Effect of protective filters on fire fighter respiratory health: field validation during prescribed burns

Background Bushfire smoke contains a range of air toxics. To prevent inhalation of these toxics, fire fighters use respiratory equipment. Yet, little is known about the effectiveness of the equipment on the fire ground. Experimental trials in a smoke chamber demonstrated that, the particulate/organic vapor/formaldehyde (POVF) filter performed best under simulated conditions. This article reports on the field validation trials during prescribed burns in Western Australia. Methods Sixty-seven career fire fighters from the Fire and Emergency Services Authority of Western Australia were allocated one of the three types of filters. Spirometry, oximetry, self-reported symptom, and personal air sampling data were collected before, during and after exposure to bushfire smoke from prescribed burns. Results Declines in FEV1 and SaO2 were demonstrated after 60 and 120 min exposure. A significant higher number of participants in the P filter group reported increases in respiratory symptoms after the exposure. Air sampling inside the respirators demonstrated formaldehyde levels significantly higher in the P filter group compared to the POV and the POVF filter group. Conclusions The field validation trials during prescribed burns supported the findings from the controlled exposure trials in the smoke chamber. Testing the effectiveness of three types of different filters under bushfire smoke conditions in the field for up to 2 hr demonstrated that the P filter is ineffective in filtering out respiratory irritants. The performance of the POV and the POVF filter appears to be equally effective after 2 hr bushfire smoke exposure in the field. Am. J. Ind. Med. 52:76-87, 2009.

Annemarie J.B.M. De Vos MPH RN ICCert1 * Angus Cook PhD MBChB(NZ) VATGP1 Brian Devine BAppSc1 Philip J. Thompson MBBS FRACP FCCP MRACMA2 Philip Weinstein PhD MBBS MAppEpi BSc FAFPHM3
[1]School of Population Health M431, The University of Western Australia, Crawley, Western Australia, Australia;[2]Lung Institute of Western Australia, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia;[3]School of Population Health, University of Queensland, Herston Road, Herston, Queensland, Australia

Near miss and minor occupational injury: Does it share a common causal pathway with major injury?

Background An essential assumption of injury prevention programs is the common cause hypothesis that the causal pathways of near misses and minor injuries are similar to those of major injuries. Methods The rates of near miss, minor injury and major injury of all reported incidents and musculoskeletal incidents (MSIs) were calculated for three health regions using information from a surveillance database and productive hours from payroll data. The relative distribution of individual causes and activities involved in near miss, minor injury and major injury were then compared. Results For all reported incidents, there were significant differences in the relative distribution of causes for near miss, minor, and major injury. However, the relative distribution of causes and activities involved in minor and major MSIs were similar. The top causes and activities involved were the same across near miss, minor, and major injury. Conclusions Finding from this study support the use of near miss and minor injury data as potential outcome measures for injury prevention programs. Am. J. Ind. Med. 52:69-75, 2009.

Hasanat Alamgir MBA PhD* Shicheng Yu PhD Erin Gorman BHK Karen Ngan BSc Jaime Guzman MD MSc FRCPC
Occupational Health and Safety Agency for Healthcare (OHSAH) in BC, Vancouver, British Columbia, Canada

Psychosocial factors and shoulder symptom development among workers

Background Shoulder injuries are a common cause of pain and discomfort. Many work-related factors have been associated with the onset of shoulder symptoms. The psychosocial concepts in the demand-control model have been studied in association with musculoskeletal symptoms but with heterogeneous findings. The purpose of this study was to assess the relationship between the psychosocial concepts of the demand-control model and the incidence of shoulder symptoms in a working population. Methods After following 424 subjects for approximately 1 year, 85 incident cases were identified from self-reported data. Cox proportional hazards modeling was used to assess the associations between shoulder symptoms and demand-control model quadrants. Results Cases were more likely to be female and report other upper extremity symptoms at baseline (P < 0.05). From the hazard models, being in either a passive or high strain job quadrant was associated with the incidence of shoulder symptoms. Hazard ratios were 2.17, 95% CI 1.02-4.66 and 2.19, 95% CI 1.08-4.42, respectively. Conclusions Using self-reporting to determine demand-control quadrants was successful in identifying subjects at risk of developing work-related shoulder symptoms. Research is needed to determine if this relationship holds with clinically diagnosed shoulder and other upper extremity musculoskeletal disorders. This may be part of a simple tool for assessing risk of developing these UEMSDs. Am. J. Ind. Med. 52:57-68, 2009. Caroline K. Smith MPH1 * Barbara A. Silverstein PhD MPH CPE1 Z. Joyce Fan PhD1 Stephen Bao PhD CPE1 Peter W. Johnson PhD2 [1]Safety & Health Assessment and Research for Prevention (SHARP), Washington State Department of Labor & Industries, Olympia, Washington;[2]Department of Environmental and Occupational Health Sciences, University of Washington, Seattle, Washington

Productivity loss in the workforce: associations with health, work demands, and individual characteristics

Background Decreased productivity at work is an important consequence of the presence of health problems at work. Methods The study population consisted of 2,252 workers in 24 different companies in The Netherlands in 2005-2006 (response 56%). Self-reported loss of productivity on the previous workday was measured on a 10-point numerical rating scale by the Quantity and Quality method. Logistic regression analysis was used to explore the associations between work demands, health problems, individual characteristics, and lifestyle factors with the occurrence of productivity loss. Results About 45% of the workers reported some degree of productivity loss on the previous workday, with an average loss of 11%. Moderate and severe functional limitations due to health problems (OR = 1.28 and 1.63, respectively) and lack of control at work (OR = 1.36) were associated with productivity loss at work with population attributable fractions of 7%, 6%, and 16%, respectively. Conclusion Productivity losses at work frequently occur due to health problems and subsequent impairments, and lack of control over the pace and planning of work. This will substantially contribute to indirect costs of health problems among workers. Am. J. Ind. Med. 52:49-56, 2009.

Seyed Mohammad Alavinia MD1 Duco Molenaar MA2 Alex Burdorf PhD1 *
[1]Department of Public Health, Erasmus MC, University Medical Center Rotterdam, The Netherlands;[2]PreventNed, Enschede, The Netherlands

Work-related non-fatal injuries among foreign-born and US-born workers: Findings from the U.S. National Health Interview Survey, 1997-2005

Background Millions of foreign-born workers are employed in the US. Population-based surveys have value in describing the non-fatal work-related injuries that these workers suffer. Methods Using data from the 1997-2005 National Health Interview Survey, we compared the rates of non-fatal work-related injuries among foreign-born and US-born adult workers. Logistic regression was used to produce work-related injury odds ratios (ORs) and 95% confidence intervals (95% CI) by nativity and years of residence while controlling for sex, age, race/ethnicity, education, poverty, family size, insurance status, delayed medical care, and alcohol use. Industry-specific rates were also compared. Results Foreign-born workers reported a lower rate of work-related injuries than US-born workers, 50 per 10,000 foreign-born workers versus 89 per 10,000 US-born workers (P < 0.01). After controlling for confounding variables, the OR of work-related injuries for foreign-born workers as compared to US-born workers was 0.50 (95% CI = 0.38-0.66). The construction, agriculture/forestry and fisheries, and manufacturing industries had the highest work-related injury rates for both groups of workers. Conclusions Foreign-born workers had a lower overall rate of work-related injury when compared to US-born workers. Both US-born and foreign-born workers face significant injury risks, especially in certain industries. Interventions tailored with ethnic and cultural differences in mind are still warranted. Am. J. Ind. Med. 52:25-36, 2009. Xiaofei Zhang MD PhD1 Songlin Yu MD1 Krista Wheeler MS1 Kelly Kelleher MD MPH2 Lorann Stallones PhD3 Huiyun Xiang MD PhD1 * [1]The Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital, Columbus, Ohio;[2]The Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, College of Medicine, Columbus, Ohio;[3]Colorado Injury Control Research Center, Colorado State University, Fort Collins, Colorado

Inhalation incidents and respiratory health: results from the European Community respiratory health survey

Background Inhalation incidents are an important cause of acute respiratory symptoms, but little is known about how these incidents affect chronic respiratory health. Methods We assessed reported inhalation incidents among 3,763 European Community Respiratory Health Survey (ECRHS) participants with and without cough, phlegm, asthma, wheezing or bronchial hyperresponsiveness. We then examined whether inhalation incidents during the 9-year ECRHS follow-up period were associated with a new onset of any of these respiratory outcomes among 2,809 participants who were free of all five outcomes at the time of the baseline ECRHS survey. Results Inhalation incidents were reported by 5% of participants, with higher percentages reported among individuals with asthma-related outcomes at the time of the baseline survey. Among participants without symptoms at baseline, our analyses generated non-statistically significant elevated estimates of the risk of cough, phlegm, asthma and wheezing and a non-statistically significant inverse estimate of the risk of bronchial hyperresponsiveness among participants who reported an inhalation incident compared to those without such an event reported. Discussion Our findings provide limited evidence of an association between inhalation incidents and asthma-related symptoms. These data could be affected by differences in the reporting of inhalation incidents according to symptom status at the time of the baseline survey; they should thus be interpreted with caution. Am. J. Ind. Med. 52:17-24, 2009.

Maria C. Mirabelli MPH PhD1 2 3 * Mario Olivieri MD4 Hans Kromhout PhD5 Dan Norb#228 ck PhD6 Katja Radon PhD7 Kjell Torén MD PhD8 9 Marc van Sprundel MD PhD10 Simona Villani PhD11 Jan-Paul Zock PhD1 2 3
[1]Centre for Research in Environmental Epidemiology, Barcelona, Spain;[2]Municipal Institute of Medical Research (IMIM-Hospital del Mar), Barcelona, Spain;[3]CIBER Epidemiologoiá y Salud Pública, Spain;[4]Department of Medicine and Public Health, Unit of Occupational Medicine, University of Verona, Verona, Italy;[5]Institute for Risk Assessment Sciences, Environmental Epidemiology Division, Utrecht University, Utrecht, The Netherlands;[6]Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University and University Hospital, Uppsala, Sweden;[7]Unit for Occupational and Environmental Epidemiology & NetTeaching, Institute for Occupational, Social and Environmental Medicine, Ludwig-Maximilians-University, Munich, Germany;[8]Department of Allergology, Sahlgrenska University Hospital, Göteborg, Sweden;[9]Department of Occupational and Environmental Medicine, Sahlgrenska University Hospital, Göteborg, Sweden;[10]Department of Epidemiology and Social Medicine, University of Antwerp, Antwerp, Belgium;[11]Section of Medical Statistics and Epidemiology, Department of Health Sciences, University of Pavia, Pavia, Italy

Impact of implementing the washington state ergonomics rule on employer reported risk factors and hazard reduction activity

Background In Washington State an ergonomics rule was adopted in 2000 that focused on primary prevention. The implementation process followed a 6-year phase-in schedule where employers came into compliance based upon their size and industry. In late 2003 the rule was repealed by an industry-funded voter initiative. Evaluating the implementation of this rule offers a unique opportunity to observe the general deterrent effect of a new public health regulation and to study how employers and workers responded to new requirements. Methods Weighted survey regression methods were used to analyze the results from three employer surveys covering more than 5,000 workplaces administered in 2001, 2003, and 2005. These were compared to a baseline employer survey conducted in 1998 before the rule was promulgated. Questions covered the following topics: WMSDs experienced at the workplace; levels of employee exposure to musculoskeletal hazards; steps being taken, if any, to address these hazards; results of these steps; and sources of ergonomic information/assistance used. Results From 1998 to 2003 there was a reduction in reported exposures among workplaces in the highest hazard industries. Following the rule’s repeal, however, hazard exposures increased. While more workplaces reported taking steps to reduce exposures between 1998 and 2001, this gain was reversed in 2003 and 2005. Employers who took steps reported positive results in injury and absenteeism reduction. Large workplaces in the high hazard industries were more active in taking steps and used a wide variety of resources to address ergonomics issues. Small employers relied more on trade associations and the state. Am. J. Ind. Med. 52:1-16, 2009.

Michael Foley MA1 * Barbara Silverstein PhD MPH CPE1 Nayak Polissar PhD2 Blazej Neradilek MS2
[1]Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, Washington;[2]The Mountain-Whisper-Light-Statistical Consulting, Seattle, Washington

Protecting human subjects: How much responsibility falls to editorial boards?

Editorial policy for biomedical journals increasingly calls on authors to affirm that approval was received from an Institutional Review Board (IRB) (or equivalent) prior to initiating any human subjects research presented in a manuscript submitted for publication. For most investigations and investigators this does not present any problem. However, when research is carried out in a setting where there is no IRB, should editors consider a report of such a study based on the merits alone? There is no simple answer to this question. This commentary explores aspects of the question and presents issues to be considered in developing an answer. Am. J. Ind. Med. 52:172-175, 2009.

David H. Wegman MD MSc1 * Elaine Major MS2
[1]School of Health and Environment, University of Massachusetts Lowell, Lowell, Massachusetts;[2]Institutional Compliance, University of Massachusetts Lowell, Lowell, Massachusetts

Geographic variation in opioid prescribing for acute, work-related, low back pain and associated factors: A multilevel analysis

Background Given reports about variation in opioid prescribing, concerns about increasing opioid use and its associated negative consequences make understanding the sources of variability important. The aims of the study were to assess the extent of and factors associated with geographic variation in early opioid prescribing for acute, work-related, low back pain (LBP). Methods Cases were selected from workers compensation administrative data filed between January 1, 2002 and December 31, 2003 and included claims from states with more than 40 cases. Early opioid prescribing (one or more prescriptions within first 15 days) was the outcome. Weighted coefficient of variation (wCOV) estimated geographic variation, and multilevel models measured variability controlling for individual and contextual factors. Results Of the 8,262 claimants, 21.3% received at least one early opioid prescription. Significant between-state variation was found (wCOV = 53%), from 5.7% (Massachusetts) to 52.9% (South Carolina). Seventy-nine percent of the between-state variation was explained by three contextual factors: state household income inequality (prevalence ratio [PR] 1.06, 95% confidence interval [CI] = 1.01, 1.12), number of physicians per capita (PR 0.99, 95% CI = 0.98, 0.99), and workers compensation cost containment effort score (PR 1.12, 95% CI = 1.02, 1.24). Individual-level factors, including severity, explained only a small portion of the geographic variability. Conclusion Geographic variation of early opioid prescribing for acute LBP is important and almost fully explained by state-level contextual factors. The study suggests that clinician and patient interaction and the subsequent decision to use opioids are substantially framed by social conditions and control systems. Am. J. Ind. Med. 52:162-171, 2009.

Barbara S. Webster BSPT PA-C1 * Manuel Cifuentes MD MPH ScD1 2 Santosh Verma MBBS MPH3 Glenn Pransky MD MOccH1
[1]Liberty Mutual Research Institute for Safety, Center for Disability Research, Hopkinton, Massachusetts;[2]Work Environment Department, University of Massachusetts, Lowell, Massachusetts;[3]Liberty Mutual Research Institute for Safety, Center for Injury Epidemiology, Hopkinton, Massachusetts

Sickness absence and workplace levels of satisfaction with psychosocial work conditions at public service workplaces

Background The objective of this study was to examine the impact of psychosocial work conditions on sickness absence while addressing methodological weaknesses in earlier studies. Methods The participants were 13,437 employees from 698 public service workplace units in Aarhus County, Denmark. Satisfaction with psychosocial work conditions was rated on a scale from 0 (low) to 10 (high). Individual ratings were aggregated to workplace scores. Analysis of variance was used to compare the average number of days of yearly sickness absence in three groups with different levels of satisfaction with psychosocial work conditions. Results Sickness absence was 30.8% lower in the most satisfied group (11.7 days/year (CI 95%: 10.2; 13.1)) than in the least satisfied group (16.9 days/year (CI 95%: 15.3; 18.6)) adjusted for the covariates included. Conclusions Satisfaction with psychosocial work conditions has a strong and independent impact on sickness absence. Am. J. Ind. Med. 52:153-161, 2009.

Torsten Munch-Hansen MSc1 * Joanna Wieclaw PhD1 Esben Agerbo PhD2 Niels Westergaard-Nielsen PhD3 Mikael Rosenkilde MSc1 Jens Peter Bonde MD1
[1]Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark;[2]National Center for Register Based Research, Aarhus University Hospital, Aarhus, Denmark;[3]Aarhus School of Business, Aarhus, Denmark