Injury and Illness Costs in the Certified Safe Farm Study

CONTEXT: The Certified Safe Farm (CSF) intervention program aims to reduce occupational injuries and illnesses, and promote wellness to reduce health care and related costs to farmers, insurers, and other stakeholders. PURPOSE: To evaluate the cost effectiveness of CSF. METHODS: Farms (316) located in a 9-county area of northwestern Iowa were recruited and randomized into intervention and control cohorts. Intervention farms received occupational health screenings, health and wellness screening, education, on-farm safety reviews, and performance incentives. For both cohorts, quarterly calls over 3 years were used to collect self-reported occupational injury and illness information, including costs to the farmers and their insurers. FINDINGS: Annual occupational injury and illness costs per farmer paid by insurers were 45% lower in the intervention cohort ($183) than in the control cohort ($332). Although out-of-pocket expenses were similar for both cohorts, combined costs of insurance and out-of-pocket expenses were 27% lower in the intervention cohort ($374/year per farmer) compared to the control cohort ($512/year per farmer). Within the cohort of intervention farmers, annual occupational injury and illness cost savings were directly associated with on-farm safety review scores. Reported health care costs were $237 per farmer in the safest farms (those farms scoring in the highest tertile) versus $485 per farmer in the least safe farms (lowest tertile). CONCLUSIONS: Results suggest that farmers receiving the intervention had lower health care costs for occupational injuries and illnesses than control farmers. These cost savings more than cover the cost of providing CSF services (about $100 per farm per year).     

Development of an occupational illness and injury surveillance database for the electric energy sector

Currently available occupational injury and illness data for electric energy companies provide only overall summary rates. Specific information about types of injury or illnesses, rates by occupational or work environments, and injury costs and severity are generally not readily available. Relevant data such as personnel and claims information are frequently not integrated into a comprehensive health and safety surveillance system suitable for epidemiologic and health and safety research purposes. Epidemiological methods are valuable for identifying key risk factors for work-related injuries and illnesses and assessing their magnitude, as well establishing priorities for health and safety research. Application of such methods can result in long-term reductions in injury and illness rates and their attendant costs. Aggregation of relevant health and safety data across companies improves statistical power for the assessment of rare (yet costly) injuries or illness or specific at-risk subgroups within the electric energy sector. A pilot occupational injury and illness database has been developed that can incorporate and standardize data across a spectrum of companies of differing sizes and configurations. In illustrative data analyses, injury trends were summarized by company size, occupation, and demographic factors, among others. Trends observed in these illustrative analyses were consistent with results previously reported in the epidemiological literature, however, results are considered preliminary pending development of the full database. This study shows that development of a standardized surveillance occupational injury and illness database across companies with different database configurations is feasible. This database will ultimately provide a stable and accurate occupational health and safety assessment tool not currently available for this sector.     

Mexican Urban Occupational Health in the US: A Population at Risk

Mexicans are the largest immigrant group in the US. Little is known about their urban occupational health status. We assess occupational illness, injury, and safety training among New York City Mexican immigrants. This study is a consecutive sample of the Mexican immigrant population utilizing Mexican Consulate services in New York City over two weeks in March 2009. Bilingual research assistants approached persons waiting in line at the Consulate and administered an occupational health questionnaire. 185 people agreed to participate. Most work in restaurants (37%), cleaning (18%), construction (12%), babysitting/nanny (7%), retail (9%), and factories (5%). 22% had received safety training. 18% reported work-related pain or illness. 18% suffered from a job-related injury since immigrating. Most injuries were in construction, factories, and restaurants. 29% had not reported their injury. This study provides evidence that the urban Mexican immigrant population is at high risk for work-related illness and injury, is not receiving adequate safety training, and is under-reporting occupational injury. Culturally and linguistically responsive community outreach programs are needed to provide occupational health and safety information and resources for urban Mexican workers.     

Health risk factors and occupation among Iowa workers

BACKGROUND: Health behaviors represent major risks for premature morbidity and mortality. This study aimed to establish whether health risks varied substantially across occupational groups. METHODS: We focused on the 2223 Iowa Behavioral Risk Factor Surveillance System (BRFSS) subjects who reported, in 1999, that they were currently working. RESULTS: Even after controlling for age and gender, we found significant associations between occupation and health risk factors. We found these associations among the different categories of health risk factors, including insurance/access, health conditions, preventive behaviors, and screening behaviors. CONCLUSIONS: The considerable differences in the prevalence of risk factors for chronic disease and injury across occupational groups in Iowa underscore the need for nationwide ongoing collection of occupational status in the BRFSS. These national data on the distribution of risk factors across occupations will support development of more targeted prevention interventions.     

Comparing Occupational Health and Safety Management System Programming with Injury Rates in Poultry Production

Effective methods to reduce work-related injuries and illnesses in animal production agriculture are sorely needed. One approach that may be helpful for agriculture producers is the adoption of occupational health and safety management systems. In this replication study, the authors compared the injury rates on 32 poultry growing operations with the level of occupational health and safety management system programming at each farm. Overall correlations between injury rates and programming level were determined, as were correlations between individual management system subcomponents to ascertain which parts might be the most useful for poultry producers. It was found that, in general, higher levels of occupational health and safety management system programming were associated with lower rates of workplace injuries and illnesses, and that Management Leadership was the system subcomponent with the strongest correlation. The strength and significance of the observed associations were greater on poultry farms with more complete management system assessments. These findings are similar to those from a previous study of the dairy production industry, suggesting that occupational health and safety management systems may hold promise as a comprehensive way for producers to improve occupational health and safety performance. Further research is needed to determine the effectiveness of such systems to reduce farm work injuries and illnesses. These results are timely given the increasing focus on occupational safety and health management systems.     

Evaluation of a Multicomponent Workplace Health Promotion Program Conducted in Japan for Improving Employees' Cardiovascular Disease Risk Factors

BACKGROUND: The long-term effectiveness of multicomponent worksite health promotion programs targeting cardiovascular disease risk factors remains unclear in Japan. This study was conducted to evaluate the effectiveness of such a health promotion program consisting of a main program provided over 4 days and a follow-up program provided over 1 year. METHODS: The subjects of this randomized controlled trial were male employees working for a building maintenance company in Japan. The intervention group (n = 152) and the control group (n = 150) consisted of employees having abnormal findings in at least one of the following items at baseline health examination: body mass index (BMI), systolic (SBP) or diastolic blood pressure, total cholesterol, HDL cholesterol, triglycerides, and fasting blood glucose. Evaluation was conducted at 18 months after the main program. RESULTS: BMI, SBP, total cholesterol, and triglycerides improved significantly in the intervention group compared with the control group (P < 0.05). When comparisons were limited to those who showed abnormality at baseline, BMI, total cholesterol, and triglycerides improved significantly in the intervention group (P < 0.05). CONCLUSIONS: The multicomponent health promotion program provided to employees was shown to be effective in improving obesity, high blood pressure, and hyperlipidemia when evaluated 18 months after the main intervention program.     

Health and safety in the catering industry

There is evidence that the catering industry has high levels of work-related injury and disease. This study examined the incidence, nature and causes of work-related injury and disease among 315 catering students, at a large school of catering in the west of Ireland, over a 10 month academic year. A high incidence of accidents that caused injury was found. Cuts and lacerations, arising from accidents with knives, were the most common injuries seen, followed by burns and scalds from handling hot liquids. A significant level of work-related dermatitis was also recorded. Trainee chefs were identified as an occupational group with a high risk of occupational injury and disease. This group would benefit from vaccination against tetanus. Work-related injuries and disease generated a significant workload for the student health unit, which in itself is a good reason for catering establishments to make use of occupational health services. Health and safety procedures need to be audited and constantly reviewed at a local level. Further research is necessary to more accurately determine the incidence, nature and leading causes of work-related injury and disease in the catering industry in Ireland. This would help in the planning and implementation of an effective health and safety management system.     

The influence of exercise and BMI on injuries and illnesses in overweight and obese individuals: a randomized control trial

Background

Medically treated injuries have been shown to increase with increasing body mass index (BMI). Information is lacking on the frequency and type of injuries and illnesses among overweight and obese adults who engage in regular physical activities as part of weight loss or weight gain prevention programs.

Methods

Sedentary adults with BMIs between 25 and 40 kg/m² (n = 397) enrolled in one of two randomized clinical trials that emphasized exercise as part of a weight loss or weight gain prevention program. Interventions differed by duration of the exercise goal (150, 200, or 300 minutes/week or control group). Walking was prescribed as the primary mode of exercise. At six month intervals, participants were asked, "During the past six months, did you have any injury or illness that affected your ability to exercise?" Longitudinal models were used to assess the effects of exercise and BMI on the pattern of injuries/illnesses attributed to exercise over time; censored linear regression was used to identify predictors of time to first injury/illness attributed to exercise.

Results

During the 18-month study, 46% reported at least one injury/illness, and 32% reported at least one injury that was attributed to exercise. Lower-body musculoskeletal injuries (21%) were the most commonly reported injury followed by cold/flu/respiratory infections (18%) and back pain/injury (10%). Knee injuries comprised one-third of the lower-body musculoskeletal injuries. Only 7% of the injuries were attributed to exercise alone, and 59% of the injuries did not involve exercise. BMI (p ≤ 0.01) but not exercise (p ≥ 0.41) was significantly associated with time to first injury and injuries over time. Participants with higher BMIs were injured earlier or had increased odds of injury over time than participants with lower BMIs. Due to the linear dose-response relationship between BMI and injury/illness, any weight loss and reduction in BMI was associated with a decrease risk of injury/illness and delay in time to injury/illness.

Conclusions

Overweight and obese adults who were prescribed exercise as part of weight loss or weight gain prevention intervention were not at increased risk of injury compared to overweight adults randomized not to participate in prescribed exercise. Since onset of injury/illness and pattern of injuries over time in overweight and obese individuals were attributed to BMI, weight reduction may be an avenue to reduce the risk of injury/illness in sedentary and previously sedentary overweight and obese adults.

Trial Registration

Clinicaltrials.gov NCT00177502 and NCT00177476     

某有色金属矿山职业伤害瞬时危险因素研究

目的探索有色金属矿山职业伤害的瞬时危险因素，估计其作用强度，为及时纠正，采取应急措施，避免职业伤害的发生提供科学依据。方法用病例一交叉设计方法，研究职业伤害是否由某些称瞬时危险因素所诱发。以某有色金属企业下属4个矿山2006年131例职业伤害者为病例和对照。结果24h及1周配对时间段分析都有15项以上因素进入回归方程，其中与家人同事关系、是否执行安全员要求，是否进入不安全场所、是否执行作业规程，注意力是否集中、衣着是否安全、工作班次、受伤地点，设备运转，操作是否犯错等因素OR值大于1，是职业伤害的危险因素；一般频数法分析有工作条件、劳动管理以及个人因素方面的11项危险因素OR值大于1。结论有色金属矿山职业伤害发生与多项瞬时危险因素关联。预防和控制瞬时危险因素，保护重点人群，开展健康促进计划，可以有效地控制和减少职业伤害的发生。     

Iowa Agricultural Health and Safety Service Project

A model community-based comprehensive agricultural occupational health and safety service program has been implemented in Iowa. The functional center of coordination is based in the College of Medicine at the University of Iowa. The community-based hub of the service is the community hospital, where the majority of the direct client services originate. The University provides training of hospital staff, programming, direction, consultation, and referral. The services offered include primary care, health surveillance, industrial hygiene and safety, and education. Through a detailed evaluation of the project's objectives we will be able to evaluate, modify, and disseminate a model agricultural health and safety services delivery program. This model should be effective in changing the farming population's health and safety attitudes and behaviors through a community-based program.     

Farmer Assessment of the Certified Safe Farm Program

ABSTRACT

This article summarizes the qualitative findings from a study evaluating a novel agricultural health and safety program called Certified Safe Farm (CSF). Results are presented from focus groups held in 2002 and 2006 as well as mail-out surveys conducted in 2001 and 2002. Focus group participants and survey responders were farmers involved in CSF intervention studies. CSF aims to remove hazards through on-farm safety reviews, detect health concerns through clinical screenings, provide personalized occupational health and wellness education, and provide incentives for meeting farm safety targets. Farmers overwhelmingly felt that CSF was beneficial for their health and safety by improving their knowledge and behaviors. In both the focus groups and questionnaires, farmers felt that occupational health screening was the most important component of CSF, and on-farm safety review was the second most important component. Farmers also helped to identify areas in which CSF could be improved in the future. Major areas of suggested program improvement included increased involvement of entire farm families, increased enrollment of younger farmers, increased program incentives such as reduced insurance premiums, and increased ease of access to program providers (AgriSafe clinics), among other recommendations.     

Behavioral and Nonbehavioral Risk Factors for Occupational Injuries and Health Problems Among Belgian Farmers

ABSTRACT

Preventive interventions to reduce occupational injuries and diseases among farmers require an appraisal of the relative importance of the various risk factors. This paper describes the results of a cross-sectional study investigating determinants of occupational health and injuries among 510 Belgian farmers, looking at health-related behaviors (machinery use, animal handling, fall prevention, and pesticide use), as well as nonbehavioral risk factors (demographic characteristics, farm characteristics, and participation in safety training). Education level and number of employees on the farm were identified as nonbehavioral risk factors for injuries, with highly educated farmers and working with one employee associated with a higher injury risk. In contrast, none of the nonbehavioral factors were related to occupational disease. Unsafe machinery use, animal handling, fall prevention, and pesticide use were behavioral risk factors for injuries, with unsafe pesticide use representing the highest risk. Unsafe machinery and pesticide use were also risks for disease. Significant differences in self-reported behavior were found for gender, age, number of employees, and the interaction between age and education. The study highlights the importance of behavioral factors as determinants of occupational injuries and diseases among farmers, and suggests that tailored preventive interventions should be developed to accommodate for differences in these behaviors among subgroups of farmers.     

Adapting Certified Safe Farm to North Carolina Agriculture: An Implementation Study

Certified Safe Farm (CSF) is a multimodal safety and health program developed and assessed through multiple controlled intervention studies in Iowa. Although developed with the intent to be broadly applicable to agriculture, CSF has not been widely implemented outside the midwestern United States. This article describes the CSF implementation process in North Carolina (NC), as piloted on a large-scale in three agriculturally diverse and productive counties of NC, and reports its effectiveness using the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Implementation involved (1) capacity building through safety and health training, (2) adaptation of components of Iowa’s CSF model to NC agriculture, (3) marketing and recruitment, and (4) formative evaluation, including an online survey and focus group discussion. From 2009 to 2012, 113 farms participated in at least one component of the CSF intervention, representing a NC farm participation rate of 3.1% in the study area. A major adaptation of NC implementation was the utilization of NC Cooperative Extension as the local driver of implementation in contrast to local AgriSafe clinics in Iowa. The most innovative adaptation to CSF components was the development of a defined economic incentive in the form of a cost-share program. The RE-AIM framework was found to be useful and relevant to the field of agricultural health and safety translational research. This study provides effectiveness measures and implementation alternatives useful for those considering implementing CSF. It informs current efforts to move CSF from research to practice through the National Sustainable Model CSF Program initiative.     

Work-related injuries among Iowa farm operators: An analysis of the Iowa Farm Family Health and Hazard Surveillance Project

In 1994, the Iowa Farm Family Health and Hazard Surveillance Project carried out a two-stage, stratified, cluster survey of Iowa farms using a mail survey. With data from this representative sample of Iowa farmers, we examined the associations between farm-work–related injuries and possible risk factors for 390 principal farm operators. Forty (10.3%) of these operators reported being injured while doing farm work. We developed a logistic regression to assess associations between potential risk factors and injury. We found three factors significantly associated with injury: younger age (odds ratio [OR] = 3.1, confidence interval [CI] = 1.1–9.3), having an impairment or health problem that limits work (OR = 2.4, CI = 1.5–3.8), and hand or arm exposure to acids or alkalis (OR = 2.6, CI = 1.1–5.9). In the univariate analysis, safety training did not seem to protect farmers from injuries. Am. J. Ind. Med. 33:510–517, 1998. Published 1998 Wiley-Liss, Inc.     

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.     

Adjusting Rehabilitation Costs and Benefits for Health Capital: The Case of Low Back Occupational Injuries

Introduction Case-mix adjustments for treatment/rehabilitation costs and benefits of non-traumatic injuries, such as occupational back pain, are much more difficult than adjustments for traumatic injuries. We present a new method for adjusting for severity differences in the costs and benefits of treating occupational low back injuries. Methods Using initial post-injury differences in the health capital of prospective sample of 1,831 occupational related back pain patients, we combine survey data with workers’ compensation claim files and medical billing information to adjust the costs and benefits of treatment using multivariate techniques. Results We find that large differences in the net benefits of treatment between the three lowest cost provider groups virtually disappear once adjustments are made for worker’s health capital (injury severity) at entry into treatment. Conclusions Once adjustments are made for initial health capital immediately after injury, the net benefits of treating occupational low back pain are virtually identical for physician only care, physician plus physical therapy care, and chiropractic care. Net benefits of care are lower for combined physician/chiropractic care, and lowest for all other forms of care (principally, treatment by orthopedic surgeons). Our method is readily adapted for comparisons among individual health care/occupational rehabilitation professionals or among group practices and other health care organizations.     

Pesticide safety among farmworkers: perceived risk and perceived control as factors reflecting environmental justice

Farmworkers in the United States constitute a population at risk for serious environmental and occupational illness and injury as well as health disparities typically associated with poverty. Pesticides are a major source of occupational injury and illness to which farmworkers are exposed. Efforts to provide safety training for farmworkers have not been fully evaluated. Based on the Health Belief Model, this analysis examines how safety information affects perceived pesticide safety risk and control among farmworkers and how perceived risk and control affect farmworker knowledge and safety behavior. Data are based on interviews conducted in 1999 with 293 farmworkers in eastern North Carolina as part of the Preventing Agricultural Chemical Exposure in North Carolina Farmworkers' Project. Perceived pesticide risk and perceived pesticide control scales were developed from interview items. Analysis of the items and scales showed that farmworkers had fairly high levels of perceived risk from pesticides and perceived control of pesticide safety. Receiving information about pesticide safety (e.g., warning signs) reduced perceived risk and increased perceived control. Pesticide exposure knowledge was strongly related to perceived risk. However, perceived risk had a limited relationship to safety knowledge and was not related to safety behavior. Perceived control was not related to pesticide exposure knowledge, but was strongly related to safety knowledge and safety behavior. A key tenet of environmental justice is that communities must have control over their environment. These results argue that for pesticide safety education to be effective, it must address issues of farmworker control in implementing workplace pesticide safety.     

An aging workforce and injury in the construction industry

The relatively large birth cohort between 1946 and 1964, combined with the economic recession in the first decade of the 21st century, have led to an increase in the proportion of older workers in the US workplace. Understanding the health and safety needs of an aging workforce will be critical, especially in the construction industry, where physical job demands are high. This paper reviews the epidemiologic literature on the impact of age on injury among workers in the construction industry in terms of cause, type, and cost. PubMed was searched by using the following terms: older workers, construction, construction industry, injury, and age. The available studies reported that, among the construction industry workforce, older age at injury was related to higher injury costs but not to number of injuries. The higher injury costs associated with worker age are likely due in part to the severity of the injuries sustained by older workers. Identification of injury trends and subsequent analytical research efforts designed to ascertain factors associated with injury among older construction workers are needed for employers to effectively manage a health and safety program that addresses the needs of the aging worker.     

A Review of Health and Safety Leadership and Managerial Practices on Modern Dairy Farms

ABSTRACT

As modern dairy operations around the world expand, farmers are increasingly reliant on greater automation and larger numbers of hired labor to milk cows and perform other essential farm tasks. Dairy farming is among the most dangerous occupations, with high rates of injury, illness, and employee turnover. Lower education levels, illiteracy, and limited language proficiency increase the possibility of injury or death associated with higher risk occupations such as dairy. Sustaining a healthy, productive workforce is a critical component of risk management; however, many owners and managers have not received formal training in employee management or occupational health and safety. Optimal dairy farming management should address milk production that is sustainable and responsible from the animal welfare, social, economic, and environmental perspectives. Each of these aspects is interdependent with each other and with a sustainable, healthy, productive workforce. Very few studies address the effectiveness of risk management in the dairy industry. Studies suggest that labor management practices are a potential competitive advantage for dairy farms, but the connection with efficiency, productivity, and profitability has not been clearly demonstrated. Transformational leadership has been associated with improved safety climate and reduced incidence of injury, whereas passive leadership styles have opposite effects. There is a need to develop and evaluate the effectiveness of safety-specific transformational leadership among dairy owners and managers. A systematic approach to risk management should address worker health and safety as an integral component of production, food safety, and animal welfare. A successful program must address the cultural and linguistic barriers associated with immigrant workers.     

Pesticide-related Illness and Injuries among Banana Workers in Costa Rica: A Comparison between 1993 and 1996

Abstract

An intervention program considerably decreased systemic poisonings on banana plantations in Costa Rica in the early 1990s. Nevertheless, pesticide safety continues to be controversial .To examine the determinants of acute pesticide related illness on banana plantations, the authors surveyed occupational injuries and illness among banana workers in the Atlantic Region of Costa. Rica that were reported during 1993 and 1996 to the National Insurance Institute. Incidence rates were calculated for categories of pesticides and types of medical problems, for all and subgroups of banana workers. Between 1993 and 1996, an overall 35% decrease in injuries was observed, attributable to a marked decline in topical injuries (3.3 vs 1.9 per 100 workers), whereas systemic poisonings remained the same (0.7 per 100 in both years). The decrease concerned selectively milder skin contlltioris, indicating underreporting of less severe health effects. In both years, paraquat was the pesticide most frequently associated with injuries, mostly skin and eye lesions. Workers at highest risk per unit time of exposure were nematocide applicators, herbicide applicators, and cleaners of packing plants. Despite control measures, further reduction of systemic illness had not been achieved. The decrease of topical injuries may be partly explained by improved work conditions, but possible underreporting hinders interpretation. Pesticide related illness on banana plantations is a persistent problem.