Epidemiology of occupational accidents among Iranian insured workers

Work-related accidents are considered as a major health problem worldwide. The aim of present study was to determine the epidemiological pattern of occupational accidents among workers insured by the Iranian Social Security Organization (ISSO) between 2001 and 2005.Subjects consisted of all workers and drivers who had a work-related accident during 2001–2005 and were registered in the Iranian Social Security Organization (ISSO) database according to the inspection reports. An ordinal logistic regression model (proportional odds regression model) was used to assess the concurrent effects of independent variables on accident outcomes.Overall, 86,437 work-related accidents were investigated. The accidents were more frequent in metal workplaces and electrical industries, respectively. More than half of the accidents were due to incautious activities. Workers’ age (age at the time of accident) (OR = 0.99, CI: 0.989–0.994), gender (OR = 1.3, CI: 1.191–1.683), marital status (OR = 1.25, CI: 1.143–1.675) as well as accident setting (OR = 1.88, CI: 1.728–1.975) had significant effect on accident outcomes. Pattern of occupational injuries in Iran was consistent with the global pattern for accident outcomes.     

Prevalence of work-site injuries and relationship between obesity and injury among U.S. workers: NHIS 2004–2012

Introduction: Studies have reported associations between obesity and injury in a single occupation or industry. Our study estimated the prevalence of work-site injuries and investigated the association between obesity and work-site injury in a nationally representative sample of U.S. workers. Methods: Self-reported weight, height, and injuries within the previous three months were collected annually for U.S. workers in the National Health Interview Survey (NHIS) from 2004–2012. Participants were categorized as normal weight (BMI: 18.5–24.9 kg/m²), overweight (BMI: 25.0–29.9), obese I (BMI: 30.0–34.9), and obese II (BMI: 35 +). The prevalence of injury and prevalence ratios from fitted logistic regression models was used to assess relationships between obesity and injury after adjusting for covariates. Sampling weights were incorporated using SUDAAN software. Results: During the 9-year study period from 2004 to 2012, 1120 workers (78 workers per 10,000) experienced a work-related injury during the previous three months. The anatomical sites with the highest prevalence of injury were the back (14.3/10,000 ± 1.2), fingers (11.5 ± 1.3), and knees (7.1 ± 0.8). The most common types of injuries were sprains/strains/twists (41.5% of all injuries), cuts (20.0%), and fractures (11.8%). Compared to normal weight workers, overweight and obese workers were more likely to experience work-site injuries [overweight: PR = 1.25 (95% CI = 1.04–1.52); obese I: 1.41 (1.14–1.74); obese II: 1.68 (1.32–2.14)]. These injuries were more likely to affect the lower extremities [overweight: PR = 1.48, (95% CI = 1.03–2.13); obese I: 1.70 (1.13–2.55); obese II: 2.91 (1.91–4.41)] and were more likely to be due to sprains/strains/twists [overweight: PR = 1.73 (95% CI = 1.29–2.31); obese I: PR = 2.24 (1.64–3.06); obese II: PR = 2.95 (2.04–4.26)]. Conclusions: Among NHIS participants, overweight and obese workers were 25% to 68% more likely to experience injuries than normal weight workers. Practical applications: Weight reduction policies and management programs may be effectively targeted towards overweight and obese groups to prevent or reduce work-site injuries.     

Using a cluster randomized controlled trial to determine the effects of intervention of battery and hardwired smoke alarms in New South Wales,Australia: Home fire safety checks pilot program

IntroductionIn 2014, Fire & Rescue New South Wales piloted the delivery of its home fire safety checks program (HFSC) aimed at engaging and educating targeted top “at risk” groups to prevent and prepare for fire. This pilot study aimed to assess the effectiveness of smoke alarms using a cluster randomized controlled trial.MethodsSurvey questionnaires were distributed to the households that had participated in the HFSC program (intervention group). A separate survey questionnaire was distributed to the control group that was identified with similar characteristics to the intervention group in the same suburb. To adjust for potential clustering effects, generalized estimation equations with a log link were used.ResultsMultivariable analyses revealed that battery and hardwired smoking alarm usage increased by 9% and 3% respectively among the intervention group compared to the control group. Females were more likely to install battery smoke alarms than males. Respondents who possessed a certificate or diploma (AOR = 1.31, 95% CI 1.00–1.70, P = 0.047) and those who were educated up to years 8–12 (AOR = 1.32, 95% CI 1.06–1.64, P = 0.012) were significantly more likely to install battery smoke alarms than those who completed bachelor degrees. Conversely, holders of a certificate or diploma and people who were educated up to years 8–12 were 31% (AOR = 0.69, 95% CI 0.52–0.93, P = 0.014) and 24% (AOR = 0.76, 95% CI 0.60–0.95, P = 0.015) significantly less likely to install a hardwired smoke alarm compared to those who completed bachelor degrees.ConclusionsThis pilot study provided evidence of the benefit of the HFSC in New South Wales. Practical Applications: Fire safety intervention programs, like HFSC, need to be targeted to male adults with lower level of schooling even when they are aware of their risks.     

Prevention of occupational injuries: Evidence for effective good practices in foundries

IntroductionOccupational injuries are a relevant research and practical issue. However, intervention studies evaluating the effectiveness of workplace injury prevention programs are seldom performed. Method: The effectiveness of a multifaceted intervention aimed at reducing occupational injury rates (incidence/employment-based = IR, frequency/hours-based = FR, severity = SR) was evaluated between 2008 and 2013 in 29 Italian foundries (22 ferrous; 7 non-ferrous; 3,460 male blue collar workers/year) of varying sizes. Each foundry established an internal multidisciplinary prevention team for risk assessment, monitoring and prevention of occupational injuries, involving employers, occupational physicians, safety personnel, workers' representatives, supervisors. Targets of intervention were workers, equipment, organization, workplace, job tasks. An interrupted time series (ITS) design was applied. Results: 4,604 occupational injuries and 83,156 lost workdays were registered between 2003 and 2013. Statistical analysis showed, after intervention, a reduction of all injury rates (− 26% IR, − 15% FR, −18% SR) in ferrous foundries and of SR (− 4%) in non-ferrous foundries. A significant (p = 0.021) ‘step-effect’ was shown for IR in ferrous foundries, independent of secular trends (p < 0.001). Sector-specific benchmarks for all injury rates were developed separately for ferrous and non-ferrous foundries. Conclusions: Strengths of the study were: ITS design, according to standardized quality criteria (i.e., at least three data points before and three data points after intervention; clearly defined intervention point); pragmatic approach, with good external validity; promotion of effective good practices. Main limitations were the non-randomized nature and a medium length post-intervention period. In conclusion, a multifaceted, pragmatic and accountable intervention is effective in reducing the burden of occupational injuries in small-, medium- and large-sized foundries. Practical Applications: The study poses the basis for feasible good practice guidelines to be implemented to prevent occupational injuries, by means of sector-specific numerical benchmarks, with potentially relevant impacts on workers, companies, occupational health professionals and society at large.     

Better effect of the use of a needle safety device in combination with an interactive workshop to prevent needle stick injuries

ObjectivesThis study compares the effectiveness of two types of interventions with no intervention on the prevention of needle stick injuries (NSIs).MethodsHealth care workers, who were at risk for NSIs, were eligible for this three-armed cluster randomized controlled trial. In total, 23 hospital wards were randomly assigned to 1 of 2 intervention groups, which were given either a needle safety device and a workshop (NW; 7 wards, n = 267) or a workshop only (W; 8 wards, n = 263), or to a control group (C; 8 wards, n = 266). The primary outcome was the half-year incidence of NSIs, which was measured through questionnaires and official notification at the occupational health service at baseline (T0), 6 months (T1) and 12 months (T2) after baseline. Analysis were done by intention to treat. This study is registered as a prospective randomized trial, number NTR1207.ResultsA statistically significant difference was found between the groups for the half-year incidence of NSIs (p = 0.046) on the basis of questionnaire data with ORs for reported NSIs for the NW group compared with the control group of 0.34 (95% CI: 0.13–0.91) and 0.45 (95% CI: 0.19–1.06) for the W group compared with the control group. The officially registered NSIs during the study period showed no statistical differences between the groups.ConclusionsThe combined intervention of the introduction of needle safety devices and an interactive workshop led to the highest reduction in the number of self-reported NSIs compared to a workshop alone or no intervention.     

Validation of the principles of injury risk zones for motorcycle protective clothing

IntroductionThe distributions of motorcycle crash impacts and injuries were compared to the four impact risk zones and protective performance specified in the European Standard for motorcycle clothing (EN 13595).MethodsCrashed motorcyclists' (n = 117) injuries and clothing damage were categorized by body area into the four risk zones. Three levels of protection were defined: protective clothing with impact protection, protective clothing only and non-protective clothing.ResultsThe distribution of impact/injury sites corresponded to the predictions of EN 13595, with the proportion of all injuries decreasing from 43.9% in Zone 1, to 18.0%, 16.7%, and 11.5% in Zones 2 to 4, respectively. Protective clothing modified the distribution of injuries with substantially more injuries (OR = 2.69, 95% CL: 20.1–3.59) at unprotected impact sites.Practical applicationThese findings support an appropriate framework for determining performance specifications for the manufacture of motorcycle clothing that will effectively reduce the risk of injury in crashes.     

Evaluation of an in-vehicle monitoring system (IVMS) to reduce risky driving behaviors in commercial drivers: Comparison of in-cab warning lights and supervisory coaching with videos of driving behavior

ProblemRoadway incidents are the leading cause of work-related death in the United States.MethodsThe objective of this research was to evaluate whether two types of feedback from a commercially available in-vehicle monitoring system (IVMS) would reduce the incidence of risky driving behaviors in drivers from two companies. IVMS were installed in 315 vehicles representing the industries of local truck transportation and oil and gas support operations, and data were collected over an approximate two-year period in intervention and control groups. In one period, intervention group drivers were given feedback from in-cab warning lights from an IVMS that indicated occurrence of harsh vehicle maneuvers. In another period, intervention group drivers viewed video recordings of their risky driving behaviors with supervisors, and were coached by supervisors on safe driving practices.ResultsRisky driving behaviors declined significantly more during the period with coaching plus instant feedback with lights in comparison to the period with lights-only feedback (ORadj = 0.61 95% CI 0.43–0.86; Holm-adjusted p = 0.035) and the control group (ORadj = 0.52 95% CI 0.33–0.82; Holm-adjusted p = 0.032). Lights-only feedback was not found to be significantly different than the control group's decline from baseline (ORadj = 0.86 95% CI 0.51–1.43; Holm-adjusted p > 0.05).ConclusionsThe largest decline in the rate of risky driving behaviors occurred when feedback included both supervisory coaching and lights.Practical applicationsSupervisory coaching is an effective form of feedback to improve driving habits in the workplace. The potential advantages and limitations of this IVMS-based intervention program are discussed.     

The impact of the 2007 graduated driver licensing law in Massachusetts on the rate of citations and licensing in teenage drivers

ObjectiveWe recently demonstrated that the 2007 Massachusetts Graduated Driving Licensing (GDL) law decreased the rate of motor vehicle crashes in teenage drivers. To better understand this decrease, we sought to examine the law's impact on the issuance of driving licenses and traffic citations to teenage drivers.MethodsCitation and license data were obtained from the Massachusetts Department of Transportation. Census data were obtained from the Census Data Center. Two study periods were defined: pre-GDL (2002–2006) and post-GDL (2007–2012). Two populations were defined: the study population (aged 16–17) and the control population (aged 25–29). The rates of licenses per population were compared pre- vs. post-GDL for the study group. The numbers of total, state, and local citations per population were compared pre- vs. post-GDL for both populations. A sensitivity analysis was performed for the rates of citations using licenses issued as a denominator.ResultsWhile licenses per population obtained by the study group decreased over the entire period, there was no change in the rate of decrease per year pre- vs. post-GDL (2.0% vs. 1.4%; p = 0.6392). In the study population, total, state, and local citations decreased post-GDL (17.8% vs. 8.1%, p < 0.0001; 3.7% vs. 2.2%, p < 0.0001; 14.1% vs. 5.8%, p < 0.0001, respectively). In the control group, total and state citations did not change (26.7% vs. 23.9%, p = 0.3606; 9.2% vs. 10.2%, p = 0.3404, respectively), and local citations decreased (17.5% vs. 13.7%, p = 0.0389). The rates of decrease per year for total, state, and local citations were significantly greater in the study population compared with control (p < 0.0001, p = 0.0002, p < 0.0001, respectively).ConclusionsThe 2007 GDL law in Massachusetts was associated with fewer traffic citations without a change in the rate of licenses issued to teenagers. These findings suggest that 2007 GDL may be improving driving habits as opposed to motivating teenagers to delay the issuing of licenses.     

Healthcare utilization and costs among older adult female drivers and former drivers

PurposeThis study compared the healthcare utilization and costs for specific types of medical services among older adult women who currently drive and those who no longer drive.MethodsThis study included 347 women aged 65 or older who were either former (had stopped driving) or current drivers, randomly sampled from a large U.S. health plan to participate in a telephone survey, and who had automated health records with healthcare utilization and cost data. Bivariate analyses and generalized linear modeling were used to examine associations between driving status and healthcare utilization and costs.ResultsAdjusting for age, income, and marital status, former drivers were more likely than current drivers to use mental health care services (RR = 3.37; 95% CI: 1.03, 10.98). Former drivers also tended to use more inpatient (RR = 1.85; 95% CI: 0.88, 3.87) and emergency services (RR = 1.89; 95% CI: 0.96, 3.70), but results did not reach statistical significance. Total annual healthcare costs in 2005 were almost twice as high for former drivers compared with current drivers ($13,046 vs. $7,054; mean difference = $5,992; 95% CI: -$360, $12,344), although this relationship was not statistically significant (CR = 1.61; 95% CI: 0.88, 2.96).Impact on IndustryFormer drivers were more than three times as likely as current drivers to use mental health services, and tended to use more emergency and inpatient services. Further research on factors that potentially mediate the relationship between driving status and health service use is warranted.     

Workers' compensation loss prevention representative contact and risk of lost-time injury in construction policyholders

IntroductionInsurance loss prevention (LP) representatives have access and contact with businesses and employees to provide targeted safety and health resources. Construction firms, especially those smaller in size, are a high-risk population. This research evaluated the association between LP rep contact and risk for lost-time injuries in construction policyholders.MethodsWorkers' compensation data were utilized to track LP rep contact with policyholders and incidence of lost-time injury over time. Survival analysis with repeated events modeling calculated hazard ratios (HR) and 95% confidence intervals (CI).ResultsCompared no LP contact, one contact was associated with a 27% reduction of risk (HR = 0.73, CI = 0.65–0.82), two with a 41% (HR = 0.59, CI = 0.51–0.68), and three or more contacts with a 28% reduction of risk (HR = 0.72, CI = 0.65–0.81).ConclusionsLP reps appear to be a valuable partner in efforts to reduce injury burden. Their presence or contact with policyholders is consistent with reduction in overall incidence of lost-time injuries.Practical applicationsReduction in lost-time injuries, resulting in reduced workers' compensation costs for policyholders and insurance companies, builds a business-case for safety and injury prevention. LP reps are often a low or no-cost benefit for insurance policyholders and may be an important injury prevention resource for small firms and/or those with lack of safety resources and staff.     

Educational status and organizational safety climate: Does educational attainment influence workers’ perceptions of workplace safety?

From a practical perspective, understanding the impact of education on perceptions of workplace safety would benefit management’s decisions regarding workers’ adaptability, general work effectiveness, accident frequency, implementation of safety management policies, and handling of education-related accident characteristics. The current study thus examined the relationship between educational attainment and (i) safety perception, (ii) job satisfaction, (iii) compliance with safety management policies, and (iv) accident frequency. Participants were Ghanaian industrial workers (N = 320) categorized into four educational groups based on their responses: basic education 50% (n = 159); secondary education, n = 98 (30%); vocational/professional education, 17% (n = 56); and university education, 3% (n = 7). Workplace safety perception was assessed with Hayes et al.’s 50-item Work Safety Scale (WSS): a scale that effectively captures the dimensions identified by safety experts to influence perceptions of workplace safety. Multivariate analysis (MANOVA) was used to test for differences of statistical significance. Posterior comparison with t-test consistently revealed significant differences between the two higher-educated cohorts and their lower-educated counterparts. The results indicated a positive association between education and safety perception. Higher-educated workers recorded the best perceptions on safety, indicated the highest level of job satisfaction, were the most compliant with safety procedures and recorded the lowest accident involvement rate.     

How perceptions of experience-based analysis influence explanations of work accidents

IntroductionThis article looks into how perceptions of experience-based analysis (EBA) influence causal explanations of accidents given by managers and workers in the chemical industry (n = 409) and in the nuclear industry (n = 222).MethodThe approach is based on the model of naive explanations of accidents (Kouabenan, 1999, 2006, 2009), which recommends taking into account explanations of accidents spontaneously given by individuals, including laypersons, not only to better understand why accidents occur but also to design and implement the most appropriate prevention measures. The study reported here describes the impact of perceptions about EBA (perceived effectiveness, personal commitment, and the feeling of being involved in EBA practices) on managers' and workers' explanations of accidents likely to occur at the workplace.ResultsThe results indicated that both managers and workers made more internal explanations than external ones when they perceived EBA positively. Moreover, the more the participants felt involved in EBA, were committed to it, and judged it effective, the more they explained accidents in terms of factors internal to the workers. Practical Applications: Recommendations are proposed for reducing defensive reactions, increasing personal commitment to EBA, and improving EBA effectiveness.     

Assessing the impact of risk-taking behavior on road crash involvement among University students residing in two Mediterranean countries

Surveillance systems are indispensable for injury prevention; yet, detailed electronic records are rarely available. The “Student’s Health Card” is a self-reporting electronic tool addressing health issues of University students, while aiming to actively involve them in preventive practices and health promotion. Utilizing data from the injury prevention related section, this study sought to investigate the impact of risk-taking behavior on road crash involvement among University students residing in two Mediterranean countries. A total of 978 University students, 451 Greek and 527 Italian, provided information on prior road crash involvement, as well as on eight behavioral variables, comprising a risky behavior score. Multiple logistic regression analysis was performed. The already known tendency for clustering of risky behaviors was evident. One degree increment in the risky behavior score was found to increase the risk of road crash involvement by 35%. Driving after drinking (OR = 2.55, CI = 1.53–4.26), riding with a drunk driver (OR = 2.19, CI = 1.08–4.45) and tobacco smoking (OR = 1.95, CI = 1.18–3.22) significantly multiplied the risk. Despite their better compliance with safety measures, Italian students, compared with Greek, reported worse alcohol-related driving habits and engaged more frequently in mobile phone use while driving. Clustering of risky behaviors was found to be an important predictor of road crash involvement. Screening and awareness of risk-taking propensity of University students could guide early intervention. The “Student’s Health Card” could provide, at minimal cost, reliable risk-taking and road crash involvement information, which is needed for both personal risk assessment and surveillance purposes.     

Fatigue and on-duty injury among police officers: The BCOPS study

IntroductionPolicing involves inherent physical and psychological dangers as well as occupational stressors that could lead to chronic fatigue. Although accounts of adverse events associated with police fatigue are not scarce, literature on the association between chronic fatigue and on-duty injury are limited. Methods: Participants were officers from the Buffalo Cardio-Metabolic Occupational Police Stress (BCOPS) Study. A 10-item questionnaire was administered to assess how tired or energetic the officers generally felt irrespective of sleep hours or workload. The questionnaire consisted of five positively worded and five negatively phrased items that measured feelings of vigor/energy and tiredness, respectively. Total as well as separate scores for positive and negative items were computed by summing scores of individual items. Payroll records documenting each officer's work history were used to assess occurrence of injury. Poisson regression was used to estimate prevalence ratios (PR) of injury. Results: Nearly 40% of officers reported feeling drained. Overall prevalence of on-duty injury during the past year was 23.9%. Injury prevalence showed a significant increasing trend across tertiles of total fatigue score: 19.6, 21.7, and 30.8% for lowest, middle and highest tertiles, respectively (trend p-value = 0.037). After controlling for potential confounders, a 5-unit increase in total fatigue score was associated with a 12% increase in prevalence of injury which was marginally significant (p = 0.075). A 5-unit increase in fatigue score of the positively worded items was associated with a 33% increase in prevalence of injury (PR = 1.33, 95% CI: 1.04–1.70, p = 0.022). Conclusion: Officers who do not feel active, full of vigor, alert, or lively had a significantly higher prevalence of non-fatal work place injury compared to their counter parts. Practical applications: With additional prospective evidence, workplace interventions designed to enhance level of energy may reduce feelings of tiredness and hence may prevent workplace injury.     

Occupational stressors identified by small-scale,independent commercial crab pot fishermen

IntroductionWe interviewed fishermen to identify jobs and/or tasks of concern in order to guide and inform current ergonomic interventions.MethodsWe administered surveys to two groups of southeastern US commercial crab fishermen: a cohort contacted by telephone and fishermen recruited at 11 local fish houses. Fishermen were asked to rate physical stress of selected work tasks and conditions on a scale from 0 (no problem) to 10 (major problem). Fishermen were also asked open-ended questions about other work-issues of concern.ResultsFishermen who completed the survey (n = 91) were predominantly male (90%), white (96%), and over 40 years of age (71%). The five most physically strenuous tasks and conditions as rated by fishermen were pulling pots by hand (mean 6.4), rough weather (6.1) or rough water (6.2), unloading without mechanical assistance (5.8), and long work days (5.3). Task stress ratings with the most variability measured by the inter-quartile range (IQR) included: pulling pots by hand (IQR = 5), unloading without mechanical assistance (IQR = 5), gear maintenance (IQR = 4.5), and moving boxes and baskets on board (IQR = 4.5). Other situations that fishermen identified as a problem included: economic, off-shore work, declining industry, mental stress, environment, regulation, conflict with other commercial or recreational fishermen, issues with crew, sun (glare or burn), and breaking up frozen bait.ConclusionsIn general, stressful tasks identified from previous research were rated similarly by the fishermen surveyed. Development and testing of ergonomic interventions is ongoing.     

Investigation of affecting parameters on treating high-strength compost leachate in a hybrid EGSB and fixed-bed reactor followed by electrocoagulation–flotation process

In this research, treatability of high-load compost leachate in a hybrid expanded granular sludge bed (EGSB) and fixed-bed (FB) bioreactor followed by electrocoagulation–flotation (ECF) system was examined. The operational factors in EGSB–FB were influent chemical oxygen demand (COD), hydraulic retention time (HRT) and COD/nitrogen ratio (COD/N). And, their interactive effects on the efficiency of COD removal and biogas production rate (BPR) as responses were analyzed and correlated by response surface methodology (RSM). The optimum conditions of the hybrid EGSB–FB reactor were acquired at COD = 7800 mg/L, HRT = 35 h, COD/N = 70, in which COD removal efficiency was 83% and BPR 94 mL/h. The amount of confidence interval was 95%. COD (relevant coefficient = 9.8) and HRT (relevant coefficient = −24) were resulted respectively as the most effective parameters on COD removal and BPR. Yet, COD/N parameter imposed negative effect on COD removal and BPR in values less than about 100. The outcomes indicated that operated ECF as post-treatment in constant conditions (electrolysis time = 75 min, electrodes distance = 3 cm, voltage = 20 V) successfully satisfied discharge criteria in the most part of experimental domains.     

Substance exposure and helmet use in all-terrain vehicle accidents: Nine years of experience at a level 1 trauma center

IntroductionThe surging popularity of all-terrain vehicles (ATV) in the United States has caused an “epidemic of injuries and mortality.” The U.S. Consumer Product Safety Commission reported 99,600 injuries and 426 fatalities from ATV accidents in 2013. The aim of this study was to examine the relationship between helmet use and positive toxicology screenings on outcomes in ATV accident victims.MethodsThis is a retrospective study of patients admitted to a Level 1 Trauma Center in southwestern West Virginia following an ATV accident between 2005 and 2013. Data were obtained from the institution's Trauma Registry.ResultsA total of 1,857 patients were admitted during the study period with 39 (1.9%) reported deaths. Positive serum alcohol and/or urine drug screens were obtained in 66.4% of the patients tested (n = 1,293). Those with positive screenings were 9.5% less likely to utilize a helmet (13.2% vs. 22.7%, p < 0.001); and the lack of helmet use was associated with an increase in traumatic brain injury (57.1% vs. 41.7%, p < 0.001). Positivity for substances or the lack of helmet use was significantly associated with higher morbidity. Lack of helmet use resulted in a 3.94-fold increase in the risk of discharge in a vegetative state or death.ConclusionsDrugs and alcohol use may predispose riders to be less likely to wear helmets and significantly increase the risk of a poor clinical outcome following an ATV accident. Rigorous efforts should be made to enhance safety measures through educational endeavors and amendment of current regulations to promote safe and responsible use of ATVs.Practical applicationsModification of regulatory requirements should be considered in order to mandate the wearing of helmets during ATV operation. In addition, expansion of safety programs should be considered in an effort to improve availability, affordability and awareness of safe ATV practices.     

Injury risks in schoolchildren with attention-deficit/hyperactivity or autism spectrum disorder: Results from two school-based health surveys of 6- to 17-year-old children in Sweden

IntroductionInjuries are one of the leading causes of death and disability among children in Sweden and attention-deficit/hyperactivity disorder (ADHD) has previously been associated with an increased risk of injury in pediatric populations elsewhere in the world. Current evidence regarding the possible link between autism spectrum disorder (ASD) and injury risk appears limited, even though some potentially risk-increasing symptoms overlap. The purpose of this study was thus to study the association between both ADHD and ASD concerning the risk of injury among Swedish schoolchildren.MethodsTwo samples were used: a population-based register study containing data from 18,416 children ranging from the ages of 6–17 years collected by school nurses during 2012/2014 (Survey A), and a national cross-sectional study of 3202 ninth-grade children (~ 15 years old) collected from 92 schools in 2011 (Survey B). The data were analyzed using χ²-tests and log-binomial generalized linear models to obtain risk ratios (RR), comparing cases reportedly affected by ADHD or ASD to unaffected controls.ResultsAfter adjusting for confounders, ADHD was associated with a 65% increased risk of injury (RR 1.65 [95% CI: 1.32–2.05] in Survey A, and a 57% increased risk of injury (RR 1.57 [95% CI: 1.27–1.95]) in Survey B. ASD was not significantly associated with any differences in injury risk (RR 0.81 [95% CI: 0.57–1.14]).ConclusionsThe results indicate that there is an elevated injury risk among Swedish schoolchildren with ADHD but not for children with ASD. Future studies should focus on causal mechanisms mediating the association between ADHD and injuries in order to facilitate injury prevention strategies.Practical applicationsParents and teachers of schoolchildren with ADHD should be made aware of the elevated injury risks associated with the diagnosis. Safety experts and injury control professionals should consider the development of specialized prevention strategies in order to reduce these risks.     

Prevalence and demographic differences in microaccidents and safety behaviors among young workers in Canada

IntroductionThe present study examines the self-reported frequency of non-lost work time workplace injuries (“microaccidents”) and the frequency of three types of work-related safety behaviors (i.e., safety voice, safety compliance, and safety neglect) recalled over a four-week period.MethodWe analyzed data on microaccidents and safety behaviors from 19,547 young workers (aged 15–25 years, Mdn = 18 years; 55% male) from multiple Canadian provinces.ResultsApproximately one-third of all young workers recalled experiencing at least one microaccident at work in the last four weeks. Comparisons across three age groups revealed that younger workers, particularly between the ages of 15–18, reported more frequent microaccidents, less safety voice, less safety compliance, and more safety neglect than workers aged 19–22. This pattern of results also held for comparisons between workers in 19–22 and 23–25 age groups, except for safety voice which did not differ between these two older age groups. In terms of gender, males and females reported the same frequency of microaccidents, but males reported more safety voice, more safety compliance, and more safety neglect than females did. The results and limitations of the present study are discussed.ConclusionFrequency of microaccidents and safety behavior vary among young worker age sub-groups.     

Does a tow-bar increase the risk of neck injury in rear-end collisions?

IntroductionDoes a tow-bar increase the risk of neck injury in the struck car in a rear-end collision? The rear part of a modern car has collision zones that are rendered nonoperational when the car is equipped with a tow-bar. Past crash tests have shown that a car's acceleration was higher in a car equipped with a tow-bar and also that a dummy placed in a car with a tow-bar had higher peak acceleration in the lower neck area.MethodThis study aimed to investigate the association between the risk of neck injury in drivers and passengers, and the presence of a registered tow-bar on the struck car in a rear-end collision. We performed a merger of police reports, the National Hospital Discharge Registry, and the National Registry of Motor Vehicles in Denmark. We identified 9,370 drivers and passengers of whom 1,519 were diagnosed with neck injury within the first year after the collision. We found a statistically insignificant 5% decrease in the risk of neck injury in the occupants of the struck car when a tow-bar was fitted compared to when it was not fitted (hazard ratio = 0.95; 95% confidence level = 0.85–1.05; p = 0.32). The result was controlled for gender, age, and the seat of the occupant. Several other collision and car characteristics and demographic information on the drivers and passengers were evaluated as confounders but were not statistically significant.ConclusionsThe present study may serve as valuable input for a meta-analysis on the effect of a tow-bar because negative results are necessary in order to avoid publication bias.