Long-term psychological outcome of workers after occupational injury: prevalence and risk factors.

INTRODUCTION: This study aimed to examine the prevalence rates of both post-traumatic stress disorder (PTSD) and major depression at 12 months in workers experiencing different types of occupational injury in Taiwan. Demographic and injury-related risk factors for psychological symptoms were also evaluated. METHODS: Our study candidates were injured workers in Taiwan who were hospitalized for 3 days or longer and received hospitalization benefits from the Labor Insurance program. A two-staged survey study was conducted. A self-reported questionnaire including the Brief Symptom Rating Scale and Post-traumatic Symptom Checklist was sent to workers at 12 months after injury. Those who met the criteria were recruited for the second-stage phone interview with a psychiatrist using the Mini-international Neuropsychiatric Interview (MINI). RESULTS: A total of 1,233 workers completed the questionnaire (response rate 28.0 %). Among them, 167 (13.5 %) fulfilled the criteria for the MINI interview and were invited. A total of 106 (63.5 %) completed the phone interview. The estimated rate of either PTSD/PPTSD or major depression was 5.2 %. The risk factors for psychological symptoms were female gender, lower education level, loss of consciousness after occupational injury, injury affecting physical appearance, occupational injury experience before this event, life experience before and after this injury, length of hospital stay, self-rated injury severity, and percentage of income to the family. CONCLUSIONS: These results showed that occupational injury can cause long-term psychological impact in workers. Key demographic and injury characteristics may enhance the identification of at-risk occupational injured workers who would benefit from targeted screening and early intervention efforts.

Mortality among shipbreaking workers in Taiwan--a retrospective cohort study from 1985 to 2008.

BACKGROUND: Shipbreaking workers are typically exposed to a wide range of hazardous chemicals. However, long-term follow-up studies of their mortality patterns are lacking. This study examined mortality among shipbreaking workers over a 24-year follow-up period. METHODS: A total of 4,962 shipbreaking workers were recruited from the database of the Kaohsiung Shipbreaking Workers Union. The data were then linked to the Taiwan National Death Registry from 1985 to 2008. The mortality ratios-standardized for age and calendar years-(SMRs) for various causes of deaths were calculated with reference to the general population of Taiwan. RESULTS: Among men workers, a statistically significant increased SMR was observed for all causes (SMR = 1.28), all cancers (SMR = 1.26; particularly noteworthy for lesions of oral and nasopharyngeal: SMR 2.03, liver: SMR 4.63, and lung: SMR 1.36), cirrhosis of the liver (SMR = 1.32), and accidents (SMR = 1.91). A statistically significant increase in mortality was observed for respiratory system cancer (SMR = 1.87) and lung cancer (SMR = 1.91) among workers with a longer duration of employment (≥7 years). The result also showed that among shipbreaking workers who were still alive, two people had mesothelioma and 10 people have asbestosis. CONCLUSIONS: Those employed in shipbreaking industries experienced an increase in mortality from all causes. The increased SMR for lung cancer was probably related to asbestos, metals, and welding fume exposure.

The impact of psychological symptoms on return to work in workers after occupational injury.

INTRODUCTION: This study aimed to investigate the impact of psychological symptoms on return to work (RTW) in workers after occupational injuries. METHODS: Our study candidates were injured workers who were hospitalized for 3 days or longer and received hospitalization benefits from the Labor Insurance. A self-reported questionnaire including Brief Symptom Rating Scale (BSRS-50) and RTW was sent to workers at 12 weeks after injury. At 1 year, all participants were contacted again to determine whether or not they had RTW. RESULTS: A total of 2001 workers completed the questionnaire (response rate 45.5 %) at 12 weeks after injury, among them, 1,149 had returned to work. Among the 852 who were unable to return to work at 12 weeks after injury, 225 reportedly returned to work by 1 year. A proportional hazards regression indicated that after adjusting for all possible risk factors, higher scores in BSRS-50 and BSRS-5 at 12 weeks after injury were significant risk factors for not return to work (NRTW) at 1 year after injury. Other risk factors were gender, education level, length of hospitalization, affected physical appearance, and injury type. Among 10 psycho-physiological symptoms of BSRS-50, a proportional hazards regression indicated that high score in phobic-anxiety scale was a risk factor for NRTW. CONCLUSIONS: After considering all other factors, psychological symptoms further predicted poorer probability of returning to work after occupational injury, and phobic-anxiety was the most significant symptom predicting poor RTW. Development of preventive measures among injured workers according to the risk factors identified in this study is warranted.

Reduction of cooking oil fume exposure following an engineering intervention in Chinese restaurants.

BACKGROUND: A new engineering intervention measure, an embracing air curtain device (EACD), was used to increase the capture efficiency of cooker hoods and reduce cooking oil fume (COF) exposure in Chinese restaurants. METHODS: An EACD was installed in six Chinese restaurants where the cooks complained of COF exposure. Before- and after-installation measurements were taken to compare changes in particulate matter (PM) and polycyclic aromatic hydrocarbons (PAHs) in kitchen air, and changes in levels of urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) and malondialdehyde (MDA). The association between PM and PAHs in air and 8-OHdG and MDA in urine was evaluated by linear mixed-effects regression analysis. RESULTS: Results showed that geometric mean kitchen air levels of PM(10), PM(2.5), PM(1.0) and total particulate PAHs were significantly reduced after the EACDs were introduced. Urinary levels of 8-OHdG and MDA in cooks were also significantly lower after EACD instalment. PM(2.5), PM(1.0) and benzo(a)pyrene (BaP) levels were positively associated with urinary 8-OHdG levels after adjusting for key personal covariates. Urinary MDA levels in cooks were also positively associated with BaP levels after adjusting for key personal covariates. CONCLUSION: This study demonstrates that the EACD is effective for reducing COF and oxidative stress levels in cooks working in Chinese kitchens.

Employment insecurity, workplace justice and employees' burnout in Taiwanese employees: a validation study.

BACKGROUND: Employment insecurity and workplace injustice are important psychosocial hazards. However, few studies of these associations have been conducted in Chinese-speaking populations. PURPOSE: This study evaluated the psychometric properties of a Chinese version of employment insecurity and workplace justice scales, and examined their associations with the levels of workers' burnout status in Taiwanese workers. METHOD: Study subjects were participants in a national survey of employees in Taiwan, consisting of 9,636 men and 7,406 women. A self-administered questionnaire was used to assess employment insecurity (six items) and workplace justice (nine items), as well as other psychosocial work characteristics. After the survey was completed, in-depth interviews with 10 employees were conducted for a qualitative evaluation. RESULTS: Cronbach's α was 0.87 or greater for the workplace justice scale and 0.76 or greater for the employment insecurity scale, indicating satisfactory internal consistencies. Exploratory factor analyses revealed a factor pattern consistent with the theoretically assumed structure, except that the items with statements in reversed direction were loaded on separated factors. Higher levels of employment insecurity and lower levels of workplace justice were associated with higher burnout scores. However, results from the qualitative interviews suggested that some questionnaire items contained double-barreled questions, and some questions were misinterpreted or considered irrelevant by participants. CONCLUSION: The Chinese version of employment insecurity and workplace justice scales were found to have satisfactory reliability and validity. However, improvement of these scales is still needed.

Physical exercise and health education for neck and shoulder complaints among sedentary workers.

OBJECTIVE: To assess the effectiveness of 3 different health promotion exercise programs for work-related shoulder and neck pain. DESIGN: Comparative study design. SUBJECTS: A total of 178 employees were recruited and grouped. METHODS: Those in the "Self-exercise group" (n = 56) were given a lecture about the exercise program and then performed the program by themselves during their office break. "Team-exercise group I" (n = 69) performed the program once under the supervision of a physiotherapist after the lecture. "Team-exercise group II" (n = 14) performed the program twice; once under a physiotherapist's supervision. A modified Nordic questionnaire, pain threshold and cervical range of motion were used to evaluate the effect of intervention. There were 39 subjects in the reference group. RESULTS: When daily change of pain threshold (post-work-pre-work) was treated as an improvement index, the odds ratios for the self-exercise group, team-exercise group I and team-exercise group II were 1.39, 4.63 (p < 0.05) and 7.06 (p < 0.05), respectively, compared with the reference group. A dose-response effect of intervention intensity was demonstrated. CONCLUSION: An intensive team-exercise program is beneficial in reducing neck and shoulder symptoms in sedentary workers.

Six-month follow-up study of health markers of nanomaterials among workers handling engineered nanomaterials.

The aim of this study was to identify the health hazards and possible exposure surveillance markers of workers exposed to nanoparticles during manufacturing and application in comparison to a group of unexposed workers. For this longitudinal study, we recruited 158 nanomaterial-handling workers and 104 non-exposed workers from 14 manufacturing plants in Taiwan (baseline). Among them, 124 nanomaterial-handling workers and 77 unexposed workers were monitored 6 months later. We investigated pulmonary and cardiovascular disease markers, inflammation and oxidative stress markers, antioxidant enzymes and genotoxicity markers. Antioxidant enzymes (superoxide dismutase, glutathione peroxidase) and cardiovascular markers (vascular cell adhesion molecule, paraoxonase) were significantly associated with nanomaterial-handling during the 6-month follow-up period. In addition, the small airway damage marker (Clara cell protein 16) and lung function test parameters were also significantly associated with handling nanomaterials. The study markers and lung function tests are possible markers that could be useful for surveillance of nanomaterial-handling workers.

Psychological outcome of injured workers at 3 months after occupational injury requiring hospitalization in Taiwan.

INTRODUCTION: After a traumatic event, a significant proportion of victims develop psychiatric disorders. Trauma has been an important ailment among workers. This study aimed to determine the prevalence of post-traumatic stress disorder (PTSD) and other psychiatric disorders at three months after occupational injuries. METHODS: Our study candidates were injured workers in Taiwan who were hospitalized for 3 days or longer and received hospitalization benefits from the Labor Insurance program. A two-staged survey study was conducted. A self-reported questionnaire including the Brief Symptom Rating Scale (BSRS-50) and Post-traumatic Symptom Checklist (PTSC) was sent to workers at 3 months after injury. Those who met the criteria were recruited for the second stage phone interview with a psychiatrist using the Mini-international Neuropsychiatrie Interview (MINI). RESULTS: A total of 2001 workers completed the questionnaire (response rate 45.5%). Among them, 357 (17.8%) fulfilled the criteria for the MINI interview and were invited. A total of 148 (41.5%) completed the phone interview. The estimated rates of PTSD, partial PTSD (PPTSD), major depression, comorbid PTSD/PPTSD and major depression, and either PTSD/PPTSD or major depression were 2.7, 4.1, 3.0, 2.3, and 7.5%, respectively. The estimated rates of either PTSD/PPTSD or major depression among workers who suffered from intracranial injury, fracture, burn, crushing injury, and open wound of upper limbs were 10.4, 6.9, 5.9, 5.8 and 0%, respectively. CONCLUSIONS: At three months after occupational injuries, a significant proportion of workers suffered from psychiatric disorders. The rates of psychiatric disorders occurring after intracranial injuries were significantly higher than those occurring after non-intracranial injuries.

Carpal tunnel syndrome in male visual display terminal (VDT) workers.

BACKGROUND: The association between working at a video display terminal (VDT) and development of carpal tunnel syndrome (CTS) is not well-established. The study surveyed the prevalence of CTS symptoms, explored the risk factors and evaluated the clinical application of hand diagrams, physical tests and electrodiagnosis among male VDT workers. METHODS: A cross-sectional study was performed in an information and communication technology company. Three-forty questionnaires were completed and 82 volunteers participated in the physical examination and nerve conduction study. The personal and occupational risk factors for CTS were analyzed. RESULTS: The prevalence of CTS symptoms was 3.8% among 340 subjects, while prolonged median motor distal latency (>4.2 msec) was disclosed in 3.7% of a subgroup receiving examination. Classic/probable CTS symptoms was associated with high body mass index (>28 kg/m(2), odds ratio = 4.1, P = 0.029) and moderate job seniority (3-5 years, odds ratio = 4.6, P = 0.023). Prolonged median motor distal latency was associated with older age (>35 years old). We did not observe correlation between CTS symptoms, abnormal NCS, positive Tinel's sign or Phalen's test. CONCLUSION: The prevalence of CTS symptoms was not high among the group of male VDT workers studied. Job seniority, but not specific tasks, was associated with CTS symptoms. More reliable and valid methods to quantify the ergonomic exposure are needed to establish the association of VDT tasks and CTS.

Work-related upper limb amputations in Taiwan, 1999-2001.

BACKGROUND: Work-related upper limb amputations account for a significant number of occupational injuries. This study analyzes the nationwide incidence of work-related amputations of upper limbs in Taiwan by using the workers' compensation database. METHODS: A total of 2,950 cases were retrieved and analyzed from the database of workers' compensatory disability claims between the years 1999 and 2001. RESULTS: The cases were workers with an average age of 39.1 years, of whom 23.0% were female, the highest percentage of cases was in the 30-49 age group, but the incidence based on insured population was the highest for those under 20 years old. About 96% of the cases involved finger amputation, and 85% of all amputations were related to common powered machines. The average annual incidence of disability claims due to occupational amputation of upper extremities was 12.5 per 100,000 workers. Claims were most prevalent among manufacturing workers and male workers. The male to female risk ratios ranged from 2.62 for manufacturing workers to 9.05 for transport, storage and communication workers by the Poisson regression analysis. CONCLUSIONS: Young male manufacturing workers were at high risk of occupational amputation of upper extremities in Taiwan. These results provide an epidemiological base for developing a prevention strategy.