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Two NIOSH resources for implementing workplace safety and health surveillance.

To improve safety and health in the workplace, appropriate occupational health programs should be implemented utilizing expertise from multiple disciplines. In other words, the occupational health program should be a team effort. Expertise from all aspects of occupational health should be utilized, from the industrial hygienist, to the safety officer, to the occupational health nurse, and the practicing physician--all should be involved in the program to maintain a safe and healthy workplace. Two NIOSH resources have been described to assist the occupational health professional in the improvement of safety and health in the workplace. First, the SHEO approach, where a separate SHEO list is to be developed for each workplace. This may be a problem when the physician is an outside contractor, but with the help of the team approach, a list of SHEOs can be developed. Second, medical screening and biological monitoring is often required. While we realize that medical screening and biological monitoring is part of the complete occupational health program, the table of medical tests that we have prepared may give some leads into the type(s) of medical tests to be conducted on the individual worker at a particular worksite.

Communicable Diseases↗

Hip pain onset in relation to cumulative workplace and leisure time mechanical load: a population based case-control study.

OBJECTIVE: In an unselected community sample of adults, to assess the role and importance of exposure to mechanical factors both at work and leisure in the aetiology of hip pain. METHOD: A population based prevalence case-control study. Cases and controls were identified from a population survey of 3847 subjects registered with two general practices in Cheshire, United Kingdom. All subjects received a postal questionnaire which inquired about hip pain during the past month. An occupational history was obtained, including exposure to each of seven physical demands. Information was also obtained on history of participation in eight common sporting activities. RESULTS: 88% of those invited to participate returned a completed questionnaire. The 352 subjects with hip pain were designated as cases, and the remaining 3002 subjects as controls. In people ever employed, hip pain was significantly associated with high cumulative workplace exposure (before onset) of walking long distances over rough ground, lifting/moving heavy weights, sitting for prolonged periods, walking long distances, frequent jumping between different levels, and standing for prolonged periods. Odds ratios (ORs) in the higher exposure categories ranged from 1.46 to 2.65. Cumulative exposure to three sporting activities was significantly associated with hip pain: track and field sports, jogging, and walking, with odds ratios varying between 1.57 to 1.94. On multivariate analysis three factors were independent predictors of hip pain onset: cumulative exposure of sitting for prolonged periods (higher exposure v not exposed: OR=1.82, 95% confidence interval (CI) 1.13 to 2.92), lifting weights >50 lb (23 kg) (OR=1.74, 95% CI 1.06 to 2.86) (both relating to the workplace), and walking as a leisure activity (OR=1.97, 95% CI 1.32 to 2.94). The population attributable risk associated with each of these activities was 21%, 13%, and 16%, respectively CONCLUSIONS: Cumulative exposure to some workplace and sporting "mechanical" risk factors for hip osteoarthritis (OA) appear to be related to hip pain in general-some (but not all) have previously been related to hip OA. Because these are common workplace or leisure time activities their attributable risk is high.

Adolescent↗

Asthma-related work disability in Sweden. The impact of workplace exposures.

Work disability due to respiratory disease, especially asthma, is common and costly among working age adults. The goal of this analysis was to characterize the risk factors for such disability. We analyzed data from the Swedish part of the European Community Respiratory Health Survey (ECRHS), a random population-based sample of adults age 20 to 44, enriched with symptomatic subjects at increased likelihood of having asthma. We analyzed structured interview data available for 2,065 subjects and further analyzed methacholine challenge and skin prick test data for 1,562 of these. We defined respiratory work disability as reported job change or work loss due to breathing affected by a job. We used binary generalized linear modeling with a log link to estimate disability risk. Eighty-four subjects (4%) reported such work disability. This increased to 13% among those with asthma (45 of 350 subjects). Adjusting for covariates, occupations at high risk for asthma were associated with disability (prevalence ratio [PR] 1.8; 95% confidence interval [CI] 1.1 to 3.0), as was self-reported regular exposure to environmental tobacco smoke (ETS) at work (PR 1.8; 95% CI 1.1 to 3.1) and self- reported job exposure to vapors, gases, dust, or fumes (VGDF) (PR 4.3; 95% CI 2.2 to 8.6). Workplace ETS exposure was also associated with methacholine challenge-positive asthma reported to be symptomatic at work among male subjects (PR 4. 2; 95% CI 1.8 to 9.8), whereas high asthma-risk occupations were associated with this outcome among female subjects (PR 2.7; 95% CI 1. 05 to 7.1). Respiratory work disability, defined as breathing-related job change due to work loss, was associated with workplace exposures themselves, even after taking into account other covariates. Better control of workplace exposures, including workplace ETS, may reduce work disability caused by respiratory conditions, especially adult asthma.

Adult↗

A web-based therapeutic workplace for the treatment of drug addiction and chronic unemployment.

This article describes a Web-based therapeutic workplace intervention designed to promote heroin and cocaine abstinence and train and employ participants as data entry operators. Patients are paid to participate in training and then to perform data entry jobs in a therapeutic workplace business. Salary is linked to abstinence by requiring patients to provide drug-free urine samples to gain access to the workplace. Prior data show that a prototype of the intervention could promote drug abstinence. Preliminary data on the Web-based intervention suggest that it should be able to teach adults with histories of chronic unemployment and drug addiction to become skilled data entry operators in about 3 to 6 months. Early experience in the business provides preliminary evidence that it might become financially successful. The therapeutic workplace intervention may serve as an effective and practical long-term treatment for chronic unemployment and heroin and cocaine addiction.

Adult↗

Workplace lactation support, Part I: A return-to-work breastfeeding assessment tool.

As health professionals with expertise in the physiological and social aspects of breastfeeding, lactation consultants are in a unique position to help new mothers succeed at combining breastfeeding and employment. This involves helping women address logistical and interpersonal issues in the workplace as well as the mechanics of safe pumping and storage of breast milk. This article describes a return-to-work breastfeeding assessment tool designed to help lactation consultants evaluate clients' workplace lactation support. It also offers suggestions for use of this tool and other exercises to help new mothers negotiate the time, space and workplace support necessary to continue nursing upon return to work. The second part of this series addresses how lactation consultants can work with employers to support workplace lactation.

Adult↗

Iron-deficiency anemia in young working women can be reduced by increasing the consumption of cereal-based fermented foods or gooseberry juice at the workplace.

This efficacy for both employers and employees (young working women 18 to 23 years of age) was undertaken to determine whether culturally acceptable dietary changes in lunches in the workplace and at home could bring about a behavioral change and improvement in their iron-deficiency anemia status. Maximum weight was given to increasing consumption of iddli, a popular cereal-based-fermented food, or of gooseberry juice. Four small factories were selected in periurban Bangalore, with a sample of 302 women. The 180-day interventions were supervised at the workplace. In unit 1 (72 women), the intervention consisted of iddli four times a week plus information, education, and communication (IEC) related to iron-deficiency anemia. Unit 2 (80 women) received 20 ml of gooseberry juice (containing 40 mg of vitamin C) three times a week plus IEC once a month. Women in unit 3 (70 women), the positive control, received 400 mg albendazole once plus ferrous sulfate tablets (60 mg elemental iron) two times a week. No IEC was given. Unit 4 (70 women) served as the negative control and received no intervention. The pre-post impact measures were dietary and nutrient intake, knowledge and practice, and hemoglobin status. In units 1, 2, and 3, the hemoglobin status of the women improved significantly from 11.10 to 12.30 g/dl, 11.20 to 12.70 g/dl, and 11.50 to 13.00 g/dl, respectively. In unit 4 there was no change: the values were 10.90 g/dl before and after intervention. The results show that the type of workplace lunch was of greater significance than IEC. Knowledge gains were impressive, but behavioral change was not sustained. It was concluded that the hemoglobin levels of the workers can easily be improved by cost-effective workplace lunches that also lead to better employer-employee relations.

Adolescent↗

The impact of a worksite migraine intervention program on work productivity, productivity costs, and non-workplace impairment among Spanish postal service employees from an employer perspective.

BACKGROUND: Migraine is associated with a significant productivity loss to employers, who may benefit from making a migraine intervention available to their employees. OBJECTIVE: To evaluate changes in migraine-related productivity and non-workplace impairment associated with a migraine intervention program from the employer perspective. METHODS: This was a pre-test post-test study of Spanish Postal Service employees with migraine. The intervention consisted of counseling from occupational health physicians and rizatriptan 10 mg for symptomatic treatment of two subsequent migraine headaches. Physicians also prescribed additional medications for migraine prophylaxis, treatment of tension headaches, and rescue medications. Migraine-related work loss and non-workplace impairment (interference with daily and social activities) were self-reported at baseline (pre-intervention) and separately following each migraine headache (post-intervention) with the aid of a diary. Migraine-related work loss was reported as work loss due to absenteeism, reduced productivity while at work, and the sum of the two (total lost work day equivalents [LWDE]). An employer perspective was taken for the cost analysis, and thus productivity costs were the only costs considered. RESULTS: A total of 436 patients comprised the population for analysis. The number of migraine-related LWDE per migraine attack were 0.48 days per migraine headache in the month before the intervention, decreasing to 0.20 days and 0.07 days per migraine headache during the first and second migraine headaches following the intervention (p < 0.0001 vs. baseline). Total migraine-related productivity costs per migraine headache were 34 euros/patient before the intervention, decreasing to 14 euros/patient and 5 euros/patient during the first and second headaches following the intervention (p < 0.0001). Non-workplace activity impairment was also significantly reduced (p < 0.0001) following the intervention. The main limitations of the study were the lack of a parallel control group and the potential for differential recall bias between the usual care and the intervention periods. In addition, the results may not be generalizable to other employers or other countries. CONCLUSION: This study documents the value of a workplace migraine intervention program, which focused on migraine prevention and rizatriptan-based symptomatic treatment. It also highlights the important role occupational health clinics can play in helping employers and employees reduce the burden of migraine.

Absenteeism↗

Systems of safety and active worker-participation strategies for a safe workplace: the philosophical and structural underpinnings of the labor institute, and the Paper, Allied-industrial, Chemical And Energy Workers International Union, Accident Prevention Programs.

For the last ten years, The Labor Institute, in cooperation with the Paper, Allied-Industrial, Chemical and Energy Workers International Union (PACE) and several other international unions, has been training workers and managers to prevent accidents in the workplace using what we call a Systems of Safety (SOS) approach. We teach workers to identify major categories of safety systems and sub-systems in the workplace and to assign a hierarchical prevention value to each category. The SOS approach enables workers to look beyond the simplest explanations for an accident to identify the full range of factors that contributed to the event. As a result, Systems of Safety training provides workers with an unparalleled opportunity to reduce the frequency and severity of in-plant accidents. Unfortunately, the full benefits of an SOS system cannot be realized in most workplaces as they are now organized. Our decades of experience--and a review of relevant literature--tell us that worker participation is the key to preventing accidents. Maximum accident prevention is only achievable through maximum worker participation. In most workplaces, hierarchical structures--and workers' internalization of that hierarchy--prevent full worker participation. This article will explore barriers to achieving maximum worker participation, and strategies for providing workers with some measure of control over the systems of safety that determine the level of safety at their work sites.

Journal Article↗

Workplace health and safety: report from Canada.

This article represents a critical analysis of the major policy responses to workplace health and safety in Canada. It examines the deficiencies inherent in the legislative development of Joint Health and Safety Committees in most Canadian jurisdictions, the limitations regarding standard-setting of worker exposure to contaminants, and disincentive for employers to positively improve the workplace because of Workers Compensation legislation. Collective bargaining agreements in Canada have had only limited positive effects, while the ultimate legal sanction of criminal prosecution by the regulatory agencies has weakened enforcement and compliance of existing regulations. There has never been a successful criminal prosecution of an employer in Canada, even for multiple deaths. The article suggests the following four reasons for this "underdevelopment" of occupational health and safety in Canada: the concealment of the dimension of the incidence of industrial disease based on Workers Compensation Board statistics; the application of an incorrect theory of causation of both industrial disease and injury by both managers and government administrators of occupational health and safety programs; the resistance of both senior and middle managers against increased worker participation in both work organization and job design questions; and the general "moral underdevelopment," rather than ignorance, of managers in favoring economic considerations or values at the expense of worker health and safety. In light of the magnitude of the problem and the deficiencies of existing policy approaches, the author proposes the need for greater workplace democratization of production and industry as a necessary and sufficient reform of workplace health and safety.

Accident Prevention↗

Relationships between five factor personality variables, workplace accidents, and self-efficacy.

Past research has examined the relationships between personality variables and workplace accidents; however, few studies have examined these relationships using the Five Factor Model of personality and trait-state relationships have not been examined in this context. The present study was undertaken to examine the relationships between personality characteristics based on the Five Factor Model, workplace accidents, and self-efficacy. To examine these relationships, personality, workplace accident, and self-efficacy data were collected from 202 undergraduate volunteers (134 women and 68 men) at a large midwestern urban university. The mean age of participants was 20.9 yr. (SD=5.0). The results indicated that scores on Agreeableness and Conscientiousness were significantly correlated with workplace accidents as were the self-efficacy variables. Neuroticism and Agreeableness were significantly related to self-efficacy.

Accidents, Occupational↗

Drug and alcohol testing in the workplace--objectives, pitfalls, and guidelines.

This paper examines the historical development of drug testing, the motivations underlying proposals to implement workplace testing for drugs and alcohol, the types of programs currently in use, and the potential pitfalls of workplace testing. It also examines the basic principles involved in disputes about the legality of workplace testing. Finally, this paper discusses guidelines to ensure that workplace testing programs are fair and to minimize unwanted and harmful effects of testing.

Alcoholism↗

Empowering nurses for politically astute change in the workplace.

While studies of the shortage of nurses have documented the need for nurses to play a greater role in decision-making processes in their workplaces, it cannot be assumed that nurses have the confidence or skills for making changes in the workplace in politically astute ways that will be effective. This article describes a continuing education program that was designed to prepare nurses to realize their potential power and to develop skills for effectively bringing about changes in their workplaces. Based on a feminist model of empowerment, the program content and methods reflected three dimensions of empowerment: consciousness-raising, building self-esteem, and skill development. Both short- and long-term evaluations (immediate and at 7 months) demonstrated that education can be a vehicle for empowering nurses to effectively bring about changes in their workplaces. The program was sponsored by the Manitoba Nurses Union, The University of Manitoba Continuing Education Division, and The University of Manitoba School of Nursing.

Decision Making, Organizational↗

[The relationship between environmental concentration and exposure concentration in the airborne dust of workplace].

The authors studied the relationship between environmental concentration and exposure concentration in the airborne dust of workplaces, using instantaneous fixed points sampling and personal wear sampling. The results showed that there was a correlation between two kinds of concentrations in the automatic and man-made packing workplaces (r = 0.9914, 0.9977). A relationship between them in the unsteady workplace was found after analysed by one-accumulated generating operation (1-AGO) (r = 0.9945). The samples of environmental and exposure concentrations could be thought from the same normal distribution, that is, the bivariable random sampling in the normal distribution population. Moreover, the exposure concentration could be estimated by environmental one after 1-AGO in the unsteady workplace of airborne dust.

Air Pollutants, Occupational↗

The Alcohol Use Disorders Identification Test (AUDIT) and carbohydrate-deficient transferrin (CDT) in a routine workplace health examination.

BACKGROUND: Only a few studies on workplaces have examined the Alcohol Use Disorders Identification Test (AUDIT) or carbohydrate-deficient transferrin (CDT) as screening instruments for the early identification of elevated and risky levels of alcohol consumption. The purpose of this study was to compare the performances of AUDIT, CDT, and gamma-glutamyltransferase (GGT) in a routine health examination (alcohol screening) in the workplace. METHODS: The study, carried out over 16 months in a large workplace in the transport sector, was part of an on-going controlled study. Employees who came to the company health service for a routine health examination were offered the opportunity to undergo an alcohol screening and check their alcohol habits. RESULTS: Of the 570 subjects who participated, 105 (18.4%) screened positive according to AUDIT, CDT, or both. Only 7.6% of the persons who screened positive did so according to both instruments. If GGT had been included as a screening instrument, the proportion of positive results would have increased to 22.0%. If we had only used AUDIT in the screening process, the proportion of positives would have fallen by nearly half. CONCLUSIONS: The present findings suggest that AUDIT and CDT are complementary instruments for alcohol screening in a routine workplace health examination, and each has value for identifying a different segment of the risky drinking population.

Adult↗

Before the storm: informing and involving stakeholder groups in workplace biomarker monitoring.

The social, legal and ethical implications of advances in biomarker indentification have been discussed by scholars and environmental researchers, but not by the "everyday" professionals and workers who may eventually make and be affected by decisions about their workplace applications. Through the use of a hypothetical scenario, this study introduced members of various professional and occupational groups to the potential uses of biomarkers research on biological monitoring in the workplace. The purpose was to obtain opinions about how events would proceed based on the scenario, leading to a broad discussion of potential uses and abuses of biomarker-based health monitoring. Six professionally homogeneous focus groups, comprised of 1) company health professionals, 2) third-party payers, 3) attorneys, 4) human resource managers, 5) non-unionized workers, and 6) unionized workers, participated in focus groups presented as "think-tank" discussions in Greenville and Charleston, S.C. Participants were given a fictitious "newspaper article" about the use of biomarker-based monitoring at a chemical plant and were asked to comment on what they thought would happen next. The discussion expanded to a general consideration of biological monitoring and its legal, social and ethical ramifications. Data was analyzed through the "immersion/crystallization" method. Few participants reported any knowledge of biological monitoring prior to the focus group session. Some had initial difficulty understanding the concept and how it differs from other means of measuring environmental risk. Although biological monitoring was previously unknown to many participants, occupational groups were relatively consistent in the issues they raised about its use in the workplace. In all groups, questions about potential discrimination against employees were raised. The general consensus was that the use of biomarker-based monitoring would result in conflict and litigation without regulations to protect employees from discrimination. Although most participants saw potential health benefits resulting from the preventive advantages associated with this technology, their concerns about its misuses were paramount. Perceptions varied as a function of occupation. Non-unionized workers expressed the most concern about discriminatory uses of biological monitoring. Unionized workers, who said they believed the union would support their interests, expressed much less concern. Health professionals (company physicians and nurse practitioners) were most alarmed about the "extra work" a monitoring program would create for them. Human resource managers concentrated on the company's "damage control" efforts. Attorneys emphasized that the reliable use of such tests would establish a causal relationship between exposure and personal injury. The results of this project illustrate that people who are most likely to be affected by biomarker-based biological monitoring in the workplace readily understand and are alarmed by its legal and ethical implications. It is unlikely that this technology will be fully accepted as an environmental risk assessment tool or as a prevention strategy without stringent protection of workers' rights. This study demonstrated the value of focus groups in obtaining opinion data about an environmental risk issue that it not yet well known to the general public.

Adult↗

Creating a safer workplace to provide quality care.

In recent years, increasing interest has been placed on how health care workers can be trained and equipped to better protect them from possible workplace accidents and injuries while improving the care they deliver. Better workplace safety also means better customer and employee satisfaction, improved workforce retention and recruitment, and cost savings. Workplace safety is constantly evolving and addresses a whole host of issues ranging from needles and sharps injuries to moving patients to human factor analyses. This issue takes a cross-sectional look at how hospitals and health systems are addressing problem areas--and sharing information and best practices--to strengthen their quality of care at the workplace level.

Ergonomics↗

Occupational health services and maintenance of work ability at workplaces.

This paper describe the concept of maintenance of work ability (MWA) at workplaces and the contribution of occupational health services (OHS). Changing working life and its demands increase the need for MWA. The concept of MWA is approximately ten years old in Finland. It has attained large popularity in media and is a central trend in the promotion of well-being at workplaces. It has received wide approval in politics and labour market as one of the main topics of internal policies. The maintenance of work ability has become the main service of occupational health. The activities of MWA are increasing. It is considered profitable and it has many positive effects at workplaces, but has not yet been established properly as a part of everyday work processes. Occupational health services play a significant role in different phases of MWA process, but it should be more significant, especially in small workplaces. More trust, communication and collaboration are needed.

Finland↗

Development of the Health and Work Questionnaire (HWQ): an instrument for assessing workplace productivity in relation to worker health.

BACKGROUND: Workplace productivity evaluations often involve subjective assessments. This study was performed to develop and validate a new multidimensional instrument, the Health and Work Questionnaire (HWQ), for measuring workplace productivity and worker heath. METHODS: In a prospective, non-randomized study, objective and subjective workplace productivity (measured with the HWQ) was assessed among 96 current, 94 former, and 104 non-smoking volunteer reservation agents at a US-based international airline. RESULTS: Six HWQ sub-scales were identified from factor analyses: productivity, concentration/focus, supervisor relations, impatience/irritability, work satisfaction, and non-work satisfaction. Non-smokers (individuals who had never smoked) had higher scores on all scales. The HWQ scale scores all correlated significantly with the objective measure "Time Lost"; two of the scales correlated significantly with the summary objective performance measure. Magnitudes of the significant correlations were modest (0.12 to 0.22). CONCLUSIONS: The HWQ may be useful for evaluating the impact of interventions on workplace productivity. Additional validation research on the HWQ is recommended before use as a primary measure in studies of worker productivity.

Adult↗