Association between job stress and occupational injuries among Korean firefighters: a nationwide cross-sectional study

Occupational Injuries of Spanish Wildland Firefighters: A Descriptive Analysis

The work of wildland firefighters, especially of the so-called 'Brigadas de Refuerzo contra Incendios Forestales', is characterised by high physical demands and extreme operating conditions. These professionals face long workdays (12 h), walking with heavy loads (~25 kg), being exposed to high temperatures (>30 °C), and handling specialised tools in high-risk environments. This study aimed to describe the prevalence of occupational injuries among members of the 'Brigadas de Refuerzo contra Incendios Forestales' and its relationship to variables such as age and work experience. A total of 217 wildland firefighters (18 female and 199 male) correctly answered a questionnaire developed on an ad hoc basis to meet the study's objectives. A high prevalence of occupational injuries was observed among them (~76%). Age and work experience were shown to be significantly associated with injuries. Individuals over 35 years of age with more than 10 years' experience had a higher probability of injury (OR = 2.14, CI = 1.12-4.06 and OR = 2.46, CI = 1.30-4.67, respectively). Injuries occurred mainly during physical training (~46%), followed by preventive work (~33%) and forest fires (~20%). The most common injuries were tendonitis and muscle pain (~44% and ~21% respectively), followed by sprains (~21%). The results underline the need for physical activity programmes adapted to help wildland firefighters, especially older and more experienced individuals. The identification of risk factors such as age and work experience can contribute to the prevention and management of occupational injuries among this group of highly specialised forestry workers. Specific preventative measures during training are required to mitigate the risk of injury among these crews, who play a crucial role in protecting the environment and public safety.

The Influence of Emergency Call Volume on Occupational Workload and Sleep Quality in Urban Firefighters

OBJECTIVE

The aim of the study is to determine the impact of emergency call volume on exertion, autonomic activity, and sleep among urban structural firefighters.

METHODS

Thirty-four firefighters wore a wrist-based monitor to track sleep and autonomic parameters and rated their level of perceived exertion (Borg Rating of Perceived Exertion) and subjective sleepiness after a 24-hour shift. Predictive variables included total run time and total run time after 11:59 PM.

RESULTS

Total run time and sleep duration accounted for Borg Rating of Perceived Exertion and subjective sleepiness, while total run time and total run time after 11:59 PM accounted for sleep durations on-duty.

CONCLUSIONS

The current results suggest that emergency call volume is associated with indicators of exertion and sleep. As such, call volume tracking is an important consideration for departments to ensure personnel readiness and wellness and provide a method of tracking the occupational demands experienced by firefighters on-duty.

Resilience, job satisfaction, occupational stress, and occupational accidents among healthcare professionals: A Bayesian network analysis

BACKGROUND

Occupational accidents remain a critical challenge for healthcare professionals.

OBJECTIVE

In the present study, using the Bayesian network (BN) approach association among resilience, job satisfaction, stress, and occupational accidents among healthcare professionals is examined.

METHODS

Data was gathered using several valid questionnaires. The BN approach was utilized to analyze the r5/31/2024ionships between the variables of the current study. The performance of BN analysis was evaluated using related indexes.

RESULTS

In total, 300 healthcare professionals participated in this study. Results showed that almost 23% of healthcare professionals had experienced occupational accidents. Results of the sensitivity analysis demonstrated that job satisfaction had the most significant influence on occupational accidents in healthcare settings. The belief updating analysis results showed that by increasing job satisfaction and decreasing stress of healthcare professionals the occurrence of occupational accidents decreased 9.8% and 6.4%, respectively. Moreover, decreasing the stress of healthcare professionals can lead to an increase in the level of job satisfaction. Evaluation indexes showed that the performance of the developed BN was acceptable (error rate: 16.09).

CONCLUSION

The Findings reveal that both job satisfaction and stress had a significant influence on occupational accidents in healthcare professionals. Moreover, by influencing job satisfaction and stress, resilience can indirectly affect occupational accidents.

Relationships between job stress, post-traumatic stress and musculoskeletal symptoms in firefighters and the role of job burnout and depression mediators: a bayesian network model

INTRODUCTION

Job stress, post-traumatic stress disorder (PTSD), and negative psychological outcomes in firefighters can be caused, or aggravated, by their work. These mental disorders can impart musculoskeletal symptoms. This study aimed to investigate relationships between musculoskeletal and psychological disorders in a population of firefighters using a Bayesian network model.

METHODS

This cross-sectional study, conducted in 2022, included 2339 firefighters who completed questionnaires during their rest periods. The questionnaires comprised of demographical information, the Occupational Stress Questionnaire-HSE, the PTSD Checklist, Maslach Burnout Inventory, Center for Epidemiologic Studies - Depression scale (CES-D), and Nordic Musculoskeletal Questionnaire. GeNIe academic software was used to analyze the Bayesian network.

RESULTS

High job stress and high PTSD each increased the probability of musculoskeletal symptoms by 34%. When combined, high job stress and high PTSD increased the probability of musculoskeletal symptoms by 37%. Among the mediator's burnout and depression, depression had the highest association with musculoskeletal symptoms.

CONCLUSIONS

Job stress and PTSD can increase musculoskeletal symptoms and are influenced by psychological mediators (like burnout and depression). Adopting preventive and therapeutic measures to mitigate job stress and PTSD, mitigate and rehabilitate WMSD, and manage associated mediators are critical for the mental and physical health of firefighters.

Association of polycyclic aromatic hydrocarbon metabolite concentration in urine and occupational stress in underground coal miners in China: propensity score and bayesian kernel machine regression

This study intends to examine the association of urinary monohydroxyl PAHs (OH-PAHs) concentration and occupational stress in coal miners. We sampled 671 underground coal miners from Datong, China, assessed their occupational stress using the Occupational Stress Inventory-Revised edition (OSI-R), and categorized them into the high stress miners and controls based on that. We determined urinary OH-PAHs concentration using ultrahigh performance liquid chromatography-tandem mass spectrometry, and analyzed its association with occupational stress using multiple linear regression, covariate balancing generalized propensity score (CBGPS), and Bayesian kernel machine regression (BKMR). The low molecular weight (LMW) OH-PAHs in quartile or homologue was significantly positively associated with Occupational Role Questionnaire (ORQ) and Personal Strain Questionnaire (PSQ) score, but was not associated with Personal Resources Questionnaire (PRQ) score. The OH-PAHs concentration was positively associated with ORQ and PSQ scores in coal miners, particularly the LMW OH-PAHs. Non-association was found in the OH-PAHs with PRQ score.

Heat strain of Japanese firefighters wearing personal protective equipment: a review for developing a test method

The aim of this review was to develop a test method for the evaluation of heat strain for structural firefighters wearing personal protective equipment (PPE) in Japan. We analysed a series of our laboratory's questionnaires and experimental studies and reviewed international standards on test methods. We investigated the actual average working conditions (total firefighting time on one incidence, working time with full PPE, maximum temperature and humidity during firefighting) at structural firefighting site in Japan by conducting a large-scale questionnaire survey of Japanese firefighters. We discussed test subjects (firefighters vs. non-firefighters; body size; physical fitness), exercise intensity (absolutes vs. relative; light vs. heavy) and duration, experimental temperature and relative humidity, experimental clothing items including station uniforms (shorts vs. long), and measurement variables (physiological and subjective responses), and suggested a standard test method to evaluate the heat strain of firefighters in hot and humid environments.Practitioner summary: We reviewed studies on human wear trials of firefighting personal protective equipment (PPE) in hot environments and suggested a standard test method to evaluate the heat strain of firefighters. The test method can be internationally utilised to examine the comfort functions and heat stress of PPE in hot, humid environments.

Examining the effect of safety climate on accident risk through job stress: a path analysis

BACKGROUND

Job stress is a probable mediator of the relationship between safety climate and accident occurrence. To demonstrate this, this study investigates the relationship between safety climate, job stress, and accident risk using a large number of surveys. The study will use structural equation modeling (SEM) to analyze the data collected from the surveys to examine the effect of safety climate on accident risk through job stress.

METHODS

The study is a cross-sectional study that was conducted on 1,530 male workers of a petrochemical company. The subjects were asked to complete several questionnaires during rest periods, which included demographic information, the Nordic safety climate questionnaire (NOSACQ-50), and the generic job stress questionnaire (GJSQ). Additionally, data on the frequency and intensity of accidents among participants were gathered from the health unit of the company. Path analysis was conducted by structural equation modeling (SEM) in Analysis of Moment Structures (AMOS) software.

RESULTS

The results revealed that the latent variable of safety climate with an effect coefficient of - 0.112 did not have a direct effect on accident risk (P = 0.343). However, safety climate with an effect coefficient of - 0.633 had an indirect effect on accident risk through job stress (P < 0.001). The total score of job stress had a significant direct effect (0.649) on accident risk (P < 0.001). Among the dimensions of safety climate, the variables of management's safety priority, commitment, and competence (- 0.108) and workers' safety commitment (- 0.107) had the highest indirect effect coefficients on accident risk. Among the dimensions of job stress, the highest indirect effects belonged to the variables of conflict at work (0.636), physical environment (0.631), and workload and responsibility (0.631), respectively.

CONCLUSION

The results of the study revealed that job stress mediates the relationship between safety climate and accident risk. This finding suggests that organizations can potentially decrease accidents in industries by addressing and managing job stress in the workplace.

Behavioral Health and Stress in Agriculture

Behavioral health and stress are often antecedents to chronic health problems and injury; however, until recently addressing health and safety issues from a behavioral perspective has received little treatment. In this article, we review the current state of behavioral health and stress in agriculture, examine current trends to address this stress, identify gaps still to be filled and make recommendations for future efforts.

Do employees' work schedules put them at-risk? The role of shift scheduling and holidays in predicting near miss and incident likelihood

INTRODUCTION

Using crew scheduling and injury incident data from a Fortune 500 manufacturing company, this study analyzed the effect of consecutive shifts and shifts near holidays on near misses and incidents.

METHODS

Logistic regressions were conducted with consecutive workdays, days near holidays, and time of shift as predictors of incident and near miss outcomes.

RESULTS

The logistic regression analysis indicated that working consecutive day shifts increases the probability of an incident occurring, with the fourth consecutive shift resulting in the most risk. The consecutive shift pattern did not replicate to employees working the night shift. However, the first and second shifts when transferring to a night schedule appear to have a greater chance of incident. Shifts near holidays did not have a significantly higher risk than other shifts.

PRACTICAL APPLICATION

The current research suggests that organizations can use similar analytic techniques to determine if shift scheduling might be related to increased risk and allocate resources to mitigate hazards during those peak probability shifts.

Firefighters' Health Knowledge, Cardiovascular Disease Risk Factors, and Sociodemographic Characteristics as Predictors of Firefighters Attitudes Toward Health

OBJECTIVE

The aim of the study is to determine the predictors of firefighters' attitudes toward health based on firefighters' knowledge cardiovascular disease (CVD) risk factors and sociodemographic characteristics.

METHODS

The study used a web-based cross-sectional, descriptive, and correlational research design. Convenience sampling was used to recruit 110 firefighters, males, and females, aged 18 to 65 years.

RESULTS

Firefighters' health knowledge, age group 30 to 39 years, and having CVD risk factors present were significant predictors of firefighters' attitudes toward regular aerobic exercise ( P < 0.05). Firefighters' health knowledge was a significant predictor of firefighters liking exercise to look physically fit, and health knowledge and the age group 20 to 29 and 30 to 39 years were significant predictors of firefighters liking exercise to be fit for firefighting ( P < 0.05).

CONCLUSIONS

Health knowledge, age group, years of experience, and having CVD risk factors present were significant predictors of firefighters' attitudes toward health.

Linking mental health to safety behavior in construction workers: The mediating effect of work ability and sleep quality

BACKGROUND: The severity of occupational accidents and injuries in the construction industry is the greatest across all industries. Few studies have examined the causal relationships among physical and psychological variables affecting the safety behavior of construction workers. OBJECTIVE: This study aimed to investigate the relationships among three factors (metal health, work ability and sleep quality) influencing the safety behavior of construction workers. METHODS: This cross-sectional study was conducted on 204 workers in civil construction projects in Iran. The data were gathered via self-reporting questionnaires. The acquired data were analyzed by the Smart PLS3 software using structural equation modeling with the partial least squares (PLS) regression approach. RESULTS: The R square revealed an acceptable fineness of the structural model. Similarly, as Q square values were higher than 0.15 for all factors, the predictability of the model was approved. The direct effect of mental health on safety behavior was not significant, but work ability and sleep quality had significant direct effects on safety behavior. Moreover, a decrease in mental health significantly reduced construction workers’ sleep quality and work ability. CONCLUSION: The results of this study prove that sleep quality and work ability mediate the relationship between mental health and safety behavior. The deterioration of construction workers’ mental health can increase the risk of unsafe behavior and occupational injuries. Therefore, appropriate measures need to be taken to maintain and improve the mental health of construction workers.

Exercise and Occupational Stress among Firefighters

The aim of our study was to evaluate the potential association between physical activity and occupational stress among firefighters. Data were collected from Cypriot firefighters through a web-based battery of internationally validated questionnaires completed anonymously (COPSOQ, DASS). A total of 430 firefighters (response rate 68%) completed the survey (age range: 21-60 years). More than half of the firefighters (54%) reported either no or minimal physical activity. A total of 11% of firefighters reported moderate to extremely severe stress based on the DASS-S scale. Using multivariable-adjusted logistic regression models, we showed that firefighters who exercised had 50% lower risk of occupational stress, and using a categorical model, we found that every hour per week of increased physical activity among firefighters was associated with 16% lower risk of occupational stress after adjusting for age, education, smoking, and body mass index (OR = 1.16; p = 0.05). In addition, our findings suggest an inverse dose-response relationship between physical activity and occupational stress among firefighters. Physical activity appears to be inversely associated with occupational stress and serves as an important mitigating factor of occupational stress in firefighters. Further research is warranted to evaluate the potential effect of exercise interventions on occupational stress, and the overall mental health of firefighters and other occupational groups.

Relationship Between Physical Activity, Coronary Artery Disease Risk Factors and Musculoskeletal Injuries in the City of Cape Town Fire and Rescue Service

Musculoskeletal injuries in firefighters are a common occurrence, that increase as firefighters age, and may be related to the firefighters’ physical activity habits outside of the job. Certain CAD risk factors, such as obesity, cigarette smoking and ageing may be linked to increased injury risk in firefighters. Although firefighters may meet the recommended minimum physical activity minutes, they may remain at risk for sustaining musculoskeletal injuries. Therefore, this study aims to determine the relationship between physical activity and CAD risk factors, between CAD risk factors and musculoskeletal injuries and between physical activity and musculoskeletal injuries. A total of 124 full-time firefighters, males and females, were conveniently recruited from the City of Cape Town Fire and Rescue Service. A researcher-generated questionnaire was used to collect injury, CAD risk factor and physical activity data. The proportion of firefighters who participated in leisure-time physical activity (LTPA) was 63.7%, and those who were physically inactive was 69.4%. The prevalence musculoskeletal injuries among all firefighters was 27.4%. The most prevalent musculoskeletal injury was shoulder injuries in 35.3% of firefighters, followed by multiple injuries in 26.5% and back injuries in 14.7%. Age was a significant predictor of physical inactivity in firefighters [P = .002, OR = 1.08], BMI was a significant predictor of physical inactivity [P = .050, OR = 1.08], cigarette smoking was a significant predictor of firefighters not exercising [P = .007, OR = 2.31] and the total amount of vigorous-intensity exercise was a significant predictor of musculoskeletal injuries [P = .050, OR = 1.00]. In conclusion, older firefighters were more physically inactive and had a higher prevalence of musculoskeletal injuries, and the latter decreased significantly after the age of 50 years. Emphasis should be placed on firefighters exercising in their leisure-time, especially as they aged.

Occupational stressors and work accidents among health workers

OBJECTIVE

To test the association between occupational stressors and work accidents due to exposure to biological material (ATbio) in health workers, considering the isolated and combined analysis of the dimensions of two models, the demand-control model (DCM) and the effort-reward imbalance model (ERI).

METHODS

Cross-sectional study in a representative sample of workers with higher, technical and secondary education, including health agents from primary and medium-complexity care units in five cities in Bahia. Random sampling was selected, stratified by geographic area, level of service complexity and occupation. The outcome variable was ATbio; The main exposure was occupational stressors, assessed by the DCM and ERI. Incidences and relative risks were estimated as a function of the acute, short-term nature of the outcome of interest. Associations between ATbio and isolated and combined DCM and ERI dimensions were tested.

RESULTS

A total of 3,084 workers participated in the study. The global incidence of ATbio was 3.4% and was associated with high psychological demand, high effort and high commitment to work, adjusted for sex, age, education and work shift. High-strain work and a situation of imbalance between efforts and rewards were associated with ATbio. With the combination of the models, an increase in the measure of association with the outcome was observed. Significant associations of greater magnitude were observed in the complete combined models. ATbio’s risk was 5.23 times higher among those exposed in both complete models compared to the absence of exposure in both models.

CONCLUSIONS

Occupational stressors were associated with ATbio. Advantages in using the combined models were observed. The approach of different psychosocial dimensions has expanded the ability to identify exposed groups, offering a solid basis for interventions for ATbio’s prevention in health.

Feasibility, Acceptability, and Preliminary Efficacy of an App-Based Meditation Intervention to Decrease Firefighter Psychological Distress and Burnout: A One-Group Pilot Study (Preprint)

Background

Firefighters are often exposed to occupational stressors that can result in psychological distress (ie, anxiety and depression) and burnout. These occupational stressors have only intensified with the onset of the COVID-19 pandemic and will likely persist in the postpandemic world.

Objective

To address occupational stressors confronting firefighters, we pilot tested a novel, cost-effective, smartphone app–based meditation intervention created by Healthy Minds Innovations that focused on mindfulness (awareness) training along with practices designed to cultivate positive relationships (connection), insight into the nature of the self (insight), and a sense of purpose in the context of challenge (purpose) with a sample of professional firefighters from a large metropolitan area in southwestern United States.

Methods

A total of 35 participants were recruited from a closed online group listserv and completed the self-guided 10-unit meditation app over the course of 10 days, at 1 unit per day. We assessed anxiety symptoms, depression symptoms, burnout, and negative affect as well as saliva diurnal cortisol rhythm, an objective indicator of stress-related biology, before and after use of the meditation app.

Results

This study demonstrated the meditation app was both feasible and acceptable for use by the majority of firefighters. We also found significant reductions in firefighters’ anxiety (P=.01), burnout (P=.05), and negative affect (P=.04), as well as changes in cortisol diurnal rhythm, such as waking cortisol (P=.02), from before to after use of the meditation app.

Conclusions

Our study findings call for future research to demonstrate the efficacy of this meditation app to reduce psychological distress and burnout in firefighters.

Effect of Joint Exposure to Psychosocial and Physical Work Factors on the Incidence of Workplace Injuries: Results From a Longitudinal Survey

OBJECTIVE

To analyze the interaction between physical and psychosocial work factors regarding the workplace injuries incidence among 6900 workers out of a longitudinal survey.

METHODS

Based on responses to questionnaires, we obtained exposure groups respectively for physical factors and for psychosocial factors using hierarchical clustering. We performed multiple Poisson regression model with the workplace injuries incidence during 4 years of follow-up as the outcome and the clusters as the independent variables of interest.

RESULTS

High psychosocial exposure had a deleterious effect on workplace injuries incidence, which was no longer significant when adjusting for physical factors. The difference in model-based workplace injuries rates between high and low psychosocial exposures seemed to increase (non-significantly) with increasing physical exposure.

CONCLUSIONS

The risk of workplace injuries was highest among workers with high physical exposures regardless of the psychosocial exposures.

The relations of job stress dimensions to safety climate and accidents occurrence among the workers

Based on a literature review, likely, there is a relationship between job stress and safety climate, and in this way, the accident occurrence is affected. Therefore, the present study was aimed to investigate the relations of job stress dimensions to safety climate and accidents occurrence among the workers using regression models. This cross-sectional study was carried out on 1530 male employees in 2019. People were randomly selected from various departments. The participants filled out the questionnaires, including demographical information and accident history questionnaire, the NIOSH generic job stress questionnaire, and the Nordic safety climate questionnaire. In addition, information on occupational experience and accident history was obtained from the health unit of the petrochemical company. In the end, data were analyzed using statistical tests of bivariate correlation, multivariate correlation, and logistic regression. Based on the bivariate analysis, the variables of job satisfaction (0.998), problem at work (0.900), depression (-0.836), and physical environment (-0.796) among the job stress dimensions had the highest correlation coefficients with the total score of the safety climate, respectively. The results of the logistic regression analysis with the adjustment of the effect of the safety climate indicated that the relationships between the dimensions of the job satisfaction (Wald = 6.50, OR = 4.96, and p-value<0.05) and social supports (Wald = 5.88, OR = 3.20, and p-value<0.05) with the accident occurrence were significant. To increase the positive safety climate and decrease the accident occurrence, industries must try to reduce job stress in the workplaces through controlling the important factors, such as low job satisfaction and poor social supports.

Work-Related Musculoskeletal Disorders Among Hospital Midwives in Chenzhou, Hunan Province, China and Associations with Job Stress and Working Conditions

Background

Midwives have a high risk of work-related musculoskeletal disorders (WMSDs), which are the leading cause of pain and disability. However, the association between job stress and WMSDs among midwives has not been studied. The aim of this project was to specifically describe relationships between the job stress and WMSDs among a sample of hospital midwives in Chenzhou, Hunan Province, China.

Methods

We conducted a cross-sectional study among a sample of 769 eligible midwives in the city of Chenzhou in Hunan Province, China from May 2018 to January 2019. All participants completed a questionnaire regarding the presence and severity of different pain symptoms and job stress assessed by the Korean occupational stress scale.

Results

A total of 597 participants responded (77.6%), and 491 (82.2%) reported that they had experienced WMSDs at some time over a 12-month period. The most common pain site was low back (72.7%), followed by the neck (52.8%) and shoulders (42.7%). We revealed that various aspects of job stress were associated with WMSDs in the current study, namely “Owing to my workload, I always feel time pressure” (OR, 2.05; 95% CI: 1.28–3.28), “My job has become increasingly overbearing” (OR, 2.34; 95% CI: 1.46–3.77), “My work requires long lasting concentration” (OR, 3.50; 95% CI: 2.13–5.74), “I have to do various jobs simultaneously”, (OR, 3.15; 95% CI: 1.93–5.14)), “My work requires creativity” (OR, 2.15; 95% CI: 1.31–3.54), “My work requires a high level of skill or knowledge” (OR, 2.83; 95% CI: 1.67–4.80), “My supervisor is helpful in getting the job done” (OR, 0.53; 95% CI: 0.33–0.84), “I have someone who understands my difficulties at work” (OR, 0.53; 95% CI: 0.34–0.85), “Undesirable changes (ie, downsizing) will come to my job” (OR, 3.28; 95% CI: 2.01–5.77), “My company provides me with sufficient organizational support” (OR, 0.47; 95% CI: 0.29–0.74), “Departments cooperate each other without conflicts” (OR, 0.50; 95% CI: 0.32–0.80), “I am provided with the opportunity to develop my capacity” (OR, 0.57; 95% CI: 0.36–0.91) and “My company climate is authoritative and hierarchical” (OR: 3.21; 95% CI: 1.97-5.23).

Conclusion

Overall, this study suggests that job stress has an important influence on WMSDs among a sample of hospital midwives in Chenzhou, Hunan Province, China. Given the multifaceted nature of identified risk, a comprehensive approach to reduce this risk is clearly required and a job stress management program will be essential.

Prevalence of chronic lower back pain in Brazilian military firefighters

Objectives. Lower back pain (LBP) is a common health problem worldwide, affecting an increasing number of individuals. Military firefighters (MFFs) face high levels of physical and psychological demands and are commonly exposed to different occupational risk factors. This study aimed to estimate the prevalence of chronic lower back pain (CLBP) in Brazilian enlisted MFFs. Methods. This cross-sectional study was carried out at the Military Firefighters Department of the Brazilian Federal District (Corpo de Bombeiros Militar do Distrito Federal [CBMDF]). The estimated sample size was 608 MFFs. Results. Of the 623 participants, 575 valid and complete questionnaires were analyzed. A total of 183 participants reported CLBP, indicating a point prevalence of 31.8% (95% confidence interval [CI] [28.2, 35.4]). The prevalence of acute and subacute LBP was 9.2% (95% CI [7.1, 11.9]), and 59% (95% CI [54.9, 62.9]) reported no back pain. CLBP was more common among men aged 40-49 years, who were insufficiently active and overweight. Conclusion. Around one-third of the study population reported CLPB. Prevalence estimates of CLPB were greater among men and those between 40 and 49 years old. Our data support the need for programs to prevent and treat CLBP among firefighters.

A Behavioral-Analytic Model for Assessing Stress in Firefighters

Research has documented a number of acute and chronic stressors unique to the fire service. Due to the rise in mental health concerns in firefighters, there has been increased awareness of the negative effects of unmanaged stress. The present study employed a behavioral-analytic model to construct a brief screening measure of stress for this population: the Firefighter Assessment of Stress Test (FAST). Psychometric properties of the FAST were evaluated using data from active-duty firefighters throughout the United States. Results indicated the FAST has good internal reliability (α = 0.89), as well as good convergent and discriminant validity. Also, the factor structure of the FAST revealed three significant subscales reflective of stress associated with responding to calls, administrative difficulties, and being overworked. Scoring and interpretation guidelines were established to suggest when further assessment is warranted. The FAST offers a brief and valid method of self-assessment of current stress levels in firefighters. Information obtained from the FAST (i.e., overall stress level and domains) has the potential to facilitate more immediate identification and recognition of stress in firefighters than what has been possible to date. Moreover, heightened awareness of stress and its effects will hopefully culminate in expanded efforts directed toward stress reduction and intervention for firefighters and their families.

The effect of a mental health promotion program on Korean firefighters

BACKGROUND

There is worldwide interest in the mental health of firefighters, since they are more prone to exposure to traumatic stress and psychiatric disorders.

AIMS

This study aimed to assess their mental health and provide individualized support to local firefighters through a mental health promotion program.

METHOD

Eighteen hundred and fifty-nine active Korean firefighters in 2015 and 2017 (502 and 1,357, respectively) participated in the 'Visiting Counselling Centre for Firefighters' program commissioned by the National Fire Agency. The program consisted of self-administered questionnaires, a group education session, an individual counseling session for every participant, four counseling sessions for certain participants and additional brief intensive counseling (BIC). We administered the Post-traumatic stress disorder Checklist (PCL), Beck's Depression Inventory (BDI), Beck's Anxiety Inventory (BAI), Beck Scale for Suicidal ideation (BSS), Insomnia Severity Index (ISI), Korean version of the Alcohol Use Disorders Identification Test (AUDIT-K) and the abbreviated World Health Organization Quality of Life (WHOQOL-BREF) before and after the program. Additional analysis was performed to determine whether BIC participation further improved the psychopathological outcome.

RESULTS

The participants showed meaningful improvement in all psychopathological scales; the PCL, BDI, BAI, BSS, ISI, AUDIT-K and WHOQOL-BREF scores all significantly improved. Meanwhile, BIC participation improved certain psychopathological symptoms at a higher degree; the BDI, BAI, BSS and AUDIT-K scores significantly improved.

CONCLUSION

The mental health promotion program improved the mental health of the participating active firefighters in Korea. Meanwhile, BIC participation improved certain psychopathological symptoms at a higher degree. A comprehensive approach for supporting the mental health of firefighters should be considered.

Association of work-life balance with occupational injury and work-related musculoskeletal pain among Korean workers

Background

The concept of work-life balance (WLB) has become an important issue in workers' health and safety. This study aims to investigate the relationship between WLB and occupational injury and work-related musculoskeletal pain.

Method

The study included 27,383 workers who participated in the Fifth Korean Working Conditions Survey. Participants were divided into good WLB and poor WLB groups based on their responses to the five question items which comprised two dimensions: work-on-life conflict (items, 1–3) and life-on-work conflict (items 4 and 5). Occupational injury and musculoskeletal pain were also assessed using the question items. The χ² test and multivariate logistic regression analyses were performed to examine the relationship of WLB to occupational injury and musculoskeletal pain while considering socio-demographic and occupational characteristics and ergonomic and psychological risk factors.

Results

Of the 27,383 participants, 252 (0.9%) had experienced an occupational injury and 6,408 (23.4%) had musculoskeletal pain. The poor WLB group had higher injury rates for both men (1.7%) and women (0.9%) than the good WLB group (1.1% and 0.4%, respectively). Additionally, the prevalence of musculoskeletal pain was higher for both men and women in the poor WLB group (25.2% and 28.0%, respectively) than for men and women in the good WLB group (18.7% and 23.6%, respectively). In the logistic regression analysis, the adjusted odds ratio of WLB for occupational injury was 1.37 (95% confidence interval [CI]: 1.06–1.78), and that for musculoskeletal pain was 1.14 (95% CI: 1.07–1.21), showing positive associations of WLB with both occupational injury and musculoskeletal pain.

Conclusions

Poor WLB causes an increase in occupational injury and musculoskeletal pain. Therefore, an improvement in WLB may reduce the incidence of occupational injury and musculoskeletal pain among workers. Social and policy-related initiatives are needed to improve workers' WLB to reduce occupational injury and musculoskeletal pain.

Occupational stressors among firefighters: application of multi-criteria decision making (MCDM)Techniques

Background

Firefighters are exposed to a wide range of occupational stressors due to the nature of their job. Multi-criteria decision-making technique (MCDM) is a method for identifying, evaluating, and preventing occupational stressors among firefighters. The purpose of this study was to identify and prioritize the occupational stressors among firefighters using the fuzzy delphi method (FDM) and fuzzy analytical hierarchy process (FAHP).

Methods

This qualitative-descriptive study was carried out in two stages. First, the most important occupational stressors of firefighters were identified and screened using a systematic review of scientific references and expert opinions based on the FDM. Then, all of the screened stressors were weighted and prioritized by the FAHP using the opinions of experts. All results were analyzed using Excel software.

Results

Among, the 52 occupational stressors of firefighters identified in the first stage, 27 stressors were selected to enter into the FAHP. The FAHP results showed that among the four main dimensions, the weight of managerial factors (0.358) was more than other dimensions. The overall result of the study, regardless of the stressors' main dimensions showed that the most important stressors among firefighters were financial strain due to inadequate pay, fear of explosion at incident scenes, toxic smoke, and gases produced at fires and lack of attention given to job safety by management, respectively.

Conclusion

According to the results of the study, most occupational stressors of the firefighters are caused by organizational factors. Therefore, the implementation of management strategies to reduce the occupational stress of firefighters is recommended.

Cohort Profile: Firefighter Research on the Enhancement of Safety and Health (FRESH), a Prospective Cohort Study on Korean Firefighters

Firefighters have a high risk of developing cardiovascular and mental disorders due to their physical and chemical environments. However, in Korea, few studies have been conducted on environmental risk of firefighters. The Firefighter Research on the Enhancement of Safety and Health (FRESH) study aimed to discover the risk factors for cardiovascular disease and mental disorders among firefighters. Former and current firefighters were recruited from three university hospitals. A total of 1022 participants completed baseline health examinations from 2016 to 2017. All participants were scheduled for follow-ups every 2 years. Baseline health survey, laboratory testing of blood and urine samples, blood heavy metal concentration, urine polycyclic aromatic hydrocarbons (PAHs) metabolites, stress-related hormone test, natural killer cell activity, as well as physical and mental health examinations that focused on cardiovascular and mental disorders, were conducted. In addition, 3 Tesla (3T) brain magnetic resonance imaging (MRI) and neuropsychological tests were also performed to investigate structural and functional changes in the brains of 352 firefighters aged >40 years or new hires with less than 1 year of service.

Prevalence and correlates of suicidal ideation in Korean firefighters: a nationwide study

BACKGROUND

It is generally known that firefighters are at increased risk of suicide. However, the prevalence and correlates of suicidal ideation in firefighters have not been thoroughly described to date. The aim of this study was to measure the 1-year prevalence of suicidal ideation in firefighters and to investigate the correlates of past-year suicidal ideation among the demographic, occupational and clinical characteristics.

METHOD

A web-based survey was conducted using a self-reported questionnaire. A total of 45,698 Korean firefighters were included for analysis. The prevalence of suicidal ideation in the past year was calculated and its correlates were elucidated using a multivariable logistic regression analysis.

RESULTS

The 1-year prevalence of suicidal ideation was 10.66% in Korean firefighters. Recent traumatic experience, high levels of occupational stress from physical work environment and emotional labor, as well as current duty of officer were significant correlates of suicidal ideation in the previous year, even after controlling for the effects of PTSD and depressive symptoms. With respect to demographic factors, female gender and marital status of divorced/separated/widowed were identified to be associated with suicidal ideation in the previous year among firefighters.

CONCLUSIONS

The 1-year prevalence of suicidal ideation was high in Korean firefighters and was associated with various occupational factors as well as psychiatric symptoms. Early detection and management of these risk factors could reduce the risk of suicidal ideation in firefighters.

Two-month point prevalence of exposure to critical incidents in firefighters in a single fire service

BACKGROUND

Firefighters have high rates of exposures to critical events that contribute to physical and mental stress, resulting in high rates of injury and work-injury compensation claims.

OBJECTIVE

To determine the prevalence of critical incidents in firefighters from a single fire service, and whether the number of critical events varied based on age, gender, years of service and/or rank.

METHODS

We recruited 300 full-time firefighters. Firefighters were asked to complete a self-report Critical Incident Inventory survey that included questions on exposure to critical events during firefighting duties, with a time reference point of the past two months.

RESULTS

Among the 293 firefighters, 252 (85%) indicated exposure to some type of critical incident. More specifically, 187 (64%) reported a respond to incident involving one or two deaths, 155 (53%) indicated a direct exposure to blood and body fluids, and 98 (33%) reported a response to an incident involving multiple serious injuries. Age, gender, years of service and rank accounted for only 1% of the variance in the number of critical incidents among firefighters.

CONCLUSIONS

In this study, 85% of firefighters had been exposed to some type of critical incident in the previous 2-months and this did not vary by age, gender, years of service and/or rank.

Twenty-four-hour pattern of operations-related injury occurrence and severity of off-site/on-call volunteer French firefighters

We assessed the 24-h pattern of operations-related injuries (ORI) experienced by scheduled off-site/on-call French volunteer firefighters (VFF) through analysis of an archival database. Occurrence and severity - evaluated by number of lost work days (LWD) and total medical costs (TMC) - of ORI were explored in terms of risk ratios, respectively, number of ORI/number of service operations (RR_ORI), number of LWD/number of ORI (RS_LWD,) and TMC/number of ORI (RS_TMC). Additionally, the collective work performance of all involved VFF was measured in terms of the lag time (LT) between emergency call-center firefighter-answered communication for service of observer-presumed out-of-hospital cardiac arrest (OHCA) and departure of vehicle from fire station to render aid, designated LT_OHCA. Cosinor and cross-correlation statistical methods were applied. A total of 252 ORI occurred while performing 146,479 service operations. High-amplitude 24 h variation was detected in RR_ORI (p < .003), SR_LWD (p < .001), SR_TMC (p < .012), and LT_OHCA (p < .001), all with nocturnal peak time. Coherence was found between the day/night variation of LT_OHCA and RR_ORI (r = 0.7, p < .0002), SR_LWD (r = 0.5, p < .02), and SR_TMC (r = 0.4, p < .05). This investigation verifies the occurrence and severity of ORI of scheduled off-site/on-call VFF exhibit high-amplitude 24 h patterning with nocturnal excess that closely coincides with their day/night work performance measured by LT_OHCA. These findings, which are essentially identical to ones of a previous study entailing on-site/on-call career firefighters, indicate the need for fatigue management and ORI prevention programs not yet available to VFF, who compose the majority of the field service workforce of French fire departments. Abbreviations:FF: firefighters; CFF: career firefighters; VFF: volunteer firefighters; FD: fire department; LT_OHCA: lag time (LT) response in min:sec between fire department call-center-answered communication for service of presumed out-of-hospital cardiac arrest (OHCA) and departure from fire station of vehicle to render aid; LWD: lost work days; ORI: operations-related injuries; SR_LWD: severity ratio of operations-related injuries in terms of number of lost work days, calculated as number of lost work days/number of operations-related injuries; RR_ORI: risk ratio of operations-related injuries calculated as number of operations-related injuries/number of operations; SR_TMC: severity ratio of operations-related injuries in terms of total medical costs, calculated as total medical costs/number of operations-related injuries; TMC: total medical costs.

Alcohol use disorders and insomnia mediate the association between PTSD symptoms and suicidal ideation in Korean firefighters

BACKGROUND

There has been a strong association between posttraumatic stress disorder (PTSD) and suicidal ideation, which are both major mental health concerns in firefighters. Alcohol use disorders (AUDs) and insomnia are linked with both PTSD and suicidal ideation, but no studies have examined whether the relationship between PTSD and suicidal ideation can be explained by AUDs and insomnia. The purpose of this study was to investigate the mediating role of AUDs and insomnia in the relationship between PTSD symptoms and suicidal ideation.

METHODS

A total of 7190 Korean firefighters filled out self-reported questionnaires to assess the number of exposure to incident stressors and the severity of PTSD symptoms, suicidal ideation, AUDs, and insomnia. Hierarchical multivariable linear regression analyses were performed to identify the relationship of AUDs and insomnia with suicidal ideation. Path analyses were applied to investigate the mediation effects of AUDs and insomnia on the relationship between PTSD symptoms and suicidal ideation.

RESULTS

AUDs and insomnia showed significant associations with suicidal ideation, even after adjusting for demographic factors, number of traumatic events, and PTSD symptoms. The relationship between PTSD symptoms and suicidal ideation was partially mediated by AUDs and insomnia. AUDs also had both direct and indirect effects on suicidal ideation, with the indirect effect mediated by insomnia.

CONCLUSIONS

We presented a model in which AUDs and insomnia mediate the relationship between PTSD symptoms and suicidal ideation in firefighters. Efforts to treat AUDs and alleviate insomnia could be beneficial in minimizing suicidal ideation in firefighters.

Workplace psychosocial stressors experienced by migrant workers in Australia: A cross-sectional study

OBJECTIVE

To explore work-related psychosocial stressors among people of Chinese, Vietnamese and Arabic-speaking backgrounds currently working in Australia.

METHODS

In 2015, a telephone survey of 585 Vietnamese, Chinese and Arabic-speaking workers asked about workplace bullying, ethnic discrimination, job complexity, degree of control, security and fairness of payment along with demographic and employment information. Estimates of job-related psychosocial stressors were derived and regression analyses used to identify significant associations.

RESULTS

At least one workplace stressor was reported by 83% of the workers in the study. Education was significantly associated with experiencing any psychosocial stressor and also with the total number of stressors. Workers aged 45 years and older were more likely to be bullied or experience racial discrimination compared with younger workers of any ethnicity. There was a greater likelihood of reporting low control over a job when the interview was conducted in a language other than English and the workers were either Chinese or Arabic. Workers on a fixed-term contract, independent of ethnicity were more likely to report a job with low security. Overall psychosocial job quality decreased with education and was associated with occupation type which interacted with ethnicity and gender.

CONCLUSIONS

The results suggest that job-related psychosocial stressors are widespread but not uniform across ethnic groups. Further research into what drives differences in work experience for migrant groups would provide information to guide both employers and migrants in ways to reduce workplace psychosocial stressors.

Satisfaction with life and the risk of occupational injury

Background

Occupational injuries increase burden on society as well as personal health. Low satisfaction with life may not only increases the risk of occupational injuries directly, but also influences other factors that increase the risk of occupational injury. Along with previous studies on the risk of occupational injury, we sought to explore the relationship between satisfaction with life and occupational injury.

Methods

The study participants were 6234workers health screened at a university hospital in Incheon. Information on occupational injury and satisfaction with life scale (SWLS) was obtained in a self-report format. Participants were allocated to one of four SWLS groups; the dissatisfied group, the slightly dissatisfied group, the slightly satisfied group, and the satisfied group. The analysis was performed using the chi-square test primarily and by logistic regression adjusted for potential confounders.

Results

In men, the un-adjusted and adjusted odds ratios (ORs) of low satisfaction with life (SWLS< 20) were 1.98(CI1.55-2.53) and 1.81(CI 1.41-2.32), respectively. When the SWLS were divided into four groups, the adjusted ORs of the slightly satisfied (20-25), slightly dissatisfied(15-19), and dissatisfied(≤14) groups were 1.21, 1.72, and 2.70, respectively. That is ORs tended to increase linearly with decreasing SWLS score (p for trend < 0.001). In women, this relation was of borderline significance at best.When subjects were dichotomized based on SWLS scores, for males, the cured and adjusted RRs of occupational injury in the low satisfaction with life group were1.91 (95% CI: 1.50-2.42) and 1.66 (95% CI: 1.30-2.13), and for females, the adjusted-RR was marginally significant (1.67; 95% CI: 0.93-2.99).When subjects were divided into four groups by SWLS scores, adjusted RRs tended to increase linearly with decreasing SWLS score for males (slightly satisfied: 1.18, 95% CI: 0.77-1.82; slightly dissatisfied: 1.65, 95% CI: 1.08-2.52; dissatisfied: 2.22, 95% CI: 1.44-3.42; p for trend < 0.001) and for females (slightly satisfied: 1.17, 95% CI: 0.42-3.30; slightly dissatisfied: 1.56, 95% CI: 0.56-4.36; dissatisfied: 2.38, 95% CI: 0.84-6.74; p for trend = 0.040).

Conclusions

This study suggests that the risk of occupational injury was higher in workers not satisfied with life, and indicates attention to satisfaction with life may promote the health of workers.

Association between workplace discrimination and depressive symptoms among firefighters in South Korea

BACKGROUND

Workplace discrimination is associated with poor mental health. However, there is a lack of studies examining the effects of discrimination on depressive symptoms among firefighters.

METHODS

We analyzed a national cross-sectional survey of 6369 firefighters in South Korea. Workplace discrimination during the past year was measured and main reasons for the discriminatory experience (gender, birth region, age, education, field/office work, job division) were identified separately by gender and job division. Depressive symptoms during the previous week were measured by the CES-D11.

RESULTS

Overall, 30.3% of firefighters experienced workplace discrimination and the main reasons for discrimination differed by gender and job division. Firefighters who experienced workplace discrimination had a higher likelihood of depressive symptoms than those who did not after adjusting for potential confounders (PR: 1.73; 95%CI: 1.55, 1.92).

CONCLUSIONS

This finding suggests that experience of workplace discrimination could aggravate the mental health of firefighters who provide an important public service.

The mediation effect of PTSD, perceived job stress and resilience on the relationship between trauma exposure and the development of depression and alcohol use problems in Korean firefighters: A cross-sectional study

BACKGROUND

Firefighters constitute a high-risk group for depression and alcohol use disorders (AUDs) due to frequent exposure to trauma. Perceived job stress and resilience are powerful factors affecting the occurrence of depression and AUDs; however, research on this subject is scarce.

METHODS

We investigated the relationship of perceived job stress and resilience with depression or AUDs in firefighters. A total of 7151 Korean firefighters were included for analysis. Participants completed self-report scales, including a self-reported number of exposure to incident stressors, the Korean Occupational Stress Scale - Short Form, the Post-traumatic Stress Disorder (PTSD) Symptoms Checklist - Civilian version, the Patient Health Questionnaire 9, the Brief Resilience Scale, and the Alcohol Use Disorders Identification Test. Hierarchical multivariable linear regression analyses were performed to identify the relationship of perceived job stress and resilience with depression or AUDs. Path analyses were applied to investigate the mediation effects of PTSD, perceived job stress and resilience between trauma exposure and depression or AUDs.

RESULTS

There were significant associations of perceived job stress and resilience with depression and AUDs, respectively, even after adjusting for demographic factors, number of traumatic events, and PTSD symptoms. The relationship between trauma exposure and depression/AUDs was mediated by PTSD symptoms, which had both direct and indirect effects on depression and AUDs; indirect effect was mediated by job stress and resilience.

CONCLUSIONS

The findings in this study demonstrated that PTSD, perceived job stress and resilience can mediate the development of depression or AUDs following trauma exposure in firefighters. Efforts to prevent PTSD, reduce job stress and increase individual resilience could help prevent depression and AUDs.

LIMITATIONS

The cross-sectional study design and self-report nature of the assessment tools limit the current findings.

Do police officers and firefighters have a higher risk of disease than other public officers? A 13-year nationwide cohort study in South Korea

OBJECTIVES

The work of public officers involves repeated and long-term exposure to heavy workloads, high job strain and workplace violence, all of which negatively impact physical and mental health. This study aimed to evaluate and compare the incidences of diseases among different categories of public officers in Korea, in order to further understand the health risks associated with these occupations.

DESIGN

A cohort study using the National Health Insurance data.

PARTICIPANTS

We collated claims data between 2002 and 2014 for 860 221 public officers.

PRIMARY AND SECONDARY OUTCOME MEASURES

Age-standardised rates were calculated using the direct standardisation method, and HRs were calculated using the Cox proportional hazard regression models.

RESULTS

Overall, we found that police officers and firefighters had a higher incidence of a range of diseases when compared with national and regional government officers (NRG). The most prominent HRs were observed among police officers for angina pectoris (HR: 1.52, 95% CI 1.49 to 1.54), acute myocardial infarction (HR: 1.84, 95% CI 1.77 to 1.92) and cerebrovascular disease (HR: 1.36, 95% CI 1.31 to 1.40). Firefighters were more susceptible to physical ailments and were at a significantly higher risk for traumatic stress disorders (HR: 1.40, 95% CI 1.26 to 1.56) than NRGs.

CONCLUSION

Compared withNRGs, police officers had higher HRs for all measured diseases, except for traumatic stress disorders. While firefighters had higher HRs for almost all diseases examined, public education officers had a higher HR for traumatic stress disorders, when compared with NRGs.

Perceptions of health and cancer risk among newly recruited firefighters in South Florida

PURPOSE

Despite hazardous exposures to cancer-causing agents in the line of duty, the main health and safety concerns of active firefighters have yet to be studied. We compare the perceptions of health and cancer risks between rookie and experienced firefighters.

METHODS

Focus groups were used to investigate potential risk of job exposures, and broad-based concerns regarding work and health. An 18-item demographic survey was also administered. Five focus group sessions were conducted with a total of 57 firefighters.

RESULTS

Our findings indicate that both rookie and experienced firefighters have a "high risk, high reward" mindset and identify injury, chronic disease, and stress as main health concerns. Experienced firefighters reported a shift in firefighter culture related to health.

CONCLUSION

The perception of health and cancer risk of rookie and experienced firefighters differ in the prioritization of their concerns, however both groups equally report occupational cancer risk as their main health concern.

The association between perceived discriminations and well-being in Korean employed workers: the 4th Korean working conditions survey

Background

Around the globe, discrimination has emerged as a social issue requiring serious consideration. From the perspective of public health, the impact of discrimination on the health of affected individuals is a subject of great importance. On the other hand, subjective well-being is a key indicator of an individual’s physical, mental, and social health. The present study aims to analyze the relationship between Korean employed workers’ subjective health and their exposure to perceived discrimination.

Methods

The Fourth Korean Working Conditions Survey (KWCS, 2014) was conducted on a representative sample of the economically active population aged 15 years or older, who were either employees or self-employed at the time of interview. After removing inconsistent data, 32,984 employed workers were examined in this study. The data included general and occupational characteristics, perceived discrimination, and well-being. Well-being was measured through the WHO-Five index (1998 version). Multiple logistic regression analysis was used to examine the association between perceived discrimination and well-being.

Result

As a group, employed workers who were exposed to discrimination had a significantly higher likelihood of “poor well-being” than their counterparts who were not exposed to discrimination. More specifically, the workers exposed to age discrimination had an odds ratio(OR) of 1.51 (95% CI: 1.36–1.68), workers exposed to discrimination based on educational attainment had an OR of 1.43 (95% CI: 1.26–1.61), and workers exposed to discrimination based on employment type had an OR of 1.68 (95% CI: 1.48–1.91) with respect to poor well-being.

Furthermore, workers exposed to a greater number of discriminatory incidents were also at a higher risk of “poor well-being” than their counterparts who were exposed to fewer such incidents. More specifically, the workers with three exposures to discrimination had an OR of 2.60 (95% CI: 1.92–3.53), the workers with two such exposures had an OR of 1.69 (95% CI: 1.44–1.99), and the workers with one such exposure had an OR of 1.32 (95% CI: 1.20–1.45).

Conclusion

The present study found that discrimination based on age, educational attainment, or employment type put workers at a higher risk of “poor well-being,” and that the greater the exposure to discrimination, the higher the risk of poor well-being.