Testing the associations between leading and lagging indicators in a contractor safety pre-qualification database.
ABSTRACT: BACKGROUND:Safety prequalification assessing contractors' safety management systems and safety programs lack validation in predicting construction worker injuries. METHODS:Safety assessments of leading indicators from 2198 construction contractors, including Safety Management Systems (SMS), Safety Programs (e.g., falls, hearing protection), and Special Elements (drug testing, return to work) scales as well as the history of citations from the Occupational Safety and Health Administration (OSHA) were compared to contractors' lagging indicators of recordable injury case rates (RC) and rates of injuries involving days away, restricted, or transferred (DART). RESULTS:Increased SMS scores were related to lower injury rates. Each one-point increase in SMS values was associated with 34% reduced odds of a recordable case rate greater than zero (Odds ratio (OR): 0.66, 95% Confidence Interval (CI): (0.57, 0.79)), and a 9% reduced recordable case rate, if one occurs (Risk Ratio (RR): 0.91, 95% CI: (0.88, 0.94)). A one-point increase in SMS was associated with 28% reduced odds of a DART (OR?=?0.72, 95%CI (0.56, 0.91)), and 9% reduced DART rate, if one occurs (RR?=?0.91, 95%CI (0.87, 0.95)). Safety programs did not show consistent associations with injury outcomes. Having additional Special Elements related to drug and alcohol programs was associated with lower injury rates while the Special Element related to return to work showed no consistent associations with injury. Having more OSHA Citations was associated with lower injury rates for companies with injuries. CONCLUSIONS:These results support pre-qualification methods based on SMS and suggest the need for safety management systems in contractors.
Project description:OBJECTIVE:The aim of this study was to estimate the extent to which work-related injuries contribute to medical expenditures paid for by group health insurance. METHODS:Administrative data on OSHA recordable injuries spanning 2010 to 2013 were obtained for female patient care workers (n?=?2495). Expenditures were aggregated group health insurance claims for 3 and 6-month periods before/after injury. Group health insurance plan type, age group, and job category were control variables. RESULTS:Being injured is associated with the odds of having expenditures at both 3 months, odds ratio (OR) 2.17 [95% confidence interval (95% CI) 1.61 to 2.92], and 6 months, 2.95 (95% CI 1.96 to 4.45). Injury was associated with $275 of additional expenditures (95% CI $38 to $549) over 3 months and $587 of additional expenditures (95% CI $167 to $1140) over 6 months. CONCLUSIONS:Injury was associated with increased odds of positive expenditures and increased expenditures paid for by group health insurance.
Project description:<h4>Objectives</h4>The purpose of this nationwide intervention was to improve machine safety in small metal fabrication businesses (3 to 150 employees). The failure to implement machine safety programs related to guarding and lockout/tagout (LOTO) are frequent causes of Occupational Safety and Health Administration (OSHA) citations and may result in serious traumatic injury.<h4>Methods</h4>Insurance safety consultants conducted a standardized evaluation of machine guarding, safety programs, and LOTO. Businesses received a baseline evaluation, two intervention visits, and a 12-month follow-up evaluation.<h4>Results</h4>The intervention was completed by 160 businesses. Adding a safety committee was associated with a 10% point increase in business-level machine scores (P?<?0.0001) and a 33% point increase in LOTO program scores (P?<?0.0001).<h4>Conclusions</h4>Insurance safety consultants proved effective at disseminating a machine safety and LOTO intervention via management-employee safety committees.
Project description:BACKGROUND:Logging is recognized as one of the most dangerous industries in the United States (US), ranking among those with the highest occupational injury and fatality rates. Although logging operations in the Southeastern US have lower rates of injuries and fatalities compared to other regions of the US, due in part to the use of large machinery to fell timber as opposed to chainsaw felling, safety hazards continue to persist. The hazards present in the logging cut sites in which loggers operate may result in worker injury, illness, or fatality. Our objective was to develop, deliver, and evaluate a safety management and leadership training among logging contractors and supervisors using mobile tablets as a personal learning environment. METHODS:A safety leadership and management training vignette was developed based on previously collected focus group needs assessment data. A non-random sample of 31 male logging supervisors received the safety leadership and management training on a mobile tablet. Kirkpatrick Levels 1, 2, and 3 training effectiveness evaluations were performed. RESULTS:A statistically significant large effect size suggests safety knowledge was gained among training participants when comparing post-test scores to pre-test scores (Level-2). Participants rated their training experience favorably (Level-1), and applied knowledge gained from the training throughout their weekly work activities three months after training (Level-3). CONCLUSION:Our findings suggest the utilization of mobile learning techniques can be an effective means to deliver safety management and leadership training content to logging contractors and supervisors. Future trainings should be linguistically and literacy-level appropriate, as well as comprehensive in nature, including meaningful and relevant content. Our observations support the use of mobile devices as just one component of a more comprehensive health and safety management program for workers in the logging industry.
Project description:OBJECTIVE: To identify strengths and weaknesses in community based child passenger safety programs by developing a scoring instrument and conducting observations of child restraint use in three Native American communities. SETTING: The three communities are autonomous Tribal reservations in the Pacific Northwest. Their per capita incomes and rates of unemployment are comparable. METHODS: In each community, 100 children under 5 years old were observed for car seat use. A six item community assessment tool (100 points maximum) awarded points for such items as the type (primary or secondary) and enforcement of child restraint laws; availability of car seats from distribution programs; extent of educational programs; and access to data on vehicle injuries. RESULTS: For children from birth to 4 years, the car seat use rate ranged from 12%-21%. Rates for infants (71%-80%) far exceeded rates for 1-4 year old children (5%-14%). Community scores ranged from 0 to 31.5 points. There was no correlation between scores and observed car seat use. One reason was the total lack of enforcement of restraint laws. CONCLUSIONS: A community assessment tool can highlight weaknesses in child passenger efforts. Linking such a tool with an objective measure of impact can be applied to other injury problems, such as fire safety or domestic violence. The very process of creating and implementing a community assessment can enhance agency collaboration and publicize evidence based "best practices" for injury prevention. Further study is needed to address methodologic issues and to examine crash and medical data in relation to community child passenger safety scores.
Project description:BACKGROUND:Text messaging (short message service, SMS) interventions show promise as a way to help cigarette smokers quit. Few studies have examined the effectiveness of text messaging (SMS) programs targeting smokers associated with primary care or hospital settings. OBJECTIVE:This study aimed to develop a text messaging (SMS) program targeting primary care smokers. METHODS:Adult smokers in primary care were recruited from February 2017 to April 2017. We sent patients 10 to 11 draft text messages (SMS) over 2 days and asked them to rate each message in real time. Patients were interviewed daily by telephone to discuss ratings, message preferences, and previous experiences with nicotine replacement therapy (NRT). Content analysis of interviews was directed by a step-wise text messaging (SMS) intervention development process and the Information-Motivation-Behavioral Skills model of medication adherence. RESULTS:We sent 149 text messages (SMS) to 15 patients. They replied with ratings for 93% (139/149) of the messages: 134 (96%, 134/139) were rated as clear or useful and 5 (4%, 5/139) as unclear or not useful. Patients' preferences included the addition of graphics, electronic cigarette (e-cigarette) content, and use of first names. Regarding NRT, patients identified informational gaps around safety and effectiveness, preferred positively framed motivational messages, and needed behavioral skills to dose and dispose of NRT. CONCLUSIONS:Patients recommended text message (SMS) personalization, inclusion of e-cigarette information and graphics, and identified barriers to NRT use. Combining real-time ratings with telephone interviews is a feasible method for incorporating primary care patients' preferences into a behavioral text messaging (SMS) program.
Project description:Objectives:The Integrated Management Information System (IMIS) is the largest multi-industry source of exposure results available in North America. In 2010, the Occupational Safety and Health Administration (OSHA) released the Chemical Exposure Health Data (CEHD) that contains analytical results of samples collected by OSHA inspectors. However, the two databanks only partially overlap, raising suspicion of bias in IMIS data. We investigated the factors associated with selective recording of CEHD results into the IMIS databank. Methods:This analysis was based on personal exposure measurements of 24 agents from 1984 to 2009. The association between nine variables (level of exposure coded as detected versus non-detected (ND), whether a sampling result was part of a panel of chemicals, duration of sampling, issuance of a citation, presence of other detected levels during the same inspection, year, OSHA region, amount of penalty, and establishment size) and a CEHD sampling result being reported in IMIS was analyzed using modified Poisson regression. Results:A total of 461900 CEHD sampling results were examined. The proportion of CEHD sampling results recorded into IMIS was 38% (51% for detected and 28% for ND measurements). In the models, the detected sampling results were associated with a higher probability of recording into IMIS than ND sampling results, and this difference was similar for panel versus non-panel samples. Probability of recording remained constant from 1984 to 2009 for sampling results measured on panels but increased for sampling results of single determinations of an agent. Some OSHA regions had probability of recording two times higher than others. No other variables that we examined were associated with a CEHD sampling result being reported in IMIS. Conclusions:Our results indicate that the under-reporting of sampling results in IMIS is differential: ND results (especially those determined from the panels) seem less likely to be recorded in IMIS than other results. It is important to consider both IMIS and CEHD data in order to reduce bias in evaluation of exposures in workplaces inspected by OSHA.
Project description:<h4>Rationale and objective</h4>Three-dimensional (3D) printing allows innovative solutions for personal protective equipment, particularly in times of crisis. Our goal was to generate an N95-alternative 3D-printed respirator that passed Occupational Safety and Health Administration (OSHA)-certified quantitative fit testing during the COVID-19 pandemic.<h4>Materials and methods</h4>3D printed prototypes for N95 solutions were created based on the design of commercial N95 respirators. Computed tomography imaging was performed on an anthropomorphic head phantom wearing a commercially available N95 respirator and these facial contour data was used in mask prototyping. Prototypes were generated using rigid and flexible polymers. According to OSHA standards, prototypes underwent subsequent quantitative respirator fit testing on volunteers who passed fit tests on commercial N95 respirators.<h4>Results</h4>A total of 10 prototypes were 3D printed using both rigid (n?=?5 designs) and flexible materials (n?=?5 designs), Prototypes generated with rigid printing materials (n?=?5 designs) did not pass quantitative respirator fit testing. Three of the five prototypes with flexible materials failed quantitative fit testing. The final two prototypes designs passed OSHA-certified quantitative fit tests with an overall mean fit factor of 138 (passing is over 100).<h4>Conclusion</h4>Through rapid prototyping, 3D printed N95 alternative masks were designed with topographical facial computed tomography data to create mask facial contour and passed OSHA-certified quantitative respiratory testing when flexible polymer was used. This mask design may provide an alternative to disposable N95 respirators in case of pandemic-related shortages. Furthermore, this approach may allow customization for those that would otherwise fail fit testing on standard commercial respirators.
Project description:BACKGROUND:Analysis of workers' compensation data and occupational health and safety trends in healthcare across Canada was conducted to provide insight concerning workplace injuries and prevention measures undertaken in the healthcare sector. METHODS:Timeloss claims data were collected for 1992-2002 from the Association of Workers' Compensation Boards of Canada. Labour Force data from Statistics Canada were used to calculate injury rates. The Occupational Health and Safety Agency for Healthcare in British Columbia coordinated with provincial occupational health and safety agencies in Ontario, Quebec and Nova Scotia to analyze injury data and collate prevention measures in their regions. RESULTS:The national timeloss injury rate declined from 4.3 to 3.7 injuries per 100 person-years since 1998. Musculoskeletal injuries consistently comprised the majority of timeloss claims. Needlestick injuries, infectious diseases and stress-related claims infrequently resulted in timeloss claims although they are known to cause great concern in the workplace. Prevention measures taken in the various provinces related to safer equipment (lifts and electric beds), return-to-work programs, and violence prevention initiatives. Different eligibility criteria as well as adjudication policies confounded the comparison of injury rates across provinces. DISCUSSION:Since 2000, all provinces experienced healthcare restructuring and increased workload in an aging workforce. Despite these increased risks, injury rates have decreased. Attribution for these trends is complex, but there is reason to believe that focus on prevention can further decrease injuries. While occupational health is a provincial jurisdiction, harmonizing data in addition to sharing data on successful prevention measures and best practices may improve workplace conditions and thereby further reduce injury rates for higher risk healthcare sector occupations.
Project description:RATIONALE:Exposure to respirable crystalline silica causes silicosis, a preventable, progressive occupational lung disease. A more rigorous occupational health standard for silica could help protect silica-exposed workers. OBJECTIVES:To describe trends over 29 years of silicosis surveillance in Michigan. METHODS:Michigan law requires the reporting of silicosis. We confirmed the diagnosis of silicosis in reported cases using medical questionnaires, review of medical records, and chest radiographs. The Michigan Occupational Safety and Health Administration (OSHA) conducted enforcement inspections at the workplaces of the silicosis cases, including air monitoring for silica and evaluation of workplace medical surveillance programs. RESULTS:The Michigan surveillance program identified 1,048 silicosis cases from 1988 to 2016, which decreased from 620 during 1988-1997, to 292 during 1998-2007, to 136 during 2008-2016. The cumulative incidence rate of silicosis decreased from 3.7 to 1.4 to 0.7 cases per 100,000 men 40 years of age and older in Michigan over the same three periods. African Americans had a higher cumulative incidence rate of silicosis, with 6.0 cases per 100,000 African American men 40 years of age and older in Michigan compared with 1.2 cases per 100,000 white men 40 years of age and older in Michigan. The cases identified had severe disease; 59% had progressive massive fibrosis or category 2 or 3 small opacities per B-reading classification of the chest radiograph. Seventeen percent reported ever having active tuberculosis. On spirometry, 76% of ever smokers and 72% of never smokers demonstrated either a restrictive or an obstructive pattern. Most (65%) had not applied for workers' compensation benefits; the percentage who applied for benefits decreased from 42% to 28-16% over the three periods. Thirty-four of 55 (62%) workplace inspections found exposures above the new OSHA 50 ?g/m3 respirable crystalline silica permissible exposure limit, and only 11% of inspected companies screened their workers for silicosis. CONCLUSIONS:Adults with confirmed cases of silicosis have advanced disease and morbidity. Most are not using workers' compensation to pay for their care. The new OSHA silica standard, which lowers the permissible exposure limit for silica and requires medical monitoring to identify workers with silicosis, will help reduce the burden of silica exposure. It is critical for pulmonologists to be vigilant to recognize and manage this preventable occupational lung disease.
Project description:As more children and adolescents are becoming involved in exercise and school or community based athletics, attention is turned towards proper training and conditioning to optimize performance, stimulate athletic development and ensure safety while tolerating long-term competition. Resistance training (RT) refers to the methodology of ensuring such optimal performance and safety. This is a common component of sports and physical fitness in schools and organized athletic programs around the country. RT is a physical conditioning program that involves various training techniques (e.g., machine based, free weight, plyometric, complex and functional training) and progressively increasing resistive loads to achieve desired muscle endurance, strength, power or a combination of the above. Proper RT programs have a plethora of associated benefits including increased strength, lower rates of sports-related injury, increased bone strength index (BSI), decreased risk of fracture and improved self-esteem and interest in fitness. There are risks involved with improper or poor training programs. Proper training programs involve knowledgeable trainers, effective supervision and tailored weight training.