All posts by Jeff Cottrill

Epidemiology of work-related traumatic brain injury: A systematic review

Vicky C. Chang, M.P.H. and Angela Colantonio, Ph.D., Dalla Lana School of Public Health, University of Toronto; E. Niki Guerriero, Bsc. (Hon.), Graduate Department of Rehabilitation Sciences, University of Toronto

This systematic review aimed to describe the burden and risk factors of work-related traumatic brain injury (wrTBI) and evaluate methodological quality of existing literature on wrTBI. A search of electronic databases (MEDLINE, EMBASE, PsycINFO, and CINAHL) was conducted to identify articles published between 1980 and 2013 using a combination of terms for work, TBI, and epidemiology, without geographical limitations. Ninety-eight studies were included in this review, of which 24 specifically focused on wrTBI. In general, male workers, those in the youngest and oldest age groups, and those working in the primary (e.g., agriculture, forestry, mining) or construction industries were more likely to sustain wrTBI, with falls being the most common mechanism of injury. This review identified workers at highest risk of wrTBI, with implications for prevention efforts. Future research of better methodological quality is needed to provide a more complete picture of the epidemiology of wrTBI.

Am J Ind Med, Volume 58, Issue 4, pages 353-377. Correspondence to: Angela Colantonio, Ph.D., Department of Occupational Science and Occupational Therapy, University of Toronto, 160-500 University Avenue, Toronto, Ontario, M5G 1V7; email: angela.colantonio@utoronto.ca.

Are elderly construction workers sufficiently fit for heavy manual labour?

Einar Jebens, Jon Ingulf Medbø and Kaj Bo Veiersted, National Institute of Occupational Health, Oslo, Norway; Asgeir Mamen, Norwegian School of Health Sciences, Kristiania University College, Oslo, Norway; and Oddvar Knudsen, Lia HMS, Trysil, Norway

This study analyzed the work ability of elderly construction workers. Forty male construction workers, 20 young (age < 33 yrs.) and 20 senior (age > 44 yrs.) workers, were tested regarding aerobic power (VO2max) and muscle strength. The aerobic demand of a number of tasks in construction work was measured and compared with the workers’ aerobic power. VO2max was higher for the young, and they performed better on most muscle-strength tests. The measurements showed that about half of the senior workers had to use more than 30 per cent of their maximum oxygen uptake on some tasks. In conclusion, because elderly construction workers decline in physical fitness, they are more exposed to overload when performing heavy manual work than are their younger peers. Increasing their individual fitness or adjusting their workload may be important for staying in the workforce for such workers. Construction workers must occasionally perform strenuous work tasks that may endanger their safety. This was more often the case for elderly workers investigated here. Elderly workers should therefore be particularly observant of their physical fitness and should possibly train during leisure time to improve their fitness.

Ergonomics, Volume 58, Issue 3, pages 450-462. Correspondence to: Asgeir Mamen, Norwegian School of Health Sciences, Kristiania University College, Oslo, Norway; email: asgeir.mamen@nhck.no.

Combined effect of back pain and stress on work ability

C. Oberlinner, M. Yong, M. Nasterlack, R.P. Pluto and S. Lang, Department of Occupational Medicine and Health Protection, BASF SE, Ludwigshafen, Germany

Back pain and occupational stress are known risk factors for absenteeism and presenteeism. In addition, the relationship between back pain (BP) and psychosocial stressors has been examined in numerous studies. This study’s aims were to examine the prevalence of BP and perceived stress among employees of different occupational status and to investigate their combined impact on work ability. A comprehensive survey combining questionnaire data and medical examination offered in one division of a major chemical company in Germany. Self-rated health and work ability were assessed using the Work Ability Index (WAI). A synergy index was used to assess a potential interaction between both exposures under an additive model. Of 867 voluntary participants, 653 returned complete questionnaires on BP and job-stress perception. Although occupational stressors were perceived differently, there was no difference in the prevalence of BP between the occupational groups. Back pain and stress perception are correlated with each other, and both are negatively associated with work ability. After adjustment for occupational status, demographic and lifestyle factors, researchers found a synergy effect of BP and stress perception with a modest-to-strong impact on declining WAI. Corporate health promotion interventions to reduce the impact of BP and stress perception on work ability should target both physical and psychological dimensions. Such interventions may be initiated in the context of regular (occupational) medical examinations.

Occ Med, Volume 65, Issue 2, pages 147-153. Correspondence to: M. Yong, Department of Occupational Medicine and Health Protection, BASF SE, GUA/CS, Carl-Bosch-Str. 38, 67056 Ludwigshafen, Germany; tel: +49 621 60 93860; fax: +49 621 60 43322; email: mei.yong@basf.com.

Patient attacks nurse in B.C. hospital emergency room

Since the B.C. Nurses’ Union (BCNU) announced that it would be lobbying for criminal charges in cases of violence against healthcare professionals (COHSN, March 3), more attacks against nurses have occurred in the province – including an especially brutal one at Abbotsford Regional Hospital and Cancer Centre in Abbotsford, just outside Greater Vancouver.

“It’s just been a really unfortunate week,” BCNU vice president Christine Sorensen said. “We’ve had a number of significant violent events across the province.”

The Abbotsford incident occurred on March 1, according to information from Fraser Health (FH), which runs the hospital. A male patient arrived in the emergency room and became agitated while a male nurse was assessing him. He beat the nurse severely around the head and face, resulting in eye surgery and stitches to his eye, face and forehead.

“He just kind of came at the nurse,” explained Ken Donohue, FH’s director of public affairs. “Security was there very quickly.” He characterized the attack as “an isolated incident” that “was out of the blue and unprovoked.”

The event was highly traumatic for the nurse, who will be off work for a while to undergo both physical and psychological recovery, Sorensen explained. The nurse “is, at this point, unsure of whether or not he will be able to return to nursing and certainly unsure whether to return to that unit.”

BCNU, which is pursuing criminal charges in the Abbotsford incident, responded as soon as it had been informed of it. “Our local representatives were onsite, making sure that the nurse was taken care of,” Sorensen said. “We notified WorkSafeBC, and they immediately dispatched an investigator to the site.” The police would be laying charges on the patient upon his release from the hospital, she added.

In a March 2 press release, the union accused the Abbotsford facility of having ignored BCNU’s requests for increased security since 2011. But Donohue maintained that the hospital was doing what it could to protect its workers.

“Anytime an incident like this happens, it gives us pause to look at our processes,” he said. “But the challenge in nursing and healthcare is that the staff are dealing with a very unpredictable environment. The behaviour of patients can be very unpredictable, and so while you think that you have all the security and safety processes in place, there are times, unfortunately, where these types of incidences will happen.”

Sorensen said that healthcare authorities needed to start being more proactive in dealing with violence in emergency rooms. “We’re also hoping that they will recognize that violent events occur in other parts of the healthcare system, whether they’re being in other inpatient units or residential care in the community,” she said. “We definitely need public awareness that this is inappropriate.”

Among the possible solutions Sorensen suggested were additional Code White training and security. “We’re also right now demanding that health authorities take a serious look at their environments that nurses practise in and provide security personnel or safety officers,” she noted, “who are trained to physically restrain patients.”

Donohue said that FH was already acting in response to the Abbotsford incident. “We’ve increased security,” he said. “We will be adding additional security to the Emergency and to the hospital. And we encourage staff to partake in the training and education sessions that are available to them, violence-prevention training, and that’s really important for people, to understand how they can deescalate certain situations.”

Before the incident occurred, the hospital had recently made changes to the infrastructure of its triage area in order to provide additional security, Donohue added.

The Abbotsford hospital was fined $75,000 for inaction on a violence issue last May, according to information from BCNU.

Saskatchewan to increase random workplace inspections

Saskatchewan’s occupational health and safety authorities are stepping up random workplace inspections, after more than a year of focusing efforts on more injury-prone workplaces. Don Morgan, provincial Minister of Labour Relations and Workplace Safety, announced on March 4 that he had ordered the ministry’s oh&s department to increase random inspections.

Morgan’s announcement came shortly after a CBC report that an October 2013 policy change had resulted in severe decreases both in inspections and in notices of contravention. Former oh&s officer Pat Bowers claimed that worker safety was at risk because of a 94 per cent decrease in notices handed out to employers.

“The concern that was expressed to our Minister was one of ‘We’re not doing any random inspections,’ when, in fact, we always have been,” Mike Carr, the province’s Deputy Minister of Labour Relations and Workplace Safety, told COHSN. “But it led the minister to make the observation that we could probably do more.”

Carr explained that the ministry’s policy change in 2013 was an attempt to lower the province’s overall injury rate – Canada’s second-highest – by narrowing the focus on the most problematic workplaces. “We used to be in a situation where 90 per cent of the work that our officers did was random, 10 per cent was focused,” he said. “We’ve repositioned our resources, done some additional training and said that our officers are going to undertake intelligence-based, evidence-based activity with a narrow group.”

Saskatchewan Federation of Labour president Larry Hubich said he was “encouraged” by the ministry’s recent decision, but still skeptical about its approach to oh&s enforcement.

“They should have never reduced the number of random inspections in the first place,” said Hubich. “I have no doubt in my mind that workplaces are more dangerous, that employers are cutting corners and that workers are more vulnerable.”

Hubich was concerned that some employers were not reporting accidents properly, but encouraging employees to stay at work with lighter duties instead, to avoid higher Workers’ Compensation Board (WCB) premiums. “I’ve had stories told to me from individuals who are afraid to go public because they’re afraid of retaliation,” he said. “That’s the climate that we’re in the midst of.”

Carr claimed that workplace injuries in Sask. had actually decreased. “In those workplaces where we have focused our attention on the target initiative, we’ve achieved a 22 per cent reduction year over year in injury rate,” he said.

But Hubich was unconvinced. “His agenda is to deliver for the corporate sector,” he said about Carr, “so I have no confidence that the interest of workers or their safety is a paramount priority for the current deputy minister. Anything that he says in this regard, I take with a grain of salt.”

Hubich also charged that the provincial government’s bureaucrats had met with those in Alberta and British Columbia to determine which oh&s laws interfered with trade. If the government put health and safety below the corporate agenda of its financial backers, he said, “I’m not confident that we’re getting an adequate enforcement of occupational health and safety legislation.”

Carr said that while random inspections would increase, the ministry would continue to invest the majority of its resources in the workplaces with the most injuries. “We did an analysis based on 2013 WCB statistics and determined that 86 per cent of Saskatchewan workplaces were injury-free that year. We said our attention should really be focused on the 14 per cent of workplaces that are having an injury experience.

“We will, in accordance with the Minister’s direction, do some more random inspections, but they will be still the smallest proportion of the work.”

“I see nothing but the watering down of occupational health and safety standards by this government,” said Hubich. “Health and safety should take priority over everything.”

Ontario plans to address sexual harassment in oh&s legislation

TORONTO, Ont. – As part of its new action plan, It’s Never Okay: An Action Plan to Stop Sexual Violence and Harassment, the Government of Ontario hopes to revise its occupational health and safety legislation to address workplace sexual harassment in a stronger way. Premier Kathleen Wynne announced on March 6 that the plan would propose concrete oh&s legislation that would require all Ontario employers to address and investigate accusations of sexual harassment in the workplace. “As a woman, ending sexual violence and harassment is a cause I feel strongly about – and as a leader, it is also one I know is right for Ontario,” Wynne said in a press statement. “Our action plan is an affirmation that everyone in this province deserves dignity, equality and respect.” A backgrounder from the government noted that 28 per cent of Canadian workers claimed that they had received unwelcome sexual advances, been asked for sexual favours and/or been subject to sexually charged talk at work.

White powder in envelopes sent to cabinet ministers turns out harmless

QUEBEC CITY, Que. – Members and employees of the Quebec provincial cabinet suffered a temporary scare on March 5, after envelopes containing suspicious white powder and threatening notes were sent to the riding offices of four cabinet ministers. Infrastructure Minister Denis Lebel’s office in Roberval, north of Quebec City, received the first envelope around 10:00 a.m., according to information from the Quebec Provincial Police; the other envelopes went to the offices of International Aid Minister Christian Paradis, Small Business Minister Maxime Bernier and Public Safety Minister Steven Blaney. The offices were evacuated and three employees were sent to hospitals as a precautionary measure, but an analysis of the powder later showed it to be harmless. “We won’t be intimidated by this,” said Lebel in a press statement following the incidents. “We don’t get into politics to be threatened, to have our employees put at risk.” The incidents occurred on the same morning on which the Quebec national assembly received a hoax bomb threat, but there was no evidence yet of a link between the two events, federal officials told the media.

City of Ottawa to invest in extra safety officers for public transit

OTTAWA, Ont. – The transportation committee for the Ottawa city council announced on March 4 that it would be investing $600,000 into hiring more safety officers for the city’s public-transit sector. The intention is to reduce the amount of traffic collisions involving city-owned buses and trucks, including OC Transpo vehicles, by increasing compliance visits with additional staff. The City plans to hire six new safety officers and to move two public-works employees over to the fleet, according to local media reports. Safety officers will now have the power to suspend a driver’s authority to operate any municipal vehicles or equipment, although the employee may still drive his or her own personal vehicles. Recent information from the federal Ministry of Transportation has said that buses and trucks owned by the City of Ottawa were involved in 942 collisions from 2013 to 2015. Most notably, a bus-train collision in the suburb of Barrhaven on Sept. 18, 2013 killed six people and injured 35 more (COHSN, Sept. 30, 2013).

Summit discusses ways to deal with work-related mental stress

TORONTO, Ont. – Representatives from government, healthcare, social services, corrections, police, fire services and other sectors came together on March 5 for the Summit on Work-Related Traumatic Mental Stress. Recommended by the Ontario Ministry of Labour’s (MOL) October report, Roundtable on Traumatic Mental Stress: Ideas Generated, the summit allowed professionals to discuss possible ways to reduce the effects and stigmas of traumatic mental stress in the workplace. “The lessons learned and best practices shared here will propel sectors in which traumatic mental stress is prevalent to implement cultural and organizational change, with an emphasis on prevention, making workplaces healthier and safer,” provincial Labour Minister Kevin Flynn stated in a press release following the event. The summit included an opening address by former lieutenant-general Roméo Dallaire and talks by experts on innovative approaches to the issue. A backgrounder from the MOL noted that the Ontario government was investing $4.4 million into resources addressing operational stress injuries for Ontario Provincial Police officers.

City of St. John’s meeting with taxi-industry reps to reduce violence

Following recent violent assaults on taxi drivers in the Newfoundland and Labrador capital, the City of St. John’s has been holding meetings with representatives of the local taxi sector to discuss ways to improve safety for cabbies.

Since two separate incidents in the city involving violence against drivers occurred over the weekend of Jan. 31/Feb. 1, two of these meetings have taken place. Although the provincial government deals with occupational health and safety issues, the city’s municipal government has been trying to facilitate a dialogue between the industry and oh&s authorities, according to St. John’s deputy mayor Ron Ellsworth, who belongs to the City’s taxi committee.

“We had seven people in total show up, which may not seem like a lot, but we were encouraged by it because it’s about getting the message out,” said Ellsworth.

Stakeholders have been concerned about the potential financial costs of safety equipment, like security cameras or barriers between drivers and passengers, he added. “What we’re saying to the industry is that a lot of these things don’t require costs.” For example, driver education and training that focus on how to deescalate dangerous situations could go a long way. “A lot of the stuff is just cheat sheets with notes on it, or a sheet of paper with ‘10 Things to Do’ sort of thing, which is very low-cost, but could have a very high impact.”

Ellsworth noted that education would be most effective with younger and newer employees, as experienced drivers usually know enough to avoid confrontation with passengers. “Some newer drivers are getting out of their vehicles and trying to get that $20 fare to pay up. So straying around your life or endangering someone is not worth that $20 bill.” It’s better to drop the customer off and deal with it later, perhaps through the police, he said.

North West Taxi owner David Fleming, who had attended the meetings, acknowledged that the city’s taxi sector had seen recent violence, but wasn’t convinced that the situation was dire enough yet to require security cameras or barriers.

“Violence can happen at any place at any time,” said Fleming. “Violence can happen in school, it can happen at offices. You can’t be responsible for what an individual is going to do.” Compared to other types of workplaces like retail or service stations, where there is always the potential for robbery, the St. John’s taxi sector wasn’t especially bad, he added. “In my experience, you’re looking at, 90 to 95 per cent of your customers are good people.”

What bothered Fleming more was the lack of crime-enforcement representation at the meetings. “There was nobody in attendance from the Justice Department or the RNC,” he said, referring to the Royal Newfoundland Constabulary. “Absolutely no input from them. I mean, they’re your first line of communication when you have an incident.” Typically, St. John’s cab drivers have ended up looking out for each other in these situations, Fleming added, because when one calls the police, “you’re 14th on the priority list.”

Aside from violence, another safety issue that concerned Fleming was insufficient snow plowing on the streets in winter. Snow and ice had been causing taxi accidents in the city, he pointed out, “but nobody wants to hear that part of it.”

Although the St. John’s taxi committee generally deals more with issues involving cab meters and inspections, driver safety is an issue that it also takes seriously, Ellsworth explained.

“We’ve had a couple more severe ones over the last couple of years, where drivers have been badly hurt,” Ellsworth added, referring to assaults. “Safety’s always one of the issues on the agenda, just the point of view of trying to make sure drivers have a safe work environment.”