation is well documented in the sociological and health literature, but studies tend to focus on only one type of stigma at a time. Future research should focus on the cumulative process of stigmatisation specifically affecting immigrant and ethnocultural minority workers and its potentially damaging impact on self-concept, healthcare delivery, rehabilitation interventions, and the return to work.Implications for rehabilitationThe repetition of certain clinical situations with people from certain groups should not lead practitioners to undue generalizations, even if they may sometimes be accurate; these generalizations must always be verified on a case by case basis.Ethnicity and culture, along with other social attributions, should serve as working hypotheses or support tools in health communication, not as hindrances to clinical reasoning.Practitioners should deepen their understanding of the patient's treatment expectations and the support available for rehabilitation in his family and community.Stigma in the context of care is linked to the idea of conforming to the proposed institutional models of care (including expected beliefs, attitudes, and behaviours). Therefore, practitioners should be aware that alleged differences, misunderstanding or disagreements can highlight an asymmetry in practitioner-patient power relationships.Organisations should also promote exchange and reflection on how to adapt their institutional models to avoid asymmetrical power relations.Intercultural training should be promoted at the various organisational levels so that managers, decision-makers, and practitioners share a common knowledge of the challenges of intervention in multi-ethnic settings.

Influence of Physical and Musculoskeletal Factors on Occupational Injuries and Accidents in Korean Workers Based on Gender and Company Size

Though the overall incidence of occupational injuries and accidents has decreased, they continue to happen. Many associated factors are known and managing them with limited resources is difficult. This study evaluates related risk factors and prioritizes their management for reducing occupational injuries and accidents at the workplace. We used data from the 4th Korean Working Condition Survey conducted by the Korea Occupational Safety Health Research Institute from June to September 2014. A total of 14,381 persons (9776 men, 4605 women) were selected; t-test, chi-square test, and logistic regression analyses were performed to analyze data. The influence of physical (vibration, noise, abnormal temperature) and musculoskeletal (awkward posture, handling of heavy objects, repetitive tasks) factors was compared according to gender and company size. The risk of occupational injuries and accidents among men was related to musculoskeletal factors and vibration in companies with “under 50” employees and with awkward posture, vibration, and noise in companies with “50 or above” employees; however, among women in companies with “under 50” employees, it was associated with only vibration. Although we evaluated only a few risk factors, prioritizing them based on gender and company size has provided new valuable information.

A systematic review on occupational hazards, injuries and diseases among police officers worldwide: Policy implications for the South African Police Service

Background

Occupational hazards, injuries and diseases are a major concern among police officers, including in Sub-Saharan Africa. However, there is limited locally relevant literature for guiding policy for the South African Police Service (SAPS). The purpose of this review was to describe the occupational hazards, injuries and diseases affecting police officers worldwide, in order to benchmark policy implications for the SAPS.

Methods

We conducted a systematic review of studies using Google Scholar, PubMed and Scopus.

Results

A total of 36 studies were included in this review. Six revealed that police officers’ exposure to accident hazards may lead to acute or chronic injuries such as sprains, fractures or even fatalities. These hazards may occur during driving, patrol or riot control. There were two studies, which confirmed physical hazards such as noise induced hearing loss (NIHL), due to exposure to high levels of noise. Three studies on chemical hazards revealed that exposure to high concentrations of carbon dioxide and general air pollution was associated with cancer, while physical exposure to other chemical substances was linked to dermatitis. Four studies on biological hazards demonstrated potential exposure to blood borne diseases from needle stick injuries (NSIs) or cuts from contaminated objects. One study on ergonomic hazards showed that musculoskeletal disorders can result from driving long distances and lifting heavy objects. There were 15 studies that indicated psychological hazards such as post-traumatic stress disorder (PTSD) as well as stress. Moreover, four studies were conducted on organizational hazards including burnout, negative workplace exposure and other factors.

Conclusions

This review outlined the global impact of occupational hazards, injuries and diseases in the police force. It served as a benchmark for understanding the policy implications for South Africa, where there is paucity of studies on occupational health and safety.

Acidentes de trabalho fatais em Palmas, Tocantins, Brasil: oportunidades perdidas de informação

Resumo Objetivo: estimar o sub-registro de acidentes de trabalho fatais (ATF) nos sistemas de informação do Ministério da Saúde, Secretaria Estadual de Segurança Pública (SSP), Ministério do Trabalho e Secretaria da Previdência Social, de 2007 a 2015, em Palmas, Tocantins. Métodos: para identificação dos casos de ATF, as fontes de dados foram o Sistema de Informação sobre Mortalidade (SIM), o Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS), o Sistema de Informações de Agravos de Notificação (SINAN), a Relação Anual de Informações Sociais (RAIS), o Sistema de Informação de Comunicação de Acidentes de Trabalho (SISCAT), os boletins de ocorrência (BO), Guias de Encaminhamento Cadavérico (GEC) e Laudo de Exame Cadavérico (LEC). Para calcular a subnotificação de cada sistema, uma base de dados única foi criada com os registros de todas as fontes, eliminando-se repetições. Resultados: foram identificados 114 casos. Os sub-registros encontrados foram: SIM, 28,9%; SINAN, 44,7%; SSP, 55,3%; RAIS, 73,1%; SISCAT, 65,4%, para trabalhadores segurados. Conclusão: o melhor desempenho de registro é o do SIM. Observou-se extenso sub-registro em todas as demais fontes. Registros de mortalidade por ATF são subestimados. Ações de melhoria dos registros, especialmente no SIH-SUS, RAIS, SISCAT, SSP, seguidos pelo SINAN e SIM, são necessárias.

Workplace fatalities in Brunei Darussalam

In 2012, there were about 2.3 million deaths worldwide attributed to work. The highest workplace fatality rate (WFR) was reported on construction sites due to high risk activities. Globally, fall from height is the leading cause of fatal injuries for construction workers. The objectives are to determine Brunei Darussalam's demographic distribution of occupational fatality; identify causal agents and industry where occupational fatalities commonly occur; and determine WFR by year. This cross-sectional study retrospectively reviewed records of occupational fatality which were notified to the Occupational Health Division, Ministry of Health, from January 2012 until December 2016. Notified occupational fatalities in Brunei over a five-year period was 50. Most of the cases were in 31-40 age group. 38% of fatality cases occurred in Indonesian workers. 60% were from the Construction industry. 38% were due to fall from height. WFR averaged 5.28 and the highest industry-specific fatality rate was seen in the Construction industry, ranging from 27.94 to 56.45 per 100,000 workers. WFR for Brunei Darussalam from 2012 to 2016 was similar to that of Malaysia, but higher than Singapore and the UK. Industry-specific fatality rate for the Construction and Manufacturing industries were higher than those of Singapore and the UK.

Catastrophic health expenditure among industrial workers in a large-scale industry in Nepal, 2017: a cross-sectional study

OBJECTIVES

The study aimed at estimating out-of-pocket (OOP) expenditure, catastrophic health expenditure (CHE) and distress financing due to hospitalisation and outpatient care among industrial workers in Eastern Nepal.

METHODS

We conducted a cross-sectional study involving industrial workers employed in a large-scale industry in Eastern Nepal. Those who were hospitalised in the last 1 year or availed outpatient care within the last 30 days were administered a structured questionnaire to estimate the cost of illness. CHE was defined as expenditure more than 20% of annual household income. Distress financing was defined as borrowing money/loan or selling assets to cope with OOP expenditure on health.

RESULTS

Of 1824 workers eligible for the study, 1405 (77%) were screened, of which 85 (6%) were hospitalised last year; 223 (16%) attended outpatient department last month. The median (IQR) OOP expenditure from hospitalisation and outpatient care was US$124 (71-282) and US$36 (19-61), respectively. Among those hospitalised, the prevalence of CHE and distress financing was found to be 13% and 42%, respectively, and due to outpatient care was 0.4% and 42%, respectively. Drugs and diagnostics account for a large share of direct costs in both public and private sectors. More than 80% sought hospitalisation and outpatient care in a private sector.

CONCLUSION

Industrial workers face significant financial risks due to ill health compared with the general population. Poor utilisation and higher cost of care in public health facilities warrant strengthening of public sector through increased government spending. The labour act 2014 of Nepal should be strictly adhered.

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk-outcome associations.

METHODS

We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.

FINDINGS

In 2017, 34·1 million (95% uncertainty interval [UI] 33·3-35·0) deaths and 1·21 billion (1·14-1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6-62·4) of deaths and 48·3% (46·3-50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39-11·5) deaths and 218 million (198-237) DALYs, followed by smoking (7·10 million [6·83-7·37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6·53 million [5·23-8·23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4·72 million [2·99-6·70] deaths and 148 million [98·6-202] DALYs), and short gestation for birthweight (1·43 million [1·36-1·51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3-6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low.

INTERPRETATION

By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning.

FUNDING

Bill & Melinda Gates Foundation.

Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

BACKGROUND

The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 comparative risk assessment (CRA) is a comprehensive approach to risk factor quantification that offers a useful tool for synthesising evidence on risks and risk-outcome associations. With each annual GBD study, we update the GBD CRA to incorporate improved methods, new risks and risk-outcome pairs, and new data on risk exposure levels and risk-outcome associations.

METHODS

We used the CRA framework developed for previous iterations of GBD to estimate levels and trends in exposure, attributable deaths, and attributable disability-adjusted life-years (DALYs), by age group, sex, year, and location for 84 behavioural, environmental and occupational, and metabolic risks or groups of risks from 1990 to 2017. This study included 476 risk-outcome pairs that met the GBD study criteria for convincing or probable evidence of causation. We extracted relative risk and exposure estimates from 46 749 randomised controlled trials, cohort studies, household surveys, census data, satellite data, and other sources. We used statistical models to pool data, adjust for bias, and incorporate covariates. Using the counterfactual scenario of theoretical minimum risk exposure level (TMREL), we estimated the portion of deaths and DALYs that could be attributed to a given risk. We explored the relationship between development and risk exposure by modelling the relationship between the Socio-demographic Index (SDI) and risk-weighted exposure prevalence and estimated expected levels of exposure and risk-attributable burden by SDI. Finally, we explored temporal changes in risk-attributable DALYs by decomposing those changes into six main component drivers of change as follows: (1) population growth; (2) changes in population age structures; (3) changes in exposure to environmental and occupational risks; (4) changes in exposure to behavioural risks; (5) changes in exposure to metabolic risks; and (6) changes due to all other factors, approximated as the risk-deleted death and DALY rates, where the risk-deleted rate is the rate that would be observed had we reduced the exposure levels to the TMREL for all risk factors included in GBD 2017.

FINDINGS

In 2017, 34·1 million (95% uncertainty interval [UI] 33·3-35·0) deaths and 1·21 billion (1·14-1·28) DALYs were attributable to GBD risk factors. Globally, 61·0% (59·6-62·4) of deaths and 48·3% (46·3-50·2) of DALYs were attributed to the GBD 2017 risk factors. When ranked by risk-attributable DALYs, high systolic blood pressure (SBP) was the leading risk factor, accounting for 10·4 million (9·39-11·5) deaths and 218 million (198-237) DALYs, followed by smoking (7·10 million [6·83-7·37] deaths and 182 million [173-193] DALYs), high fasting plasma glucose (6·53 million [5·23-8·23] deaths and 171 million [144-201] DALYs), high body-mass index (BMI; 4·72 million [2·99-6·70] deaths and 148 million [98·6-202] DALYs), and short gestation for birthweight (1·43 million [1·36-1·51] deaths and 139 million [131-147] DALYs). In total, risk-attributable DALYs declined by 4·9% (3·3-6·5) between 2007 and 2017. In the absence of demographic changes (ie, population growth and ageing), changes in risk exposure and risk-deleted DALYs would have led to a 23·5% decline in DALYs during that period. Conversely, in the absence of changes in risk exposure and risk-deleted DALYs, demographic changes would have led to an 18·6% increase in DALYs during that period. The ratios of observed risk exposure levels to exposure levels expected based on SDI (O/E ratios) increased globally for unsafe drinking water and household air pollution between 1990 and 2017. This result suggests that development is occurring more rapidly than are changes in the underlying risk structure in a population. Conversely, nearly universal declines in O/E ratios for smoking and alcohol use indicate that, for a given SDI, exposure to these risks is declining. In 2017, the leading Level 4 risk factor for age-standardised DALY rates was high SBP in four super-regions: central Europe, eastern Europe, and central Asia; north Africa and Middle East; south Asia; and southeast Asia, east Asia, and Oceania. The leading risk factor in the high-income super-region was smoking, in Latin America and Caribbean was high BMI, and in sub-Saharan Africa was unsafe sex. O/E ratios for unsafe sex in sub-Saharan Africa were notably high, and those for alcohol use in north Africa and the Middle East were notably low.

INTERPRETATION

By quantifying levels and trends in exposures to risk factors and the resulting disease burden, this assessment offers insight into where past policy and programme efforts might have been successful and highlights current priorities for public health action. Decreases in behavioural, environmental, and occupational risks have largely offset the effects of population growth and ageing, in relation to trends in absolute burden. Conversely, the combination of increasing metabolic risks and population ageing will probably continue to drive the increasing trends in non-communicable diseases at the global level, which presents both a public health challenge and opportunity. We see considerable spatiotemporal heterogeneity in levels of risk exposure and risk-attributable burden. Although levels of development underlie some of this heterogeneity, O/E ratios show risks for which countries are overperforming or underperforming relative to their level of development. As such, these ratios provide a benchmarking tool to help to focus local decision making. Our findings reinforce the importance of both risk exposure monitoring and epidemiological research to assess causal connections between risks and health outcomes, and they highlight the usefulness of the GBD study in synthesising data to draw comprehensive and robust conclusions that help to inform good policy and strategic health planning.

FUNDING

Bill & Melinda Gates Foundation.

Global output of research on the health of international migrant workers from 2000 to 2017

BACKGROUND

Approximately 150 million international migrant workers work under conditions that increase their risk of illness and injuries. The current study aimed to assess and analyze the global output of research on the health of international migrant workers to promote national and international policies that could help improve the health of international migrant workers.

METHODS

A bibliometric methodology was implemented using Scopus database after retrieving documents relevant to the health of migrant workers during the study period from 2000 to 2017.

RESULTS

In total, 955 documents were retrieved. The mean number of authors per document was 4.5 while the mean number of citation per document was 10.2. The retrieved documents were mainly in health policy and systems (n = 452; 47.3%), infectious diseases (n = 252; 26.4%), and mental and psychosocial health (n = 239; 25.0%). The health of Latino migrant farmworkers represented the largest cluster of keywords. The USA led (n = 389; 40.7%) with regard to the number of publications followed by China (n = 86; 9.0%) and the UK (n = 66; 6.9%). Researchers from the USA and Spain dominated the field. There were limited international research collaboration and a limited number and size of research networks. The American Journal of Industrial Medicine was most active (7.1%; n = 68) in publishing documents on health of migrant workers while the Wake Forest University was the most active (10.9%; n = 104) institution in this topic.

CONCLUSION

The volume of global research output on the health of migrant workers was low. There was inadequate research on non-communicable diseases and maternal health of migrant workers. International research collaboration and the number of research networks were limited. Role of several world regions, particularly Arab region with 11% of international migrant workforce was also limited. There is an urgent need to prioritize research on migrant workers, especially female migrant workers in regions with low research contribution.

Cost-benefit analysis of investment in occupational health and safety in Colombian companies

OBJECTIVE

To determine whether investment in preventive measures by a Colombian insurer reduces rates of work-related injuries and results in positive returns from these investments.

METHODS

The study is based on monthly panel data of 2011-2015 of 303 medium and large companies affiliated with a private insurer in Colombia. We undertook regression modeling analysis to assess the effectiveness of incremental investments in occupational health and safety (OHS) prevention measures. The cost-benefit analysis is from the insurer's perspective.

RESULTS

Investment in OHS per full-time equivalent was statistically significant at the 1% level. We estimated that 4919 injuries were averted through these investments, resulting in the avoidance of $3 949 957 in costs. Our results suggest that the investments were worth undertaking from the insurer's perspective.

CONCLUSIONS

This paper provides new empirical evidence on the effectiveness and cost-benefit of OHS investments in a middle-income country. Incremental investment in OHS can be effective and cost-beneficial.

Disparities in Unintentional Occupational Injury Mortality between High-Income Countries and Low- and Middle-Income Countries: 1990⁻2016

Objective: Using estimates from the Global Burden of Disease (GBD) study, we examined differences in unintentional occupational injury mortality rates from 1990 to 2016 between high-income countries (HICs) and low- and middle-income countries (LMICs). Methods: Unintentional occupational injury mortality rates were obtained through the GBD online visualization tool. We quantified mortality changes over time for common external causes of injury for ages 15–49 years and 50–69 years separately in HICs and LMICs using negative binomial regression models. Results: In 2016, there were 24,396 and 303,999 unintentional occupational injury deaths among individuals aged 15 to 69 years in HICs and LMICs, respectively, corresponding to 3.1 and 7.0 per 100,000 people. Between 1990 and 2016, unintentional occupational injury mortality for people aged 15–69 years dropped 46% (from 5.7 to 3.1 per 100,000 people) in HICs and 42% in LMICs (from 13.2 to 7.0 per 100,000 people). Sustained and large disparities existed between HICs and LMICs for both sexes and both age groups during 1990–2016 (mortality rate ratio: 2.2–2.4). All unintentional occupational injury causes of death displayed significant reduction with one exception (ages 15–49 years in HICs). Country-specific analysis revealed large variations in unintentional occupational injury mortality and changes in occupational injury mortality between 1990 and 2016. Conclusions: Despite substantial decreases in mortality between 1990 and 2016 for both HICs and LMICs, a large disparity continues to exist between HICs and LMICs. Multifaceted efforts are needed to reduce the disparity.

Employment status changes of workers after referral to an occupational disease clinic

Objective:

Occupational diseases (OD) are among the most significant issues of work life, with economic, medical, social, and ethical aspects. The majority of studies concerning OD focus on the causes or medical outcomes of OD. There are a limited number of studies investigating the social and economic impacts of being diagnosed with an OD. One of the important social aspects of OD is the employability of workers after an OD diagnosis. The aim of this study is to evaluate the changes in employment status after the OD diagnosis process.

Methods:

This is a cross sectional study. There were 204 eligible cases, and 198 (97%) completed the study. The study data were obtained from patient files, including OD Committee reports and questionnaires applied via telephone interview.

Results:

Among the 198 applicants, 170 (85.9%) were male and 146 (73.7%) were diagnosed with an OD. Of these workers, 106 (53.5%) had quit their current jobs. Of those workers, 89 out of 106 were in the OD group, and 17 were in the non-OD group. Diagnosis with OD (OR: 3.1 CI: 1.4-6.8) and non-union membership (OR: 11.1 CI: 5.2-23.5) increased the likelihood of quitting the job after an OD diagnosis.

Conclusion:

The short-term prognosis of OD was relatively poor. OD diagnosis or even referral to an outpatient clinic may cause quitting the job. Policies should account for the risk of unemployment after an OD diagnosis, and OD surveillance systems should obtain data on the employment status of workers following diagnosis.

The Epidemiology, Cost, and Occupational Context of Spinal Injuries Sustained While 'Working for Income' in NSW: A Record-Linkage Study

This study aimed to describe the epidemiological characteristics, the occupational context, and the cost of hospitalised work-related traumatic spinal injuries, across New South Wales, Australia. A record-linkage study of hospitalised cases of work-related spinal injury (ICD10-AM code U73.0 or workers compensation) was conducted. Study period 2013⁻2016. Eight hundred and twenty-four individuals sustained work-related spinal injuries; 86.2% of whom were males and had a mean age of 46.6 years. Falls led to 50% of the injuries; predominantly falls from building/structures, ladders or between levels. Falls occurred predominantly in the construction industry (78%). Transport crashes caused 31% of injuries and 24% in heavy vehicles. Half of all the transport injuries occurred 'off road'. The external cause was coded as 'non-specific work activity' in 44.5% of cases; missing in 11.5%. Acute care bed days numbered at 13,302; total cost $19,500,000. High numbers of work-related spinal injuries occurred in the construction industry; particularly falling from a height. Off-road transport-related injuries were significant and likely unaddressed by 'on-road' prevention policies. Medical record documentation was insufficient in injury mechanism and context specificity. Workers in the construction industry or those using vehicles off-road were at high risk of spinal injury, suggesting inefficient systems approaches or ineffective prevention policies. Reducing the use of non-specific external cause codes in patients' medical records would improve the measurement of policy effectiveness.

Occupational safety and health regulations and implementation challenges in Uganda

The burden of occupational diseases and injuries is high in developing countries due to several challenges including poor regulatory frameworks. To explore the status of occupational safety and health (OSH) policies and related implementation challenges in Uganda, we reviewed OSH regulations and conducted key informant interviews with stakeholders. We found that the existing OSH laws were largely outdated compared to the current needs of workplaces. Challenges affecting implementation are related to: gaps in the legal framework, low public awareness about OSH, poor planning, and limited human capacity, transparency, and accountability. Measures to address these gaps including training, upgrading OSH laws and policies, and prioritization are warranted to improve the status of OSH in Uganda.

Work related injuries in Qatar: a framework for prevention and control

Work related injuries (WRIs) are a growing public health concern that remains under-recognized, inadequately addressed and largely unmeasured in low and middle-income countries (LMIC’s). However, even in high-income countries, such as those in Gulf Cooperating Council (GCC) like Qatar, there are challenges in assuring the health and safety of its labor population. Countries in the GCC have been rapidly developing as a result of the economic boom from the petrochemical industry during the early seventies. Economic prosperity has propelled the migration of workers from less developed countries to make up for the human resource deficiency to develop its infrastructure, service and hospitality industries. Although these countries have gradually made huge gains in health, economy and human development index, including improvements in life expectancy, education, and standard of living, there remains a high incidence of work-related injuries especially in jobs in the construction and petrochemical sector. Currently, there is scarcity of literature on work-related injuries, especially empirical studies documenting the burden, characteristics and risk factors of work injuries and the work injured population, which includes large numbers of migrant workers in many GCC countries. This paper will focus on the current understanding of WRIs in those countries and identify the gaps in current approaches to workplace injury prevention, outlining current status of WRI prevention efforts in Qatar, and propose a framework of concerted action by multi-sectoral engagement.

Updating the Evidence on Functional Capacity Evaluation Methods: A Systematic Review

Objectives To synthesize the evidence on the psychometrics functional capacity evaluation (FCE) methods. Methods A systematic literature search in nine databases. The resulting articles were screened based on predefined in- and exclusion criteria. Two reviewers independently performed this screening. Included studies were appraised based on their methodological quality. Results The search resulted in 20 eligible studies about nine different FCE methods. The Baltimore Therapeutic Equipment work simulator showed a moderate predictive validity. The Ergo-Kit (EK) showed moderate variability and high inter- and intra-rater reliability. Low discriminative abilities and high convergent validity were found for the EK. Concurrent validity of the EK and the ERGOS Work Simulator was low to moderate. Moderate to high test-retest, inter- and intra-reliability was found in the Isernhagen Work-Systems (IWS) FCE. The predictive validity of the IWS was low. The physical work performance evaluation (PWPE) showed moderate test-retest reliability and moderate to high inter-rater reliability. Low internal and external responsiveness were found for the PWPE, predictive validity was high. The predictive validity of the short-form FCE was also high but need to be further examined on several psychometric properties. Low discriminative and convergent validity were found for the work disability functional assessment battery. The WorkHab showed moderate to high test-retest, inter- and intra-rater reliability. Conclusion Well-known FCE methods have been rigorously studied, but some of the research indicates weaknesses in their reliability and validity. Future research should address how these weaknesses can be overcome.

Interstitial Lung Diseases in the U.S. Mining Industry: Using MSHA Data to Examine Trends and the Prevention Effects of Compliance with Health Regulations, 1996-2015

Given the recent increase in dust-induced lung disease among U.S. coal miners and the respiratory hazards encountered across the U.S. mining industry, it is important to enhance an understanding of lung disease trends and the organizational contexts that precede these events. In addition to exploring overall trends reported to the Mine Safety and Health Administration (MSHA), the current study uses MSHA's enforcement database to examine whether or not compliance with health regulations resulted in fewer mine-level counts of these diseases over time. The findings suggest that interstitial lung diseases were more prevalent in coal mines compared to other mining commodities, in Appalachian coal mines compared to the rest of the United States, and in underground compared to surface coal mines. Mines that followed a relevant subset of MSHA's health regulations were less likely to report a lung disease over time. The findings are discussed from a lung disease prevention strategy perspective.

National and subnational mortality and disability-adjusted life years (DALYs) attributable to 17 occupational risk factors in Iran, 1990-2015

We estimated age-sex specific and cause-specific mortality, years of life lost due to premature mortality (YLLs), years lived with disability (YLDs) and disability-adjusted life years (DALYs) attributable to 17 individual occupational risks in Iran at the national and subnational levels in 1990-2015 based on the Global Burden of Disease Study 2015 (GBD 2015). The burden of disease attributable to occupational risk factors was calculated using the comparative risk assessment methodology based on 10 outcomes and 21 risk-outcome pairs. The temporal changes in the attributable burden of disease were decomposed into the contribution of population growth, population ageing, risk-deleted DALY rate, and risk exposure. National DALYs attributable to occupational risks at the national level in 1990, 2005, and 2015 were 138,210 (95% uncertainty interval 64,429-223,028), 193,243 (91,645-310,281), and 228,310 (106,782-371,709), respectively indicating a total increase of 65% (65-67) during the study period. Between 1990 and 2015, the share of the attributable DALYs for women rose by 55% (51-58) from 13% (12-14) to 20% (19-21). The proportion of YLLs in national DALYs attributable to occupational risks during the study period slightly decreased from 24% in 1990 to 23% in 2015. The five occupational risks with the highest contributions in the national attributable DALYs in 2015 were ergonomic factors (107,490), noise (52,122), exposure to particulate matter, gases, and fumes (26,847), asthmagens (19,347), and exposure to asbestos (7842). From 1990 to 2015, the increase in total DALYs attributable to occupational carcinogens (112%) was higher than that for other occupational risks. During the study period, changes in risk deleted DALY rate and risk exposure led to decreases in total DALYs attributable to occupational risks by 14% and 30%, respectively. Based on the Gini coefficient, spatial inequality in DALY rate attributable to occupational risks at the provincial level decreased during 1990-2015. A comprehensive plan for management of exposure to occupational risks, especially occupational carcinogens can cause an important effect for control of the increasing trend of occupational health losses.

Occupational safety and health management in developing countries: a study of construction companies in Malawi

Purpose. Whilst occupational safety and health (OSH) management is recognized as an important mechanism for addressing poor OSH performance, limited empirical insight is available on OSH management by construction companies in sub-Saharan Africa. This study investigated OSH management by construction companies (i.e., contractors) in Malawi in order to unpick implementation issues that need attention. Materials and methods. 46 OSH management practices were probed through a survey of contractors. Results. Implementation of OSH practices amongst contractors is low, particularly for practices related to the policy, organizing, measuring and reviewing, and auditing elements of OSH management. Company size is associated with implementation of nearly half of the 46 OSH practices. Certification of the company to Standard No. OHSAS 1800:2007 is associated with the implementation of fewer practices. Conclusions. OSH management improvement efforts would need to focus on the elements with particularly low implementation of practices as well as include initiatives that focus on helping microenterprises to improve their OSH management. The association between business characteristics and OSH management may be more evident with certain elements, such as the organizing element. Furthermore, certification to Standard No. OHSAS 1800:2007 may not necessarily translate into greater implementation of OSH management practices, especially in developing countries.

From awareness to action: Sudbury, mining and occupational disease in a time of change

BACKGROUND:

Miners work in highly hazardous environments, but surprisingly, there are more fatalities from occupational diseases, including cancers, than from fatalities from injuries. Over the last few decades, the mining environment has become safer with fewer injuries and less exposure to the toxins that lead to occupational disease. There have been improvements in working conditions, and a reduction in the number of workers exposed, together with an overall improvement in the health of miners.

OBJECTIVES:

This study attempted to gain a deeper understanding of the impetus for change to reduce occupational exposures or toxins at the industry level. It focuses on one mining community in Sudbury, Ontario, with a high cancer rate, and its reduction in occupational exposures. It explored the level of awareness of occupational exposures from the perspective of industry and worker representatives in some of the deepest mines in the world. Although awareness may be necessary, it is often not a sufficient impetus for change, and it is this gap between awareness and change that this study explored. It examined the awareness of occupational disease as an impetus to reducing toxic exposures in the mining sector, and explores other forces of change at the industrial and global levels that have led to an impact on occupational exposures in mining.

METHODS:

From 2014 and 2016, 60 interviews were conducted with individuals who were part of, or witness to the changes in mining in Sudbury. From these, 12 labour and 10 industry interviews and four focus groups were chosen for further analysis to gain a deeper understanding of industry and labour’s views on the changes in mining and the impact on miners’ health from occupational exposures. The results from this subsection of the data is the focus for this paper.

RESULTS:

The themes that emerged told a story about Sudbury. There is awareness of occupational exposures, but this awareness is dwarfed in comparison to the attention that is given to the tragic fatal injuries from injuries and accidents. The mines are now owned by foreign multinationals with a change from an engaged, albeit paternalistic sense of responsibility for the health of the miners, to a less responsive or sympathetic workplace culture. Modernization has led to the elimination, substitution, or reduction of some of the worst toxins, and hence present-day miners are less exposed to hazards that lead to occupational disease than they were in the past. However, modernization and the drop in the price of nickel has also led to a precipitous reduction in the number of unionized miners, a decline in union power, a decline in the monitoring of present-day exposures, and an increase in non-unionized contract workers. The impact has been that miners have lost their solidarity and power to investigate, monitor or object to present-day exposures.

CONCLUSIONS:

Although an increase in the awareness of occupational hazards has made a contribution to the reduction in occupational exposures, the improvement in health of miners may be considered more as a “collateral benefit” of the changes in the mining sector. Multiple forces at the industrial and global level have differentially led to an improvement in the working and living environment. However, with the loss of union power, the miners have lost their major advocate for miner health.

Design for occupational safety and health of workers in construction in developing countries: a study of architects in Nigeria

PURPOSE

Design for safety (DfS) of workers is amongst the prominent ways of tackling poor occupational safety and health performance in construction. However, in developing countries there is extremely limited research on DfS. This study thus makes an important contribution to the subject of DfS in developing countries by specifically examining the awareness and practice of DfS amongst architects within the construction sector of Nigeria.

MATERIALS AND METHODS

A survey of architects, yielding 161 valid responses, was conducted.

RESULTS

While there is high awareness of the concept of DfS, the actual practice is low. Additionally, although there is high interest in DfS training, the engagement in DfS training is low. Significantly, awareness of DfS, training and education related to DfS, and membership of a design professional body have very limited bearing on the practice of DfS by architects.

CONCLUSIONS

The findings are thus symptomatic of the prevalence of influential DfS implementation barriers within the construction sector. Industry stakeholders should seek to raise the profile of DfS practice within the sector. Furthermore, similar empirical studies in the construction sector of other developing countries would be useful in shedding light on the status of DfS in these countries.

Differences in the performance of health officers at the workplace according to their qualifications

Background

Health officers are an integral part of the occupational health service, and there have been studies to identify and improve the role of health officers in the workplace in order to improve the level of health care in the workplace. This study aimed to determine the contribution of health officers to the role of a health officer as prescribed by law and the percentage of health management work performed during work according to their qualifications.

Methods

Questionnaires were distributed to a total of 4584 workplaces where health officers were hired, and a total of 806 copies (17.58%) were returned. Of these, 336 questionnaires were finally analyzed, after excluding questionnaires missing the main variables. Using the data, the difference of role contributions and the percentage of health care work performed during the whole day according to the qualification of the health officer was analyzed.

Results

Nurses were highly rated in the field of medical care, and industrial hygienists and air environmental engineers were highly rated in terms of chemicals and risk factor management. The percentage of health care work performed during the whole day differed according to the size of the workplace and industrial classification, but it was generally the lowest among air environmental engineers.

Conclusions

Health officers play a very different role in the workplace depending on their qualification, and they need support for areas of other qualification. In order to effectively manage the health of the staff at a workplace, it is necessary to consider the development of a support system for small- and medium-sized enterprises and adjust the conditions of employment of the health officer according to the law.

Predictors for return to work after physical injury in China: A one-year review

BACKGROUND

Several studies have explored the factors influencing patients' return to work (RTW) status. However, only few studies have tried to explore the predictors for RTW in subpopulations in terms of different levels of disability, particularly in the Chinese population.

OBJECTIVE

This study describes the trends in patient's RTW and explores the predictors associated with RTW for patients with work-related injury in Mainland China.

METHODS

A total of 457 patients with different types of injury were followed up for one year. Patients were stratified into three groups according to the grade of disability as follows: mild, moderate, and severe. Variables affecting RTW were then compared between the three groups, and multiple logistic regression was performed to identify the predictors for RTW.

RESULTS

The RTW rates during the study period were significantly different among the three groups. RTW tended to increase rapidly during the early stage, but the increase plateaued during the later stage. For the mild disability group, educational level, expectation to RTW, and other types of injury (e.g., spinal cord injury, traumatic brain injury, and burn) were significant predictors for RTW. White-collar work and better employer satisfaction were positive predictors for RTW for the moderate group. Meanwhile, no significant predictor for RTW was determined for the severe disability group.

CONCLUSIONS

RTW tended to increase rapidly during the early stage, but the increase plateaued during the later stage. The predictors for RTW also varied among the patients with different levels of disability. These predictors may help vocational rehabilitation service providers provide more accurate intervention.

Workplace Accident Prevalence and Associated Factors among Tobacco Farm in São Lourenço do Sul-RS, Brazil

Agriculture has the highest risk of accidents. In Brazil the reality of this situation is unknown owing to scarcity of studies and underreporting of workplace accidents in rural areas. This article aims to evaluate workplace accident prevalence and associated factors among tobacco farm in Sao Lourenco do Sul-RS, Brazil. Cross-sectional study with 488 tobacco farmers, assessing sociodemographic, behavioural, labour characteristics and association with workplace accidents occurring in their lifetime. The injury prevalence was 24%. Being male (PR 1.62; 95%CI 1.04-2.52), and tenant farmer (PR 1.87; 95%CI 1.29-2.72), bundling tobacco leaves (PR 2.00; 95%CI 1.14-3.52) and having minor psychiatric disorders (PR 1.58; 95%CI 1.06-2.35) were positively associated with accidents. 46% of serious injuries caused superficial lesions and 26% caused fractures. Rural workplace accident prevention policies need to be established, particularly for tobacco farming. Larger studies are needed to understand work process-related aspects that increase the risk of accidents.

Occupational physical and emotional fitness

Sports medicine is a wide field of knowledge with a focus on the physical and psychological aspects of individuals; unfortunately, it is not well-known among occupational therapy practitioners. If at all, it is focused on exercise therapy for physical injuries and pain. We agree there are many types of physical pain and injuries among workers in different occupations, but not all that pain is related to physical overuse. Recently, new recommendations were presented by the American College of Sports Medicine highlighting particularly the psychological aspects of occupational emotional fitness. However, there is very little research about the concurrent effects of cost-effective packages of therapy for occupational emotional and physical fitness. Accordingly, this commentary reviews the occupational physical and emotional fitness aspects of sports medicine. In addition, this work makes suggestions to examine packages and protocols of physical and emotional fitness, with therapeutic targets for occupational cultures in different societies for employees and employers.

The Effect of Self-Efficacy on Return-to-Work Outcomes for Workers with Psychological or Upper-Body Musculoskeletal Injuries: A Review of the Literature

Purpose Work absence can result in substantial losses to the economy and workers. As a result, identifying modifiable factors associated with return-to-work (RTW) following an injury or illness is the focus of many empirical investigations. Self-efficacy, the belief about one's ability to undertake behaviours to achieve desired goals, has been identified as an important factor in RTW for injured workers. This paper systematically reviewed the literature on the association between self-efficacy and RTW outcomes for workers with an upper-body musculoskeletal injury or psychological injury. Methods A systematic search was conducted across five databases using two main search concepts- 'self-efficacy' and 'RTW'. After removing duplicates, our search strategy identified 836 studies, which were screened for relevance using titles and abstracts. Results A two stage screening process reduced the study pool to six studies using psychological injury cohorts and three using upper-body musculoskeletal (UB-MSK) cohorts. Eight cohorts from seven prospective cohort studies and one sample from a randomised control trial (RCT) were subjected to a risk of bias assessment. Higher levels of self-efficacy appeared to have a consistent and positive association with RTW across return-to-work status and work absence outcomes, injury type and follow-up periods. Effect ratios ranged from 1.00 to 5.26 indicating a potentially large impact of self-efficacy on RTW outcomes. The relationship between self-efficacy and RTW strengthened as the domain of self-efficacy became more specific to RTW and job behaviours. Studies assessing workers with psychological injuries were of a lower quality compared to those assessing workers with UB-MSK injuries. Conclusions Higher self-efficacy had consistent positive associations with RTW outcomes. Further empirical research should identify the determinants of self-efficacy, and explore the processes by which higher self-efficacy improves RTW outcomes.

Self-reported occupational accidents among Brazil's adult population based on data from the 2013 National Health Survey

Objective:

to provide an overview of occupational accidents among Brazil's adult population.

Methods:

descriptive study using data from the 2013 National Health Survey.

Results:

A total of 4.9 million workers mentioned having suffered some kind of work-related accident, which is equivalent to 3.4% (CI95% 4.6-5.6) of Brazil's adult population. Prevalence rates were higher among men, young adults aged between 18 and 39 years, and black people and in the North Region of the country. Prevalence was highest in the State of Para and lowest in the State of Rio de Janeiro State. Around one third of all accidents were commuting accidents, 50.4% (CI95% 45.3-55.5) of people who had suffered an occupational accident were prevented from carrying out some kind of routine activity due to the accident, 8.8% (CI95% 6.4-11.2) were hospitalized and 19% (CI95% 15.3-22.7) had sequelae resulting from occupational accidents.

Conclusion:

the data provided by the National Health Survey comprises an unprecedented and invaluable source of information on these issues in Brazil. The results of the survey confirm that occupational accidents are underreported, since official figures do not cover individuals working in the informal sector.