[Sleep disorders and work: guidelines for health surveillance, risk management and prevention]. / I disturbi del sonno in ambito lavorativo: indirizzi di sorveglianza sanitaria, prevenzione e gestione del rischio.

Sleep disorders and related diseases are becoming increasingly relevant for the health and wellbeing of the general and working populations. Sleep disorders affect all aspects of health, showing a bi-directionality with health conditions and comorbidity with several diseases. Consequently, sleep disorders may have severe negative consequences both for the individual and the enterprise, as well as for society on the whole, in terms of health, productivity and social costs. When considering the disturbances of the sleep/wake cycle, it is important to distinguish between those connected with endogenous biological factors from those related to socio-environmental conditions, including work, and those associated with mental and physical diseases, that are often associated and interact with each other. Many sleep disorders are still underestimated and under-valued in clinical practice and, to a much greater extent, in workers' health surveillance. The present paper is aimed at drawing the attention of the occupational health physician to some key issues, particularly regarding excessive daytime sleepiness, obstructive sleep apnea syndrome and shift and night work, as well as their implications in terms of health and occupational consequences. Information on the main aspects of clinical diagnosis and health surveillance, as well as risk management and prevention at the workplace, are provided.

Configural approaches to temperament assessment: implications for predicting risk of unintentional injury in children.

This study used two configural approaches to understand how temperament factors (surgency/extraversion, negative affect, and effortful control) might predict child injury risk. In the first approach, clustering procedures were applied to trait dimensions to identify discrete personality prototypes. In the second approach, two- and three-way trait interactions were considered dimensionally in regression models predicting injury outcomes. Injury risk was assessed through four measures: lifetime prevalence of injuries requiring professional medical attention, scores on the Injury Behavior Checklist, and frequency and severity of injuries reported in a 2-week injury diary. In the prototype analysis, three temperament clusters were obtained, which resembled resilient, overcontrolled, and undercontrolled types found in previous research. Undercontrolled children had greater risk of injury than children in the other groups. In the dimensional interaction analyses, an interaction between surgency/extraversion and negative affect tended to predict injury, especially when children lacked capacity for effortful control.

Well being, work environment and work accidents.

We examine factors that influence accident proneness among employees. We agree that the determinants of accident proneness include organizational, emotional and personal factors. Using logistic regression we estimated three models, and their predictability for accident proneness among sample of 200 injured workers interviewed upon entering hospital emergency wards in Israel. Work injuries were not contingent on age, religion, nor education. The effects of gender were strong but non-significant. Subcontracted and higher-paid workers are more likely to get repeat injuries. Prior injury experience sensitized employees to stronger perceptions of risk associated with unsafe practices. Large family households, ameliorates stress feelings and lessens the likelihood of accident proneness while poor housing conditions have the opposite effect. The full model demonstrates considerable prediction of injuries when focusing on type of employment, personal income level, being involved in dangerous jobs, emotional distress and a poor housing environment. The model contains most of the significant results of interest and provides a high level of predictability for work injuries.

El problema de los accidentes en la ciudad de Santiago / Accidents problem in Santiago city

La ciudad de Santiago fue estudiada en cuanto a morbilidad y atención médica de la población en 1993 y 1994 realizando tres encuestas domiciliarias en una muestra aleatoria de 1000 viviendas con 4663 personas. Se registraron detalladamente todos los eventos de salud percibidos en las semanas previas a cada encuesta, las que fueron realizadas por estudiantes de 6§ año de medicina, previamente adiestrados. Se registraron 125 accidentes en las quincenas de julio y diciembre de 1993, que corresponden a una tasa mensual de 26,8 pro 1000 habitantes y a una probabiliadad anual de sufrir un accidente de 0,32. Las quemaduras, contusiones, esguinces y fracturas fueron los tipos más frecuentes. Un 46 por ciento del problema se produjo en las casas, un 27 por ciento en calles y sitios públicos; un 15 por ciento fueron accidentes del trabajo; 7,3 por ciento ocurrieron en escuelas o recintos deportivos escolares y 5,6 por ciento correspondieron a accidentes del tránsito. El riesgo de accidente fue similar en ambos sexos, difiriendo sólo en el hecho de que las mayores tasas masculinas se registraron en adultos jóvenes y las femeninas, en mujeres envejecidas. No hubo diferencias significativas de acuerdo a la comuna de residencia. El mayor riesgo de accidente se apreció en personas de bajo estrato socioeconómico con ingreso familiar mensual inferior a $50.000 de 1993. Un 2,4 por ciento de los accidentados debió ser hospitalizado. La incapacidad tuvo un promedio de 6,7 días. Casi dos tercios de los accidentados recibió atención médica, la que, en la mitad de los casos 49,5 por ciento fue dada en establecimientos del S.N.S.S., mientras un 29 por ciento fue prestada en consultas y establecimientos privados y 22 por ciento en Mutuales de Seguridad del Trabajo. De las personas no atendidas, la gran mayoría informó que ello ocurrió por la baja gravedad del accidente, lo que permitió técnicas de autocuidado. De las personas no atendidas, un 8,7 por ciento adujeron problemas variados del sistema de atención. La mayoría de las personas accidentadas 65 por ciento no tuvieron desembolsos personales por el accidente. En el 35 por ciento restante, el gasto promedio alcanzó a $19.900

In-hospital injuries of medical and surgical patients: the predictive effect of a prior injury.

Four hundred three consecutive injury victims admitted via emergency ward over a 3-month period were tracked with 403 contemporaneous controls with medical illness and blindly assessed for in-hospital accidents. There was a high frequency of "incidents" (n = 161 in 107 patients, mainly falls and medication errors), but injury victim admissions resembled medically ill controls when compared by the Kaplan-Meier method for cumulative probability of occurrence of an in-hospital incident. Accelerated failure/time models using the Weibull method to compute average times from admission to incident showed little difference between groups. Admission type (injury victim vs. control) did not predict psychiatric consultation, incident type, or multiple incidents in hospital. Although the injury group had a larger proportion of males and lower mean age, stratification to control for age and sex did not significantly discriminate injury victims from controls in production of incidents: Over all risk of incidents was random. By studying patients during a hospital stay, the effects of differences in individual environment and drug and alcohol intoxication are largely factored out; under these conditions the predictive effect of a prior injury becomes insignificant. In-hospital injury is associated with host factors long known to promote falls: increasing age, debility-cum-mobility, and central nervous system depressant medication.

Assessment of injury risk in young children: a preliminary study of the injury behavior checklist.

There is a need for practical and cost-effective measures of the behavioral characteristics that predict subsequent injury in children. Previous research has focused on the predictive power of child problem behavior (e.g., hyperactivity, aggression, noncompliance) and has found reliable, but relatively weak associations with injury frequency. In an effort to improve upon this level of prediction using child behavioral measures, a care-giver report checklist of specific "risky" behaviors was developed for toddlers and preschoolers, called the Injury Behavior Checklist (IBC). A preliminary test of the reliability and validity of this instrument was undertaken in a sample of middle-class families (N = 253). Results indicated that the IBC has acceptable reliability (internal consistency = .87; 1-month test-retest correlation = .81) and is able to significantly discriminate children with two or more injuries from those with one or none (p less than .001). Multiple regression analyses indicated that the IBC was a better predictor of injury than parent-reported levels of child problem behavior using the Conners Parent Rating Scale.

Child behavior and accidental injury in 11,966 preschool children.

Social and behavioral characteristics of 11,966 British children, aged 5 years, and mothers' reports of accidental injuries between birth and age 5 years were analyzed. Aggressive behavior was associated with all accidental injuries after controlling psychosocial variables including social class; crowding; mother's psychological distress, age, and marital status; and child's sex. Overactivity was associated only with injuries not resulting in hospitalization after control of the covariates. The relative risk of injuries resulting in hospitalization was 1.9 among children with both high activity and high aggression scores compared with children with low scores on both behavioral scales. The findings support the inference that aggression and overactivity are independently associated with accidents. The associations between child behavior and injuries were stronger than the associations between injuries and the social factors including social class and crowding. This finding suggests that interventions aimed at high-risk groups may be effective supplements to environmental interventions.

Rational decisions and occupational health: a critical view.

This article critically examines a growing trend in the economics of industrial health--the tendency to predict worker behavior on the basis of rational decision models and to draw policy conclusions from these predictions. The method is found weak, both conceptually and empirically. Conceptually, it fitnesses a serious problem of equity and makes unrealistic assumptions about worker behavior and the nature of accident causation. Empirically, its predictions contradict the results of 40 years of accident research, and the evidence advanced to support it is far from convincing. In addition, it produces dangerous hypotheses in the sense in which that term is defined by the opponents of the "accident prone" theory.

Accidental policy: an analysis of the problem of unintended injuries of childhood.

The problem of childhood injury is examined from an ecological, public health perspective, and a range of preventive and ameliorative strategies is considered. Three policy evaluation criteria--efficiency, freedom of choice, and equity--are discussed. A framework is proposed, and examples given, to assist professionals concerned with mental health and with child health and development in critically analyzing policy options.