Falls among union carpenters

BACKGROUND: Falls are a leading cause of morbidity and mortality in the construction trades. METHODS: We identified a cohort of 16,215 active union carpenters, hours worked, and their workers' compensation claims for a 10-year period. The data on this well-defined cohort were used to describe their work-related falls; to define rates of injury and the associated costs; and to identify high-risk groups. RESULTS: Same level falls occurred at a rate of 1.8/200,000 hours worked; falls from elevations at a rate of 2.3/200,000 hours worked. These injuries resulted in direct payments of 0.30 dollars per hour of work or 2.40 dollars per 8-hr day. Mean costs per fall increased with increasing age. Age was not associated with risk of falls from elevations; younger carpenters had modestly reduced rates of falls from the same level. Rates of falls decreased with increasing time in the union. Carpenters whose usual work involved drywall installation or residential work were at highest risk. CONCLUSIONS: Falls are a significant public health risk for carpenters and they are responsible for a significant burden of work-related injury costs. While there is a need for prevention of falls from elevations--through training, enforcement of fall protection regulations, improved safety climate, or engineering changes--there is also the need to prevent falls from lower elevations. Differences in risk likely reflect varying exposures and safety practices in different areas of carpentry, as well as training, experience, and job assignments based on longevity in the union.     

The impact of work-related musculoskeletal disorders on workers' caregiving activities

BACKGROUND: The purpose of the study was to describe and quantify the impact of work-related musculoskeletal disorders on workers' caregiving activities. METHODS: A cross-sectional study was conducted in which a telephone survey was administered to 187 lost-time workers' compensation claimants from Ontario, of whom 49.2% were women. Forty-eight percent of the injured workers were providing unpaid care prior to the injury. RESULTS: Injured workers providing caregiving reported an average reduction in time spent in caregiving activities of 5.5 hr/week, 8 months post-injury. A Sex X Return-to-work status ANCOVA was conducted with difference in caregiving hours as the dependent variable, and with the following covariates: Mean number of caregiving hours, comorbidities, site of injury, and education. Independent of weekly hours of caregiving, decreases in caregiving hours were significantly higher if the worker was a woman or had not returned to work. CONCLUSIONS: Work-related musculoskeletal disorders have a significant impact on workers' time spent in unpaid caregiving activities, an example of the social consequences of occupational injuries. Occupational and caregiving roles are limited by work-related disorders in a parallel fashion.     

Capture-recapture estimation of unreported work-related musculoskeletal disorders in Connecticut

BACKGROUND: Estimates of the extent of musculoskeletal disorders (MSD) are usually based upon workers' compensation reports, although recent reports indicate that there may be widespread under-reporting of MSD. METHODS: An estimate of the incidence of arm and hand work-related MSD was made using capture-recapture analysis of the overlap between state workers' compensation reports and physician reports in Connecticut for 1995. The resulting estimate was compared to a population-based survey of MSD. RESULTS: There was very small overlap between the two state injury reporting systems: 6.7% of 793 reported workers' compensation cases, or 8% of 661 physician's reports. The estimate for MSD not captured by either system was 13,285, resulting in 14,686 (95% CI: 9,733-18,453) total reported and non-reported cases. This compares to an estimate of 13,775 cases (95% CI: 8,800-18,800) based on a phone survey. CONCLUSIONS: This analysis points to substantial under-reporting of MSD in Connecticut: estimates of unreported cases exceed those officially reported by a factor of 11:1. The findings have an important bearing on injury prevention programs and policy making.     

The relationship of unions to prevalence and claim filing for work-related upper-extremity musculoskeletal disorders

BACKGROUND: Unionization has been found to be related to higher filing of workers' compensation (WC) claims, but the extent of the relationship and the relationships to other variables have not been previously reported. METHODS: Telephone interviews were conducted with both a population-based and WC-based samples of musculoskeletal disorder (MSD) cases. RESULTS: Workers at unionized facilities were 5.7 times (95% CI 2.5-13.1) more likely to file a claim for WC, despite a comparable rate of MSD cases. Higher filing was also associated with several measures of MSD severity (1.8-14.1 odds ratios), economic sector (OR = 10.1 for manufacturing), hourly (vs. salary) wages (OR = 2.6), and for having a personal physician (OR = 2.5). Unions appeared to have a protective effect on social effects of work-related MSD. CONCLUSIONS: Unions appear to improve filing of work-related MSD, particularly for less severe conditions. The higher filing does not appear to be a case of "moral hazard," but rather improved and earlier reporting, as is advocated by early intervention approaches to reducing MSD.     

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.     

Correlates of bone and blood lead levels in carpenters

In the course of a health screening for construction carpenters, 127 subjects underwent blood lead testing, administration of detailed questionnaires, and in vivo measurement of bone lead levels with a ¹⁰⁹Cd K-X-ray fluorescence (K-XRF) instrument. The mean age of subjects was 48.5 (SD = 9.8) years. Blood lead levels were low, with a mean of 8.2 (SD = 4.0) μg/dl. Bone lead levels had means of 9.8 (SD = 9.3) μg/g bone mineral for the tibia and 14.0 (SD = 13.8) μg/g bone mineral for the patella (which consist primarily of cortical bone and trabecular bone, respectively). In multivariate regression models, age was the dominant predictor of both tibia and patella bone lead, with years since last worked and welding/brazing contributing an additional small amount of influence over tibia bone lead, and carpet laying, paint stripping, and regular exercise contributing an additional small amount of influence over patella bone lead. Demolition, carpet laying, and alcohol ingestion were significant predictors of blood lead. We conclude that age is the most important predictor of bone lead levels among workers with intermittent exposures to lead; in addition, K-XRF is useful in generating hypotheses on additional factors that may influence lead burden.     

Occupational health consultation as a systematic approach to managing work-related musculoskeletal injuries

An intricate balance of health care and administrative decision-making is necessary to ensure the accurate confirmation of an employee's disability and appropriate accommodation of his/her work limitations. In this article, an occupational health consult process is presented describing the interplay between the health care team, the disabled employee's supervisor, and human resource specialists—each having a categorical interest in the status of the employee. The occupational health nurse plays a central role in the administrative coordination of this interaction which requires effective yet careful communication between members of the health care team and the employee's supervisor. He/she should work closely with the disability specialist to reach common objectives. When conducted properly, occupational health consultation facilitates early and successful return to work for many employees who have incurred physical disabilities while employed. The significance of occupational health consultation is evident in light of current legislation that places greater expectations on employers to make reasonable accommodations for employees with disabilities.     

Inpatient hospital care for work-related injuries and illnesses

BACKGROUND: The aim of this study was to compile nationally representative statistics describing inpatient hospital care for patients with work-related injuries and illnesses covered under workers' compensation (WC) insurance in the United States. METHODS: Three years of data (1997-1999) from the Nationwide Inpatient Sample (NIS) were used to describe WC inpatient stays with respect to patient and hospital characteristics, principal diagnoses, number and type of procedures provided, total charges, length of stay, and time from admission to administering of the principal procedure. RESULTS: Approximately 209,139 WC hospitalizations occurred annually, representing 0.62% of all inpatient admissions. The average total charge per WC hospitalization was 14,966 dollars. After adjusting for the type of diagnosis and other factors, WC hospital care was found to involve 13-24% more procedures, have a slightly longer (4%) length of stay, and take 23-54% less time from admission to the principal procedure than inpatient care for comparable diagnoses paid by other sources. Inpatient care for disc and spinal disorders paid by WC had 16% higher charges than similar non-WC cases. Three-year trends showed a steady decline in the number of WC hospitalizations between 1997 and 1999 but a sharp 16% rise in total charges per WC stay. CONCLUSIONS: This research provides an initial foundation for understanding the extent and nature of hospitalized care for injured workers in the US and identifying significant trends in the delivery of care.