Non-fatal occupational injuries related to slips, trips and falls in seafaring

BACKGROUND: Merchant seafaring often involves hazardous occupational operations and several studies have shown increased overall injury mortality. The aim of this study was to describe the risks involved in slip, trip and fall (STF) injuries in merchant seafaring, in order to point out areas for prevention. METHODS: A questionnaire study was carried out in 11 countries with 6,461 participants. The seafarers gave information on whether they were injured during their latest tour of duty, and whether STF preceded the injury. RESULTS: Of the total reported injuries 43% (n=467) were STF related. Fractures and sprains accounted for 42% of the STF injuries compared with 17% for non-STF injuries. The proportions of STF injuries for different types of ships and areas of the ships varied from < 30% to >60%, particularly work on passenger ship decks, where STF injuries were >60%. The proportions of STF injuries increased by age and by severity of the injury. CONCLUSIONS: Injuries related to STF on merchant ships were more frequent than previous estimates. There is a need for improvements in defining, reporting, and preventing STF injuries in merchant seafaring.     

Underreporting of fatal occupational injuries in Catalonia (Spain)

BACKGROUND: Thoroughness in a given health information system is one of its most important quality indicators. In Spain, in approximately 30% of serious occupational injuries, there is no information on the final outcome. AIM: To assess underreporting of fatal occupational injuries in Catalonia. METHODS: All serious occupational injuries (excluding commuting injuries) reported in Catalonia (Spain) between 1994 and 1998 (n = 7330) were linked with data from the Catalonian Mortality Register, 117 deaths being identified during the year following the injury date. In order to assess whether death could or could not have been related to the prior occupational injury, two experts examined these cases independently. RESULTS: The experts concluded (kappa = 0.98) that 69 (59%) of these deaths were probably related to occupational injuries; the vast majority (n = 65) occurred within 3 months of the injury. This represents an accumulated risk of dying of approximately 1% for the total of serious injuries, not varying with economic activity or job category. However, this risk varied depending on the form of accident, and the site and nature of the injury. CONCLUSIONS: Occupational injury cases, especially serious ones, should be followed up over at least 3 months. These results suggest the importance of carrying out active case-finding and of incorporating the death certificate as one of the documents to be systematically reviewed in order to complete the statistics.     

Work-related injuries and occupational health and safety factors in smaller enterprises--a prospective study

The aim of this study was to determine whether any of the health, environmental and safety (HES) factors registered by visiting small mechanical enterprises in Norway at the start of the study could predict the risk of occupational injuries in subsequent years. Twelve HES factors, including injury awareness, programme for action, employee participation, training and use of personal safety devices, were registered. A questionnaire was completed by interviewing the employer and observing production. Two variables based on observation of the use of safety equipment were significantly correlated with occupational injuries. There is potential for prevention in smaller enterprises by increasing the use of personal protection devices and safety equipment on machines. Frequent inspection with feedback to the workers is probably the most effective means of attaining the desired result of reducing injuries.     

Relationship between job, lifestyle, age and occupational injuries

Background Physical job demands (PJD), age, disability and lifestylemay influence the risk of occupational injury. Aim To assess the relationships between PJD, lifestyle and injuryin workers of various ages. Methods A total of 2888 randomly selected workers from northeasternFrance, aged 15, completed a postal questionnaire. The PJD scorewas defined as the total number of the following reported jobdemands: using pneumatic tools, other vibrating hand tools,hammers, machine tools or vibrating platforms and exposure tomanual handling tasks, awkward postures, high pace of work,high physical workload, work at heights, work in adverse climatesor exposure to noise, cold or heat. Data were analysed usinglogistic regression. Results Nine per cent of subjects reported an injury duringthe previous 2 years. The PJD score was related to the injuryrate for workers aged 45: crude odds ratio (OR) 3.5 (95% confidenceinterval = 1.5–8.0) for PJD = 1, 5.0 (2.2–11.3)for PJD = 2–3 and 14.5 (6.5–32.2) for PJD 4, versusPJD = 0. Lower ORs were found for those aged <30 (1.4, 4.2and 9.9, respectively) and 30–44 (1.5, 4.4 and 6.5, respectively).The differences between age groups remained when controllingfor all factors studied. Obesity, smoking and musculoskeletaldisorders were associated with injury risk in workers aged 45(adjusted ORs 1.7–2.6). Smoking was also an injury riskfactor for workers aged <30. Conclusions PJD and lifestyle have a higher impact on injuryrates among older workers than among younger ones. Injury preventionshould address reducing PJD and improving relevant lifestylefactors, especially for older workers.     

Mandatory use of eye protection prevents eye injuries in the metal industry

BACKGROUND: Eyes are frequently injured in occupational accidents. What is the preventive effect of mandatory eye protection in metalworking? METHODS: The injury incidence was determined before and after eye protection became mandatory in a metalworking yard. RESULTS: The incidence declined from 6.09 to 0.42 injuries per million working hours after eye protection became mandatory. CONCLUSIONS: Mandatory eye protection among metalworkers in Norway has high potential for preventing eye injuries and should be implemented.     

Subjective assessments of safety, exposure to chemicals and use of personal protection equipment in seafaring

BACKGROUND: Most of the scientific publications from the maritime area are studies about the mortality and morbidity, while studies about the present hazards of potentially dangerous exposures are relatively rare. AIMS: To describe the seafarers' assessments of the occupational safety on board, their exposure to chemicals and the use of personal protection equipment and to identify the areas for further risk assessment and preventive measures. METHODS: A questionnaire study was carried out in 11 countries among seafarers who attended a regular health examination. RESULTS: The total number of seafarers who participated in the study was 6461 (response rate 93.7%). The occupational safety on board was assessed to be very good or good in 82%. Multivariate analyses showed that the safety was assessed as lowest among ratings, seafarers<30 years of age, work in the engine rooms and on dry cargo ships. It was highest on crude oil tankers and supply ships. Fifty-five per cent of seafarers were exposed to chemicals. Personal protection equipment to chemicals was used 'always/almost always' in 93% of the exposed. Multivariate analysis showed that the use of personal protection was highest on deck, on the largest ships, on roll-on roll-off ships and on crude oil tankers. CONCLUSION: The occupational safety and the use of personal protective equipment was assessed to be significantly different in some strata of the population and in specific working areas and types and sizes of ships.     

Survey of occupational health problems in an operational military environment

16 Armoured Field Ambulance provided primary and secondary medicalcare to British troops in Bosnia from April to October 1996.Patients presenting at both levels were reviewed and categorizedinto occupational illness, non-occupational disease and non-occupationalinjury. The results show that occupational illness was a smallbut significant component of primary care (8%) with non-occupationalinjury accounting for < 1%. In secondary care, the more seriousnature of the occupational disease seen is shown in that itaccounted for 38% of all admissions and 44% of the 149 patientswho had to be evacuated from theatre for further treatment. Non-occupational injury represented 8% of admissions and 13%of evacuations.     

A study of fatal injuries in Nigerian factories.

A study of the pattern of occupational injury mortality rates by industry and cause of death was undertaken to indicate the high-risk types of industry and the major causes of death, which could subsequently be used in developing cost-effective strategies for prevention. This is the first such study of accidental mortality factors in Nigerian factories. This paper reports the outcome of the study of mortality in Nigerian factories over a 10 year period (1987-1996). Between 1987 and 1996, a total of 3183 injuries were reported, of which 71 (2.2%) were fatal. The annual case fatality rate ranged from 0.94 per 100 injured workers in 1990 to 5.41 in 1994, with an overall fatality rate of 2.23 per 100 injured workers. Of the 71 deaths, 12 (16.9%) were associated with power-driven machinery. Ten (14.1%) deaths were associated with explosions, while people falling accounted for nine (12.6%) of the deaths. Eleven deaths (15.4%) occurred in the chemical/pharmaceuticals industry, nine (12.6%) occurred in the basic metal industry and seven (9.8%) occurred in the food, beverage and tobacco industry. There were seven (9.8%) deaths in the textile manufacturing industry. The highest case fatality rate per injured worker (16.6%) occurred in the coal-petroleum industry, followed by 5.9% in the wood and wood products industry. A rate of 5.8% occurred in the non-metallic manufacturing industry. The case fatality rates in Nigerian factories are compared with those of other predominantly African countries. Accident prevention programmes tailored to the work activities and specific causal factors in the high-risk types of industries are recommended following a detailed study of work situations and risk factors in these types of industries. Accident prevention programmes, including the use of protective equipment, safety education, machine guarding, a work permit system, effective supervision at work sites and the enforcement of factory laws and regulations, are recommended to improve accidental injury and death in the factories.     

Incidence of occupational skin conditions in a food manufacturing company: results of a health surveillance programme

BACKGROUND: The food industry has been associated with a high risk of work-related skin problems. Aim To examine the incidence of work-related skin conditions and the likely causative agents in a single large food company. METHOD: Analysis of a health surveillance programme, conducted over a 7 year period, in a food company with 21 000 employees working in diverse manufacturing processes. RESULTS: The mean incidence of skin conditions, taking all of the different food manufacturing operations together, was 1310 per million employees per annum. The mean incidence was greatest in the manufacturing sector whose operations involved chilled or frozen product (3180 per million employees per annum). Most of the cases reported (184/192 = 96%) were due to primary irritant dermatitis. The two commonest suspected causes of the dermatitis were contact with ingredients and hand washing. Taken together, these factors accounted for 58% of all cases. Although the wearing of gloves is often considered necessary to prevent dermatitis from exposure to ingredients and to lessen the need for hand washing, this factor itself was responsible for 9% of all cases. CONCLUSION: Analysis of a company health surveillance scheme showed the average incidence of work-related skin problems to be lower than previously reported in the food industry.     

A cross-sectional study of self-reported work conditions and psychiatric health in native Swedes and immigrants

Several studies have demonstrated that immigrants in Scandinaviancountries are more affected by psychosocial disabilities thanthe native-born population. The aim of the study was to evaluatethe possible impact of work-related stressors on psychiatrichealth in immigrants compared to native Swedes. The study includeda cluster selected cohort of 1,040 men born in 1944 (participationratio=79.9%), living in Gothenburg, Sweden. Of these, 182 (18.0%)were immigrants, defined as being born outside Sweden. Informationon work conditions and psychiatric health were obtained by self-administeredquestionnaires. Employment in native Swedes showed inverse associationsto frequent use of anxiolytics [relative risk (RR)=0.2; 95%confidence interval (Cl)=0.067ndash;0.4], frequent use of hypnotics(RR=0.1; Cl=0.02–0.2) and use of antidepressants (RR=0.3;Cl=0.2–0.5). None of the employed immigrants used anxiolyticsor hypnotics frequently. Swedes seemed to display a number ofpsychiatric ill-health factors related to working conditions.These factors included frequent use of hypnotics, frequent insomnia,use of antidepressants, a high degree of melancholy, and wererelated to shift work, dissatisfaction with current work andmanagement and a low degree of influence on work situation,often related to a high degree of stress at work and a frequentdesire to change type of work. These associations were not seenin immigrants, apart from the risk of frequent insomnia (RR=4.7;Cl=1.2–18.3) and dissatisfaction with colleagues (RR=10.4;Cl=2.27ndash;48.8) when working in shift. With a few exceptions,non-optimal working environment was associated with a low degreeof life satisfaction in both groups. It was hypothesized thatoptimal working conditions are important for maintaining psychiatrichealth, and that immigrants, when employed, seem less affectedby impaired working conditions than native Swedes.     

An investigation of the relationship between psychological health and workload among managers

BACKGROUND: Anecdotally, many workers complain of stress at work. However, the relationship between work and stress needs clarification to allow risk assessment and risk management of this hazard in the workplace. OBJECTIVES: To examine relationships between working hours, perceived work stressors, and psychological health in a group of managers. METHODS: Managers at two factories were invited to participate in an anonymous cross-sectional survey. All were asked to complete a work diary for a period of 1 week and a questionnaire comprising the 30-item General Health Questionnaire, an anxiety and depression scale, and questions identifying perceived workplace stressors. RESULTS: Over 60% of managers were above the threshold of caseness on at least one measure of psychological health. No statistically significant relationship was demonstrated between actual hours of work and psychological health. A relationship was demonstrated between some perceived workplace stressors and actual hours worked, and between some perceived workplace stressors and psychological health. CONCLUSIONS: A large proportion of managers in a typical production environment appeared at risk of developing psychological illness. Hours of work were not directly related to psychological health, but were significantly associated with individual perception of some work stressors which, in turn, were associated with measures of psychological health. Perceived workload appeared more important in determining psychological health than actual workload.     

The interaction between general practitioners and occupational health professionals in relation to rehabilitation for work: a Delphi study

BACKGROUND: Anecdotally, communication between general practitioners (GPs) and occupational health professionals is poor and acts as a barrier to successful rehabilitation for work. It is not known how widely this view is held by the many stakeholders in rehabilitation for work, or how important the observation is in its effect. METHODS: A Delphi study was conducted by initial semi-structured telephone interview, followed by a three-round collation and feedback of opinion by e-mail. The 25 participants were identified by suggestion within the study process for their position as key informants within a wide range of stakeholders. RESULTS: The process generated a consensus statement which identifies the extremely important nature of rehabilitation for work, the crucial role by GPs, the central role of occupational health professionals in case management and the barrier represented by the often very poor communication between them. CONCLUSION: The way forward is to improve communication by mutual education and understanding and a team approach to rehabilitation strategy. This may be facilitated by the GPs who work in occupational health and disability assessment and the involvement of other health professionals to great benefit for all stakeholders.     

A registry-based case-control study of risk factors for the development of multiple non-fatal injuries on the job

Using compensation records of Taiwan, we conducted a case-control study nested within a cohort of 77,846 active workers who experienced at least one incidence of non-fatal work-related injury between 1994 and 1996 in order to explore factors associated with risk of sustaining multiple non-fatal injuries in the workplace. Cases (n = 2,616) were workers with more than three incidences of non-fatal injury during the study period and controls (n = 3,974) were randomly sampled from workers who experienced only one incidence of non-fatal injury during the same period. Compared with construction workers, workers employed in mining and quarrying (OR = 2.7), manufacturing (OR = 1.2), commerce (OR = 1.6), transport, storage and communication (OR = 1.3) and social, personal and community service (OR = 1.4) were all at significantly elevated risk of multiple non-fatal injuries. Both age and wage showed a significant dose-response effect on the risk of developing multiple non-fatal injuries. The preliminary analysis suggests that workers in certain industries are at significantly elevated risks of multiple work-related non-fatal injuries, in particular those in the mining and quarry industries. Additionally, further preventive measures should be aimed at protecting older workers from such injuries and further studies would help provide more specific interpretations on the positive association between higher wage earning and risk of multiple non-fatal injuries.     

An international comparison of women's occupational health issues in the Philippines, Thailand, Malaysia, Canada, Hong Kong and Singapore: the CIDA-SEAGEP study

BACKGROUND: An international comparison study of women's occupational health issues was carried out in 2000 for the Philippines, Thailand, Malaysia, Canada, Hong Kong and Singapore. The study was funded by the Canadian International Development Agency's Southeast Asia Gender Equity Program. AIM: The objective was to compare the issues, risk factors, social determinants, and challenges in women's occupational health, according to the status of economic development as defined by the World Bank. METHOD: Data were collected through 27 key informant interviews of high-ranking government officials and senior researchers, self-administered questionnaires on country or regional statistics and 16 courtesy calls. RESULTS: Results indicated that women's occupational health problems common in these countries or regions included women's long hours of work (double workday), shift work and a caring role for family and friends. Problems reported in developing countries but not developed countries included poor access to training and protective equipment, and insufficient legislation to protect women's rights. Problems reported in developed countries but not in developing countries included obesity, smoking and not including women in health research. CONCLUSION: This paper provides insights into the changing environment in the workplace, such as increasing participation of women in the paid workforce and changes in gender differences due to the changing country economy, for improving women's occupational health.     

Sharps injuries in UK health care: a review of injury rates, viral transmission and potential efficacy of safety devices

AIMS: To review the literature on sharps injuries and occupational bloodborne virus transmission in health care in the UK and the worldwide evidence for injury prevention of sharps safety devices. METHODS: Literature review by online database and Internet resource search. RESULTS: Twenty-four relevant publications were identified regarding UK reported sharps injury rates. UK studies showed as much as a 10-fold difference between injuries reported through standard reporting systems (0.78-5.15 per 100 person-years) and rates estimated from retrospective questionnaires of clinical populations (30-284 per 100 person-years). National surveillance data from England, Wales and Northern Ireland gives a rate of 1.43 known hepatitis C virus or human immunodeficiency virus (HIV) transmissions to health care workers per annum. When extrapolated, this suggests an approximate rate of 0.009 such viral transmissions per 1000 hospital beds per annum. Risk of infection from sources with no risk factors is extremely small (less than one in one million for HIV transmission based on Scottish data). Thirty-one studies on the efficacy of sharps safety devices showed evidence of a reduction in injuries, with the greatest reductions achieved by blunt suture needles and safety cannulae. CONCLUSIONS: Although injuries remain common, confirmed viral transmission in the UK has been relatively rare. The degree of under-reporting of sharps injuries may be as much as 10-fold. Safety-engineered devices are likely to be effective at injury reduction.     

Assessment of the potential effects of population changes in attitudes, awareness and beliefs on self-reporting of occupational ill-health

BACKGROUND: It is important to take account of the effects of population changes in attitudes, awareness and beliefs when interpreting temporal trends in self-reported occupational ill-health. Aim To assess how changes in population attitudes, awareness and beliefs have influenced trends in the self-reporting of occupational and other types of ill-health. METHOD: A review of relevant literature was carried out. The criterion for inclusion was that papers must be based on empirical evidence; theoretical discussion papers were included only where empirical examples were included. RESULTS: Several examples were identified where raised awareness of a health problem following intended or unintended publicity was followed by an increase in self-reports of this problem. The magnitude of the increase varied widely according to the situation. One example was identified where self-reports decreased following a publicity programme designed to prevent the occurrence and worsening of the problem in the population. Potential mechanisms identified as influencing changes in self-reporting of ill-health following raised awareness included changes in symptom/illness management, perception of symptoms, tolerance of symptoms, recognition and diagnosis of illness, attribution of illness; social desirability and legitimacy and recall. CONCLUSION: The effects of changes in population attitudes, awareness and beliefs on trends in self-reports of occupational and other illness are difficult to predict for any given situation.     

Ethical issues in occupational medicine practice: knowledge and attitudes of occupational physicians

Views on ethical conduct in occupational medicine practice canvary from country to country and even between occupational healthpractitioners. However, there are many areas of common agreement,and this is apparent on comparing guidance documents on ethicsproduced by several different organizations. The usefulnessof these documents will depend in part on how aware practitionersare of their existence. A standardized questionnaire administeredto 70 occupational physicians in the Netherlands, UK, and Singaporeshowed that there was a lack of awareness of guidance documentson ethics, even for publications from their own countries. Onlyfive of the 70 respondents consulted an ethics document in thepast year. In addition to publications, other avenues were usedfor advice on ethical issues. There was a difference in opinionbetween the physicians from Singapore and those from the twoEuropean countries on whether specific occupational health activitieswere ethical. These findings reinforce the need for internationalguidance on ethics to take into account differences in attitudesand practice between countries. On many issues there was nounanimity of opinion, even between occupational physicians fromthe same country. This may be an indication of the complexityof ethical matters, and provides a rationale for publishingguidance on ethics in occupational medicine.     

The impact of shift work on the risk and severity of injuries for hospital employees: an analysis using Oregon workers' compensation data

BACKGROUND: While past research on health care workers has found that shift work can lead to negative physiological and psychological consequences, few studies have assessed the extent to which it increases the risk of specific work-related injuries, nor quantified and compared associated types, severity and costs. AIMS: This study aimed to derive and compare the rates, typologies, costs and disability time of injuries for various hospital worker occupations by day, evening and night shift. METHODS: This study used Oregon workers' compensation claim data from 1990 to 1997 to examine the differences in hospital employee claims (n = 7717) by shift and occupation. Oregon hospital employee claim data, hospital employment data from Oregon's Labor Market Information System and shift proportion estimates derived from the Current Population Survey (CPS) were used to calculate injury rate estimates. RESULTS: The injury rate for day shift per 10,000 employees was estimated to be 176 (95% CI 172-180), as compared with injury rate estimates of 324 (95% CI 311-337) for evening shift and 279 (95% CI 257-302), night shift workers. The average number of days taken off for injury disability was longer for injured night shift workers (46) than for day (38) or evening (39) shift workers. CONCLUSION: Evening and night shift hospital employees were found to be at greater risk of sustaining an occupational injury than day shift workers, with those on the night shift reporting injuries of the greatest severity as measured by disability leave. Staffing levels and task differences between shifts may also affect injury risk.     

Risks associated with occupational glass injury in bar staff with special consideration of hepatitis B infection

Since bar workers often sustain cuts from unwashed bar glasses,the aims of this study were to investigate risk of injury andto examine the sero-prevalence of markers for hepatitis B amongstbar staff. Ninety-one bar staff recruited by newspaper advertisementwere asked about injury experience and life-style risks associatedwith transmission of hepatitis B and were tested for hepatitisB surface antigen (HBsAg) and core antibody (anti-HBc). Seventy-fourper cent reported lacerations from broken glassware at work:18% had sustained such injuries in more than 10 incidents. Fifty-fiveper cent of respondents reported occupational skin contact withbody fluids. Anti-HBc prevalence for the study group was 1.1%,suggesting that bar staff were not at increased risk from hepatitisB infection. Although 30% wore gloves for high-risk tasks, therewas no evidence that glove wearing prevented glass lacerations.This level of injury experience and exposure to body fluidsis unacceptable and represents a potential risk of cross-infection.Hepatitis B immunization should be considered in this group.Urgent action, including the replacement, wherever possible,of annealed with tempered bar-glassware, is necessary to protectbar workers from glass injury.     

Pre-employment health assessments for food handlers: a survey of occupational physicians in the food industry

The format of pre-employment health screens within the food industry varies considerably. The aim of this study was to produce a consensus on the content of a screen that will enable employees to handle food with minimum risk to the product and employee. A questionnaire was sent to the 63 members of the Food Industry Medical Association, of whom 45 (71%) responded. As a minimum, a questionnaire completed by the applicant is thought to be sufficient. Applicants reporting health problems need to be assessed by a health professional.