Work-related injury burden, workers' compensation claim filing, and barriers: Results from a statewide survey of janitors.

BACKGROUND: Janitors are a low-wage, ethnically and linguistically diverse, hard-to-reach population of workers with a high burden of occupational injury and illness. METHODS: Data from an extensive multimodal (mail, phone, web) survey of janitors in Washington State were analyzed to characterize their working conditions and occupational health experiences. The survey included questions on demographics, work organization and tasks, health and safety topics, and discrimination and harassment. The survey was administered in eight languages. RESULTS: There were 620 complete interviews. The majority completed the survey by mail (62.6%), and in English (85.8%). More than half of responding janitors were female (56.9%), and the mean age was 45 years. Twenty percent reported having a (health-care-provider diagnosed) work-related injury or illness (WRII) in the past twelve months. Women and janitors who were Latino had significantly higher relative risk of WRII. Increased risk was also associated with several work organization factors that may indicate poor working conditions, insufficient sleep, and possible depression. Half of injured janitors did not file workers' compensation (WC) claims. CONCLUSIONS: Janitors reported a high percentage of WRII, which exceeded previously published estimates from Washington State. Women and Latino janitors had significantly increased risk of WRII, and janitors' working conditions may influence the unequal distribution of risk. WRII surveillance via WC or medical care usage in janitors and other low-wage occupations may reflect substantial underreporting. Characterizing the nature of janitors' work experience can help identify avenues for prevention, intervention, and policy changes to protect the health and safety of janitors.

Effects of a Community-Based Multimodal Exercise Program on Health-Related Physical Fitness and Physical Function in Breast Cancer Survivors: A Pilot Study.

PURPOSE: Breast cancer and oncological treatment can result in significant acute and late localized and systemic negative effects on health-related physical fitness and physical function. The aim of this single-arm study was to examine the effects of a 12-week community-based multimodal exercise program on health-related physical fitness and physical function in breast cancer survivors. METHODS: A total of 52 female breast cancer survivors (mean age = 59.7 ± 10.4 years) completed supervised exercise training consisting of (1) aerobic conditioning, (2) resistance training, and (3) balance and flexibility training, for 30 minutes each, totaling 90 minutes twice weekly for 12 weeks. Pretreatment and posttreatment outcome measures-mobility: (1) Timed Up and Go (TUG) and (2) 6-minute walk test (6MWT); muscular strength: (3) leg press strength and (4) chest press strength; upper-extremity flexibility: (5) back scratch test; and balance: (6) functional reach (FR) and (7) single-leg stance time-were assessed and compared. RESULTS: Postintervention assessment measures given as percentage improvement and effect size (ES) for mobility, TUG (18%, 0.59), and 6MWT (14%, 0.74) were significantly (P < .001) improved. Outcome measures of muscular strength, leg press strength (32%, 0.58) and chest press strength (40%, 0.61), both significantly (P < .001) improved. Postintervention assessment measure of upper-extremity flexibility (42%, 0.41) showed significant (P < .001) improvements. Outcome measures for balance, FR (18%, 0.75) and single leg stance time (24%, 0.30), showed significant (P < .001) improvements. CONCLUSIONS: Outcome measures showed moderate to large ES improvements after participants completed the 12-week multimodal exercise program for breast cancer survivors.

Effects of a community-based multimodal exercise program on physical function and quality of life in cancer survivors: a pilot study.

The purpose of this single-arm pilot study was to examine the effects of a community-based multimodal exercise program on: physical function (Timed-Up-and-Go [TUG], 6-min walk test [6MWT], leg and chest press strength, and functional reach [FR]); and quality of life, QoL [FACT-G]), in cancer survivors. Fifty-nine cancer survivors (91.5% female; mean age 59 ± 12 years) completed supervised exercise training for 90 min twice weekly for 12 weeks. Exercise training consisted of 30 min of each of the following: (1) aerobic conditioning; (2) resistance training; and (3) balance and flexibility training. Pre-post-outcome measures were compared for statistically significant differences (p < 0.01) and were related to the International Classification of Functioning, Disability and Health Model. Effect sizes (ES), minimal clinically important differences, and minimal detectable change at 90% confidence intervals were calculated. Participants decreased TUG time by 21.1% and walked 15.5% farther during 6-MWT (p < 0.001). Leg and chest press strength increased by 34.5% and 32.7%, respectively (p < 0.001). FR increased by 15.1% (p < 0.001). Significant improvements for physical well-being (13.9%), emotional well-being (6.7%), functional well-being (13.0%), and total well-being (9.6%) were found (p < 0.01). Improvements in physical function and QoL showed "moderate to large" ESs indicating improvements in physical function and QoL are clinically meaningful.

Effects of residential location and work-commuting on long-term work disability.

PURPOSE: Little is known about the independent effect of workers' residential location and work-commuting on their long-term disability due to work-related injuries. We examined 149,110 incident claims while adjusting for multiple risk factors in a large, population-based sample of Washington State workers' compensation State Fund claims during 2002-2008. METHODS: Claimants' residential addresses were geocoded with census tract and aggregated into four category classification of the Rural Urban Commuting Area Codes (RUCAs) which takes into account for tract-level work-commuting. We used logistic regressions to assess the association between RUCAs and whether or not a person was off work for more than 180 days due to injury; Quantile regressions to predict various percentiles of cumulative lost workdays by RUCAs. RESULTS: Compared to those who live in the Urban Core, workers in other areas experienced longer average paid time loss days due to work-related injury. The association between residential location and long-term disability was significant, odds ratio (OR) 1.19 (95 % confidence interval (CI) 1.11-1.27) for residents of Small Town and Isolated Rural and OR 1.17 (95 % CI 1.12-1.22) for those of Sub Urban, and persisted after controlling for injury nature, socio-demographic, employment-related, and claim administrative characteristics. The impact of residential location and work-commuting elevated as the duration of disability increased. CONCLUSIONS: This study shows that residential location and work-commuting has a significant and time-varying impact on duration of work disability. Workers living in Sub Urban and Small Town and Isolated Rural areas represent a particularly vulnerable group with respect to risk of long-term work disability.

Occupation and the prevalence of current depression and frequent mental distress, WA BRFSS 2006 and 2008.

BACKGROUND: Workers with depression and frequent mental distress (FMD) have lost work productivity. Limited systematic comparisons exist for the prevalence of depression and FMD across occupational groups. METHODS: Using a state-added question for occupation coupled to measures of depression and FMD on the Washington State (WA) 2006 and 2008 Behavioral Risk Factor Surveillance System survey, we estimated the prevalence and odds ratios (ORs) among the 20,560 WA workers. RESULTS: The prevalences of current depression and FMD were 5.2% and 7.5%, respectively. The prevalence varied considerably across occupations. Compared with Management occupation, Truck drivers had significantly increased odds for both current depression [OR = 6.18, 95% confidence interval (CI): 2.52-15.16] and FMD (OR = 1.85, 95% CI: 1.01-3.41). Cleaning/Building services (OR = 1.95, 95% CI: 1.11-3.40) and Protective services (OR = 1.97, 95% CI: 1.19-3.27) were associated with increased FMD. CONCLUSIONS: These findings demonstrate the need for research on possible sources of the differences for current depression and FMD across occupations.

Language preference and non-traumatic low back disorders in Washington State workers' compensation.

BACKGROUND: Workers in the United States with limited English proficiency likely perform more hazardous work, experience higher rates of work-related injury and illness, and have worse disability outcomes. METHODS: We conducted a descriptive study of employment characteristics, timeliness and utilization of workers' compensation (WC) insurance benefits, cost and occupational health outcomes for Washington State WC state fund, non-traumatic low back disorders (LBD) claimants by language preference. RESULTS: A greater proportion of Spanish language preferring (SLP) LBD claims filed were accepted and resulted in lost work time than English language preferring (ELP) LBD claims. There were significant differences in the demographic, employment, and occupational characteristics between the SLP and ELP compensable claimant populations. The SLP LBD compensable claimants had greater time loss duration, greater medical and total claim costs, more use of physical therapy and vocational services than the ELP LBD compensable claimants. With the exception of the timeliness for providing the first time loss payment, the time periods for provision of insurance benefits did not differ between the SLP and ELP populations. SLP compensable claimants received less back surgery and had comparable permanent partial disability payments to the ELP population. Employers were more likely to protest the acceptance of a SLP compensable than one in an ELP LBD compensable claim. CONCLUSION: For those injured workers accessing the Washington State WC system, we observed differences based on language preference for pre-injury, and workers compensation outcomes. Further research is needed to explain the observed differences.

Underreporting of work-related injury or illness to workers' compensation: individual and industry factors.

OBJECTIVE: We quantified the underreporting of work-related injury or illness to workers' compensation (WC). METHODS: Using data from 2612 wage-earning respondents who participated in the 2002 Washington State Behavioral Risk Factor Surveillance System, we assessed work-related injury or illness in the previous year and identified the factors associated with WC claim filing by logistic regression. RESULTS: The self-reported rate of work-related injury or illness of respondents was 13%. Among those who had a work-related injury or illness, 52% filed a WC claim. After adjustment for age, gender, and race, those who filed WC claims were more likely to be overweight and married. WC claim filing varies considerably across industry and occupation groups holding all other measured factors constant. CONCLUSIONS: Individual and industry/occupation factors are related to underreporting of work-related injury or illness to the WC system.