Slips, trips and falls in different work groups--with reference to age and from a preventive perspective.

Inter-record linkage between two Swedish databases on population and injury was effected to provide information on occupational slip, trip and fall (STF) accidents. The text descriptions in more than 1600 accident reports from occupational groups with high incidence rates of STF accidents were categorised by gender and age and the factors contributing to the accidents studied. Both older male and female workers had higher rates of reported STF accidents than younger workers, but it was established that within any one occupation the workplace hazards were common to all. Both for men and for women, the initial approach to the prevention of STF accidents should be to improve orderliness in the workplace.

The effects of a change in work organization upon the work environment and musculoskeletal symptoms among letter carriers.

An organizational change among 82 postal workers was studied with the aim of evaluating the effects on the work environment, work ability, and musculoskeletal complaints. The study was undertaken in 2 suburbs of Stockholm, Sweden. Psychological work demands were estimated to be reduced at the 1-year follow-up but physical work demands had changed very little. In an observation study in a subgroup of older workers, the risk of overexertion at work and musculoskeletal complaints was reduced. In spite of that, most of the older participants (>/=35 years) had unchanged or increased musculoskeletal symptoms. This shows the need for early preventive measures.

Accuracy of measurements for the revised NIOSH lifting equation. National Institute for Occupational Safety and Health.

Twenty-seven non-ergonomists who participated in a one-day training session on the use of the NIOSH lifting equation (NLE) were subsequently tested on a simulated lifting task eight weeks later to determine their accuracy in measuring the variables. Analysis of the results indicate that (1) inter-observer variability was small, especially for the most important factor (i.e. horizontal distance); (2) individuals can be trained to make measurements with sufficient accuracy to provide consistent recommended weight limit and lifting index values; and (3) measurement of the coupling and asymmetric variables were the least accurate.

Injuries after falls at work in the United Kingdom and Sweden with special reference to fractures in women over 45.

OBJECTIVES: To describe the relation with age of risk of reported injury after a fall among women at work in two countries, the United Kingdom and Sweden, with particular emphasis on fractures, and to interpret these data. METHODS: Rates of accidents compiled under the national reporting regulations of each country during a two year period were described by age, sex, cause (fall on the level, fall from a height, other), and occurrence of fracture, with emphasis on the relative risk (RR) in workers aged 45 years and over compared with those aged under 45. For fractures (major fractures only in the United Kingdom) among women, RRs were calculated for all occupations, with the three digit occupational classification schemes of each country. Summary RRs for older versus younger women, directly standardised for occupation, were derived. RESULTS: Among women, RRs for injury after a fall on the level and fall from a height were 2.77 and 1.77 respectively in Sweden and 2.28 and 1.54 in the United Kingdom. When restricted to fractures, the RRs became 4.75 and 3.66 respectively in Sweden and 3.35 and 1.97 in the United Kingdom. Standardisation for occupation gave RRs for fractures of 4.87 and 3.75 in Sweden and 3.43 and 2.16 in the United Kingdom. Almost all occupational groups with enough fractures for analysis showed an excess of fractures related to falls among older women. A different age pattern was seen for all injuries or fracture after other types of accidents and for all types of accident in men. CONCLUSION: It is argued that, for fractures at least, the results for women are unlikely to be due to reporting bias and unlikely to be explained by a greater exposure to workplace hazards among older women. Whether there is an increased risk of falling, as distinct from sustaining a fracture, is not clear. The generality of the increased risk suggest that efforts should be made to minimise hazards in all occupational sectors, particularly those using many women.

Prevention of occupational musculo-skeletal injuries. Labour Inspectorate investigation.

The present study was undertaken to investigate the effect on ergonomic conditions by Labour Inspectorate intervention at the work place and to follow health and employment among occupationally injured. 195 reports on occupational musculo-skeletal injury (accidents and diseases) from men and women with different occupations were collected consecutively at three Labour Inspectorate offices. Fifteen Labour Inspectors volunteered to investigate half of the reports by work place visits within three months. The other half was kept for control. The inspectors were trained in ergonomics and also got complementary training in ergonomic work place assessment. A check-list was designed for the purpose and tested for validity and reliability. Eighteen months after the time of the injury reports, all work places were visited by ergonomists to evaluate possible improvements in ergonomic conditions. Due to turnover and prolonged sick-leaves, evaluations were performed for only 92 of the injured. At 160 work places other employees had performed similar tasks as the injured at the time of the injury report. Evaluations of possible improvements in ergonomic conditions were performed also for these employees. As regards changes at the work place there were no differences between the injured in the study and control groups. The inspectors had delivered 11 inspection notices to the employers demanding improvements for the injured and 14 notices regarding the conditions of work-mates. For this latter group there was a significant association between delivered notices and improved ergonomic conditions eighteen months after the reports. Three years after the time of the reports a postal questionnaire on health, psychological well-being and employment was distributed to the injured. The response rate was 93%. Questionnaire answers were compared to results from other studies, where identical questions were used. There was a significantly higher prevalence of musculo-skeletal and psychological symptoms in the study group compared to data from population groups. Activities in daily life were more restricted in the study group. 109 persons were in active employment. The association between the two effect measures improved ergonomic conditions and active employment, and both individual and work-related characteristics was analysed. The odds for improved working conditions were increased where the employer had given an informative injury description in the injury report, probably indicating that an understanding of the mechanisms of injury is a prerequisite for effective prevention. Sick-leaves for more than 6 months during the year following the report had a significant negative association with active employment, whereas male sex and higher education, respectively, had a positive association. The studied musculo-skeletal injuries were associated with a high prevalence of physical and psychological symptoms. Identification and investigation of ergonomic hazards, as appearing in informative reports on the origin of injuries and in inspection notices, seemed to have a positive influence on the process of prevention.

Economic impact of ergonomic intervention-Four case studies.

The economy of ergonomic improvements is reported as case studies from four Swedish companies. Poor workplace ergonomics and related musculoskeletal problems were already known and had caused repeated sick- leave periods at these workplaces. Expenses associated with certain preventive activities were accounted for and financial effects were estimated based on interviews with representatives at the companies. When costs were compared to gains, the improvements appeared to be highly profitable.

A method assigned for the identification of ergonomic hazards - PLIBEL.

A checklist is presented for the identification of ergonomic hazards, with relevance to different body regions. Literature on the association between certain work characteristics and occupational musculoskeletal disorders was studied, and relevant items were chosen for the checklist. The method was tested for validity through workplace observations performed with the checklist and a well documented method (AET). The agreement between matching items was considerable. The inter-observer reliability yielded kappa values expressing a fair to moderate agreement. The applicability of the method is demonstrated through references to studies where it has been used.

Preventive effects of work place investigations in connection with musculo-skeletal occupational injuries.

One hundred and ninety-five reports on musculo-skeletal occupational injuries were collected and randomised into two groups: one group where the work places of the injured were visited by labour inspectors (LIs) and one control group. The inspectors were instructed to issue inspection notices (INs) where appropriate. Ninety-two such visits were paid and resulted in 20 INs. Approximately 15 months later all 195 work places were visited by 3 ergonomists and the ergonomic situations were assessed. When compared with the control group neither the visits from the LIs nor the INs issued were associated with reduced work load among the injured. However, at most work places also other employees were performing the same tasks as the injured persons. Among these employees there was a significant reduction of work load where INs had been issued to the employers. Thus, the main effects of the LI interventions were in primary preventive measures.

Factors influencing ergonomic conditions and employment rate after an occupational musculoskeletal injury.

In 195 cases of musculoskeletal occupational injury individual and work related factors and their relationship with reduction of physical work load and active employment was studied. Data concerning the injuries were obtained and after 18 months the work places were assessed. Information on employment status was obtained by a postal questionnaire after 3 years. Multiple logistic regression was used to explain the two outcome measures. Injuries classified as diseases and informative injury reports were factors positively associated with reduction of work load. Male gender, higher education, and a sick-leave shorter than 6 months were factors positively associated with employment.

A three-year follow-up of 195 reported occupational over-exertion injuries.

Three years after reporting occupational over-exertion injuries, 181 persons took part in a follow-up study by questionnaire. The objective was to study these persons with respect to their current status of health, well-being and functional capacity and when possible compare collected data to reference data from the "normal population". The studied group reported more physical and psychological symptoms than the reference groups. More than 50% reported difficulties in activities of daily living. Long sick-leaves in the year following the reported injury were associated with remaining pain and low rate of employment. Three years after the injury, 109 persons were in employment. Almost one third of these had changed occupations and now had more varied tasks than at the time of the report. Those whose work loads had been reduced after the injury, did not report less musculoskeletal disorders than others. However, access to social support was positively related with health and psychological well-being.