Recruit Fitness as a Predictor of Police Academy Graduation.

BACKGROUND: Suboptimal recruit fitness may be a risk factor for poor performance, injury, illness, and lost time during police academy training. AIMS: To assess the probability of successful completion and graduation from a police academy as a function of recruits' baseline fitness levels at the time of academy entry. METHODS: Retrospective study where all available records from recruit training courses held (2006-2012) at all Massachusetts municipal police academies were reviewed and analysed. Entry fitness levels were quantified from the following measures, as recorded at the start of each training class: body composition, push-ups, sit-ups, sit-and-reach, and 1.5-mile run-time. The primary outcome of interest was the odds of not successfully graduating from an academy. We used generalized linear mixed models in order to fit logistic regression models with random intercepts for assessing the probability of not graduating, based on entry-level fitness. The primary analyses were restricted to recruits with complete entry-level fitness data. RESULTS: The fitness measures most strongly associated with academy failure were lesser number of push-ups completed (odds ratio [OR] = 5.2, 95% confidence interval [CI] 2.3-11.7, for 20 versus 41-60 push-ups) and slower run times (OR = 3.8, 95% CI 1.8-7.8, [1.5 mile run time of ≥15'20″] versus [12'33″ to 10'37″]). CONCLUSIONS: Baseline pushups and 1.5-mile run-time showed the best ability to predict successful academy graduation, especially when considered together. Future research should include prospective validation of entry-level fitness as a predictor of subsequent police academy success.

Duty-related risk of sudden cardiac death among young US firefighters.

BACKGROUND: Little is known regarding duty-related risks for sudden cardiac death (SCD) among young firefighters. AIMS: To investigate duty-related SCD among US firefighters aged 45 or younger. METHODS: We collected data on duty-related SCD from the US Fire Administration (USFA) and the US National Institute for Occupational Safety and Health (NIOSH). Two physicians independently reviewed each record. The proportions of time spent by firefighters performing specific duties were estimated from a municipal department, 17 large metropolitan departments and a national database. We estimated the duty-specific relative risks (RRs) and 95% confidence intervals (95% CI) of SCD relative to non-emergency duties based on the observed deaths and the expected average proportions of time per duty. RESULTS: The USFA recorded 205 age-eligible on-duty SCDs between 1996 and 2012; 86 (42%) of these deaths and one additional SCD were investigated by NIOSH (total n = 206). NIOSH was more likely (P < 0.001) to report on SCD associated with physical training (69% of cases were investigated) and fire suppression (57%). Compared with non-emergency duties, the risk of SCD was increased for fire suppression (RR 22.1, 95% CI 14.8-32.9), alarm response (RR 2.6, 95% CI 1.5-4.6), alarm return (RR 4.1, 95% CI 2.7-6.2) and physical training (RR 4.8, 95% CI 3.2-7.2). RRs for SCD were higher among firefighters with a pre-existing history of a cardiac condition. All 16 SCDs associated with alarm response occurred among volunteer firefighters. CONCLUSIONS: The performance of strenuous emergency duties is strongly associated with an increased risk of SCD among young firefighters, particularly among those with a history of cardiovascular disease.

Assessment of fitness for work in health care workers: biomechanical risk factors.

In current practice the assessment of fitness for work in health care workers exposed to biomechanical risk factors is often based on conventional approaches rather than on evidence-based guidelines. However, an accurate evaluation of worker's psychophysical resources compared to job demand and potential occupational risk factors is essential in order to properly assess fitness for work. The latest published guidelines on the management of patients suffering from back pain reported that the evidence-based approach can minimize the period of inactivity by encouraging return to work (and to other non-dangerous physical activities) in a relatively short period of time. As for carpal tunnel syndrome, there is no scientific evidence supporting a restriction of physical activities requiring forceful movements of the hand/wrist.

[The contribution of the Italian scientific community to efficacy studies in Occupational Health (1990-2006)]. / L'apporto della comunità scientifica Italiana alle prove di efficacia in medicina del lavoro.

INTRODUCTION: Evidence-based prevention (EBP) is gaining growing interest among the international scientific community in the field of Occupational Health. In order to ascertain the commitment that has been made in Italy to participation in EBPR, we conducted a systematic review of scientific publications on efficacy evaluations in Italy. METHODS: We hand-searched journals and interrogated the PubMed database to identify reports of studies evaluating interventions designed to improve workers' health in Italy between 1990 and 2006. The selected articles were classified by institutional category (of the first author), intervention methodology, study design, type of risk factor, and occupational sector. RESULTS: We found 23 eligible publications in the Italian language and 9 in English. The most frequent study-design was pre-/post-intervention evaluation; 3 studies were randomized trials. The interventions were aimed mainly at controlling the effects of chemical hazards and noise; health-care settings were the most frequent. We found only 2 studies (1 in English) evaluating the efficacy of interventions targeting injury prevention. DISCUSSION: The systematic approach of EBP can be applied to most occupational health interventions. These results may contribute to the debate on methodology and outcomes in the scientific community.

Incidence rates of surgically treated idiopathic carpal tunnel syndrome in blue- and white-collar workers and housewives in Tuscany, Italy.

OBJECTIVES: Rates of surgically treated carpal tunnel syndrome (CTS) among blue- and white-collar workers and housewives in the general population were compared. METHODS: Surgically treated cases of idiopathic CTS were investigated among 25-59-year-old residents of Tuscany, Italy, during 1997-2000, based on obligatory discharge records from all Italian public/private hospitals, archived according to residence on Tuscany's regional database. Population data were extracted from the 2001 census. RESULTS: After excluding repeat admissions, 8801 eligible cases were identified. Age-standardised rates (per 100 000 person-years) of surgical CTS were: "blue-collar women", 367.8; "white-collar women", 88.1; "housewives", 334.5; "blue-collar men", 73.5; and "white-collar men", 15.3. Compared with reference categories (same-sex white-collar workers): female blue-collar workers experienced a 4.2-fold higher standardised rate; housewives, a 3.8-fold excess; and male blue-collar workers, a 4.8-fold excess (all p<0.001). Male and female blue-collar workers showed approximately three to sevenfold higher age-specific rates compared to their white-collar counterparts (all p<0.001). Housewives' rates were similar to those of blue-collar female workers up to 40-44 years of age, after which they were significantly lower (p<0.002). At all ages, housewives' rates were much higher (p<0.001) than those of white-collar women. CONCLUSIONS: Surgically treated CTS was three to seven times more common (depending on age/gender) in blue-collar than in white-collar workers, which is difficult to explain by differences in body weight or other individual factors. Thus, occupational risk factors seem relevant throughout working life. The high rates for full-time housewives suggest that domestic chores should be investigated as a possible risk factor for CTS.

[Evidence based prevention and upper limb work-related musculoskeletal disorders]. / Evidence based prevention e rischio biomeccanico per l'arto superiore.

To evaluate interventions for primary prevention of Upper limb Work-related Musculoskeletal Disorders (UWMSD) we conducted a literature search from the biomedical database Medline and the Cochrane Collaboration Occupational Health Field. A total of 41 studies were selected: the majority investigated the effect of interventions among office workers, few involved industrial workplaces. Studies were characterized by a wide range of interventions (engineering, administrative, ergonomic training) and methodological heterogeneity (in the study design and outcome measures). Only four studies examine interventions for the prevention of specific outcomes (Carpal Tunnel Syndrome and Hand Arm Vibration Syndrome). At present, the multidimensional approach of interventions and the poor outcome definitions hamper the isolation of the potentially effective component of the intervention. Future intervention studies should be based on well defined risk assessment and outcome measures, rigorous and long-term study design. Only strong levels of evidence could be the base of policy recommendations.