Creating safer and healthier workplaces: role of organizational factors and job characteristics

Improving Safety Performance of Construction Workers through Learning from Incidents

Learning from incidents (LFI) is a process to seek, analyse, and disseminate the severity and causes of incidents, and take corrective measures to prevent the recurrence of similar events. However, the effects of LFI on the learner's safety performance remain unexplored. This study aimed to identify the effects of the major LFI factors on the safety performance of workers. A questionnaire survey was administered among 210 construction workers in China. A factor analysis was conducted to reveal the underlying LFI factors. A stepwise multiple linear regression was performed to analyse the relationship between the underlying LFI factors and safety performance. A Bayesian Network (BN) was further modelled to identify the probabilistic relational network between the underlying LFI factors and safety performance. The results of BN modelling showed that all the underlying factors were important to improve the safety performance of construction workers. Additionally, sensitivity analysis revealed that the two underlying factors-information sharing and utilization and management commitment-had the largest effects on improving workers' safety performance. The proposed BN also helped find out the most efficient strategy to improve workers' safety performance. This research may serve as a useful guide for better implementation of LFI practices in the construction sector.

Socioeconomic status is associated with mechanism and intent of injury in patients presenting to a UK Major Trauma Centre

BACKGROUND

Lower socioeconomic status (SES) is linked to poorer health, health outcomes and higher rates of trauma. The aim of this study was to investigate the impact SES had on the mechanism and intent of trauma in patients presenting to a UK regional Major Trauma Centre (MTC).

MATERIALS AND METHODS

Trauma data from a UK MTC over a five-year period was obtained from the Trauma Audit and Research Network. Deprivation data was obtained from English Indices of Multiple Deprivation 2019 data and the study population classified into quintiles. Odds ratios were calculated, comparing mechanism and intent of trauma with each SES quintile with the least deprived quintile as the baseline for comparison.

RESULTS

Lower SES was associated with an increased odds ratio of undifferentiated trauma (OR 1.32, P<0.001). Falls from less than 2m constitute most trauma presentations and were not associated with SES (OR 1.09, P=0.114, 58.3% of trauma). The greater odds ratios for trauma in the socially deprived was accounted for by an increase in high-energy mechanisms and injury intents that include falls more than 2m (OR 1.75), stabbing (OR 5.18), blow injury (OR 2.75), high-risk behaviour (OR 4.61), assault (OR 6.63) and self-harm (OR 2.94) (P-values <0.001).

CONCLUSION

In this large, retrospective analysis of a UK MTC, we have shown that the increased risk of trauma seen with lower SES is not uniform across all mechanisms or intents and is mediated by high-energy and violent mechanisms. Targeted public health education and intervention within these demographics, appropriate to mechanisms observed as over-represented, may prove beneficial in the primary prevention of trauma, and help to guide local health service planning.

Accident Prevention Analysis: Exploring the Intellectual Structure of a Research Field

Accident prevention is of great significance in avoiding or reducing all kinds of casualties and economic losses, and is one of the main challenges for social sustainable development. Hence, it has been an active research field for many decades around the world. To master the research status of accident prevention, and explore the knowledge base and hot trends, 1294 papers from the WOS retrieval platform SCIE and SSCI databases from 1990 to 2021 were selected as data samples. Co-occurrence analysis, co-citation analysis, co-authorship analysis, and keyword analysis were performed on the literature on accident prevention research with bibliometric analysis methods. The study showed that the United States ranked first in the number of publications of any country/region and Georgia Inst Technol ranked first in the number of institutional publications. System analysis and accident model establishment, analysis of construction accidents, road accident prevention, and safety culture and safety climate are the knowledge base in the accident prevention studies and the core journals in this field are Safety Science, Accident Analysis and Prevention, Pediatrics, and Reliability Engineering & System Safety. There are four major research hotspots in accident prevention studies: routine accident prevention, model-based research, systems analysis and accident prediction, and occupational safety and public health research. At present, the basic theory and structural system of accident prevention research have been basically established, with many research directions and a wide range of frontier branches. Safety management, public safety, Bayesian networks, and simulation are the research frontiers of accident prevention.

Safety interventions for the prevention of accidents at work: A systematic review

Background

Limited knowledge regarding the relative effectiveness of workplace accident prevention approaches creates barriers to informed decision-making by policy makers, public health practitioners, workplace, and worker advocates.

Objectives

The objective of this review was to assess the effectiveness of broad categories of safety interventions in preventing accidents at work. The review aims to compare effects of safety interventions to no intervention, usual activities, or alternative intervention, and if possible, to examine which constituent components of safety intervention programs contribute more strongly to preventing accidents at work in a given setting or context.

Date Sources

Studies were identified through electronic bibliographic searches, government policy databanks, and Internet search engines. The last search was carried out on July 9, 2015. Gray literature were identified by searching OSH ROM and Google. No language or date restrictions were applied. Searches done between February and July of 2015 included PubMed (1966), Embase (1980), CINAHL (1981), OSH ROM (NIOSHTIC 1977, HSELINE 1977, CIS-DOC 1974), PsycINFO (1806), EconLit (1969), Web of Science (1969), and ProQuest (1861); dates represent initial availability of each database. Websites of pertinent institutions (NIOSH, Perosh) were also searched.

Study Eligibility Criteria Participants and Interventions

Included studies had to focus on accidents at work, include an evaluation of a safety intervention, and have used injuries at work, or a relevant proxy, as an outcome measure. Experimental, quasi-experimental, and observational study designs were utilized, including randomized controlled trials (RCTs), controlled before and after (CBA) studies, and observational designs using serial measures (interrupted time series, retrospective cohort designs, and before and after studies using multiple measures). Interventions were classified by approach at the individual or group level, and broad categories based on the prevention approach including modification of: Attitudes (through information and persuasive campaign messaging).Behaviors (through training, incentives, goal setting, feedback/coaching).Physiological condition (by physical training).Climate/norms/culture (by coaching, feedback, modification of safety management/leadership).Structural conditions (including physical environment, engineering, legislation and enforcement, sectorial-level norms). When combined approaches were used, interventions were termed "multifaceted," and when an approach(es) is applied to more than one organizational level (e.g., individual, group, and/or organization), it is termed "across levels."

Study Appraisal and Synthesis Methods

Narrative report review captured industry (NACE), work setting, participant characteristics, theoretical basis for approach, intervention fidelity, research design, risk of bias, contextual detail, outcomes measures and results. Additional items were extracted for studies with serial measures including approaches to improve internal validity, assessments of reasonable statistical approaches (Effective Practice of Organization of Care [EPOC] criteria) and overall inference. Random-effects inverse variance weighted meta-analytic methods were used to synthesize odds ratios, rate ratios, or standardized mean differences for the outcomes for RCT and CBA studies with low or moderate levels of heterogeneity. For studies with greater heterogeneity and those using serial measures, we relied on narrative analyses to synthesize findings.

Results

In total 100 original studies were included for synthesis analysis, including 16 RCT study designs, 30 CBA study designs, and 54 studies using serial measures (ITS study designs). These studies represented 120 cases of safety interventions. The number of participants included 31,971,908 individuals in 59 safety interventions, 417,693 groups/firms in 35 safety interventions, and 15,505 injuries in 17 safety interventions. Out of the 59 safety interventions, two were evaluating national prevention measures, which alone accounted for 31,667,110 individuals. The remaining nine safety interventions used other types of measures, such as safety exposure, safety observations, gloves or claim rates. Strong evidence supports greater effects being achieved with safety interventions directed toward the group or organization level rather than individual behavior change. Engineering controls are more effective at reducing injuries than other approaches, particularly when engineered changes can be introduced without requiring "decision-to-use" by workplaces. Multifaceted approaches combining intervention elements on the organizational level, or across levels, provided moderate to strong effects, in particular when engineering controls were included. Interventions based on firm epidemiologic evidence of causality and a strong conceptual approach were more effective. Effects that are more modest were observed (in short follow-up) for safety climate interventions, using techniques such as feedback or leadership training to improve safety communication. There was limited evidence for a strong effect at medium-term with more intense counseling approaches. Evidence supports regulation/legislation as contributing to the prevention of accidents at work, but with lower effect sizes. Enforcement appears to work more consistently, but with smaller effects. In general, the results were consistent with previous systematic reviews of specific types of safety interventions, although the effectiveness of economic incentives to prevent accidents at work was not consistent with our results, and effectiveness of physiological safety intervention was only consistent to some extent.

Limitations

Acute musculoskeletal injuries and injuries from more long-time workplace exposures were not always clearly distinguished in research reports. In some studies acute and chronic exposures were mixed, resulting in inevitable misclassification. Of note, the classification of these events also remains problematic in clinical medicine. It was not possible to conduct meta-analyses on all types of interventions (due to variability in approach, context, and participants). The findings presented for most intervention types are from limited sources, and assessment of publication bias was not possible. These issues are not surprising, given the breadth of the field of occupational safety. To incorporate studies using serial measures, which provide the only source of information for some safety interventions such as legislation, we took a systematic, grounded approach to their review. Rather than requiring more stringent, specific criteria for inclusion of ITS studies, we chose to assess how investigators justified their approach to design and analyses, based on the context in which they were working. We sought to identify measures taken to improve external validity of studies, reasonable statistical inference, as well as an overall appropriate inferential process. We found the process useful and enlightening. Given the new approach, we may have failed to extract points others may find relevant. Similarly, to facilitate the broad nature of this review, we used a novel categorization of safety interventions, which is likely to evolve with additional use. The broad scope of this review and the time and resources available did not allow for contacting authors of original papers or seeking translation of non-English manuscripts, resulting in a few cases where we did not have sufficient information that may have been possible to obtain from the authors.

Conclusions and Implications of Key Findings

Our synthesis of the relative effectiveness of workplace safety interventions is in accordance with the Public Health Hierarchy of Hazard Control. Specifically, more effective interventions eliminate risk at the source of the hazard through engineering solutions or the separation of workers from hazards; effects were greater when these control measures worked independently of worker "decision-to-use" at the worksite. Interventions based on firm epidemiological evidence of causality and clear theoretical bases for the intervention approach were more effective in preventing injuries. Less effective behavioral approaches were often directed at the prevention of all workplace injuries through a common pathway, such as introducing safety training, without explicitly addressing specific hazards. We caution that this does not mean that training does not play an essential function in worker safety, but rather that it is not effective in the absence of other efforts. Due to the potential to reach large groups of workers through regulation and enforcement, these interventions with relatively modest effects, could have large population-based effects.

Protecting the mental and physical well-being of frontline health care workers during COVID-19: Study protocol of a cluster randomized controlled trial

Introduction

The COVID-19 pandemic has placed health care workers at unprecedented risk of stress, burnout, and moral injury. This paper describes the design of an ongoing cluster randomized controlled trial to compare the effectiveness of Stress First Aid (SFA) to Usual Care (UC) in protecting the well-being of frontline health care workers.

Methods

We plan to recruit a diverse set of hospitals and health centers (eight matched pairs of hospitals and six pairs of centers), with a goal of approximately 50 HCW per health center and 170 per hospital. Participating sites in each pair are randomly assigned to SFA or UC (i.e., whatever psychosocial support is currently being received by HCW). Each site identified a leader to provide organizational support of the study; SFA sites also identified at least one champion to be trained in the intervention. Using a “train the trainer” model, champions in turn trained their peers in selected HCW teams or units to implement SFA over an eight-week period. We surveyed HCW before and after the implementation period. The primary outcomes are posttraumatic stress disorder and general psychological distress; secondary outcomes include depression and anxiety symptoms, sleep problems, social functioning problems, burnout, moral distress, and resilience. In addition, through in-depth qualitative interviews with leaders, champions, and HCW, we assessed the implementation of SFA, including acceptability, feasibility, and uptake.

Discussion

Results from this study will provide initial evidence for the application of SFA to support HCW well-being during a pandemic.

Trial registration: (Clinicaltrials.govNCT04723576).

A comparative analysis of safety management and safety performance in twelve construction projects

INTRODUCTION

Safety management in construction is complicated due to the complex "nature" of the construction industry. The aim of this research was to identify safety management factors (e.g., risk management and site management), contextual factors (e.g., organisational complexity) and combinations of such factors connected to safety performance.

METHOD

Twelve construction projects were selected to compare their safety management and safety performance. An analytical framework was developed based on previous research, regulations, and standards where each management factor was defined. We employed qualitative comparative analysis (QCA) to produce case knowledge, compare the cases, and identify connections between the factors and safety performance. The material collected and analyzed included, for example, construction planning documents, reports from OHS-inspections, safety indicators, and interviews with project leaders and OHS experts.

RESULTS AND CONCLUSIONS

The research showed that: (a) the average score on 12 safety management factors was higher among projects with high safety performance compared to projects with low safety performance; (b) high safety performance can be achieved with both high and low construction complexity and organizational complexity, but these factors complicate coordination of actors and operations; (c) it is possible to achieve high safety performance despite relatively poor performance on many safety management factors; (d) eight safety management factors were found to be "necessary" for high safety performance, namely roles and responsibilities, project management, OHS management and integration, safety climate, learning, site management, staff management, and operative risk management. Site management, operative risk management, and staff management were the three factors most strongly connected to safety performance.

PRACTICAL IMPLICATIONS

Construction stakeholders should understand that the ability to achieve high safety performance in construction projects is connected to key safety management factors, contextual factors, and combinations of such factors.

Characteristics of construction firms at risk for future workers' compensation claims using administrative data systems, Washington State

INTRODUCTION

Construction is high-hazard industry, and continually ranks among those with the highest workers' compensation (WC) claim rates in Washington State (WA). However, not all construction firms are at equal risk. We tested the ability to identify those construction firms most at risk for future claims using only administrative WC and unemployment insurance data.

METHODS

We collected information on construction firms with 10-50 average full time equivalent (FTE) employees from the WA unemployment insurance and WC data systems (n=1228). Negative binomial regression was used to test the ability of firm characteristics measured during 2011-2013 to predict time-loss claim rates in the following year, 2014.

RESULTS

Claim rates in 2014 varied by construction industry groups, ranging from 0.7 (Land Subdivision) to 4.6 (Foundation, Structure, and Building Construction) claims per 100 FTE. Construction firms with higher average WC premium rates, a history of WC claims, increasing number of quarterly FTE, and lower average wage rates during 2011-2013 were predicted to have higher WC claim rates in 2014.

CONCLUSIONS

We demonstrate the ability to leverage administrative data to identify construction firms predicted to have future WC claims. This study should be repeated to determine if these results are applicable to other high-hazard industries. Practical Applications: This study identified characteristics that may be used to further refine targeted outreach and prevention to construction firms at risk.

The Employer Perspective on Sustainable Employability in the Construction Industry

OBJECTIVE

To determine the measures employers in the construction industry take to promote sustainable employability, the barriers and facilitators that influence implementation and employer needs.

METHODS

Questionnaire among 499 employers and interviews with 17 employers.

RESULTS

Employers expressed a need for alternative jobs for workers who can no longer perform physically demanding tasks, as well as means to stimulate proactive employee behavior. Measures frequently targeted the work environment (95%) and employee health (79%), less frequently personal development (63%) and organization (65%). Implementation was influenced by economic factors, rules and regulations, client demands, employee demands, company vision, company culture, and time/manpower/expertise.

CONCLUSIONS

Implementation of measures aimed at reducing physical load and the promotion of personal development are needed.

Confirmatory Factor and Rasch Analyses Support a Revised 14-Item Version of the Organizational, Policies, and Practices (OPP) Scale

Background The long version of the organizational, policies and practices (OPP) had a high burden and short versions were developed to solve this drawback. The 11-item version showed promise, but the ergonomic subscale was deficient. The OPP-14 was developed by adding three additional items to the ergonomics subscale. The aim of this study is to evaluate the factor structure using confirmatory factor and Rasch analyses in healthy firefighters. Methods A sample of 261 firefighters (Mean age 42 years, 95 % male) were sampled. A confirmatory factor and Rasch analyses were used to assess the internal consistency, factor structure and other psychometric characteristics of revised OPP-14. Results The OPP-14 demonstrates sound factor structure and internal consistency in firefighters. Confirmatory factor analysis confirmed the consistency of the original 4-domain structure (CFI = 0.97, TLI = 0.96, and RMSEA = 0.053). The 5 items showing misfit initially with disordered thresholds were rescored. The four subscales satisfied Rasch expectations with well target and acceptable reliability. Conclusions The OPP-14 scale shows a promising factor structure in this sample and remediated deficits found in OPP-11. This version may be preferable for musculoskeletal concerns or work applications where ergonomic indicators are relevant.

Nurses' Perception of Their Work Environment, Health, and Well-Being

The purpose of this analysis was to identify themes nurses expressed in open-ended comments at the end of a working conditions survey related to their work environment, health, and well-being. The nursing shortage, downsizing, and long working hours create challenges for nurses trying to deliver quality client care. In addition, nurses are experiencing high levels of physical injury in their work environments. Injuries on the job have led nurses to leave the workplace. Free form comments offered at the completion of a mailed survey of RNs were analyzed for content. Randomly selected nurses from two U.S. states were surveyed in 1999 and 2000 about their jobs with special reference to neck, shoulder, and back pain and disorders. Of the 1,428 respondents, 309 produced usable comments for this content analysis. Constant comparative analysis was used to identify themes present in these comments. The themes addressed in the nurses' comments included excessive work demands, injustice or unfairness, and nurses' personal solutions to their work environments. Based on the issues raised in the themes, recommendations are provided for improving retention while promoting nurses' health and well-being.

The contribution of parents' driving behavior, family climate for road safety, and parent-targeted intervention to young male driving behavior

One of the prominent issues in contemporary research on young drivers deals with the mechanisms underlying parents' influences on their offspring's driving behavior. The present study combines two sets of data: the first gathered from in-vehicle data recorders tracking the driving of parents and their teenage sons, and the second derived from self-report questionnaires completed by the young drivers. The aim was to evaluate the contribution of parents' driving behavior, participation in a parent-targeted intervention, and the teen drivers' perception of the family climate for road safety, to the driving behavior of young drivers during solo driving. The data was collected over the course of 12 months, beginning with the licensure of the teen driver, and examined a sample of 166 families who were randomly assigned to one of three intervention groups (receiving different forms of feedback) or a control group (with no feedback). Findings indicate that young male drivers' risky driving events rate was positively associated with that of their parents. In addition, any type of intervention led to a lower rate of risky driving events among young drivers compared to the control group. Finally, a higher perception of parents as not committed to safety and lower perceived parental monitoring were related to a higher risky driving events rate among young drivers. The results highlight the need to consider a complex set of antecedents in parents' attitudes and behavior, as well as the family's safety atmosphere, in order to better understand young drivers' risky driving. The practical implications refer to the effective use of the family as a lever in the attempt to promote safety awareness among young drivers.

The Relationship between Injury and Socioeconomic Status in Reference to the Fourth Korean National Health and Nutrition Examination Survey

Objectives

This study aims to investigate the relationship between the total injury experience rate and socioeconomic status based on the fourth Korea National Health and Nutrition Examination Survey (KNHANES).

Methods

By analyzing data from the fourth KNHANES conducted from 2007 to 2009, we estimated the injury experience rate according to socioeconomic status, including the occupational characteristics of 11,837 subjects. Setting the injury experience rate as a dependent variable and socioeconomic status as an independent variable, we performed logistic regression to calculate odds ratios reflecting the likelihood of injury according to socioeconomic status while controlling for relevant covariates.

Results

In 797 subjects who had injury experience over the past 1 year, 290 persons (36.4%) had a work-related injury. As their income, home value, and educational status increased, their injury experiences decreased. Among occupational groups, the craft, equipment, machine operating, and assembling workers showed the highest rate (10.6%) of injury experience, and the lowest rate (5.7%) was found in the unemployed group. After adjusting for the confounding variables, the experience of injury was significantly related to several socioeconomic factors: high income (OR = 0.54; 95% CI: 0.34-0.86), high home value (OR = 0.65; 95% CI: 0.43-0.96), low education status (OR = 1.28; 95% CI: 1.07-1.52), and specific occupations such as craft, equipment, machine operating, and assembling work (OR = 1.99; 95% CI: 1.60-2.47), skilled agriculture, forestry and fishery work (OR = 1.43; 95% CI: 1.02-2.01), and simple labor (OR = 1.38; 95% CI: 1.04-1.82).

Conclusions

The injury experience rate differed depending on the socioeconomic status. A negative correlation was found between the injury experience rate and income, low home value, and education level. Moreover, a higher rate of injury experience was found in occupation groups and physical worker groups in comparison to the unemployed group and white-collar worker groups. This study would be useful in selecting appropriate priorities for injury management in Korea.

Safety climate dimensions as predictors for risk behavior

This study examines the interactive relationship between three dimensions of safety climate (management commitment to safety, priority of safety, and pressure for production), and their impact on risk behavior reported by employees. The sample consisted of 623 employees from a chemical manufacturing organization in South Africa. Hierarchical regression analyses were carried out to test the direct effects and the interaction effect of the three safety climate dimensions on risk behavior. The results showed that, as expected, employees' risk behavior was negatively related to management commitment to safety and priority of safety and positively related to pressure for production. Moreover, as expected, the three-way interaction between management commitment to safety, priority of safety and pressure for production was significant. When pressure for production was high, management commitment to safety was negatively related to risk behavior, regardless of level of priority of safety on plant. When pressure for production was low, the effect of management commitment to safety on risk behavior was nullified under conditions of high, as compared to low priority of safety on plant. These findings highlight the importance of managerial commitment to safety in contexts where employees experience tensions between production deadlines and safety procedures.

Family climate for road safety: a new concept and measure

This research adapted the workplace concept of safety climate to the domain of safe driving, defining a new construct of "family climate for road safety". Four studies were conducted in Israel with the aim of developing and validating a multidimensional instrument to assess this construct among young drivers. Study 1 (n=632) focused on developing the Family Climate for Road Safety Scale (FCRSS), a self-report scale assessing the family climate by means of seven aspects of the parent-child relationship: Modeling, Feedback, Communication, Monitoring, Noncommitment, Messages, and Limits. Significant differences were found between young men and women on all factors. In addition, significant associations were found between the FCRSS factors on the one hand, and the reported frequency of risky driving and personal commitment to safety on the other. Studies 2-4 confirmed the factorial structure of the FCRSS and the reliability of its factors, adding to its criterion and convergent validity. Study 2 (n=178) yielded significant associations between the scale and young drivers' perception of their parents as involved, encouraging autonomy, and providing warmth; Study 3 (n=117) revealed significant associations between the scale and youngsters' reported proneness to take risks while driving, as well as significant associations between the factors and various dimensions of family functioning; and Study 4 (n=156) found associations between the FCRSS factors and both driving styles (risky, angry, anxious, careful) and family cohesion and adaptability. The discussion deals with the validity and utility of the concept of family climate for road safety and its measurement, addressing the practical implications for road safety.

The contribution of family climate for road safety and social environment to the reported driving behavior of young drivers

Two studies examined the contribution of the new concept of "family climate for road safety" and several aspects of the social environment to the driving behavior of young drivers. Study 1 (n=120) investigated the effect of the seven dimensions of the family climate for road safety - Modeling, Feedback, Communication, Monitoring, Noncommitment, Messages, and Limits - as well as a general tendency to conform to authority, and peer pressure. Study 2 (n=154) examined the dimensions of family climate for road safety and perceived popularity of reckless driving among peers. The findings indicate associations both between the familial and the social aspects, and between these variables and driving styles, willingness to take risks while driving, reckless driving habits, and personal commitment to safe driving. Positive aspects of the parent-child relationship and high levels of conformity to authority were related to greater endorsement of the careful driving style, whereas family's noncommitment to safety, higher peer pressure, and lower conformity to authority were associated with greater endorsement of the reckless driving style. In addition, positive aspects of the family climate for road safety and lower perceived popularity of reckless driving among friends were associated with more personal commitment to safe driving and a lower tendency for risky driving. The discussion stresses the need to look at the complex set of antecedents of reckless driving among young drivers and addresses the practical implications of the findings for road safety.

Occupational injury in America: An analysis of risk factors using data from the General Social Survey (GSS)

INTRODUCTION

Although much is known about the distribution of occupational injury in terms of various job and employment factors, considerably less is known about other possible risk factors, particularly those involving psychosocial and organizational factors. These factors have not been emphasized in most injury surveillance systems or large scale, population based surveys.

METHOD

In this study, data from the 2002 General Social Survey (GSS) and NIOSH Quality of Work Life (QWL) module were used to examine the risk of occupational injury in terms of socio-demographic factors, employment characteristics, and organizational factors.

RESULTS

The most informative results were obtained from Poisson regression analyses, which identified race, occupational category, and work-family interference as risk factors, and safety climate and organizational effectiveness as protective factors for occupational injury. These results provide guidance for targeting interventions and protective measures to curtail occupational injury in the United States.

The 11-item workplace organizational policies and practices questionnaire (OPP-11): examination of its construct validity, factor structure, and predictive validity in injured workers with upper-limb disorders

BACKGROUND

Reliable and valid measurement of workplace organizational policies and practices (OPPs) is needed to evaluate their influences on the prevention and management of occupational injuries.

METHODS

Injured workers (n = 614) attending an upper-limb specialty clinic operated by the Workplace Safety & Insurance Board of Ontario were recruited for a 1-year study. The OPP-11, completed at baseline, was examined for scaling properties (floor/ceiling effects, internal consistency, and item-convergent/discriminant validity), construct validity, and factor structure. Predictive validity for longitudinal work disability was examined using multivariable logistic regressions.

RESULTS

Strong scaling properties were observed for the OPP-11. High internal consistency (Cronbach's alpha = 0.80-0.90) and expected associations with comparator constructs were evident. A 4-domain structure (fit statistics: CFI = 0.98, TLI = 0.97, and RMSEA = 0.06) was supported. Higher OPP-11 predicted more favorable 12-month work disability outcomes, after adjusting for demographic and health attributes.

CONCLUSIONS

The OPP-11 is valid for use in upper-limb disorders. Expanding the ergonomic practices domain could be considered.

Safety climate: new developments in conceptualization, theory, and research

Although the important role of safety climate in safety outcomes has been established and many studies have been done by scholars in different disciplines and across different cultures, there are still gaps in the literature. The articles in this Special Issue explore the topics of new developments in the conceptualization of safety climate and occupational/industry-focused studies of safety climate, with the goal of identifying different challenges and findings that arise within or across various occupations or industries. We are pleased to have a closing article by Dr. Dov Zohar on "Thirty Years of Safety Climate Research: Reflections and Future Directions."

Implementing evidence-based practices for people with schizophrenia

Over the last decade, a consensus has emerged regarding a set of evidence-based practices for schizophrenia that address symptom management and psychosocial functioning. Yet, surveys suggest that the great majority of the population of individuals with schizophrenia do not receive evidence-based care. In this article, we review the empirical literature on implementation of evidence-based practices for schizophrenia patients. We first examine lessons learned from implementation studies in general medicine. We then summarize the implementation literature specific to schizophrenia, including medication practices, psychosocial interventions, information technology, and state- and federal-level interventions. We conclude with recommendations for future directions.

Individualization and quality improvement: two new scales to complement measurement of program fidelity

Fidelity scales have been widely used to assess program adherence to the principles of an evidence-based practice, but they do not measure important aspects of quality of care. Pragmatic scales measuring clinical quality of services are needed to complement fidelity scales measuring structural aspects of program implementation. As part of the instrumentation developed for the National Implementing Evidence-Based Practices Project, we piloted a new instrument with two 5-item quality scales, Individualization (a client-level quality scale) and Quality Improvement (an organizational-level quality scale). Pairs of independent fidelity assessors conducted fidelity reviews in 49 sites in 8 states at baseline and at four subsequent 6-month intervals over a 2-year follow-up period. The assessors followed a standardized protocol to administer these quality scales during daylong site visits; during these same visits they assessed programs on fidelity to the evidence-based practice that the site was seeking to implement. Assessors achieved acceptable interrater reliability for both Individualization and Quality Improvement. Principal components factor analysis confirmed the 2-scale structure. The two scales were modestly correlated with each other and with the evidence-based practice fidelity scales. Over the first year, Individualization and Quality Improvement improved, but showed little or no improvement during the last year of follow-up. The two newly developed scales showed adequate psychometric properties in this preliminary study, but further research is needed to assess their validity and utility in routine clinical practice.

Work injuries and disability

PROBLEM

This study estimated the hazard ratio for disability pension retirement (DPR) for persons who have experienced a work injury causing absence lasting at least one day after the accidental injury occurred and to estimate the fraction of DPR attributable to work injuries.

METHODS

A total of 4,217 male and 4,105 female employees from a national survey were followed up for subsequent DPR.

RESULTS AND IMPACT ON INDUSTRY AND GOVERNMENT

Having had a work injury was a strong predictor of DPR among men. After control for age, smoking, body mass index, body postures, and physical demands, the hazard ratio (HR) among those employees who had ever experienced a work injury was 1.80 (95% confidence interval (CI): 1.20-2.68). No association was found among women.

SUMMARY

Having had a reportable work injury is a strong predictor of subsequent DPR for men.

The Effect of Occupational Safety Legislation in Preventing Accidents at Work: Traditional versus Advanced Manufacturing Industries

We analyze the effect of occupational safety and health (OSH) legislation in reducing workplace accidents. It is argued that different impacts should be expected in advanced and traditional manufacturing sectors. We test this hypothesis with data on Spanish manufacturing throughout the period 1988–2004. To that effect, we estimate the relationship between the number of serious injuries and the potential risk factors, by means of diverse specifications of the negative binomial regression model for panel data. Our results indicate that, while the adoption of the new OSH regulation did contribute to the reduction in the number of injuries in advanced manufacturing sectors, the accident rates in traditional manufacturing did not show any statistically significant change following the reform.

The role of contextual factors for musculoskeletal disorders in the New Zealand meat processing industry

Musculoskeletal disorders (MSD) are the leading cause of occupational injury internationally. In New Zealand, the highest incidence of MSD is in meat processing, accounting for over half the injury compensation costs for the sector. MSD in meat processing have proven highly resistant to physical, micro-level interventions, suggesting a new approach is required. This paper reports on part of a 2-year study looking at MSD in the New Zealand meat processing industry. The qualitative study involved interviews with 237 workers, management, union and safety personnel in 28 processing sites. These data were summarised into a list of contextual factors, which, it is postulated, may create conditions under which greater exposure to physical and psychosocial factors can occur in meat processing. Some of the contextual factors are recognised as problematic by the industry, but have not previously been associated with MSD risk. The paper concludes by reflecting on conducting MSD research with a focus on contextual factors and how this may influence MSD prevention. The manuscript provides industry-based data on MSD risk and outlines the approach used in its collection. Identifying contextual factors and understanding their role in creating MSD risk may help improve the acceptance and effectiveness of MSD interventions in industry.

Challenges and opportunities for preventing depression in the workplace: a review of the evidence supporting workplace factors and interventions

OBJECTIVE

To explore the literature regarding prevention of depression in the workplace.

METHOD

Literature review of what the author believes are seminal articles highlighting workplace factors and interventions in preventing depression in the workplace.

RESULTS

Employees can help prevent depression by building protective factors such as better coping and stress management skills. Employees may be candidates for depression screening if they have certain risk factors such as performance concerns. Organizational interventions such as improving mental health literacy and focusing on work-life balance may help prevent depression in the workplace but deserve further study.

CONCLUSION

A strategy to prevent depression in the workplace can include developing individual resilience, screening high-risk individuals and reducing that risk, improving organizational literacy, and integrating workplace and health care systems to allow access to proactive quality interventions.

Workplace policies and prevalence of knee osteoarthritis: the Johnston County Osteoarthritis Project

OBJECTIVE

Previous studies on work and knee osteoarthritis (KOA) have been primarily focused on physical demands; very little is known about work-related organisational policies and KOA risks and outcomes. We examined the associations between workplace policies and KOA in a community-based population in the USA.

METHODS

The associations between employment offering accommodations (switch to physically less demanding jobs; part-time work for people needing reduced time) and benefits policies (paid sick leave; disability payment) with KOA outcomes (knee symptoms; symptomatic KOA [sKOA]; asymptomatic radiographic KOA [rKOA]) were analysed in participants (n = 1639) aged <65 years old and with completed employment histories and knee radiographs at baseline examination of the Johnston County Osteoarthritis Project. Multiple logistic regression models were used to estimate the prevalence odds ratios (ORs) of KOA associated with each workplace policy, adjusting for sociodemographic features, lifestyle factors, knee injuries, body mass index and other workplace characteristics. We used propensity score models to evaluate the differential selection in employment offering favourable policies and adjust for this potential bias accordingly.

RESULTS

Individuals employed in workplaces offering better policies had significantly less knee symptoms. Lower sKOA prevalence was noted in workplaces offering job-switch accommodation (8% vs. 13%), paid sick leave (9% vs. 16%) and disability payment (8% vs. 16%) than their counterparts. In multivariable models, the difference in sKOA prevalence was statistically significant for paid sick leave (adjusted OR 0.58, 95% CI 0.37 to 0.91) and disability payment policies (adjusted OR 0.54, 95% CI 0.35 to 0.85). Even among those without overt knee-related symptoms, a similar pattern of negative association between workplace policies and rKOA was present and remained robust after propensity score adjustment.

CONCLUSION

The negative associations between KOA and workplace policies raise concerns about possible employment discrimination or beneficial effects of workplace policies. Longitudinal studies are needed to clarify the dynamic complexities of KOA risks and outcomes in relation to workplace policies.

The association of socioeconomic status and psychosocial and physical workplace factors with musculoskeletal injury in hospital workers

BACKGROUND

The combined effect of socioeconomic, organizational, psychosocial, and physical factors on work-related musculoskeletal disorders (WRMSDs) were studied in a heterogeneous, socioeconomically diverse sample (cases and their matched referents) of hospital workers.

METHODS

Cases were defined by a new acute or cumulative work-related musculoskeletal injury; referents were matched by job group, shift length, or at random. Information was obtained through telephone interviews and on-site ergonomics observation. Questionnaire items included sociodemographic variables, lost work time, work effectiveness, health status, pain/disability, and psychosocial working conditions using Effort Reward Imbalance (ERI) and Demand-Control (DC) models. Two multivariate models were tested: Model 1 included occupation as a predictor; Model 2 included education-income as a predictor.

RESULTS

Cases reported greater pain, disability, lost time, and decreased work effectiveness than the referents. Model 1 was statistically significant for neck/upper extremity injury (Chi-square = 19.3, P = 0.01), back/lower extremity injury (Chi-square = 14.0, P = 0.05), and all injuries combined (Chi-square = 25.4, P = 0.001). "Other Clinical" occupations (34% mental health workers) had the highest risk of injury (OR 4.5: 95%CI, 1.7-12.1) for all injuries. The ERI ratio was a significant predictor for neck and upper extremity (OR 1.5: 95%CI, 1.1-1.9) and all injuries (OR 1.3; 95%CI, 1.04-1.5), per SD change in score.

CONCLUSIONS

In this study, the risk of WRMSDs was more strongly influenced by specific psychosocial and physical job-related exposures than by broad socioeconomic factors such as education and income.

Engaging health care workers in improving their work environment

AIM

This study describes the perceptions of health care workers who were involved in a participatory approach for the reorganization of care and work, aimed at creating an optimum work environment.

BACKGROUND

Quebec's health network has undertaken large-scale organizational changes to ensure the quality of health care and services for the population.

METHOD

This participatory research was carried out by means of interviews. The sample consisted of 20 participants involved in the participatory approach for making changes to the organization of care and work in two pilot units.

RESULTS

Four main perspectives emerged from the analysis: (1) views on the legitimacy of change, (2) commitment, indifference and resistance, (3) day-to-day concrete changes as signs of hope and (4) the elements of the success of the participatory approach.

CONCLUSION

The management team's support and leadership and the participatory approach were significant factors in the success of the project.

Disability management practices in Ontario health care workplaces

BACKGROUND

Workplace disability management programs are important in managing injury and disability.

METHODS

A stratified random sample of 188 employers in health care workplaces (71 hospitals, 48 nursing homes, 42 private clinics, and 27 community clinics) completed a mailed Organizational Policies and Practices (OPP) questionnaire. The OPP asked questions about eight workplace disability management practices. This article compares disability management practices across the four types of health care workplaces.

RESULTS

A one-way analysis of variance for each of the eight practices demonstrated significant differences across facility types for all practices, except ergonomic practices. For unionized versus non-unionized workplaces, there were significant differences in all practices, except ergonomic practices. For workplaces with formal policies versus those without policies, there were significant differences in all practices, except people-oriented culture and safety diligence.

CONCLUSION

Variations in disability management practices in health care workplaces need to be addressed to provide more effective prevention and treatment of work-related injuries and disability.

Changes in job stressors in the Canadian working population

OBJECTIVES

To determine the changes in levels of work stressors in a nationally representative sample of Canadian workers from 1994/95 to 2000/01.

METHODS

We compared responses for an abbreviated version of the Job Content Questionnaire in two waves of the National Population Health Survey (NPHS). Other items and scales related to work and health were also analyzed. Data were transformed to range from 0 to 10. Comparisons of the 2000/01 data were also made with the Canadian Community Health Survey (CCHS) conducted in 2000.

RESULTS

There were only very small absolute differences between NPHS 2000/01 data and CCHS 2000 data. The NPHS comparison from 1994/95 to 2000/01 showed an increase in job security (change in means = 0.49, 95% CI 0.39 to 0.58) and a decrease in job physical demands (change in means = 0.45, 95% CI 0.35 to 0.54). Other changes in work characteristics were small in absolute value. The combined "overall work stressors" index dropped by 0.12 (95% CI 0.08 to 0.15).

CONCLUSIONS

Levels of work stressors did not increase over the period. Some subscales showed an improvement.

The relationship between safety climate and injury rates across industries: the need to adjust for injury hazards

Previous studies have suggested that strong safety climates (shared perceptions of safe conducts at work) are associated with lower workplace-injury rates, but they rarely control for differences in industry hazards. Based on 33 companies, we assessed its association with injury rates using three rate based injury measures (claims per 100 employees, claims per 100,000 h worked, and claims per 1 million US dollars payroll), which were derived from workers' compensation injury claims. Linear regression models were used to test the predictability of safety climate on injury rates, followed by controlling for differences in hazard across industries gauged by national industry-specific injury rates. In the unadjusted model, company level safety climate were negatively and significantly associated with injury rates. However, all of the above associations were no longer apparent when controlling for the hazardousness of the specific industry. These findings may be due to over adjustment of hazard risk, or the overwhelming effects of industry specific hazards relative to safety climate effects that could not be differentiated with the statistical power in our study. Industry differences in hazard, conceptualized as one type of injury risk, however need to be considered when testing the association between safety climate and injury across different industries.

Negatively oriented personality and perceived negative job characteristics as predictors of future psychological and physical symptoms: a meta-analytic structural modelling approach

OBJECTIVES

There is evidence that perceptions of negative job characteristics (e.g., lack of control) and negatively oriented personality (e.g., negative affect) both predict symptom reporting. However, the relative contribution of these factors is rarely examined. This paper uses meta-analytic structural equation modelling (MA-SEM) to explore their relative contribution.

METHODS

A meta-analysis of recent longitudinal studies was conducted. Eight studies covering 10 separate samples met the inclusion criteria (N=2104) and were used in the MA-SEM. Meta-correlations were used to construct structural equations models in which perceived negative job characteristics (PNJC) and negatively oriented personality (NOP) at baseline were used to predict concurrent and future symptom reporting, controlling for symptom reporting at baseline.

RESULTS

The results indicated that a model based solely on NOP offered a more parsimonious account for baseline and future symptom reporting than did PNJC.

CONCLUSIONS

The evidence indicates interventions should focus on both individuals and organizations, and not just organizational-level interventions.

Organizational Climate: Implications for the Home Healthcare Workforce

Organizational climate generally refers to staff members' perceptions of organizational features like decision making, leadership, and norms. It is widely acknowledged that these perceptions influence patient, employee, and system outcomes. However, there has been little consensus on how best to measure these important relationships. This article examines how organizational climate has been defined and measured in health services research and identifies factors most important in home healthcare delivery. Standardization of climate measures will facilitate the ultimate goal of translating results into evidence-based management practices to improve the quality of care delivery.

Trends in injuries, illnesses, and policies in Canadian healthcare workplaces

Background

Analysis of workers’ compensation data and occupational health and safety trends in healthcare across Canada was conducted to provide insight concerning workplace injuries and prevention measures undertaken in the healthcare sector.

Methods

Timeloss claims data were collected for 1992–2002 from the Association of Workers’ Compensation Boards of Canada. Labour Force data from Statistics Canada were used to calculate injury rates. The Occupational Health and Safety Agency for Healthcare in British Columbia coordinated with provincial occupational health and safety agencies in Ontario, Quebec and Nova Scotia to analyze injury data and collate prevention measures in their regions.

Results

The national timeloss injury rate declined from 4.3 to 3.7 injuries per 100 personyears since 1998. Musculoskeletal injuries consistently comprised the majority of timeloss claims. Needlestick injuries, infectious diseases and stress-related claims infrequently resulted in timeloss claims although they are known to cause great concern in the workplace. Prevention measures taken in the various provinces related to safer equipment (lifts and electric beds), return-to-work programs, and violence prevention initiatives. Different eligibility criteria as well as adjudication policies confounded the comparison of injury rates across provinces.

Discussion

Since 2000, all provinces experienced healthcare restructuring and increased workload in an aging workforce. Despite these increased risks, injury rates have decreased. Attribution for these trends is complex, but there is reason to believe that focus on prevention can further decrease injuries. While occupational health is a provincial jurisdiction, harmonizing data in addition to sharing data on successful prevention measures and best practices may improve workplace conditions and thereby further reduce injury rates for higher risk healthcare sector occupations.

Improving the prevention and control of hazardous substance exposures: a randomized controlled trial in manufacturing worksites

BACKGROUND

New measures of exposure prevention (EP) activity were used to evaluate the effectiveness of a 16-month management-focused intervention addressing hazardous substance exposures in manufacturing work settings.

METHODS

EP efforts were assessed using a rating scheme developed for this study. The rating scheme yields a set of measures of exposure potential and protection, which are combined into an overall EP summary rating. A randomized, controlled design was used to assess intervention effectiveness. Fifteen large manufacturing worksites completed the 16-month intervention and follow-up assessments. Analyses were conducted on the 107 production processes assessed at both baseline and final.

RESULTS

Patterns of improvement within the intervention condition were consistent with the intervention emphasis on upstream or source-focused intervention; whereas patterns in controls were consistent with prevalent practice (more downstream, worker-focused). A mixed model analysis of variance showed greater improvement in EP ratings in intervention versus controls, but the difference in improvement was moderate and statistically non-significant.

CONCLUSIONS

This study has demonstrated that EP efforts in the manufacturing sector can be systematically assessed across the full range of hazardous substances in use, and that such assessments can serve both needs assessment and effectiveness evaluation functions. Findings suggest that more sustained or intense management-focused intervention would significantly improve EP activity in manufacturing settings.

Prevention of injuries at work: the role of the occupational physician

OBJECTIVES

To highlight the role of occupational physician (OP) in occupational injuries (OI) prevention and management. To suggest an approach beyond traditional focus on descriptive epidemiology, engineering interventions, administrative aspects of OI prevention. To promote a person- and enterprise-tailored approach, entailing greater attention to human factors and to practical problems of the specific workplace, with a call to a leading role played by OP.

METHODS AND RESULTS

Analysis of the literature on the broader topic of OI prevention revealed thousands of publications; however, only a handful of them mention or describe the participation of OP in OI prevention. While recognizing that literature search is not the proper and only way to appreciate the current role of OP in this field, therefore, it seems necessary to call OP to a stronger effort in prevention and management of OI, through the context of a comprehensive intervention in cooperation with managers, supervisors, safety personnel and workers, focusing on specific needs of each enterprise. The following areas of OP intervention were examined: risk assessment, health surveillance, management, scientific research and health education. Within each of these topics, possible contributions, methodologies, instruments available for the OP were discussed, taking into account the relevant literature. Pathways for practical applications were illustrated, e.g., OI data generation and analyses, predictors of OI, fitness for work, case management, team work, educational issues, first aid, suggestion for OP contribution in specific research questions.

CONCLUSIONS

OI continue to take a remarkable toll from individuals and society. New multidisciplinary interventions are needed to prevent OI. Focused activities at the single worksite with a central role from OP are definite options. OP is an effective interface between workforce and management and may offer, through a proactive approach, valuable practical and cultural contributions, while respecting technical and ethical guidelines of occupational health professionals.

Workplace organizational policies and practices in Ontario educational facilities

BACKGROUND

Workplace organizational policies and practices (OPPs) play a pivotal role in managing injury and disability. This study identifies the workplace OPPs in Ontario's education sector.

METHODS

OPPs were examined using a cross-sectional survey with 157 participants. The relationship among the type of school, workplace OPPs and injury and disability outcomes were investigated.

RESULTS

Mean subscale scores (potential range 1-5) varied from 3.1 (SD, 1.0) to 4.2 (SD, 0.6) for all schools. Private schools scored lowest on measures of disability prevention, disability management, and corporate culture. Ergonomic practices and return to work initiatives were achieved less frequently than other OPPs for all schools. Higher scores on safety diligence were associated with lower injury and disability incidence (proportion of variance explained ranged from 10 to 23%). Higher scores on people-oriented culture were associated with lower disability incidence and duration (proportion of variance explained ranged from 7 to 20%).

CONCLUSIONS

Public schools engage more often in workplace OPPs than private schools. Improved achievements on safety diligence and people-oriented culture practices predict reduced injury and disability outcomes.

Trends in injuries, illnesses, and policies in Canadian healthcare workplaces

BACKGROUND

Analysis of workers' compensation data and occupational health and safety trends in healthcare across Canada was conducted to provide insight concerning workplace injuries and prevention measures undertaken in the healthcare sector.

METHODS

Timeloss claims data were collected for 1992-2002 from the Association of Workers' Compensation Boards of Canada. Labour Force data from Statistics Canada were used to calculate injury rates. The Occupational Health and Safety Agency for Healthcare in British Columbia coordinated with provincial occupational health and safety agencies in Ontario, Quebec and Nova Scotia to analyze injury data and collate prevention measures in their regions.

RESULTS

The national timeloss injury rate declined from 4.3 to 3.7 injuries per 100 person-years since 1998. Musculoskeletal injuries consistently comprised the majority of timeloss claims. Needlestick injuries, infectious diseases and stress-related claims infrequently resulted in timeloss claims although they are known to cause great concern in the workplace. Prevention measures taken in the various provinces related to safer equipment (lifts and electric beds), return-to-work programs, and violence prevention initiatives. Different eligibility criteria as well as adjudication policies confounded the comparison of injury rates across provinces.

DISCUSSION

Since 2000, all provinces experienced healthcare restructuring and increased workload in an aging workforce. Despite these increased risks, injury rates have decreased. Attribution for these trends is complex, but there is reason to believe that focus on prevention can further decrease injuries. While occupational health is a provincial jurisdiction, harmonizing data in addition to sharing data on successful prevention measures and best practices may improve workplace conditions and thereby further reduce injury rates for higher risk healthcare sector occupations.

Improving the psychosocial work environment

AIM

This paper reports a pilot project to evaluate the effectiveness of a participatory organizational intervention to improve the psychosocial work environment in one long-term care unit.

BACKGROUND

Since the early 1990s, health care institutions in Quebec have been constantly changing in order to improve the efficiency of the health care system. These changes have affected the work environment and have contributed to higher rates of burnout and absenteeism among nurses and other health care workers.

METHOD

The study participants were health care workers in a long-term care unit (n = 60). The participatory organizational intervention was based on a contract and carried out by a work team. Work constraints were identified, and an action plan implemented, The effectiveness of the intervention was evaluated by pre- and postintervention questionnaires: the Job Content Questionnaire, Effort-Reward Imbalance Questionnaire and Psychiatric Symptom Index.

RESULTS

There was a significant increase in reward (P < or = 0.01) and a significant decrease in Effort-Reward Imbalance (P < or = 0.01) following the intervention. Absenteeism rates decreased from 8.26% to 1.86% over the study period, but in the rest of the institution remained the same. However, there was a significant decrease in social support from supervisors (P < 0.05) at post-test.

CONCLUSION

Participation by health care workers and action plans targeting problematic aspects of the psychosocial work environment are key elements in interventions to improve their health. However, such interventions present challenges, such as the involvement of managers, involvement of all relevant participants, and re-establishment of trust within work teams. Recognition and respect must be re-established, and supervisors must engage with health care workers and give support at all stages of the intervention.

Preliminary evaluation of the generalized work distress scale in patients with work-related upper extremity disorders

This study evaluated the reliability and construct validity of the Generalized Work Distress Scale in 207 patients attending a specialty clinic with work-related upper extremity disorders. Factor analyses were conducted and compared to the original developmental study confirming a two-factor solution: an internal factor related to Work-Related Dysphoria and an external factor related to Work-Related Support. Reliability (internal consistency) of factors was high (Cronbach's alpha = 0.87 and 0.89). The Work-Related Dysphoria factor was more related to self-reported global depressed mood and self-reported upper extremity functional disability, than was Work-Related Support. This study provided preliminary support for the use of this scale in patients with work-related upper extremity disorders and consideration to depressive symptoms in these patients. Further investigation of the psychometric properties of this scale and its predictive validity are required.

Outcomes in work-related injuries: a comparison of older and younger workers

BACKGROUND

The "graying of the workforce" has generated concerns about the physical capacity of older workers to maintain their health and productivity on the job, especially after an injury occurs. There is little detailed research on age-related differences in work outcomes after an occupational injury.

METHODS

A self-report survey about occupational, health, and financial outcomes, and related factors was administered 2-8 weeks post-injury to workers aged < 55 and > or = 55 who had lost time due to a work injury.

RESULTS

Despite more severe injuries in older workers, most outcomes were similar in both age groups. In multivariate models, age was unrelated or inversely related to poor outcomes. Injury severity, physical functioning, and problems upon return to work were associated with adverse work injury outcomes.

CONCLUSIONS

Older workers appear to fare better than younger workers after a work injury; their relative advantage may be primarily due to longer workplace attachment and the healthy worker effect.

Assessing and intervening on OSH programmes: effectiveness evaluation of the Wellworks-2 intervention in 15 manufacturing worksites

AIMS

(1) To develop a transparent and broadly applicable method for assessing occupational safety and health (OSH) programmes or management systems; (2) to assess OSH programmes in a sample of manufacturing worksites; and (3) to determine whether a management focused occupational health intervention results in greater improvement in OSH programmes compared to minimal intervention controls.

METHODS

OSH programmes were assessed using an adaptation of the US Occupational Safety & Health Administration's 1995 Program Evaluation Profile. Scores were generated from 91 binary indicator variables grouped under four "Essential Elements". Essential Element scores were weighted to contribute to an overall programme score on a 100 point scale. Seventeen large manufacturing worksites were assessed at baseline; 15 sites completed the 16 month intervention and follow up assessments.

RESULTS

There was considerable variation in Essential Element scores across sites at baseline as judged by our instrument, particularly in "management commitment and employee participation" and "workplace analysis". Most sites scored highly on "hazard prevention and control" and "training and education". For overall OSH programme scores, most sites scored in the 60-80% range at baseline, with four sites scoring below 60%, suggesting weak programmes. Intervention sites showed greater improvements than controls in the four programme elements and in overall programme scores, with significantly greater improvements in "management commitment and employee participation".

CONCLUSIONS

The OSH programme assessment method used is broadly applicable to manufacturing work settings, and baseline profiles suggest needs for improvement in OSH programmes in most such worksites. Despite a small sample size, results showed that sustained management focused intervention can result in improvement in these OSH programme measures.

Factors associated with staff injuries in intermediate care facilities in British Columbia, Canada

BACKGROUND

Large variations in staff injury rates across intermediate care facilities suggest that injuries may be driven by facility-specific work environment factors.

OBJECTIVES

To identify work organization, psychosocial, and biomechanical factors associated with staff injuries in intermediate care facilities, to pinpoint management practices that may contribute to lower staff injuries, and to generate a provisional conceptual framework of work organization characteristics.

METHODS

Four representative intermediate care facilities with high staff injury rates and four facilities with comparable low staff injury rates were selected from Workers' Compensation Board (WCB) databases. Methods included on-site injury data collection and review of associated WCB data, ergonomic study of workloads, a telephone survey of resident care staff, manager-staff interviews, and focus groups. Pearson product-moment correlation coefficients identified associations between variables. Analysis of variance and t tests were used to determine differences between low and high staff injury rate facilities. Content analysis guided the qualitative analysis.

RESULTS

There were no significant differences between low and high staff injury rate facilities in terms of workers' characteristics, residents' characteristics, and per capita public funding. The ergonomic study supported the survey data in demonstrating a relation among low staffing levels, greater muscle loading, and greater risk of injury. As compared with facilities that had high staff injury rates, facilities with low staff injury rates had significantly more favorable staffing levels and supportive work environments. Perceived quality of care was strongly correlated with burnout, health, and satisfaction.

CONCLUSIONS

Safer work environments are promoted by favorable staffing levels, convenient access to mechanical lifts, workers' perceptions of employer fairness, and management practices that support the caregiving role.

How we prevent prevention of musculoskeletal disorders in the workplace

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.

Individual and combined impacts of biomechanical and work organization factors in work-related musculoskeletal symptoms

BACKGROUND

Investigations of work-related low back (LB) and upper extremity (UE) disorders have increasingly utilized multivariable models that include biomechanical/physical and work organization factors. However, the nature of any interactive effects is not well understood.

METHODS

Using questionnaires, high and low exposure groups for biomechanical/physical factors, cognitive demands, cognitive processing, interpersonal demands, participatory management, skill discretion, and time pressure for 289 individuals (U.S. Marines) were identified. Musculoskeletal symptom status was also determined by questionnaire. Individual and biomechanical-psychosocial combinations were examined in adjusted multivariable logistic regression analyses.

RESULTS

Time pressure was associated with both LB and UE symptoms (odds ratio(s) (OR) range = 2.13-3.09), while higher biomechanical exposures were risk factors for LB symptoms (OR = 2.07; 95% confidence intervals (CI): 1.00-4.35) and concurrent LB and UE symptoms (OR = 2.80; CI: 1.35-5.83). Greater risks for concurrent LB and UE symptoms were indicated for combinations involving higher biomechanical exposure and: time pressure (OR = 2.21; CI: 1.19-4.10); cognitive demands (OR = 2.25; CI: 1.23-4.09); cognitive processing (OR = 2.08; CI: 1.16-3.75); interpersonal demands (OR = 2.44; CI: 1.35-4.41); participatory management (OR = 2.50; CI: 1.30-4.81). Results did not suggest any interaction between biomechanical and work organization factors.

CONCLUSIONS

While no synergism was indicated, the present findings emphasize the need to consider both biomechanical factors and specific work organization factors, particularly time pressure, in reducing musculoskeletal-related morbidity.