The association between janitor physical workload, mental workload, and stress: The SWEEP study.

BACKGROUND: Approximately 2.38 million janitors are employed in the U.S. While high physical workload may explain a lost-work days rate 2.7 times greater than other occupations, little is known about the association between janitors' physical workload, mental workload, and stress. OBJECTIVE: The objective of this study was to assess the associations between physical (ergonomic) and mental workload exposures and stress outcomes among janitors. METHODS: Questionnaire data, focused on ergonomic workload, mental workload and stress, were collected from Minnesota janitors for a one-year period. Physical workload was assessed with Borg Scales and Rapid Entire Body Assessments (REBA). Mental workload assessment utilized the NASA Task Load Index (TLX). Stress assessments utilized single-item ordinal stress scale (SISS) and Perceived Stress Scale-4 (PSS-4) measures. Descriptive and multivariable analyses, including bias adjustment, were conducted. RESULTS: Odds ratios (OR) and 95% confidence intervals (CI) for ergonomic workload (task frequency) effects on SISS were: REBA (1.18 OR, 1.02-1.37 CI); Borg (1.25 OR, 1.00-1.56 CI); combined REBA and Borg (1.10 OR, 1.01-1.20 CI). Mental workload was associated with higher PSS-4 levels (0.15 Mean Difference, 0.08-0.22 CI) and a 3% increased risk for each one-unit increase in the SISS scale (1.03 OR, 1.02-1.05 CI). CONCLUSIONS: This research demonstrated a moderate effect of physical and mental workloads on stress among janitors.

A marginal structural model approach to analyse work-related injuries: an example using data from the health and retirement study.

BACKGROUND: Biases may exist in the limited longitudinal data focusing on work-related injuries among the ageing workforce. Standard statistical techniques may not provide valid estimates when the data are time-varying and when prior exposures and outcomes may influence future outcomes. This research effort uses marginal structural models (MSMs), a class of causal models rarely applied for injury epidemiology research to analyse work-related injuries. METHODS: 7212 working US adults aged ≥50 years, obtained from the Health and Retirement Study sample in the year 2004 formed the study cohort that was followed until 2014. The analyses compared estimates measuring the associations between physical work requirements and work-related injuries using MSMs and a traditional regression model. The weights used in the MSMs, besides accounting for time-varying exposures, also accounted for the recurrent nature of injuries. RESULTS: The results were consistent with regard to directionality between the two models. However, the effect estimate was greater when the same data were analysed using MSMs, built without the restriction for complete case analyses. CONCLUSIONS: MSMs can be particularly useful for observational data, especially with the inclusion of recurrent outcomes as these can be incorporated in the weights themselves.

Knowledge of work-related injury reporting and perceived barriers among janitors.

INTRODUCTION: The goal of this study was to evaluate and improve janitors' knowledge of workers' rights and responsibilities for assessing and reporting work-related injuries, and to determine the barriers for reporting occupational injuries. METHODS: Questionnaires, designed to collect data retrospectively for two, sequential six-month periods, were disseminated to 1200 full-time unionized janitors in the Twin Cities. Immediately following the baseline questionnaire administration, a randomly selected sub-group of janitors (~600) received information on workers' rights and responsibilities for reporting injuries; six-months later a questionnaire comparable to the baseline questionnaire was disseminated to the 1200 janitors. Analyses included basic descriptive analyses and identification of potential differences in proportions of job-specific reporting barriers pre-post-intervention. RESULTS: Among the participating janitors (n = 390), approximately half (53%) were initially unsure of what an OSHA 300 Log was; 56% reported not knowing what workers' compensation was. At baseline, in both intervention and non-intervention groups, approximately 25% reported having a perceived barrier to reporting an injury to their employer. Reported barriers included "fear," "reporting takes too long," "being unsure of the reporting process," and an "understanding that injuries are a part of the job." At follow-up, among the intervention group, there was an important reduction (24%-12%) in having a perceived barrier for reporting a work-related injury. CONCLUSIONS: A majority of janitors lacked knowledge and awareness of OSHA injury reporting and Workers' Compensation. In order to improve reporting, it is essential to educate employees on OSHA and Workers' Compensation and inform janitors of the injury reporting process through training. Practical applications: Future intervention efforts must focus on the specific barriers for reporting occupational injuries and be tailored specifically to the janitor population. To reduce underreporting of injuries, they must be encouraged to report their occupational injuries. Barriers to reporting these injuries must be eliminated.

The Relationship Between Shiftwork and Violence Against Nurses: A Case Control Study.

This study investigated the potential relationship between shiftwork and work-related physical assault (PA) against nurses who are at high risk of violence globally. Nurses (6,300), randomly selected from the licensing database and working in Minnesota, were surveyed regarding PA experiences. Through a nested case-control study, nurses who reported a PA in the previous 12 months and controls who were randomly selected from their assault-free working months, respectively, identified exposures experienced during the month prior to the assault month (cases) and the random non-PA months (controls). Comparing case and control exposures, shiftwork was examined relevant to PA. Among 310 cases and 946 controls, most worked 8 hours or less (87%, 88%) during day shifts (44%, 70%). Multivariable analyses (odds ratios [ORs] and 95% confidence intervals [CIs]) revealed increased risk of PA for nurses working evening (OR = 1.55, 95% CI = [1.05, 2.27]), night (OR = 3.54, 95% CI = [2.31, 5.44]), and rotating day and evening (OR = 2.88, 95% CI = [1.22, 6.80]) shifts, which provides a basis for intervention opportunities.

Large Machinery-Related Agricultural Injuries Across a Five-State Region in the Midwest.

OBJECTIVE: High agricultural injury related mortality and morbidity rates persist. This study addressed a knowledge gap regarding large machinery-related injury magnitude, consequences, and risk factors. METHODS: From randomly selected Midwestern agricultural operations in 1999 and 2001, 7420 eligible households participated. Demographic, exposure, and injury data collected for four 6-month periods used a computer-assisted telephone interview. An a priori causal model enabled survey development, data analysis, and interpretation. Directed acyclic graphs, developed from this model, facilitated potential confounder identification for specific exposures in multivariate analyses. RESULTS: The injury rate was 12.82 events per 1000 persons per year. Increased risk was associated with male gender, increasing age, state of residence, history of prior injury, and increasing hours worked per week. CONCLUSIONS: Large machinery-related agricultural injuries can result in significant consequences. Associated increased injury risks require further investigation and targeting of relevant interventions.

Injury rates, severity, and drug testing programs in small construction companies.

PROBLEM: Construction work is hazardous and workers consistently rank in the top of all occupations and industries for illicit drug and heavy alcohol use. METHODS: Drug-testing programs were classified into three categories: no program, pre-employment/post-accident, and pre-employment/post-accident/random/suspicion. We analyzed workers' compensation claims from 1,360 construction companies over a six-year period to assess the possible association of testing program with injury rate. RESULTS: Compared to no program, results respectively were RR=0.85 (CI=0.72-1.0) and RR=0.97 (CI=0.86-1.10) for all injuries, and RR=0.78 (CI=0.60-1.03) and RR=1.01 (CI=0.86-1.19) for lost-time injuries. Variability of results was exhibited across trade and union status, among other categories. SUMMARY: Drug-testing programs may be associated with lower, non-significant, injury rates in this population. IMPACT ON INDUSTRY: Drug-testing programs may be associated with lower injury rates, but care should be exercised to ensure accurate injury reporting, characterize underlying safety practices of a company, and to determine quality and consistency of testing.

Animal-related injuries: a population-based study of a five-state region in the upper Midwest: Regional Rural Injury Study II.

PROBLEM: While agricultural injury has been identified among the major causes of occupational injury mortality and morbidity, data have been limited pertinent to the magnitude, consequences, and potential risk factors for animal-related injuries -- a major source of morbidity among agricultural operations. METHODS: Demographics, exposure, and injury data were collected for 1999 and 2001 among agricultural households in a five-state region. Causal models facilitated survey design, data analyses, and interpretation of results; directed acyclic graphs guided multivariate modeling. RESULTS: From 7,420 households (84% response of eligible), a total of 5,045 injury events were reported; 1,016 (20.1%) were animal-related. Multivariate analyses revealed increased risks for those <20 years; residents of all states compared to Minnesota; all age groups compared to 0-4 years; >0 hours worked; and prior agricultural injury history. For those 20+ years, increased risks were identified for: South Dakota residents; males; >0 hours worked; and prior agricultural injury history. For those cases <20 and 20+ years of age, 58% and 46%, respectively, resulted in lost work time on their agricultural operations (31% and 50%, one week or more). CONCLUSIONS: Animal-related injury has a major impact on the agricultural industry. Results serve as a basis for interventions and further research. IMPACT ON INDUSTRY: The impact of animal-related injuries on the agricultural industry appears significant; among age groups <20 and 20+, 85% and 82%, respectively, had some resulting restriction. For all events combined, 29% and 30%, respectively, involved restriction from one week to 3+ months; 12% and 15% involved restriction for one month or more. Among those <20 and 20+ years of age, 58% and 46%, respectively, lost work time on their own agricultural operation as a result of injuries associated with their own operation; 22% and 15% lost one week or more. Moreover, of the non-agriculture-related injuries, 31% and 50% resulted in lost work time on their own operation; 15% and 28%, respectively, lost one week or more. Restrictions such as these can affect the productivity of the operation, resulting in financial impacts, especially on small operations that have few people to manage the required tasks.

Work practices and childhood agricultural injury.

OBJECTIVE: To evaluate whether children's agricultural work practices were associated with agricultural injury and to identify injury and work practice predictors. DESIGN: Analyses were based on nested case-control data collected by the Regional Rural Injury Study-II (RRIS-II) surveillance study in 1999 and 2001 by computer-assisted telephone interviews. SUBJECTS: Cases (n=425) and controls (n=1886) were persons younger than 20 years of age from Midwestern agricultural households. Those reporting agricultural injuries became cases; controls (no injury) were selected using incidence density sampling. MAIN OUTCOME MEASURES: Multivariate logistic regression was used to estimate the risks of injury associated with agricultural work, performing chores earlier than developmentally appropriate, hours worked per week, and number of chores performed. RESULTS: Increased risks of injury were observed for children who performed chores 2-3 years younger than recommended, compared to being "age-appropriate" (odds ratio (OR)=2.6, 95% confidence interval (CI)=1.4-4.5); performed any agricultural work (3.9 (2.6-5.6)); performed seven to ten chores per month compared to one chore (2.2 (1.3-3.5)); and worked 11-30 or 31-40 h per week compared to 1-10 h (1.6 (1.2-2.1) and 2.2 (1.3-3.7), respectively). Decreased risks of injury were observed for non-working children compared to children performing what are commonly considered safe levels of agricultural work. CONCLUSIONS: This study demonstrated elevated risks of agricultural injury among children who perform developmentally inappropriate chores. Results suggest that the efficacy of age restrictions for preventing the occurrence of childhood agricultural injuries warrants further evaluation.

Successful return to work for cancer survivors.

This study investigated factors associated with successful return to work for cancer survivors in accordance with the Americans with Disabilities Act. A focus group was held with seven female cancer survivors. Participants discussed return-to-work issues following a cancer diagnosis. Factors such as coworker support and job flexibility improved their experiences, whereas coworker and supervisor ignorance about cancer and lack of support made returning to work more stressful. Participants discussed personal, environmental, and cancer-related factors that influenced their experiences with returning to work following a cancer diagnosis. Knowledge of factors that support employees helps occupational health nurses ease their transition, and may improve quality of life for employees. Physicians and health care provider teams may play a critical role in the employees' positive evaluation of their recovery process. This pilot study serves as a basis for a larger, population-based study.

Fall-related injuries among agricultural household members: Regional Rural Injury Study II (RRIS-II).

OBJECTIVE: The objective of this study was to identify the magnitude and consequences of and potential risk factors for fall-related injuries among agricultural operation households. METHODS: Demographic, injury, and exposure data were collected through 1999 from 3765 households in a five-state region. A causal model facilitated survey design, data analyses, and interpretation of results; directed acyclic graphs guided multivariate modeling. RESULTS: The 16,538 participants experienced 766 fall-related injury events (48.3 per 1000 persons). Consequences included lost agricultural and other work time. Increased risks involved residence in states other than Minnesota, male gender, and injury history. Decreased risks were among those less than 35 years of age and those who worked 40 hours or less per week. CONCLUSIONS: Fall-related injury is a major problem for the agricultural population. This effort serves as a basis for further in-depth research.

Risk factors for work-related assaults on nurses.

BACKGROUND: Work-related homicides have been the subject of considerable study, but little is known about nonfatal violence and relevant risk factors. METHODS: We surveyed 6300 Minnesota nurses who were selected randomly from the 1998 licensing database and determined their employment and occupational violence experience. In a nested case-control study, we examined environmental exposures and physical assault. Cases of assault in the previous 12 months and controls randomly selected from assault-free months were surveyed about prior-month exposures. RESULTS: After adjustment by multiple logistic regression, incidence of physical assault was 13.2 per 100 persons per year (95% confidence interval = 12.2-14.3). Among 310 cases and 946 control subjects, odds ratios for assault were increased: in nursing homes or long-term care facilities (2.6; 1.9-3.6), emergency departments (4.2; 1.3-12.8), and psychiatric departments (2.0; 1.1-3.7); in environments not "bright as daylight" (2.2; 1.6-2.8); and for each additional hour of shift duration (1.05; 0.99-1.11). Risks were decreased when carrying cellular telephones or personal alarms (0.3; 0.2-0.7). CONCLUSIONS: These results may guide in-depth investigation of ways protective and risk factors can control violence against nurses.

Tractor-related injuries: a population-based study of a five-state region in the Midwest.

BACKGROUND: Tractor-related injuries are among the most severe of agricultural injuries. This study identifies the incidence, consequences, and potential risk factors for tractor injuries among 3,765 agricultural households in a five-state region. METHODS: Demographic, injury, and exposure data were collected for two 6-month recall periods in 1999 using computer assisted telephone interviews. A causal model served as a basis for survey design, data analysis, and interpretation of results; associated directed acyclic graphs guided development of multivariate models. RESULTS: The overall injury rate was 9.6 events per 1,000 persons per year. Increased personal risk was observed for males and prior agricultural injury experience. Compared with ages 35-44, decreased risks were identified for those less than 5, 5-9, 10-14, 15-19, and 20-24. CONCLUSIONS: Risk of tractor injury among agricultural household members varied by gender, age, and prior injury experience. .

Impact of training on work-related assault.

Although training is often recommended as a part of a comprehensive approach to address occupational violence, little empirical literature exists to support this recommendation. Over 40% of nurses responding to the Minnesota Nurses Study reported being trained about occupational violence, involving seven different training topics. Although at the univariate level, an increased risk was identified for nurses trained in managing assaultive/violent patients, no statistically significant results remained at the multivariate level. This lack of protection from training is consistent with previous research, although the explanations for this lack of effect remain unclear. Additional research is necessary to obtain more specific details on occupational violence training, including training content and methods, to understand more thoroughly the impact of training on occupational violence.

Marijuana use and injury events resulting in hospitalization.

PURPOSE: Information on the potential relation between marijuana use and the incidence of hospitalized injury is extremely limited. The purpose of this effort was to investigate the potential for this association. METHODS: A retrospective study was conducted in a large prepaid Northern California health care program cohort (n = 64,657) that completed baseline questionnaires about health behaviors, including marijuana use, and health status between 1979 and 1985. All injury hospitalizations through December 31, 1991, (n = 965) were identified and validated. RESULTS: Using Poisson regression modeling, increased rate-ratios and 95% confidence intervals were identified for all-cause injury hospitalizations for both men and women among current users (1.28; 1.01 to 1.61 and 1.37; 1.04 to 1.79, respectively) relative to nonusers, adjusted for age, cigarette and alcohol use, and other potential confounders. Increased rates of motor vehicle (1.96; 1.23 to 3.14), and assault (1.90, 1.16 to 3.15), injuries were identified among men who were current users; an increased rate of assault was suggestive in women (2.21; 0.92 to 5.19). CONCLUSIONS: Though the results must be viewed cautiously, they suggest that marijuana use may be independently associated with increased risk of hospitalized injury. Further study of the physiological and behavioral mechanisms is warranted [corrected].

A Study of Players With Pain.

The results of this study suggest that the harmful effects of tennis are cumulative and that many variables may interact before elbow pain occurs.