This article introduces the idea of human rights to the topic of workers' compensation in the United States. It discusses what constitutes a human rights approach and explains how this approach conflicts with those policy ideas that have provided the foundation historically for workers' compensation in the United States.

Using legal and historical research, key international labor and human rights standards on employment injury benefits and influential writings in the development of the U.S. workers' compensation system are cited.

Workers' injury and illness compensation in the United States does not conform to basic international human rights norms.

A comprehensive review of the U.S. workers' compensation system under international human rights standards is needed. Examples of policy changes are highlighted that would begin the process of moving workers' compensation into conformity with human rights standards. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

The aim of this study was to define the risk factors for occupational hand injuries and explore the relationship between the machines and the fingers injured, based on the records of a hospital in Turkey specialized in hand and microsurgery.

Five thousand twenty seven occupational hand injuries treated at a hand and microsurgery hospital between 1992 and 2005 were included in the study. All the injuries were retrospectively recoded according to ICD-10, (ICECI) and ILO recommendations. Logistic regression and chi-square for trend analysis were used to evaluate the risk factors for occupational injuries.

The most frequent injuries were traumatic amputation of wrist and hand (53.2%), open wound of wrist and hand (46.3%). Considering all injuries, 60.9% of agricultural machines, 52.7% of metal working machines, 54.7% of transmission machinery, and 42.8% of wood and assimilated machines affected the right hand. Powered wood cutters, presses, planning and milling machines, and machine belts were the most frequent five machines involved in injuries, each having a different finger pattern. The proportion of machinery among all hand injuries was significantly decreasing with time.

A stricter and more frequent supervision of the use of protective equipment and prohibition of the purchase of machinery not complying with the regulations could contribute to the prevention of hand injuries. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

Fish consumption is considered the most important source of contaminant exposure for humans beings, and farmed fish can be exposed to contaminants via feed supply.

Total mercury concentrations (THg) were determined in the muscle, liver, and feed of farmed Nile tilapia (juveniles and adults) from four different fish farms in Brazil (net cages and intensive tanks systems), by a flow injection mercury system.

Mercury concentrations observed in fish muscle were markedly lower (13.5–30.5 µg kg⁻¹) than the values recommended by ANVISA/MAPA for edible part of fish (500 µg kg⁻¹), and in the liver the concentrations found were higher than in the muscle.

These low levels of THg in farmed tilapia may be due to the low THg concentrations found in the analyzed fish feed, that ranged from 5.2 to 33.2 µg kg⁻¹, below the limit of 100 µg kg⁻¹ established by the European Commission. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

Following the results of a previous study that highlighted the potential for significant levels of dust exposure in South African soybean processing plants, a clinical investigation was undertaken to study the respiratory health of workers in this industry.

Workers from three soybean-processing plants were studied with a respiratory questionnaire and estimation of atopy and specific soybean IgE.

A total of 144 of the 181 (79.6% participation rate) plant employees completed the questionnaire and 136 (75.1%) gave blood samples for analysis of specific IgE. There was a significant association between work-related chest tightness (OR 4.0 [95% CI 1.3–12.6]), work-related nasal symptoms (OR 4.3 [95% CI 1.3–14.6]) and cough or chest tightness after handling soybean (OR 3.6 [95% CI 1.1–11.6]) and soybean sensitization. There was a significant association between current exposure to dust during soybean off-loading and “flu-like” illness (OR 2.7 [95% CI 1.0–7.2]), and cough or chest tightness after such work (OR 7.4 [95% CI 2.4–23.6]). The strongest predictor of work related nasal symptoms was sensitization to soybean, the latter strongly predicted by the presence of atopy (OR 34.7 [95% CI 6.6–182.5]).

Exposure and sensitization to soybean were associated with the presence of work related symptoms, including flu-like symptoms, cough, chest tightness, and nasal symptoms. The aetiology of these symptoms and more particularly the best intervention strategies require more detailed investigation. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

Bricklayers may be at increased risk of lung cancer, although a firm association has not been established. We examined this association within the EAGLE (Environment And Genetics in Lung cancer Etiology) study, a population-based case–control study conducted in Italy between 2002 and 2005.

For men in selected occupations in the construction sector we calculated smoking-adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs). For bricklayers we estimated the population attributable fraction (PAF) and the attributable community risk (ACR).

We found increased lung cancer risk for bricklayers (OR 1.57, 95% CI 1.12–2.21; 147 cases, 81 controls). The PAF was 3.9% (95% CI 0.7–7.0), corresponding to an ACR of 4.1 cases annually per 100,000 men (95% CI 0.7–7.3) in the whole community. Among bricklayers, there were increased risks for squamous cell (OR 2.03, 95% CI 1.32–3.13, 56 exposed cases) and small cell carcinomas (OR 2.29, 95% CI 1.29–4.07, 21 exposed cases), while no excess (OR 1.06, 95% CI 0.68–1.65, 41 exposed cases) was found for adenocarcinoma.

Our findings provide additional evidence of increased lung cancer risk in Italian bricklayers. The association is plausible because they are exposed to several carcinogens, notably crystalline silica. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

Health effects due to air pollution is becoming a major public health problem with growing traffic congestion and establishment of small- to medium-scale industries with poor emission controls in urban cities of Sri Lanka.

Respiratory health status of 7- to 10-year-old children in two settings (urban and semi-urban) was assessed using standard questionnaires. Information on socio-demographic characteristics and potential determinants of both outdoor and indoor air pollutants exposure levels were also obtained. The respiratory health status of children in the two settings was compared.

We found that children from the urban setting had a significantly higher prevalence of wheezing within the last 12 months as compared to children from the semi-urban setting (adjusted OR = 2.02; 95% CI = 1.13–3.59). Indoor cooking with unclean fuels was a risk factor for wheezing independent of the area of residence (adjusted OR = 1.57; 95% CI = 1.01–2.46).

Poor indoor air quality was a major determinant of wheezing for the overall study group. Children from urban areas of Sri Lanka have poorer respiratory health status as compared to children from semi-urban areas. Besides poor outdoor air quality, this difference may also be due to other unexplored factors which may differ between urban and semi-urban areas in Sri Lanka. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

We test the psychometric properties of a short version of the Effort–Reward Imbalance (ERI) questionnaire in addition to testing an interaction term of this model's main components on health functioning.

A self-administered survey was conducted in a sample of 2,738 industrial workers (77% men with mean age 41.6 years) from a large manufacturing company in Southern Germany. The internal consistency reliability, structural validity, and criterion validity were analyzed.

Satisfactory internal consistencies of the three scales: “Effort”, “reward”, and “overcommitment”, were obtained (Cronbach's alpha coefficients 0.77, 0.82, and 0.83, respectively). Confirmatory factor analysis showed a good model fit of the data with the theoretical structure (AGFI = 0.94, RMSEA = 0.060). Evidence of criterion validity was demonstrated. Importantly, a significant synergistic interaction effect of ERI and overcommitment on poor mental health functioning was observed (odds ratio 6.74 (95% CI 5.32–8.52); synergy index 1.78 (95% CI 1.25–2.55)).

This short version of the ERI questionnaire is a reliable and valid tool for epidemiological research on occupational health. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

Previous studies suggest that many persons with disabilities caused by work do not receive workers' compensation benefits.

Data from surveys of persons with disabilities were used to estimate the proportion of disability due to work-related injuries and diseases. Studies examining the proportion of workers with work-related disability who received workers' compensation benefits were reviewed. Legal and other factors explaining the lack of receipt of workers' compensation benefits were examined.

Many workers with disabilities caused by work do not receive workers' compensation benefits. The obstacles to compensation include increasingly restrictive rules for compensability in many state workers' compensation programs.

A substantial proportion of persons with work-related disabilities do not receive workers' compensation benefits. The solutions to this problem, such as providing healthcare to workers regardless of the source of injuries or diseases, are complicated and controversial, and will be difficult to implement. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

Rates of occupational injury among immigrant workers are widely believed to be underestimated. The goal of this study was to enhance understanding of the burden of occupational injury and the work organization factors underlying injury among immigrant Latino residential construction workers.

Prospective data were obtained from a community-based sample of Latino residential construction workers (N = 107) over a 3-month period.

Twenty-eight participants were injured, resulting in an injury incidence rate of 55.0/100 FTE (95% CI = 41.4–71.6) during the 3-month observation period. The injury rate involving days away from work during the observation period was 3.9/100 FTE (CI = 0.2–7.2). Injuries were elevated among roofers relative to framers and general construction workers. Roofers had elevated exposure to a variety of deleterious work organization factors.

Although imprecise given the small sample, our results suggest a threefold to fourfold underestimate of the injury burden to immigrant Latino construction workers. Work organization may contribute to elevated rates of non-fatal occupational injury, particularly among roofers. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

Workplace exposures that can potentially cause both allergic occupational contact dermatitis (AOCD) and occupational asthma (OA) are not clearly identified.

Occupational contact allergens (OCAs) were identified using North American Contact Dermatitis Group (NACDG) data. Reference documents and systematic reviews were used to determine whether each OCA had been reported to potentially cause OA. The presence or absence of a sensitizer notation in occupational hygiene reference documents was also examined.

The 10 most common OCAs were: epoxy resin*, thiuram, carba mix, nickel sulfate*, cobalt chloride*, potassium dichromate*, glyceryl thioglycolate, p-phenylenediamine*, formaldehyde* and glutaraldehyde*. Seven (indicated by *) were determined to be possible causes of OA. Information on sensitizing potential from OH reference materials contained conflicting information.

Several common OCAs can also potentially cause OA. Inhalation and dermal exposures to these agents should be controlled and both OA and AOCD should be considered as possible health outcomes. Increased consistency in sensitizer notations is needed. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

Although lung cancer risks can vary by race/ethnicity and by construction occupation, these risks have not been examined extensively.

This study analyzed 110,937 lung cancer cases identified from the California Cancer Registry between 1988 and 2007. Mean age at diagnosis, proportion diagnosed at an advanced stage, and proportion with 3-year survival were calculated for lung cancer cases employed in the construction industry. Case–control methodology was also used to assess the risk of lung cancer. Morbidity odds ratios (MORs) were estimated by conditional logistic regression.

Construction workers were found to have a significantly elevated risk for all lung cancer combined (MOR = 1.57) and for each lung cancer histologic subtype examined. All construction occupations, except managers/engineers and supervisors, had a significantly elevated risk for all lung cancer combined. Roofers and welders had the highest risks for total lung cancer and for each of the histologic subtypes. Construction workers in each of the four race/ethnicity groups also had significantly increased lung cancer risks. Compared to non-construction workers, construction workers were diagnosed at an earlier age, at a more advanced stage, and had significantly lower 3-year survival, though differences were modest.

These findings justify additional reductions in carcinogenic exposures in construction, and increased support for smoking cessation programs at construction sites. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

Musculoskeletal disorders (MSDs) are the most common occupational injuries and illnesses among hospital workers in the United States. To date, there is little in the literature examining the principal effect of patient handling on MSDs. The primary objective of this study was to investigate and confirm the principal effect of patient handling on hospital worker MSDs.

Workers' Compensation (WC) claims related to MSDs filed during 2003–2009 by employees in a large US healthcare system were classified using ICD-9. Patient handling, demographic, work, and injury characteristics were obtained. Two multivariable Poisson regression models were compared to evaluate association between risk factors and MSDs. One model contained all risk factors, excluding patient handling; the other model included patient handling.

Among 3,452 claims from 24,824 FTEs, 76% were MSDs. About half of the MSDs involved patient handling. In the regression model without patient handling, EMS workers, women, 50–59 years of age, union members, evening shift workers, and fulltime workers showed associations with MSDs. However, all the observed associations disappeared when patient handling was included in the second regression model; patient handling was the only factor showing an association with MSDs, although the effect was not strong (RR = 1.2, 95% CI = 1.2–1.3).

All the observed associations of risk factors disappeared and were further away from patient handling on the causal pathway to MSDs. Patient handling involves numerous work elements and dynamic physical activities. Understanding the work elements of patient handling and conducting interventions based on specific patient handling tasks can substantially reduce MSDs among hospital workers. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

Occupational stress and unhealthy lifestyles are common characteristics of urban workers. The association between health behaviors and job stress of urban Brazilian civil servants was studied.

A cross-sectional study included 893 workers. Health markers, the dependent variables, were: Fruit/vegetable (FV) and alcohol (A) intake, physical activity (PA), including at work (PAW), smoking (S), BMI ≥ 25 Kg/m². Occupational stress, assessed by Job Stress Scale-Brazilian version, classified employees into: High-strain, Low-strain, Active, and Passive. Prevalence rates and multivariate Poisson models were adopted.

On average, employees (mean age = 40.2 years; 69.1% female) reported healthy lifestyle factors: FV (56%); PA (59.7%); S (13.3%); however, 49.4% were overweight. Compared to low-strain, high-strain workers reported higher PAW; passive workers lesser PA and higher PAW. After adjusting for socio-demographics and work characteristics, the occupational stress dimensions were no longer associated to health behaviors.

Our results do not support the hypothesis of an effect for occupational stress on urban employees' health behaviors. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

Several genes are associated with an increased susceptibility to asthma, which may be exacerbated by ambient air pollution. These genes include GSTM1 (glutathione-S-transferase M1 gene) and GSTP1 (glutathione-S-transferase P1 gene), which may modulate the response to epithelial oxidative changes caused by air pollutant exposure. This study evaluated fluctuations in the forced expiratory volume in one second (FEV₁) in relation to lagged daily averages of ambient air pollutants (SO₂, NO₂, NO, and PM₁₀) while considering genotype as an effect modifier.

A longitudinal cohort of 129 schoolchildren of African descent from Durban, South Africa was assessed. GSTM1 (null vs. present genotype) and GSTP1 (Ile105Val; AA → AG/GG) genotypes were determined using standard techniques. SO₂, NO₂, NO, and PM₁₀ were measured continuously over a year using validated methods. The outcome was intraday variability in FEV₁. Data were collected daily over a 3-week period in each of four seasons (2004–2005).

Among the children tested, 27% had the GSTM1 null genotype and 81% carried the GSTP1 G allele. Approximately 26 out 104 children (25%) showed evidence of bronchial hyperreactivity, 13% reported having symptoms in keeping with persistent asthma, and a further 25% reported symptoms of mild intermittent asthma. PM₁₀ and SO₂ levels were moderately high relative to international guidelines. Neither GSTM1 nor GSTP1 genotypes alone were significantly associated with FEV₁ intraday variability. In models not including genotype, FEV₁ variability was statistically significantly associated only with NO₂ for 5-day lags (% change in intraday variability in FEV1 per interquartile range = 1.59, CI 0.58, 2.61). The GSTP1 genotype modified the effect of 3 days prior 24-hr average PM₁₀ and increased FEV₁ variability. A similar pattern was observed for lagged 3 day SO₂ exposure (P interaction < 0.05). Adverse effects of these pollutants were limited to individuals carrying the G allele for this polymorphism.

Among this indigenous South African children cohort, the GSTP1 genotype modified the effects of ambient exposures to PM₁₀ and SO₂ and lung function. A plausible mechanism for these observed effects is decreased capacity to mount an effective response to oxidative stress associated with the GSTP1 AG + GG genotype. Am. J. Ind. Med. © 2012 Wiley Periodicals, Inc.

Although environmental and occupational health (EOH) research and services in Sri Lanka have a long history, policies related to EOH are outdated.

We review the International Training and Research in Environmental and Occupational Health (ITREOH) program in Sri Lanka that commenced in 2006 as a collaboration between the University of Alabama at Birmingham and the Faculty of Medicine of the University of Kelaniya, Sri Lanka.

The program has trained over 20 scientists in conducting EOH research. New pioneering research in EOH was initiated. The program was instrumental in furthering the training and research in EOH by initiating a MPH degree program, the first in the country.

The program has established North–South, South–South and in-country collaborations between institutions and scientists, increasing the visibility of EOH in the future. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

Among police responders enrolled in the World Trade Center Health Registry (WTCHR), Post-traumatic Stress Disorder (PTSD) was almost twice as prevalent among women as men 2–3 years after the 9/11 attacks.

Police participants in the WTCHR Wave 1 survey 2–3 years after 9/11/01, were reassessed for probable PTSD at Wave 2, 5–6 years after 9/11/01, using PCL DSM-IV criteria.

Police participants in the Wave 2 survey included 2,527 men, 413 women. The prevalence of “Probable PTSD” was 7.8% at Wave 1 and 16.5% at Wave 2. Mean PCL scores increased from 25.1 to 29.9 for men and 28.6 to 32.2 for women. Prevalence of PTSD was higher for women than for men at Wave 1 (χ² = 10.882, P = 0.002), but not Wave 2 (χ² = 2.416, P = 0.133). Other risk factors included losing one's job after 9/11 and being disabled.

Prevalence of probable PTSD among police doubled between 2003–2004 and 2006–2007. After the 2-year time span, the gender difference was no longer significant; prevalence of PTSD symptoms increased and there was a substantial amount of co-morbidity with other mental health problems. Further development of prevention and intervention strategies for police responders with symptoms of PTSD is needed. The observed upward trend in PCL scores over time in police officers with PCL scores less than 44, suggests that PTSD prevention and intervention strategies should be applied to all police affected by the 9/11 attacks, not limited just to those with PTSD symptoms. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

A systematic review was undertaken to establish risk factors for the development of musculoskeletal disorders (MSDs) among farmers.

Comprehensive electronic searches of Pubmed, Web of Science, CINAHL, SCOPUS, EMBASE, Agris Database, and Cochrane Library were carried out using a battery of key words for MSDs and farmers. The studies methods quality was assessed using a standardized checklist.

Thirty-three studies fulfilled the inclusion criteria. The median method score was 65% of the maximum attainable score, resulting in 15 studies of higher methodological. Risks were categorized into: Work characteristics (n = 11), personal characteristics (n = 5), and psychosocial factors (n = 5). Spinal MSD risk factors include exposure to working in tree crops, vibration, postural load, being an owner operator, age, education beyond high school, suffering from asthma or depression, having <8 hr nightly sleep, bad quality sleep, and geographic location. Upper extremity MSD risk factors include being an owner operator, dust with pig workers, numbness and coldness in younger milkers and numbness in milkers >43 years, age, and body height in dairy farmers. Lower extremity MSD risk factors include, duration of farming ≥10 years, working >5 hr daily in animal barns, milking >40 cows, years as a dairy farmer, farm work, age, body mass, and female gender.

In exploring risk factors the spine was the most researched body region, followed by lower and upper extremity. Given the variance between studies, it is recommended that future studies focus on specific types of farmers and should explore specific exposures for specific body parts using standardized case definitions. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

To compare risk factors for shoulder pain without and with rotator cuff syndrome (RCS).

A total of 3,710 workers of a French region were randomly included in the cross-sectional study between 2002 and 2005. Personal and occupational risk factors were assessed during a physical examination and by a self-administered questionnaire. Multinomial logistic modeling was used for the following outcomes: no shoulder pain and no RCS (reference), shoulder pain without RCS (called “shoulder pain”) and RCS, separately for men and women.

The prevalence rates of “shoulder pain” for men and women were 28.0% and 31.1%, respectively, and the prevalence rates of RCS were 6.6% and 8.5%, respectively. In men, “shoulder pain” and RCS were associated with age, high-perceived physical exertion, and arm abduction. Automatic work pace and low supervisor support were associated with “shoulder pain,” and high psychological demand and low skill discretion with RCS. In women, “shoulder pain” and RCS were associated with age, repetitiveness of tasks, and low supervisor support. High perceived physical exertion and exposure to cold temperatures were associated with “shoulder pain.”

Age was more strongly associated with RCS than with shoulder pain without RCS for both genders. Biomechanical and psychosocial factors were associated with “shoulder pain” and RCS and differed between genders. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

Opioid use and dosing for patients with chronic non-cancer pain have dramatically increased over the past decade, resulting in a national epidemic of mortality associated with unintentional overdose, and increased risk of disability among injured workers. We assessed changes in opioid dosing patterns and opioid-related mortality in the Washington State (WA) workers' compensation system following implementation of a specific WA opioid dosing guideline in April, 2007.

Using detailed computerized billing data from WA workers' compensation, we report overall prevalence of opioid prescriptions, average morphine-equivalent dose (MED)/day, and proportion of workers on disability compensation receiving opioids and high-dose (≥120 mg/day MED) opioids over the past decade. We also report the trend of unintentional opioid deaths during the same time period.

Compared to before 2007, there has been a substantial decline in both the MED/day of long-acting DEA Schedule II opioids (by 27%) and the proportion of workers on doses ≥120 md/day MED (by 35%). There was a 50% decrease from 2009 to 2010 in the number of deaths.

The introduction in WA of an opioid dosing guideline appears to be associated temporally with a decline in the mean dose for long-acting opioids, percent of claimants receiving opioid doses ≥120 mg MED per day, and number of opioid-related deaths among injured workers. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

Underground coal mining is an expanding industry in Ukraine, yet little is known about the burden of respiratory disease among Ukrainian miners.

A Fogarty International Center-supported collaboration between researchers at the University of Illinois and the Institute of Occupational Health in Kyiv, Ukraine formed to improve capacity for conducting and monitoring medical surveillance among Ukrainian coal miners. A cross-sectional survey among a random sample of working and former miners was conducted; demographic, work, and health information were collected using a standardized questionnaire. Weighted prevalence rates were calculated and predictors of respiratory symptoms explored.

Improvements in infrastructure, including spirometry and chest radiography testing, transformed medical surveillance among these miners. Results from the health study included that the prevalence of respiratory symptoms was higher among former compared to current miners (shortness of breath 35.6% vs. 5.1%; chronic bronchitis 18.1% vs. 13.9%, respectively). A statistically significant exposure–response relationship was observed between years mining and respiratory symptoms in former miners and between years mining at the coal face and respiratory symptoms among current miners. Evidence of downward bias from the healthy worker survivor effect was observed.

This successful international collaboration built a sustainable infrastructure for conducting workplace medical surveillance and research. The resulting study was the first in the western literature to report on respiratory symptoms in this population; likely underestimation of disease rates due to selection and measurement biases was demonstrated. Efforts should continue to build this collaboration and to characterize and reduce respiratory illness among Ukrainian coal miners. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

Workplace injuries can have a substantial economic impact. Rates of workplace injuries differ across age groups, yet occupations/industry sectors at highest risk within age groups have not been identified. We examined workplace injury risk across industry sectors for three age groups using nationally representative U.S. data.

Data from 1997 to 2009 National Health Interview Survey (NHIS) were pooled for employed adults by age groups: (1) 18–25 (n = 22,261); (2) 26–54 (n = 121,559); and (3) 55+ (n = 24,851). Workplace injury risk comparisons were made using logistic regression, with the Services sector as the referent and adjustment for sample design, gender, education, race/ethnicity, age, and income-to-poverty ratio.

Overall 3-month injury prevalence was 0.88%. Highest risk sectors for workers aged 18–25 included: Agriculture/forestry/fisheries (odds ratio = 4.80; 95% confidence interval 2.23–10.32), Healthcare/social assistance (2.71; 1.50–4.91), Construction (2.66; 1.56–4.53), Manufacturing (2.66; 1.54–4.61); for workers 26–54: Construction (2.30; 1.76–3.0), Agriculture/forestry/fisheries (1.91; 1.16–3.15), and Manufacturing (1.58; 1.28–1.96); for workers 55+: Agriculture/forestry/fisheries (3.01; 1.16–7.81), Transportation/communication/other public utilities (2.55; 1.44–4.49), and Construction (2.25; 1.09–4.67).

Agriculture/forestry/fisheries and Construction were among the sectors with highest workplace injury risk for workers across all age groups. Differences in highest risk industries were identified between the youngest and oldest industry groups. Our results indicate a need for age-specific interventions in some industries, and a need for more comprehensive measures in others. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

Statewide datasets of emergency department (ED) visits may be useful for occupational injury surveillance. Using data from 12 hospitals, we evaluated two indicators of work-relatedness in reported ED data and the availability of employment information in medical charts.

Workers' compensation as payer and/or “yes” in an injury-at-work field were used to define probable work-related (PWR) injury visits in the Massachusetts ED dataset. Charts were reviewed for a sample of 1,002 PWR and 250 probable nonwork-related (PNWR) cases.

Using chart information as the gold standard, indicators of work-relatedness had a sensitivity of 82%, specificity of 97%, and predictive value positive of 86%. Employer name was in charts for 89% of PWR and 42% of PNWR cases. Occupation was available for 34% of PWR cases.

Electronic ED data are useful for state surveillance of occupational injuries. Improvements in attribution of work-relatedness and collection of available employer identifiers and occupational information would enhance its usefulness. The performance of indicators of work-relatedness in ED datasets should be examined in different states. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

A definite cause of sarcoidosis has not been identified, however past research suggests that environmental factors may be triggers of the granulomatous response in genetically susceptible individuals.

A 22-year-old male non-smoker, presented with progressive exertional dyspnea and cough of 3 months duration. One year before, when he started working in tunnel excavation, he had a normal chest radiograph. Chest imaging revealed bilateral nodules and masses of peribronchovascular distribution plus mediastinal lymphadenomegaly. Histologic lymph node analysis revealed non-caseating confluent granulomas. Sarcoidosis was diagnosed. The patient was treated with corticosteroids and advised to change jobs. Complete remission of the disease was achieved and persisted for at least one year without steroid treatment.

Sarcoidosis is believed to have environmental triggers. The timing of the onset of sarcoidosis in this patient following intensive exposure to tunnel dust suggests an environmental contribution. The recognition that sarcoidosis may have occupational triggers have medical, employment, and legal implications. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

Dump trucks are universally used in construction and other industries to haul materials to the location and to remove waste materials.

The source for dump truck-related fatality data was the Bureau of Labor Statistics Census of Fatal Occupational Injuries (CFOI) Research File.

From 1992 to 2007, 829 construction workers were killed in dump truck-related incidents nationwide. Of those, 336 were dump truck operators with 215 deaths occurring in street and highway incidents. Another 343 deaths involved workers on foot, three-quarters struck by dump trucks. Sixty-four of the construction workers killed were maintaining dump trucks, 22 when caught between the truck frame and a falling dump truck bed. Of the 86 other deaths, 55 involved streets and highways.

Recommendations include: (i) improving the reporting of seat belt usage in fatality reports; (ii) requiring use of seat belts; (iii) requiring the use of backup alarms, spotters, or other methods to alert dump truck operators to workers in their blind spots; (iv) prohibiting direct dumping at river banks and embankments; (v) using cameras or radar to enforce stopping at railway crossings; and (xi) enforcing worker safety practices (e.g., lockout/tagout procedures on elevated dump truck beds). Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

To characterize prospective agricultural injury experience among rural California Central Valley public high school students enrolled in agricultural sciences curriculum.

The University of California, Davis Youth Agricultural Injury Study (UCD-YAIS) examined prospective farm-work injury among students from 10 California Central Valley public high schools.

Of eligible subjects, 882 (62.5%) completed at least one annual follow-up survey. Of these, 489 reported farm work in the previous year, including 40 (8.2%) with at least one farm work-related injury. Fractures were the most common injury, especially among girls. Girls were more likely to suffer animal-related injury and boys injury from motor vehicles, machinery, or tool use. Prospective injury risk was strongly associated with prior-year farm injury (OR 8.53; 95% CI 4.02, 18.1) and farm work hours. After adjustment for farm work hours, grade level, and sex, risk was significantly associated with machinery operation, applying chemicals, number of hazardous tasks performed, riding motorcycles or mopeds, riding in back of an uncovered pick-up truck, and smoking. Risky attitude toward farm safety was associated prospectively with injury in stepwise fashion.

Adolescents are at risk for serious farm-work injuries. Although limitations on hazardous tasks and farm work hours are likely to be the most efficacious means for reducing injury, education will play an important role. Education should include inculcating safety-related attitudes and habits and focus on hazardous tasks, such as those involving animals (for girls) and motor vehicles and machinery (for boys), especially among youth with prior farm injury. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

Biomass cooking fuel is the main source of indoor air pollution in the majority of households in the developing world. Sri Lanka is an island of about 20 million population with urban, rural, and estate population of 14.6%, 80.0%, and 5.4%, respectively. This study describes biomass fuel use for cooking in Sri Lanka.

We analyzed data from two national Demographic Health Surveys (2000 and 2007) to identify the use and determinants of cooking fuels in Sri Lankan households. The results are based on a sample of 8,169 households in 2000 and 19,862 households in 2007.

Wood was the principal cooking fuel used in 78.3% and 78.5% of households in 2000 and 2007, respectively. In 2007, 96.3% of estate sector households used firewood as compared to 84.2% in the rural and 34.6% in the urban sectors. Similar trends were noted in 2000 as well.

The shift from firewood to cleaner fuels in Sri Lanka is negligible from 2000 to 2007. Improving the quality of life of the population does not necessarily predict a shift towards the use of cleaner cooking fuels in Sri Lanka. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

Many authorities are concerned about the rising use and the potential overuse of opioid pain medications. A study of opioid prevalence and dosage in Ohio's workers' compensation (WC) system was conducted, with comparisons made to opioid use in other WC and non-WC settings.

Systematic literature reviews of WC and non-WC opioid use and dosage nationally were conducted. Two years of Ohio WC data (2008–2009) were analyzed to determine average daily morphine equivalent dose (MED), opioid costs, pharmacies used per claimant, and extent of long-duration cases.

Nearly one-fifth (19.2%) of Ohio WC claims involved opioid use, compared to 31.8% in other WC systems and 17.9% in non-WC settings. Mean MED was 57.5 mg, compared to 47.8 mg in other WC systems, and 41.8 mg among non-WC populations. Nearly 10% of WC claims involved relatively high MED exceeding 120 mg/day.

Policy makers need to develop strategies for addressing high opioid use in WC systems. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

This study assesses state-level data sources for numerators and denominators in occupational fatality rates. Data from Oregon Fatality Assessment and Control Evaluation, 2003–2007, are used to assess numerators, and to produce fatality rates using different data sources for denominators.

Data sources for state-level occupational fatalities and the employed population are described. A statistical test for interrater reliability is applied in the comparison to Census of Fatal Occupational Injuries data. Odds ratios are calculated in the presentation of incident rates by age.

Comparison of occupational fatality data sources demonstrates substantial differences. Acquiring appropriate state-level denominator data are limited, particularly for stratified groups.

Although not decisive, occupational fatality rates may help confirm areas of concern to guide necessary field work. This assessment of data sources and identification of several priority areas of concern in Oregon may help state researchers direct their own efforts to target priorities for effective interventions. Am. J. Ind. Med. © 2011 Wiley Periodicals, Inc.

The California Department of Public Health received serial spirometry data for flavoring manufacturing workers at 20 companies at risk of bronchiolitis obliterans.

We graded spirometry quality; identified individual workers with excessive decline in forced expiratory volume in 1 s (FEV₁) using relative longitudinal limits of decline based on 4% average within-person variability; and analyzed declines by occupational risk factors.

The quality of 1,697 spirometry tests from 725 workers varied by 18 providers, with poorer quality from commercial providers. Of 416 workers with at least two tests, 40 (9.6%) had abnormal FEV₁ decline. Of 289 workers with high quality spirometry, 21 (7.3%) had abnormal decline. Only one of the 21 had airways obstruction. Abnormal FEV₁ decline rates (per person-month) were greater among workers at companies using ≥800 lbs/year diacetyl than at companies using lesser amounts. Abnormal FEV₁ decline rates were greater at companies previously having four-person clusters of spirometric obstruction than at companies with no or only one worker with obstruction.

Spirometric surveillance of flavoring workers can identify individual workers with an abnormal FEV₁decline for preventive intervention, even when the FEV₁ itself remains within the normal range. Good quality spirometry and classification of abnormal with relative longitudinal limit of decline minimize misclassification of possible work-related health effects. Am. J. Ind. Med. © 2011 Wiley-Liss, Inc.

The quality of housing provided to migrant farmworkers is often criticized, but few studies have investigated these housing conditions. This analysis examines housing regulation violations experienced by migrant farmworkers in North Carolina, and the associations of camp characteristics with the presence of housing violations.

Data were collected in183 eastern North Carolina migrant farmworker camps in 2010. Housing regulation violations for the domains of camp, sleeping room, bathroom, kitchen, laundry room, and general housing, as well as total violations were assessed using North Carolina Department of Labor standards.

Violations of housing regulations were common, ranging from 4 to 22 per camp. Housing regulation violations were common in all domains; the mean number of camp violations was 1.6, of sleeping room violations was 3.8, of bathroom violations was 4.5, of kitchen violations was 2.3, of laundry room violations was 1.2, and of general housing violations was 3.1. The mean number of total housing violations was 11.4. Several camp characteristics were consistently associated with the number of violations; camps with workers having H-2A visas, with North Carolina Department of Labor Certificates of Inspection posted, and assessed early in the season had fewer violations.

These results argue for regulatory changes to improve the quality of housing provided to migrant farmworkers, including stronger regulations and the more vigorous enforcement of existing regulations. Am. J. Ind. Med. 55:191–204, 2012. © 2011 Wiley Periodicals, Inc.

Developing nations carry a substantial portion of the global burden of injury, but without reliable injury surveillance, there is no way to characterize or prioritize the causes of work-related injury for prevention.

Injury data from 52 treatment sites in the Xuan Tien Commune, Vietnam with over 10,000 inhabitants were collected between January 1 and December 31, 2006. Injured residents were interviewed to determine work-relatedness, relevant causes, disability, and burden.

Five hundred four work-related injuries were reported from formal treatment sites (incidence rate of 87 per 1,000 FTE) with a mean lost work day of 11 days. Four thousand five hundred seventy-four lost work day equivalents were estimated based on actual days lost to recover plus work days lost earning income to pay for medical costs, accumulating a total direct burden to the community of 8,641 lost work day equivalents. Almost half of that burden was caused by work in manufacturing. First aid boxes placed in 40 manufacturing enterprises yielded the 2nd highest reporting source.

This study demonstrated the feasibility and value at the local level to build an active injury surveillance system which could have a large impact on preventing the burden of injuries in workplaces in Vietnam. Am. J. Ind. Med. 55:205–216, 2012. © 2011 Wiley Periodicals, Inc.

Police officers may be injury prone due to fatigue, erratic work hours, and insufficient sleep. This study explored injury incidence among police officers across shifts.

Day-to-day shift data from computerized payroll records (1994–2010) were available from a mid-sized urban police department (n = 430). Sleep duration, shift activity level, returning to work after days off, and injury incidence over time were also examined.

Age-adjusted incidence rate ratio (IRR) for injury on the midnight shift was 72% larger than the day shift (IRR = 1.72; 95% CI = 1.26–2.36) and 66% larger than the afternoon shift (IRR = 1.66; 95% CI = 1.23–2.25). Injury incidence for the first day back on the midnight shift was 69% larger than day shift (IRR = 1.69; 95% CI = 1.23–2.32) and 54% larger than the afternoon shift (IRR = 1.54; 95% CI = 1.36–1.76). High activity level combined with midnight shift work put officers at increased injury risk (IRR = 2.31; P = 0.0003). Probability of remaining free of injury was significantly higher for day shift than midnight shift (P < 0.0001).

Higher injury risk was associated with night shift work in police officers. Night shift combined with high work activity was strongly associated with injury risk. There was a significantly higher probability of not being injured on day compared to midnight or afternoon shifts. Am. J. Ind. Med. 55:217–227, 2012. © 2011 Wiley Periodicals, Inc.

Occupational data are a common source of workplace exposure and socioeconomic information in epidemiologic research. We compared the performance of two occupation coding methods, an automated software and a manual coder, using occupation and industry titles from U.S. historical records.

We collected parental occupational data from 1920–40s birth certificates, Census records, and city directories on 3,135 deceased individuals in the Atherosclerosis Risk in Communities (ARIC) study. Unique occupation-industry narratives were assigned codes by a manual coder and the Standardized Occupation and Industry Coding software program. We calculated agreement between coding methods of classification into major Census occupational groups.

Automated coding software assigned codes to 71% of occupations and 76% of industries. Of this subset coded by software, 73% of occupation codes and 69% of industry codes matched between automated and manual coding. For major occupational groups, agreement improved to 89% (kappa = 0.86).

Automated occupational coding is a cost-efficient alternative to manual coding. However, some manual coding is required to code incomplete information. We found substantial variability between coders in the assignment of occupations although not as large for major groups. Am. J. Ind. Med. 55:228–231, 2012. © 2011 Wiley Periodicals, Inc.

To evaluate a consistent association between jobs in “electric” occupations and amyotrophic lateral sclerosis (ALS), a comprehensive job exposure matrix (JEM) that includes electric shocks and magnetic fields (MF) is needed.

We used incident electric shocks and electrocutions from two available data sources along with expert judgment to create a JEM that was integrated into an existing MF JEM. The final JEM contained ordinal electric-shock exposure assignments for 501 job titles.

Main occupational groups experiencing the electric shocks were precision production, craft, and repair occupations. Specific jobs with the highest proportion of shocks per 100,000 workers were: electrical apprentices (99.7), mechanic and repairer helpers (74.0), hoist and winch operators (63.3), and electrical power installers (52.4). Examples of job titles with low electric-shock exposures were administrative support occupations, data-key entry operators, and waiters and waitresses.

Combining publicly available data with an expert panel is a viable method to construct an electric-shock MF JEM. This JEM will allow an evaluation of association between electric shocks and neurodegenerative diseases. Am. J. Ind. Med. 55:232–240, 2012. © 2011 Wiley Periodicals, Inc.

Currently, little is known about workers' occupational safety and health (OSH) information-seeking behavior.

We assessed whether Dutch workers have (OSH) questions, what motivates them to seek information or advice to solve these questions, and whether workers actually find the information they are looking for. A random sample of 888 workers from a large business panel were sent an online questionnaire. In total, 535 workers, likely parallel to the Dutch working population, returned the questionnaire (response rate 60%).

In the last year, 380 of the 535 respondents (71%) had at least one OSH question. In total, 159 of the 380 respondents (42%) with an OSH question actively searched for information or advice. In a logistic regression analysis, three factors were identified to influence workers' information seeking: cognitions about personal benefits or costs of solving the question (OR = 2.8, 95% CI: 1.8–4.5), emotions that accompany the question (OR = 1.8, 95% CI: 1.1–3.0), and encouragement by the social environment (OR = 1.8, 95% CI: 1.0–3.0). In total, 50% of the respondents seeking information indicated they could not find (all) the information they sought. The barrier most often mentioned (47%) was the poor applicability of the information.

Although most workers have OSH questions, only 40% seek information or advice to answer their questions. Moreover, many OSH questions remain unanswered by common information facilities. This study provides input on how to develop campaigns and new facilities that may induce workers to seek information and that offer more applicable information. Am. J. Ind. Med. 55:250–259, 2012. © 2011 Wiley Periodicals, Inc.

Exposure to deadlines at work is increasing in several countries and may affect health. We aimed to investigate cross-sectional and longitudinal associations between frequency of difficult deadlines at work and sleep quality.

Study participants were knowledge workers, drawn from a representative sample of Danish employees who responded to a baseline questionnaire in 2006 (n = 363) and a follow-up questionnaire in 2007 (n = 302). Frequency of difficult deadlines was measured by self-report and categorized into low, intermediate, and high. Sleep quality was measured with a Total Sleep Quality Score and two indexes (Awakening Index and Disturbed Sleep Index) derived from the Karolinska Sleep Questionnaire. Analyses on the association between frequency of deadlines and sleep quality scores were conducted with multiple linear regression models, adjusted for potential confounders. In addition, we used multiple logistic regression models to analyze whether frequency of deadlines at baseline predicted caseness of sleep problems at follow-up among participants free of sleep problems at baseline.

Frequent deadlines were cross-sectionally and longitudinally associated with poorer sleep quality on all three sleep quality measures. Associations in the longitudinal analyses were greatly attenuated when we adjusted for baseline sleep quality. The logistic regression analyses showed that frequent deadlines at baseline were associated with elevated odds ratios for caseness of sleep problems at follow-up, however, confidence intervals were wide in these analyses.

Frequent deadlines at work were associated with poorer sleep quality among Danish knowledge workers. We recommend investigating the relation between deadlines and health endpoints in large-scale epidemiologic studies. Am. J. Ind. Med. 55:260–269, 2012. © 2011 Wiley Periodicals, Inc.

This study aimed at assessing factors associated to the duration of sickness absence after a back injury in the Belgian working population, with a special emphasis on cultural factors.

The data were retrieved from the Belgian Fund for Work Accidents database over a 3-year period (2001–2003). The population source involved all Belgian workers under a job contract in the private sector registered as compensated cases for an accident that occurred at the workplace (n = 558,276). From that database, all back injury cases involving a complete data set and registered during the first 6 months of each year (n = 11,262) were selected and eight factors (gender, age, seniority in the current job, job category, accident regional location, enterprise size, sector of activity, and accident circumstances) were analyzed in relation to the outcome variable, sick leave duration recorded as ordered time intervals between 0 and 183–366 days.

Sick leave duration was strongly associated in a multivariate model to age (≥40 years: OR = 2.18), blue-collar job (1.55), work in building industry (1.32), and enterprise size (>100: 0.85), and to a less extent to seniority (>10y: 0.88), and circumstance of accident (falls: 1.26). Injuries occurring in the French-speaking part of the country were associated to a longer sick leave (1.07; P = 0.034).

This study shows that besides well-known risk factors, subtle cultural language-linked factors and/or regional differences in economic climate may significantly influence the length of disability period after a back injury. Am. J. Ind. Med. 55:270–280, 2012. © 2011 Wiley Periodicals, Inc.

To investigate the one-year prevalence of musculoskeletal symptoms and associated risk factors in a large sample of Chinese workers in various industrial settings.

A total of 5,338 (3,632 males and 1,706 females) workers from 13 companies participated in this study. Musculoskeletal symptoms in different body regions in the previous year and their risk factors were assessed by a self-reported questionnaire. Logistic regression analyses were performed to estimate the individual, work-related physical and psychosocial risk factors for the musculoskeletal symptoms.

The most commonly affected body regions among the workers were lower back (59.7%), neck (48.6%), shoulders (38.8%), and wrists (33.5%). Female workers had greater prevalence of musculoskeletal symptoms in the neck, shoulders, and wrists than male workers. Results of multivariate analyses indicated that individual, work-related physical and psychosocial factors were associated with the musculoskeletal symptoms.

The results suggest that interventions aimed at reducing musculoskeletal symptoms in the Chinese working population should take into account multiple risk areas including individual, physical job characteristics and work-related psychosocial factors. Am. J. Ind. Med. 55:281–293, 2012. © 2011 Wiley Periodicals, Inc.