Riscos, acidentes e doenças profissionais no bloco operatório central do hospital central de Maputo, no período de outubro a dezembro de 2021 / Risks, accidents and occupational diseases in the central operating theatre of the central hospital of Maputo, from october to december 2021

Introdução: Os riscos, acidentes e doenças profissionais a que os trabalhadores de saúde estão expostos no ambiente hospitalar, constitui um problema de saúde pública reconhecido mundialmente, em particular em Moçambique. Objectivo: analisar os riscos, acidentes e doenças profissionais dos trabalhadores da saúde afectos no Bloco Operatório Central do Hospital Central de Maputo. Métodos: É um estudo descritivo e transversal observacional no Bloco Operatório Central do HCM. A recolha de dados foi feita através de um questionário aos trabalhadores de saúde, no período de Outubro a Dezembro de 2021. Os dados foram analisados usando o programa SPSS versão 21 e aplicados testes de qui-quadrado. Resultados: Foram entrevistados 196 trabalhadores da saúde, dos quais 101 do sexo feminino e 95 do sexo masculino. 50% dos inqueridos sofreram riscos (biológicos, químicos, físicos e ergonómicos), dos quais 51% do sexo feminino e 49% do sexo masculino. Os médicos residentes foram os que mais se destacaram no grupo dos trabalhadores que sofreram acidentes, com 30,6% de casos, seguido por enfermeiros com 20,4%, médicos anestesistas 16,3%, agentes de serviço 11,2% e administrativos com 10,2%. Dos acidentes, os ricos biológicos foram os mais frequentes; sendo com fluidos Biológicos foi registo 46,9% e picada com agulha e outros instrumentos contundentes 53,1%, os acidentes com material biológico foram os mais frequentes entre os trabalhadores com idade inferior a 30 anos e em indivíduos do sexo feminino. Conclusão: As condições de trabalho do BOC do HCM são inseguras onde se destacam: a degradação da estrutura física das salas de operações, a fraca qualidade de alguns equipamentos de protecção individual, a insuficiência de iluminação e a falta de climatização do local. Durante o estudo não foi possível identificar doenças profissionais, pois, após a exposição por riscos ou acidente de trabalho, os trabalhadores fazem a profilaxia, e ao terminarem os mesmos não voltam para o seguimento clinico.

Introduction: Health workers in their workplace are exposed to risks of accidents or get diseases, because the hospital environment is a healthy place, insofar as it provides an exposure of workers to physical, chemical, chemical risks, mechanical and, mainly, biological. This study addresses the risks and occupational diseases in the Central Operating Room Service of the Maputo Central Hospital, located in Maputo City, in Mozambique. Objective: The present research aims to analyze the occupational risks and illnesses of health workers assigned to the Central Operating Room of the MCH. Methods: This is a descriptive and cross-sectional study, based on data collected at the Central Operating Room Service of the MCH. October data collection was done through an October 2 data collection period. For data collection use data from the Reported Case Report Form. The SPSS version 21 program and chi-square tests were used to analyze the results. Results: 196 health workers were interviewed, of which 101 were female and 95 were male. 50% of respondents suffered from Risks (Biological, Chemical, Physical and Ergonomic), of which 51% were female and 49% male. Resident physicians stood out the most in the group of workers who suffered accidents, with 30.6% of cases, followed by nurses with 20.4%, anesthesiologists with 16.3%, service agents with 11.2% and administrative with 10.2%. In the Central Operating Room Service, biological riches were the most frequent, with Biological fluids recording 46.9% and pricking with needles and other blunt instruments 53.1%. Conclusion: The working conditions of the BOC of the MCH are unsafe, where the following stand out: the degradation of the physical structure of the operating rooms, the poor quality of some personal protective equipment, insufficient lighting and lack of air conditioning in the place. Accidents with biological material were the most frequent among workers under the age of 30 years and among female individuals. The most affected categories were Resident Physicians, Nurses, Service Agents, Anesthesiologists and Administrative Physicians. Additionally, the group of employees with previous PCI training was the one most involved in accidents.

Importance of legal regulations resulting from technical harmonization in the European Union for improvement of work safety of farmers in Poland.

INTRODUCTION AND OBJECTIVE: Accidents exert a negative effect on the quality and standard of living of rural inhabitants, especially when they make it impossible to continue work on a farm, or this work may be performed only to a limited extent. The creation of effective legal mechanisms which would guarantee the safety of operation of machinery is a crucial issue, it is of a preventive character and considerably limits the number of accidents. Approximately 16.1 million people live in the rural areas and around 2.3 million work in the agricultural sector, which represents 14.5% of all labour in Poland in 2019. OBJECTIVE: The aim of the study was to evaluate the legal regulations resulting from the directives of technical harmonization in the European Union for improvement of safety of work with the use of agricultural machinery in Poland. MATERIALS AND METHOD: The method was critical analysis of legal acts in effect, court rulings, and statistical data concerning accidentsoin farms, made available by the Agricultural Social Insurance Fund (KRUS). BRIEF DESCRIPTION OF THE STATE OF KNOWLEDGE: As a result of Poland's membership of the European Union, rural areas were covered by globalization processes and single market rules, within which there function legal mechanisms of safety and quality of products. CONCLUSIONS: Analysis of the 16 years of Poland's membership of the EU, resulted in positive results being observed in the use of the directives of technical harmonization, especially in reducing the number of accidents involving agricultural machinery. However, this improvement may result from using newly-purchased, modern and safer agricultural machinery covered by the conformity assessment, and preventive actions carried out by the Agricultural Social Insurance Fund. An impact of other factors, not analysed in the study, cannot be ruled out.

Occupational health and safety in agriculture - a brief report on organization, legislation and support in selected European countries.

INTRODUCTION AND OBJECTIVE: Agriculture and forestry are among the most dangerous professions in Europe, with a high level of accidents affecting the sustainability and viability of the sector. International conventions, EU directives and national legislation build the fundamental basis for prevention. The aim of the study is to describe and categorize national mechanisms of occupational safety and health (OSH) for agricultural workers in Europe, to assess the extent of implementing safety regulation, the body in charge, and to give examples of health and safety initiatives. MATERIAL AND METHODS: Results of a questionnaire-survey on basic safety regulations on farms sent by e-mail to the representatives of 30 participating European countries in the context of the Sacurima COST action network (CA 16123) are presented. Due to the complexity, only selected countries are described in this study highlighting the regulative bodies, occupational health services or specific training offers, as well as the complexity of the mechanisms. RESULTS: One of the most serious issues and deficits of EU OSH regulation is the exclusion of self-employed farmers who compose nearly 90% of the farming population. This leads to serious under-reporting of accidents, and because one of the most common measures for the performance of health and safety initiatives are the injury and ill health statistics, better registration systems are urgently needed in almost all countries as a basis for preventive efforts. CONCLUSIONS: The results of the study provide a basis for raising awareness about the current OSH systems in Europe, and the importance of developing sector specific OSH strategies. The proposed activities should assist in tackling high accident rates and poor occupational health for self-employed farmers.

Key factors for successful implementation of the National Rollover Protection Structure Rebate Program: A correlation analysis using the consolidated framework for implementation research.

Objectives On US farms, tractor overturns are the leading cause of death; however, these fatalities are preventable with the use of a rollover protection structure (ROPS). A ROPS rebate program was established in New York in 2006 to address these fatalities. Due to its success, the program expanded to six additional states before being implemented as the National ROPS Rebate Program (NRRP) in 2017. The aim of this study was to evaluate the success of the NRRP implementation using short- and long-term ROPS outcome measures and identify which components of the consolidated framework for implementation research (CFIR) correlate with these outcomes. Methods Stakeholders involved in the NRRP implementation were surveyed at four time points, beginning at the time of the NRRP launch and then every six months. These surveys measured 14 relevant CFIR constructs. Correlations between CFIR survey items (representing constructs) and three outcome measures (intakes, funding progress, and retrofits) were used to identify CFIR survey items that are predictive of the outcomes. Results Eight CFIR survey items were highly correlated (rho ≥0.50) with at least one of the three outcome measures. These eight CFIR survey items included four constructs: access to knowledge and information, leadership engagement, engaging (in fundraising and funding requests), and reflecting and evaluating. Conclusions The results of this study provide important guidance for continuing the implementation of the NRRP. Similarly, these findings can inform the evaluation of other similarly structured implementation efforts and the application of CFIR in a variety of settings.

Scoping Global Aquaculture Occupational Safety and Health.

Objectives: In 2017 the Food and Agriculture Organization (FAO) Committee on Fisheries committed to prioritize occupational safety and health issues in aquaculture (AOSH). An international team was established to synthesize OSH knowledge concerning more than 19 million, often vulnerable, aquaculture workers found globally.Methods: The study was conducted as a desktop scoping exercise using both peer-reviewed and gray literature and the knowledge and expertize of an international panel. Collated information used a standard proforma. Panel members developed draft national and regional AOSH profiles outlining occupational hazards contributing to occupational injuries, diseases, and known solutions. These were work-shopped and refined after gathering additional information and used to compile the first global scoping review report on AOSH.Results: Synthesized results revealed multiple hazards, significant global knowledge gaps and some successful and unsuccessful global, national and industry-specific AOSH policies, practices and standards along the primary supply chain, in marine and freshwater contexts. Some constructive initiatives by the International Labor Organization (ILO) and FAO, industry, labor and civil society groups in a range of employment and geographical settings and across diverse populations of workers were identified.Conclusion: Global commitment to AOSH should be given the same focus as product quality, biosecurity, food safety and environmental sustainability in the sector. This needs development and implementation of integrated AOSH actions appropriate for diverse settings especially in low and middle-income countries encompassing greater uptake of international codes, better risk assessment and OSH management, adoption of technological innovations, effective OSH regulation and enforcement, adequate resources, training and information.

Occupational safety in the construction industry.

BACKGROUND: The paper is a research review focusing on occupational safety in the construction industry. OBJECTIVE: The purpose is to present research that highlights the areas of occupational safety and risks and to identify areas where research is lacking. METHODS: 146 articles from scientific journals, mainly covering the construction industry in Europe, Canada, USA, Australia and Japan have been studied. The findings are presented under 11 categories: accident statistics; individual factors; legislation and regulations; ethical considerations; risk management; leadership, management, organization; competence; safety design; cost-benefit calculations; programs and models; and technical solutions. RESULTS: The research is dominated by initiatives from researchers and government authorities, while the construction industry only appears as the object for the research. There is a scarcity of research on integrated systems encompassing subcontractors, as well as a lack of research with sociological perspectives on accidents. Furthermore, only a few studies have applied a gender perspective on safety in construction, i.e. there is a need of further research in this particular area. CONCLUSIONS: A range of initiatives have been taken to increase safety in the construction industry and the initiatives are mainly reported to be successful. There are some cultural differences, but basically researchers present similar results regardless of country.

Why do farm accidents persist? Normalising danger on the farm within the farm family.

In the western world, farming is the most dangerous occupation with the highest rates of accidents and fatalities. Farming remains largely a family business and most accidents happen to family members. Why do safety campaigns have such limited success and why do farm families bring this terrible grief on themselves? This article argues that farm accidents are a persistent social pattern requiring analysis of how families are socialised to interact with the farming space. Based on qualitative data gathered for a Scottish study, it is argued that within farm families there is a socialisation and normalisation of danger. Accidents are to be expected. Two key arguments are advanced. First, danger is normalised and children are socialised to undertake risky behaviour. Second, it is suggested that when women do take up farming, they consciously undertake dangerous farming activities to prove that they are 'authentic' farmers. No previous research has considered women's approach to danger, and the existing literature suggests women are more safety conscious. This is not supported by our findings. We argue that farm accidents and fatalities are a persistent social problem because family members socialise each other to accept danger as the norm.

¿Mejor prevenir que indemnizar?. Los accidentes de trabajo en Argentina, 1915-1955 / Better to prevent than indemnify? Work accidents in Argentina

En sincronía con la sanción y la reglamentación de la Ley de Accidentes de Trabajo en la Argentina (1915) se impulsaron una serie de medidas para prevenir los accidentes laborales y las enfermedades profesionales. Las mismas fueron diseñadas en forma asistemática y espasmódica tanto desde las agencias estatales como también por los sectores industriales. El artículo indaga en los debates legislativos, las revistas oficiales y profesionales y en los soportes gráficos con el objetivo de mostrar que en la gestión tanto gubernamental como privada, en el período estudiado, primó la lógica indemnizatoria por sobre la preventiva, y ambas estrategias se conjugaron como mecanismos de resolución de los desajustes del trabajo. Estudiar cuáles fueron las políticas preventivas y a quiénes se dirigió la difusión gráfica y las recomendaciones es una vía para analizar las inclusiones y exclusiones en el proceso de delimitación de las políticas sociales. La relevancia de este punto radica en que sobre el dilema de la responsabilidad individual o responsabilidad social, se ha construido gran parte del corpus legal en torno a las políticas sociales

In line with the sanctions and regulations of the Work Accident Law in Argentina (1915), a series of measures were adopted to prevent work accidents and professional diseases. They were designed in a non-systemic and spasmodic fashion by both state agencies and industrial sectors. Based on the investigation of legislative debates, official and professional journals, and graphic materials, this article shows that an indemnifying approach prevailed over a preventive approach in governmental and private management bodies during this period and that the two strategies were combined as mechanisms for resolving work problems. Study of the preventive policies, poster campaigns, and target audiences of recommendations is one method to identify those who were included in social policies and those who were excluded. The relevance of this issue lies in the fact that a large part of the corpus of law on social policies has been constructed around the dilemma of individual or social responsibility

Infectious risk for healthcare workers: evaluation and prevention.

Exposure to pathogenic agents is a major occupational risk factor in healthcare facilities. The most common pathogenic agents are human immunodeficiency virus, hepatitis B and C viruses, and Mycobacterium tuberculosis. In Italy, about 70-80% of all cases of exposure to biological agents result from injuries caused by needles or other sharp instruments used during healthcare procedures. These accidents place a high economic burden on healthcare facilities. Indeed, each event is estimated to cost around € 375. Various studies have shown that the adoption of needlestick-prevention devices reduces occupational exposure to biological risk. At regulatory level, Italian Legislative Decrees 81/08 and 19/14 provide for measures to protect healthcare professionals from biological exposure to pathogenic agents.

Circumstances and Structure of Occupational Sharp Injuries among Healthcare Workers of a Selected Hospital in Central Poland.

(1) Background: An analysis of work-related sharp injuries in Healthcare Workers (HCWs) based at a selected hospital in Central Poland by presenting the frequency of accidents, injury rates, and identifying circumstances of Needle Sticks and Sharp Injuries (NSSI) and giving Post-Exposure Procedures (PEP). (2) Methods: A retrospective analysis of medical documentation regarding work-related NSSI at a district hospital located in central Poland; over the period 2010⁻2017. The study group included HCWs who had an accident while on duty. (3) Results: Most injuries were reported by nurses and staff over 40, on the morning shift. The most common injuries were using a needle. The most exposed part of the body were fingers. The average annual injury rates were: 1.22/100 Nurses; 2.02/100 doctors; 1.34/100 hospital beds; and 8.59/100,000 inpatient days. The rates for 3-year periods, after the implementation of legal regulations were higher than before. CONCLUSION: Injuries rates are more reliable for comparison than frequency. Legislation on the need to register injuries seems to be necessary. In the supervision of work safety of personnel, reliable reporting of all injuries by the respective HCWs plays a key role.

Legal Aspects of Sleep Medicine in the 21st Century.

Multiple manifestations of sleep disorders may interact with the law, making it important to increase awareness of such interactions among clinicians. Patients with excessive sleepiness may have civil (and in some states criminal) liability if they fall asleep while driving and cause a motor vehicle accident. Employers may be held vicariously liable because of the actions of sleepy employees. Hence, awareness of causes of excessive sleepiness, such as sleep deprivation and OSA, is increasing among trucking, railroad, and other safety-sensitive occupations. Interestingly, litigation related to perioperative complications because of OSA is more frequent than nonoperative issues such as a failure to diagnose OSA. Parasomnia-associated sleep-related violence represents a challenge to clinicians because they may be asked to consider parasomnia as a possible contributing, mitigating, or exculpatory factor in criminal proceedings. Clinicians should also familiarize themselves with the legal and regulatory aspects of running an independent sleep laboratory. Sleep telemedicine practice using 21st century technology has opened novel and unique challenges to existing laws. In this review, we cover the most common interactions between sleep disorders and the law, including the challenges of excessive sleepiness and driving, other legal issues involving patients with OSA, and the liabilities associated with parasomnia disorder. We will also cover some practical legal aspects involving independent sleep laboratories and the field of sleep telemedicine.

Notificação compulsória de acidentes de trabalho: dificuldades e sugestões dos profissionais de saúde em Fortaleza, Ceará / Mandatory reporting of work accidents: difficulties and suggestions by healthcare professionals in Fortaleza, Ceará, Brazil

Introdução: A notificação de acidente de trabalho (AT) é hoje um importante instrumento para a saúde pública, pois a partir dela se tem real conhecimento sobre a situação dos trabalhadores atendidos pelo Sistema Único de Saúde (SUS). Objetivo: Analisar dificuldades e sugestões dos profissionais de saúde sobre a notificação compulsória de AT em unidades sentinela em saúde do trabalhador, no município de Fortaleza, Ceará. Métodos: Estudo quantitativo de cunho descritivo, realizado em unidades sentinela em saúde do trabalhador, no município de Fortaleza, Ceará, no período de fevereiro de 2013 a junho de 2014. Foram aplicados 78 questionários não estruturados aos profissionais responsáveis pela notificação de AT. A exploração dos dados obtidos foi pautada na Análise de Conteúdo. Resultados: As dificuldades encontradas pelos profissionais como impedimento para a não notificação foram: falta de conhecimento quanto ao manejo de medidas a serem tomadas, omissão e sobrecarga de trabalho. Foram citadas como sugestões: educação permanente em saúde (EPS) e divulgação de protocolos. Conclusão: Com os resultados obtidos pelo presente artigo, fica evidente a importância da capacitação dos profissionais de saúde, incentivando a realização das notificações e orientando tais profissionais para o correto preenchimento da ficha de notificação, a fim de diminuir a subnotificação do agravo

Background: Work accident (WA) reports are a relevant public health tool as they afford effective knowledge on the actual situation of workers cared within the Unified Health System (Sistema Único de Saúde ­ SUS). Objective: To analyze the difficulties posed by mandatory WA reporting and suggestions for improvement made by healthcare professionals at sentinel workers' health units in Fortaleza, Ceará, Brazil. Methods: Quantitative and descriptive study conducted at sentinel workers' health units in Fortaleza, Ceará, from February 2013 through June 2014. An unstructured questionnaire was applied to 78 professionals charged of reporting WA. The collected data were subjected to content analysis. Results: As difficulties for reporting WA the participants mentioned: lack of knowledge on how to manage required measures, omission and work overload. Suggestions to improve reporting included health continuing education and divulgation of protocols. Conclusion: The results of the present study point to the relevance of training as a means to enhance reporting and to orient professionals on how to fill report forms in order to reduce underreporting

Employer knowledge of federal requirements for recording work-related injuries and illnesses: Implications for occupational injury surveillance data.

BACKGROUND: Accuracy of the Bureau of Labor Statistics Survey of Occupational Injuries and Illnesses (SOII) data is dependent on employer compliance with workplace injury and illness recordkeeping requirements. Characterization of employer recordkeeping can inform efforts to improve the data. METHODS: We interviewed representative samples of SOII respondents from four states to identify common recordkeeping errors and to assess employer characteristics associated with limited knowledge of the recordkeeping requirements and non compliant practices. RESULTS: Less than half of the establishments required to maintain OSHA injury and illness records reported doing so. Few establishments knew to omit cases limited to diagnostic services (22%) and to count unscheduled weekend days as missed work (27%). No single state or establishment characteristic was consistently associated with better or worse record-keeping. CONCLUSION: Many employers possess a limited understanding of workplace injury recordkeeping requirements, potentially leading them to over-report minor incidents, and under-report missed work cases.

Mine Safety and Health Administration's Part 50 program does not fully capture chronic disease and injury in the Illinois mining industry.

BACKGROUND: The Mine Safety and Health Administration (MSHA) requires reporting of injuries and illnesses to their Part 50 program. A 2011 study indicated that the Part 50 program did not capture many cases of injury in Kentucky, causing concern about underreporting in other states. METHODS: MSHA Part 50 reports from Illinois for 2001-2013 were linked to Illinois Workers' Compensation Commission (IWCC) data. IWCC cases not found in the Part 50 data were considered unreported. RESULTS: Overall, the Part 50 Program did not capture 66% of IWCC cases from 2001 to 2013. Chronic injuries or illnesses were more likely to be unreported to MSHA. CONCLUSIONS: The majority of occupational injuries and illnesses found in the IWCC from this time period, were not captured by Part 50. Inaccurate reporting of injuries and illnesses to the Part 50 program hinders MSHA's ability to enforce safety and health standards in the mining industry.

[The inadequacy of official classification of work accidents in Brazil]. / A inadequação da classificação oficial dos acidentes de trabalho no Brasil.

Traditionally, work accidents in Brazil have been categorized in government documents and legal and academic texts as typical work accidents and commuting accidents. Given the increase in urban violence and the increasingly precarious work conditions in recent decades, this article addresses the conceptual inadequacy of this classification and its implications for the underestimation of work accidents in the country. An alternative classification is presented as an example and a contribution to the discussion on the improvement of statistics on work-related injuries in Brazil.

Tradicionalmente, os acidentes do trabalho no Brasil vêm sendo categorizados em documentos governamentais, bem como em textos jurídicos e acadêmicos, como típicos e de trajeto. Face ao aumento da violência urbana e à precarização do trabalho em décadas recentes, discute-se a inadequação conceitual dessa classificação e sua implicação no subdimensionamento dos acidentes do trabalho no país. É apresentada uma classificação alternativa, como ilustração e contribuição à discussão sobre o aprimoramento das estatísticas das lesões associadas ao trabalho no país.

Tradicionalmente, los accidentes de trabajo en Brasil están siendo categorizados en documentos gubernamentales, así como en textos jurídicos y académicos, como típicos y de desplazamiento. Ante el aumento de la violencia urbana y la precarización del trabajo en las décadas recientes, se discute la inadecuación conceptual de esa clasificación y su implicación en el subdimensionamiento de los accidentes de trabajo en el país. Se presenta una clasificación alternativa, como ilustración y contribución a la discusión sobre el perfeccionamiento de las estadísticas de las lesiones asociadas al trabajo en el país.

Interventions to prevent injuries in construction workers.

BACKGROUND: Construction workers are frequently exposed to various types of injury-inducing hazards. There are a number of injury prevention interventions, yet their effectiveness is uncertain. OBJECTIVES: To assess the effects of interventions for preventing injuries in construction workers. SEARCH METHODS: We searched the Cochrane Injuries Group's specialised register, CENTRAL (issue 3), MEDLINE, Embase and PsycINFO up to April 2017. The searches were not restricted by language or publication status. We also handsearched the reference lists of relevant papers and reviews. SELECTION CRITERIA: Randomised controlled trials, controlled before-after (CBA) studies and interrupted time-series (ITS) of all types of interventions for preventing fatal and non-fatal injuries among workers at construction sites. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies, extracted data and assessed their risk of bias. For ITS studies, we re-analysed the studies and used an initial effect, measured as the change in injury rate in the year after the intervention, as well as a sustained effect, measured as the change in time trend before and after the intervention. MAIN RESULTS: Seventeen studies (14 ITS and 3 CBA studies) met the inclusion criteria in this updated version of the review. The ITS studies evaluated the effects of: introducing or changing regulations that laid down safety and health requirements for the construction sites (nine studies), a safety campaign (two studies), a drug-free workplace programme (one study), a training programme (one study), and safety inspections (one study) on fatal and non-fatal occupational injuries. One CBA study evaluated the introduction of occupational health services such as risk assessment and health surveillance, one evaluated a training programme and one evaluated the effect of a subsidy for upgrading to safer scaffoldings. The overall risk of bias of most of the included studies was high, as it was uncertain for the ITS studies whether the intervention was independent from other changes and thus could be regarded as the main reason of change in the outcome. Therefore, we rated the quality of the evidence as very low for all comparisons.Compulsory interventionsRegulatory interventions at national or branch level may or may not have an initial effect (effect size (ES) of -0.33; 95% confidence interval (CI) -2.08 to 1.41) and may or may not have a sustained effect (ES -0.03; 95% CI -0.30 to 0.24) on fatal and non-fatal injuries (9 ITS studies) due to highly inconsistent results (I² = 98%). Inspections may or may not have an effect on non-fatal injuries (ES 0.07; 95% CI -2.83 to 2.97; 1 ITS study).Educational interventionsSafety training interventions may result in no significant reduction of non-fatal injuries (1 ITS study and 1 CBA study).Informational interventionsWe found no studies that had evaluated informational interventions alone such as campaigns for risk communication.Persuasive interventionsWe found no studies that had evaluated persuasive interventions alone such as peer feedback on workplace actions to increase acceptance of safe working methods.Facilitative interventionsMonetary subsidies to companies may lead to a greater decrease in non-fatal injuries from falls to a lower level than no subsidies (risk ratio (RR) at follow-up: 0.93; 95% CI 0.30 to 2.91 from RR 3.89 at baseline; 1 CBA study).Multifaceted interventionsA safety campaign intervention may result in an initial (ES -1.82; 95% CI -2.90 to -0.74) and sustained (ES -1.30; 95% CI -1.79 to -0.81) decrease in injuries at the company level (1 ITS study), but not at the regional level (1 ITS study). A multifaceted drug-free workplace programme at the company level may reduce non-fatal injuries in the year following implementation by -7.6 per 100 person-years (95% CI -11.2 to -4.0) and in the years thereafter by -2.0 per 100 person-years (95% CI -3.5 to -0.5) (1 ITS study). Introducing occupational health services may result in no decrease in fatal or non-fatal injuries (one CBA study). AUTHORS' CONCLUSIONS: The vast majority of interventions to adopt safety measures recommended by standard texts on safety, consultants and safety courses have not been adequately evaluated. There is very low-quality evidence that introducing regulations as such may or may not result in a decrease in fatal and non-fatal injuries. There is also very low-quality evidence that regionally oriented safety campaigns, training, inspections or the introduction of occupational health services may not reduce non-fatal injuries in construction companies. There is very low-quality evidence that company-oriented safety interventions such as a multifaceted safety campaign, a multifaceted drug workplace programme and subsidies for replacement of scaffoldings may reduce non-fatal injuries among construction workers. More studies, preferably cluster-randomised controlled trials, are needed to evaluate different strategies to increase the employers' and workers' adherence to the safety measures prescribed by regulation.

[Medical Knowledge in Accident Insurance : Assessing "Pneumatic Tool Damages" at the Bergmannsheil Hospital, 1929-1944]. / Medizinisches Wissen in der Unfallversicherung : Die Begutachtung von "Preßluftschäden" im Krankenhaus Bergmannsheil, 1929­1944.

The article focuses on one central element of medical activity in the context of the German social insurance system: providing expert assessments in accident pension cases. Taking an example from interwar coal mining, it aims to reconstruct how social policy makers first conceived of "pneumatic tool damages" as occupational disease and how trauma surgeons had to deal with this new entity of social law once it had been institutionalized in 1929. Drawing on physicians' publications as well as archival sources from the supreme court in social insurance, the Reichsversicherungsamt, the article examines how the controversial generation of new knowledge took place. It argues that medical knowledge was neither simply applied to administration and law nor was it compromised by the necessity to adjust it to those fields of decision-making. Expert medical opinions should instead be understood as a specific form of medical knowledge.