Fatal occupational injuries in fishing, farming and forestry 2010-2015.

BACKGROUND: Every year, 2.3 million people worldwide succumb to work-related accidents and illnesses. The primary industries have long been acknowledged with elevated accident risks. Recent levels and trends of injury and associated fatalities in these sectors are uncertain. An enhanced understanding of these risks in these industries is required for effective injury prevention in the future. AIMS: This study aimed to describe registered fatalities in the primary industries worldwide, exploring potential disparities between countries and identifying trends in injury rates. METHODS: Data were obtained on fatal occupational injuries per 100,000 workers in farming, fishing and forestry for the years 2010-2015 from the International Labour Organization ILO-STAT database. Descriptive statistics and mixed-model regression analyses were conducted. Fatal occupational injuries in upper- and middle-income countries were compared. RESULTS: The study incorporated data from 32 countries: 21 from Europe. America had the highest mean occupational fatality injury rate (76.9). The highest recorded rates for individual countries occurred in Colombia in 2014 (265.2) and Lithuania in 2015 (75.0), and the lowest in Greece in 2012 (0.2). Significant variation in injury rates was evident among the countries. There was no trend in the incidence of fatal injuries from 2010 to 2015, neither for all countries, nor Europe. Middle-income countries had higher occupational fatality injury rate than upper-income countries. CONCLUSIONS: The occupational fatality injury rate exhibited considerable variation, ranging from 0.9 to 265.2, and the injury rate was lowest in upper-income countries. There was no trend in the figures 2010-2015.

An alumni study of a Master's in international health.

OBJECTIVES: The objective of the study was to clarify the reasons why students who graduated from a Master's programme in international health were joining the programme. Another objective was to document how the Master's degree had influenced the careers of the graduates. STUDY DESIGN: An online survey of students who graduated from a Master's programme in international health, including oral science, between 2010 and 2015. METHOD: The study used an anonymous questionnaire that contained 28 items. Topics included information such as demographics, questions about the reasons for joining the Master's programme and the benefits and influence of the programme on the career of the students. RESULTS: Of the 102 alumni who were invited to participate, 70 responded. The response rate was 69%, and we have no information about the non-responders. The results showed that the main reasons for students enrolling in the programme were to improve their competence and develop their career. Around 63% of the respondents reported that the programme had increased their competencies in the jobs they had, whereas 24% answered that their increased qualifications had enabled them to acquire new positions. Thus successfully completing the programme had a positive influence on the graduates' careers in international health. Most of the graduates, who were working, were typically employed at hospitals and universities. Several graduates had proceeded to gain further qualifications by now being enrolled in a PhD programme. CONCLUSIONS: Among the 70% of responders in this survey, the master's programme had benefitted the alumni and the programme had fulfilled their expectations. The programme had a positive influence on the alumni in areas such as increased competency, development of their careers, new positions and better salaries.

Microbial dynamics in mixed culture biofilms of bacteria surviving sanitation of conveyor belts in salmon-processing plants.

AIMS: The microbiota surviving sanitation of salmon-processing conveyor belts was identified and its growth dynamics further investigated in a model mimicking processing surfaces in such plants. METHODS AND RESULTS: A diverse microbiota dominated by Gram-negative bacteria was isolated after regular sanitation in three salmon processing plants. A cocktail of 14 bacterial isolates representing all genera isolated from conveyor belts (Listeria, Pseudomonas, Stenotrophomonas, Brochothrix, Serratia, Acinetobacter, Rhodococcus and Chryseobacterium) formed stable biofilms on steel coupons (12°C, salmon broth) of about 10(9) CFU cm(-2) after 2 days. High-throughput sequencing showed that Listeria monocytogenes represented 0·1-0·01% of the biofilm population and that Pseudomonas spp dominated. Interestingly, both Brochothrix sp. and a Pseudomonas sp. dominated in the surrounding suspension. CONCLUSIONS: The microbiota surviving sanitation is dominated by Pseudomonas spp. The background microbiota in biofilms inhibit, but do not eliminate L. monocytogenes. SIGNIFICANCE AND IMPACT OF THE STUDY: The results highlights that sanitation procedures have to been improved in the salmon-processing industry, as high numbers of a diverse microbiota survived practical sanitation. High-throughput sequencing enables strain level studies of population dynamics in biofilm.

The effects of different hygiene procedures in reducing bacterial contamination in a model domestic kitchen.

AIMS: Few studies have compared the effectiveness of hygienic cleaning under simulated use conditions. This study compares commonly used and novel cleaning methods for food contact and hand contact surfaces in kitchens. METHODS AND RESULTS: We report results from two surveys on Norwegian consumers' cleaning procedures. Laboratory models involving cutting boards, tap handles and mobile phones contaminated with Escherichia coli and Staphylococcus aureus were used to compare the hygiene efficacy of commonly used cleaning methods together with new technologies (sprays, single-use wipes, and chlorine-based disinfectants). Commonly used cleaning methods produced a mean log10 reduction (LR) in contamination of 1.5-2.5. The efficacy could be improved by drying or including a disinfection step (mean LR 3.1-4.6). Cleaning of mobile phones was common and was improved by including humidity (1.5-1.9 mean LR). CONCLUSIONS: In many situations, traditional methods used by consumers may be sufficient to hygienically clean surfaces. However, in some situations, such as where there are infected or immune-compromised individuals, or where high risk foods are being handled, hygiene practices resulting in higher LR should be recommended. SIGNIFICANCE AND IMPACT OF THE STUDY: This study demonstrates that data from models simulating use conditions are required to estimate the effectiveness of detergent-based removal practices and how these can be enhanced by inactivation processes such as drying and disinfection to ensure that contamination from food-borne pathogens is reduced to acceptable levels to prevent infection transmission.

Updating and prospective validation of a prognostic model for high sickness absence.

OBJECTIVES: To further develop and validate a Dutch prognostic model for high sickness absence (SA). METHODS: Three-wave longitudinal cohort study of 2,059 Norwegian nurses. The Dutch prognostic model was used to predict high SA among Norwegian nurses at wave 2. Subsequently, the model was updated by adding person-related (age, gender, marital status, children at home, and coping strategies), health-related (BMI, physical activity, smoking, and caffeine and alcohol intake), and work-related (job satisfaction, job demands, decision latitude, social support at work, and both work-to-family and family-to-work spillover) variables. The updated model was then prospectively validated for predictions at wave 3. RESULTS: 1,557 (77 %) nurses had complete data at wave 2 and 1,342 (65 %) at wave 3. The risk of high SA was under-estimated by the Dutch model, but discrimination between high-risk and low-risk nurses was fair after re-calibration to the Norwegian data. Gender, marital status, BMI, physical activity, smoking, alcohol intake, job satisfaction, job demands, decision latitude, support at the workplace, and work-to-family spillover were identified as potential predictors of high SA. However, these predictors did not improve the model's discriminative ability, which remained fair at wave 3. CONCLUSIONS: The prognostic model correctly identifies 73 % of Norwegian nurses at risk of high SA, although additional predictors are needed before the model can be used to screen working populations for risk of high SA.

Duties performed by occupational physicians in Norway.

BACKGROUND: Occupational health care for all is a global aim but has not yet been achieved. Further development should be based on knowledge of specific alternative models of occupational health services (OHS). Little is published on different OHS models and work as a physician in these services. AIMS: To describe duties for Norwegian physicians working in two different OHS models: internal and external. In the internal model, the physician is employed in an OHS located at the company served, whereas in the external model, OHS time is shared between several companies and the physician is often located outside the companies. METHODS: A web-based survey was sent to all members of the Norwegian Occupational Medicine Association. RESULTS: There were 206 responses (response rate of 73%). Only those working as OHS physicians were included (54%). Physicians in external OHS performed individual health examinations to a greater extent, otherwise few differences between physicians working in internal and external OHS were found. Changes in the priority of the physicians' duties through a period of 20 years seem to be related to changes in legislation and official guidelines related to OHS practice. CONCLUSIONS: In this study, OHS physicians in Norway performed a large number of individual-based health examinations but this was seen more in the external OHS model. Otherwise physicians' duties had similar priority in the external and internal models. Legislation and official guidelines seem to be of major importance to the duties performed.

Reduction in respiratory symptoms among cement workers: a follow-up study.

BACKGROUND: Several studies have reported associations between cement dust exposure and adverse respiratory health effects, but there are few follow-up studies and no studies of respiratory health effects following dust control measures. AIMS: To assess changes in respiratory health among cement workers and unexposed controls after 1 year in a factory implementing a health and safety campaign with the main aim to increase use of personal protective equipment. Earlier the factory had made technical improvements which had reduced dust levels. METHODS: Respiratory questionnaire interviews and personal total dust exposure assessments were conducted in 2010 and 2011. RESULTS: A total of 171 cement workers and 98 controls participated in the study in 2010. The prevalence of cough, cough with sputum, dyspnoea and wheeze among the 134 exposed workers assessed at follow-up in 2011 was significantly lower than in 2010, but not among 63 controls followed up in 2011. Total dust exposure levels among exposed workers did not differ between 2010 and 2011. CONCLUSIONS: The prevalence of respiratory symptoms among cement workers was reduced after 1 year of follow-up following an intervention campaign to improve use of personal protective equipment.

Health complaints after a malodorous chemical explosion: a longitudinal study.

BACKGROUND: Physical and psychological symptoms are prevalent in populations recently affected by industrial accidents. Follow-up studies of human health effects are scarce, and as most of them focus on residents, little is known about the long-term health effects among workers exposed to malodorous emissions following a chemical explosion. AIMS: To assess whether subjective health complaints (SHC) among workers declined over a 4-year period after an oil tank explosion that emitted malodorous sulphurous compounds. METHODS: A longitudinal survey from 2008 (18 months after the explosion) to 2012, performed using the SHC inventory. Questionnaire data were analysed using a linear mixed effects model. RESULTS: There was a decrease in SHCs among the exposed workers, but they still had significantly more subjective neurological symptoms (P < 0.01) compared with controls, adjusted for gender, age, smoking habits, educational level and proximity to the explosion. CONCLUSIONS: Although there was a downward trend in SHCs among exposed workers in the follow-up period, they reported more subjective neurological complaints than controls. Symptoms may be mediated by perceived pollution and health risk perception, and adaptation or anxiety may cause a chronic effect, manifested by a dysfunctional and persistent neuropsychological response.

Subjective health complaints and psychosocial work environment among university personnel.

BACKGROUND: Questionnaires are often used to study health problems in working populations. An association between self-reported symptoms and psychosocial strain has been suggested, but results from such studies are difficult to interpret, as a gender difference might be present. The knowledge in this area is not clear. AIMS: To compare the prevalence of subjective health symptoms and their relation to psychosocial work strain among men and women in different age groups, all working as university staff. METHODS: A cross-sectional survey was carried out among university personnel. The questionnaire included a subjective health complaint inventory consisting of 29 items about subjective somatic and psychological symptoms experienced during the last 30 days and psychosocial work factors. Regression analyses were performed. RESULTS: In total, 172 (86%) of 201 eligible employees participated. Women had a higher prevalence of musculoskeletal symptoms than men. Significant differences were found between the genders for headaches, neck pain and arm pain. There was a significant relationship between musculoskeletal symptoms and work strain for both genders. This was found for both men and women below 40 years and among men above the age of 40. No significant difference was found between genders regarding pseudoneurological, gastrointestinal, allergic and flu-like symptoms. CONCLUSIONS: More female than male university personnel reported musculoskeletal symptoms. The musculoskeletal symptoms were associated with high work strain in both genders, but, for women, this was limited to employees under the age of 40. The cause of this gender difference is unknown.

Reduced spread of Campylobacter jejuni in broiler chickens by stimulating the bird's natural barriers.

AIM: We have tested the effect of feed structure and feeding regime to prevent the spread of the zoonotic pathogen Campylobacter jejuni in broiler chicken flocks. METHODS AND RESULTS: Birds were offered two types of feed, control diet and a diet supplemented with 15% oat/barley hulls for structure. In addition, the birds were either fed ad libitum or intermittent. One bird in each treatment group was infected with a three-strain-mix of Camp. jejuni, and the spread of Camp. jejuni within the group was investigated. Feed structure increased the gizzard weight, delayed the spread of Camp. jejuni within the group and reduced the relative amount of Camp. jejuni in the caecum compared with the control diet. CONCLUSIONS: Our results show that stimulating the bird's natural barriers is a novel and promising intervention strategy to reduce the spread of Camp. jejuni in chicken flocks. SIGNIFICANCE AND IMPACT OF THE STUDY: Preventing Camp. jejuni in broiler chicken flocks is essential to ensure food safety because this bacterium is transferred to chicken carcasses during the slaughter process and readily survive in unprocessed poultry products. We have evaluated a novel approach for stimulation of the bird's natural barriers in the upper digestive tract with promising results.

The effect of insoluble fiber and intermittent feeding on gizzard development, gut motility, and performance of broiler chickens.

Two experiments were conducted to test the following hypothesis: exposing broiler chickens to coarse insoluble fiber in the diet will result in enhanced gizzard function and performance, improved adaptability to an intermittent feeding program, and an increase in the occurrence of reverse peristalsis. In experiment 1, 102 Ross 308 broiler chickens were either intermittently or ad libitum fed a basal diet, the basal diet diluted with 15% coarse hulls (consisting of equal weights of hulls from oats and barley), or the basal diet diluted with 15% of the same hulls finely ground in a 2 × 3 factorial arrangement with 17 individually caged birds per treatment. Birds fed ad libitum had access to feed continuously for 18 h/d, whereas those on intermittent feeding had restricted access to feed from 7 d of age. From 18 d of age, the restrictive-feeding program consisted of four 1-h meals and one 2-h meal per day. In experiment 2, 156 broiler chickens in 12 pen cages with wood shaving-lined floors were exposed to 1 of 4 treatment groups with 3 pens/treatment: intermittent or ad libitum feeding of a basal diet and intermittent or ad libitum feeding of a coarse hull diet, as described above. At 31 and 32 d of age, birds in experiment 1 were inoculated with chromium EDTA via the cloaca. There was no interaction between diet and feeding regimen. The addition of hulls increased gizzard weight and content and lowered (P < 0.001) gizzard pH, but it had no effect on the ability of the birds to handle intermittent feeding. Despite the dilution with coarse hulls, weight gain and the gain:feed ratio were not affected, which could partly be explained by an increased (P < 0.001) starch digestibility. Dietary reflux was confirmed by the presence of chromium in all intestinal tract sections. Broilers exhibited reverse peristaltic contractions of sufficient magnitude to propel the marker from the cloaca to the gizzard.

Prevention of intestinal Campylobacter jejuni colonization in broilers by combinations of in-feed organic acids.

AIM: We have tested the effect of various combinations of formic acid and sorbate on Campylobacter jejuni colonization in broiler chickens to reduce the colonization of this zoonotic pathogen in broiler chicken flocks. METHODS AND RESULTS: Chickens were offered feed supplemented with different concentrations and combinations of formic acid and/or potassium sorbate. We found little or no effect on the Camp. jejuni colonization levels in chickens that were given feed supplemented with formic acid alone. A combination of 1.5% formic acid and 0.1% sorbate reduced the colonization of Camp. jejuni significantly, while a concentration of 2.0% formic acid in combination with 0.1% sorbate prevented Camp. jejuni colonization in chickens. This inhibition was replicated in two independent trials with a combination of three different Camp. jejuni strains. CONCLUSIONS: Our results show a novel and promising intervention strategy to reduce the incidence of Camp. jejuni in poultry products and to obtain safer food. SIGNIFICANCE AND IMPACT OF THE STUDY: To ensure food safety, a reduction of the carcass contamination with Camp. jejuni through reduced colonization of this pathogen in broiler chicken flocks is important. A range of organic acids as additives in feed and drinking water have already been evaluated for this purpose. However, no studies have yet shown a complete inhibition of Camp. jejuni colonization in broiler chickens.

Symptoms, complaints, ocular and nasal physiological signs in university staff in relation to indoor environment - temperature and gender interactions.

UNLABELLED: Symptoms, signs, perceptions, and objective measures were studied in university buildings. Two problem buildings with a history of dampness and complaints were compared with two control buildings. Health investigations among university staff were performed at the workplace (n = 173) including tear film stability [non-invasive break-up time (NIBUT) and self-reported break-up time (SBUT)], nasal patency (acoustic rhinometry), nasal lavage fluid analysis [NAL: eosinophil cationic protein (ECP), myeloperoxidase (MPO), lysozyme and albumin] and atopy by total serum IgE and IgE antibodies (Phadiatop). Exposure assessment included inspections, thermal and atmospheric climate at 56 points modelled for all work sites. Multiple regressions were applied, controlling for age and gender. Exposure differences between problem buildings and controls were small, and variations between rooms were greater. Workers in the problem buildings had more general and dermal symptoms, but not more objective signs than the others. Adjusted day NIBUT and SBUT increased at higher night air temperatures, with B (95% CI) 0.6 (0.04-1.2) and 1.3 (-0.02 to 2.5), respectively. Higher relative humidity at mean day air temperature <22.1 degrees C was associated with adjusted NIBUT and SBUT, with B (95% CI) 0.16 (0.03-0.29) and 0.37 (-0.01 to 0.75), respectively. Air velocity below recommended winter values and reduced relative humidity in the range of 15-30% were associated with dry air and too low temperature. PRACTICAL IMPLICATIONS: Thermal climate in university buildings may be associated with both perceptions and physiological signs. Reduced night time air temperature, increased difference in air temperature between day and night, and fast changes in air temperature might impair indoor environment. This may have implication for energy-saving policies. It might be difficult to identify the exposure behind, and find the reason why, some buildings are defined as 'problem buildings'.

A higher risk of congenital anomalies in the offspring of personnel who served aboard a Norwegian missile torpedo boat.

BACKGROUND: In the 1990s, congenital anomalies were reported among children whose fathers had served aboard a Norwegian missile torpedo boat (MTB). The Royal Norwegian Navy asked the University of Bergen to look into this problem as one part of a general health and work environment surveillance. AIMS: To estimate any increased risk of having children with congenital anomalies and having stillborn children among the offspring of workers that had served aboard the MTB and to investigate possible differences in exposure and other risk factors between these groups. METHODS: Data from a cross-sectional study among all current employees of the Norwegian Navy (n = 2265, response rate 58%) were analysed. RESULTS: The prevalence ratio of having a child with congenital malformations associated with working on the ship was 4.0 (95% CI 1.9 to 8.6). The prevalence ratio of having a child who was stillborn or died within one week was 4.1 (95% CI 1.7 to 9.9). CONCLUSION: Service aboard the MTB was associated with an increased risk of having children with congenital birth defects and having children that were stillborn. The causes of these findings are unknown.

The effects of occupational health and safety management on work environment and health: a prospective study.

According to Norway's Internal Control Regulation, all companies are required to have an occupational health and safety (H&S) management system. This study investigated the effects of implementing or improving occupational H&S management on the work environment, H&S-related behaviour and musculoskeletal health of workers in small and medium-sized companies. A one-year prospective cohort study, using self-administered questionnaires, was performed among the managers and blue-collar workers in 226 motor vehicle repair garages. Out of 1559 workers that responded at baseline 721 workers could be identified at follow-up. These 721 workers were included in the study. The workers in companies with improved H&S management from baseline to follow-up reported increased satisfaction with the H&S activities at the garage; improved support from management and colleagues; improved health-related support and control; and increased participation in H&S activities.

Ebola Care and Lack of Consensus on Personal Protective Respiratory Equipment.

The Ebola epidemic in West Africa presents a considerable occupational risk to the health personnel involved. The principal mode of virus transmission to health care personnel is through direct contact with the patient, although transmission by aerosols through the air may also occur. Many safety protocols have been suggested relating to personal protection and particularly respiratory protection. It is generally agreed that all health care workers should have easy access to personal protective equipment. However, the degree of respiratory safety escalates from a mask, to an adequate respirator, and finally to a whole body suit with integrated helmet and positive air pressure. Recent publications demonstrate a lack of consensus on the degree of safety necessary. The step from "safe enough" to being "absolutely safe" seems, in most countries, insurmountable because of costs and logistics.

The prevalence and 3-year incidence of dementia in older Black and White community residents.

OBJECTIVE: To determine the prevalence and 3-year incidence of dementia in Blacks and Whites age 65 and older in a five-county Piedmont area of North Carolina. DESIGN: Stratified random sample of members of the Duke Established Populations for Epidemiologic Studies of the Elderly (EPESE) (baseline n = 4,136; 55% Black; weighted n = 28,000). Prevalence study members were differentially selected on the basis of score on the Short Portable Mental Status Questionnaire at the second in-person Duke EPESE wave. Incidence study members included all persons with obvious cognitive decline over a 3-year period, and a 10% sample of the remainder. MEASUREMENTS: Self- and informant report on health history, functional status, and memory. Consortium to Establish a Registry for Alzheimer's Disease (CERAD) Neuropsychology Battery administered to all subjects, and CERAD Clinical Battery to those with impaired memory. Clinical consensus to determine presence and type of dementia. RESULTS: Prevalence of dementia for persons > or =68 years old was 0.070 (95% confidence interval = 0.021-0.119) for Blacks and 0.072 (0.022-0.122) for Whites. Rates for Black men (0.078, 0.001-0.155) exceeded those for Black women (0.066, 0.003-0.129), but gender rates for Whites were reversed (men: 0.044, 0.000-0.103), (women: 0.087, 0.015-0.160). Neither race nor gender differences were significant. Prevalence of dementia increased through age 84 and tapered off thereafter. Three-year incidence of dementia was 0.058 (0.026-0.090) for Blacks and 0.062 (0.027-0.097) for Whites. Neither race nor gender differences were significant. Incidence increased through age 84, but moderated thereafter for all but Black men. The proportional representation of different types of dementia varied little by race. CONCLUSION: Prevalence, 3-year incidence, and types of dementia are comparable in Black and White elderly in the Piedmont area of North Carolina.

Cancer among captains and mates on Norwegian tankers.

A cohort of 1687 registered captains and mates from a Norwegian census in 1970 was followed until 1987 using a historical prospective design. By matching the data from the census to the Norwegian Cancer Registry, 104 cases of cancer were found. A control group of 376 was chosen among non-cases at baseline (1970). Information about the seamen's work on different ships was obtained from the National Register of Norwegian Seamen. The material was analysed using multivariate logistic regression. An increased risk of developing cancer was found in the group of seamen who had been working on tankers, especially oil tankers (OR = 6.47, 95%CI: 1.14, 7.24). The increased risk was found to be significantly correlated to working as mate on these tankers (OR = 6.95, 95%CI: 3.70, 13.04), whereas working as captain showed a much lower risk (OR = 1.42, 95%CI: 0.64, 3.15). Chemical exposure is the major factor separating tankers from other ships. Mates are exposed to chemicals while captains are not. The study indicates the presence of several carcinogenic agents on these tankers.

Mortality among seamen with special reference to work on tankers.

BACKGROUND: Several studies demonstrate a high mortality among seamen but this has not been related to different types of work on board. This study examined a possible relationship between work on tankers and mortality. Tankers differ from other ships by carrying different types of oil, oil products and other chemicals. METHODS: Mortality was studied in 1687 men who were captains and mates during the period 1970-1987, and were registered by a Norwegian census in 1970. The data were linked to the Norwegian Register of Death Certificates. In all 181 deaths were found. Each case was age-matched at time of death to three individuals from the rest of the population alive at this date. Information about the seamen's work on different ships was obtained for cases and controls. The data were analysed using multivariate conditional logistic regression. RESULTS: Seamen working on tankers had a higher mortality rate ratio (RR = 2.43, 95% confidence interval [CI]: 1.65-3.60) than seamen who had not been working on tankers. The increased risk was especially related to death from cancer and from accidents, while no significantly increased mortality due to cardiovascular diseases was found. Employment as a mate on tankers showed the highest all-causes risk of death (RR = 3.14, 95% CI: 2.04-4.82) as well as for cancer (RR = 4.24, 95% CI: 2.02-8.88) and accidents (RR = 5.85, 95% CI: 1.66-20.60). Employment as a captain on tankers showed no significantly increased mortality. CONCLUSION: Exposure to chemicals on tankers may be related to the increased mortality, as this is the major difference between tankers and other ships and mates are exposed to chemical agents, while captains are not.

Serious on-the-track accidents experienced by train drivers: psychological reactions and long-term health effects.

Train drivers run a risk of on-the-track accidents, the outcome of which they can seldom influence. In a postal questionnaire study addressed to all Norwegian train drivers, present health status was assessed by GHQ-12 and three health indices calculated from a psychosomatic symptom list. Train drivers who had experienced distressing on-the-track incidents were asked to report peak intensity of psychological reactions to their most distressing experience, by the Impact of Event Scale (IES). Of 830 respondents, 395 reported distressing on-the-track incidents. Present health status was significantly lower in drivers reporting a former distressing experience compared to others. The higher the recalled IES-scores, the more pronounced health problems were reported. This relationship was most marked for musculoskeletal and psychological symptoms related to the IES Intrusion subscore. A possible causal relationship between traumatic on-the-track experiences and long-term health problems in train drivers is postulated.