M.Sc. (Med.) (Epidemiology and Biostatistics), Faculty of Health Sciences, University of the Witwatersrand, 2011 / Introduction: Work - related injuries are of major public health importance because they have severe negative economic and social impacts to individuals, families, and a country’s economy as a whole. South Africa is a rapidly expanding economy and so there is great potential for workrelated injuries. Notably, a number of studies on work-related injuries in South Africa and globally are done at the industry level. While no effort to minimise occupational injuries at the enterprise level should be spared, more information is also required on the morbidity burden of these work-related injuries at the general population level. It was therefore against this background, that this research project was carried out. Objective: The objective of this study was to determine the association between injuries and occupations among workers aged 15 - 65 years. Methods: The dataset for this dissertation was extracted from the South African 2001 Labour Force Survey. Only respondents who reported having worked in the previous twelve months were included in the study sample (n=21,751). The outcome variable was injury over the previous twelve months. The explanatory variables were socio-demographic, occupation, and occupationally related characteristics. Logistic regression controlling for the socio-demographic characteristics was used to identify occupational and occupationally related predictors for incidence of injury at 95% confidence level. Results: Injury incidence of 4% (894/ 21751) was reported which was mainly associated with age, gender, ethnicity and province of residence at p<0.05. Male workers were more likely to sustain accidents than female workers with a risk ratio of male/female of 2.4 times. Unexpectedly, injuries increased with age. In respect to ethnicity, the Coloureds, Indian/Asians and Whites were 18%, 48% and 44% less likely to sustain injuries respectively compared to the vi African blacks while workers in the group called “Other” were 5.3 times at risk than African blacks. Adjusted analyses indicated that, workers in mining and quarrying (AOR=2.2), crafts and related trade (AOR=4.0), plant and machine operators (AOR=4.4) and elementary occupations (AOR=2.7) were predisposed to a higher risk of sustaining injury than other occupations. Surprisingly, permanent workers, those with written contract, pension contribution were found to have a higher likelihood of sustaining injuries than their counterparts. Conclusions: The incidence of injury to workers in South Africa was found to be at 4%. The older, male, and permanently employed workers were at a greater risk of sustaining injuries compared to young, female and casual workers respectively. In regards to occupations, mining and quarrying, crafts and related trade and elementary occupations elevated the risk of sustaining injuries than other occupations. It is highly recommended that occupation-specific programmes be instituted to minimise worker injuries particularly among the high risk work places. Further research is also required to investigate findings that were found to be inconsistent with existing literature namely; increase of injuries with increase in age, and why workers on permanent versus casual employment were more likely to sustain injuries.

Thesis (MPH) -- University of Limpopo, 2012. / SUMMARY OCCUPATIONAL INJURIES AND DISEASES AMONGST HEALTHCARE WORKERS OF THE DEPARTMENT OF HEALTH IN LIMPOPO PROVINCE AIM: To analyse and provide data on the incidence of occupational injuries and the prevalence of occupational diseases amongst healthcare workers of Department of Health in Limpopo Province. OBJECTIVES: The specific objectives of the study were as follows: 1. To determine the most common occupational types of injuries and/or diseases amongst healthcare workers with regard to the demographic profile (i.e. age, gender, occupation, workstation) of healthcare workers; 2. To establish outcomes of these injuries and diseases fatalities regard to the demographic profile (i.e. age, gender, occupation, workstation) of healthcare workers; and 3. To assess the association between the predominant injuries and diseases with the profile of the health care workers METHOD: The researcher sourced data electronically from Department of Health as quarterly reports, four (4) for each year of the financial years 2007/2008, 2008/2009 and 2009/2010 respectively. The data was consolidated into financial years, cleaned out part of 2007 and 2010 so at to remain with 3 calendar years (2007, 2008 &2009) prior analysis. RESULTS: There were 725 per 100 000 healthcare workers affected by injuries and diseases during the study period. These injuries/and diseases affected more males than females above 40 years with the mean age being 43 years. Of the 631 injuries and diseases reported, 89% were injuries whist 11 % were diseases with most employees from Mopani district. The most common injuries which affected HCWs thus included needle stick injuries (24%), slip/trip/fall (23%), motor vehicle accidents (14%), injuries by external objects (10%) and assaults (7%). The most common diseases which affected HCWs were found to be TB (69%), diseases by chemical agents (12%), cholera (9%) and poisoning (2%). The needle stick injury affected clinical nurses (59%) more than other professionals; moreover, TB affected 63.6% of nurses. The captured outcome of this injury/disease was 4 fatalities among EMS personnel. CONCLUSION: In conclusion, this study demonstrates that tuberculosis is the most common occupational disease acquired whilst needle stick injury is the commonest occupational injury sustained by healthcare workers of the Department of Health, Limpopo Province. The employees were therefore affected by preventable occupational injuries and diseases. RECOMMENDATIONS: Preventative programs need to be strengthened to reduce morbidity of tuberculosis and needle stick injuries amongst employees.

1. Introduction Injury is the fifth leading cause of mortality and morbidity among adults in Iowa. Work-related, or occupational injuries, constitute a substantial proportion of the injury burden in the US. The Bureau of Labor Statistics reports about 4.9 million occupational injuries annually in the US and over 50,000 injuries in Iowa. The aims of this study were to assess: 1) the burden of work-related injuries using an algorithm based on analysis of the external cause of injury (i.e., E-codes) combined with injury registry variables; 2) the magnitude of disability following an occupational injury by assessing Disability Adjusted Life Years and Discharge to Long Term Care; and 3) the burden of short-term disability one year after discharge from a Level I trauma center. 2. Methods/Approach This research consisted of two observational studies of Iowa cases, ages 18-64, reported to the Iowa State Trauma Registry (STR) from January 1st 2007 to December 31st 2010. A retrospective cohort design was used to assess differences in mortality, length of stays, discharge disposition, disability risk and Disability-Adjusted Life Years (DALYs), and their associated risk factors, such as demographic characteristics, nature and severity of injury, pre-hospital and in hospital trauma care (i.e. transport, resuscitation, vascular and airway access, sedative and paralytic drug usage). A prospective follow-up study a cohort of cases discharged from the University of Iowa Resource Trauma Center was used to assess risk factors associated with short-term disabilities one year after discharge. The EuroQol-5 Dimension Questionnaire (EQ-5D) was mailed to the cohort cases, alive one year after discharge, to assess their overall health status and quality of life. The algorithm classified the study population into occupational, “Work-Likely” (WL), and non-work cases. Work-likely was defined based on work-related activities without pay, informal status or self-employed. The registry cases were matched to 2007-2011 death certificates to identify those who died after discharge and to estimate their survival time. Machine learning methods – logistic regression and 10-fold cross validation were used to validate the algorithm. The survival time from injury to death was assessed using Kaplan Meier and Cox regression modeling. The Generalized Linear Modeling, including multinomial regression, was used to analyze the mean length of stay, the risk of discharge to long term care, DALYs and disability risk. 3. Results From 2007 to 2010, there were individuals (ages 18-64) admitted (average 5,614 per year) as trauma cases to hospitals in Iowa. Based on the algorithm, 3,115 (14.0%) were classified as occupational, 847 (3.8%) as WL, and 18,454 (82.2%) were classified as non-work cases. There were notable differences in demographics, farm exposure, and rural residence. The 10-fold cross validation showed a 20% misclassification rate for occupational and 30% for WL. The area under the curve (AUC) of the receiver-operating characteristics (ROC) was measured at 0.66, which is indicative of poor discriminating effect. Overall, occupational and WL cases had better outcomes than non-work cases; they had lower mean lengths of stay and better survival rates, as detected by Kaplan-Meier and Cox regression models. WL had lower survival rates on the Kaplan Meier estimates but the Cox regression contrast statement didn't find any difference in survival between occupational and WL 30 days and one year after discharge. Multinomial regression showed major differences in the risk of discharge to long-term care (LTC) or acute care compared to discharge home between occupational, WL, and non-work cases WL cases had less risk of being discharged to LTC compared to non-work cases. There were no differences observed between occupational and non-work cases. When stratified by occupational status, the predictors of being discharged to Long term care or acute care were different for occupational, WL and non-work cases. For WL, care in Level I&II , injury type, triage mechanism, first ER systolic blood pressure were no longer good predictors of discharge to LTC compared to occupational or non-work cases. Mean DALYs were lower in the occupational (mean= 4.8; 95% CI: 4.7-4.8) and WL (mean 4.4; 95% CI: 4.4-4.7) cases than the non-work cases (mean= 5.2; 95% CI: 5.1-5.2). However, when all other risk factors were accounted for, the occupational cases had a 10% reduction in mean DALYs, and WL a 20% reduction in DALYs compared to non-work cases. When the disability was assessed separately by occupational status, the risk factors associated with disability were completely different. For WL cases, only injury location and ISS were significantly associated with DALYs. Conversely for occupational and non-work cases, injury type, coma, pre-hospital management (i.e. airway, paralytic drugs), and cause of injury were significantly associated with DALYs. The one-year follow-up questionnaire administered to 156 trauma survivors resulted in 72 (46%) valid responses. Of those who responded, 58 (81%) were occupational and 14 (19%) WL cases. Overall, from the EQ-5Dresults, 46% of the respondents reported a disability. There were no major differences in the prevalence of disability between occupational and WL injury cases. However, occupational injury cases were more likely to receive rehabilitation services. 4. Conclusions This study demonstrated the utility of using trauma registry data in epidemiologic research to study occupational injury using a unique algorithm to include informal or self-employed workers. It identified a neglected group of workers subject to occupational injury and subsequent disability.

This thesis is focused on the issue of occupational injuries, especially dealing with their consequences through insurance. The introduction deals with the issue of occupational injuries and occupational diseases and health and safety at work. The main part is dedicated to the current approach in dealing with the consequences of accidents at work by statutory liability insurance, it also outlines the historical development, characteristics of the system, including its pros and cons. Furthermore, I analyze the situation around the accident insurance, which should replace the existing system. In the final part I deal with other possible approaches of compensation for work injuries, especially compulsory liability insurance.

The purpose of this study was to investigate if the systematic management of the work environment at four departments at Umeå university lives up to the demands in the legislation, identify deficiencies and develop proposals for improvement. The methods that were used for completing this study were a literature study about work environment and related legislation and a then a practical study. The practical study consisted of two parts, interviews with head of department and work environment representatives and a questionnaire among the employees. The results show a number of deficiencies in the systematic management of the work environment. In order to live up to the demands in the legislation the departments have to implement risk assessments at changes in the organization, implement annual follow-ups of the systematic management of the work environment, start to control completed measures and include psychological and social factors. To get a more effective systematic management of the work environment the departments have to prioritize the work environment higher and enhance the employees commitment and knowledge. The conclusions of this study is that the systematic management of the work environment at this four departments at Umeå university partly lives up to the demands in the legislation, but they have a number of deficiencies that must be corrected.

MPH / Department of Public Health

Occupational Health and Safety is largely determined by the creation of a Safety Culture that minimises risk. In South Africa the construction sector is the second most hazardous industry after mining. This study focuses on two exemplary construction firms in the Western Cape. The main research question is "How do the companies ensure coherent safety management practices that create a safety culture?" Based on a modification of a Balanced Health and Safety Scorecard for the Construction sector five sub-questions address safety management practices from a Management Perspective, an Operational Perspective, a Learning Perspective and a Client and Compliance Perspective. Data has been gathered from company documents, semistructured interviews, together with on-site observation. In conclusion the study reveals that management commitment, active communication and employee acknowledgement contribute positively to creating an effective safety culture on-site. Further studies are recommended with a specific view on small and medium companies in the construction sector. / Magister Commercii - MCom

In order to describe the trend, characteristics, and cost of occupational injuries that occurred in industrial settings across the United States between 1998 and 2009, a cross sectional analysis based on hospital discharge data was conducted. The National Inpatient Sample (NIS) data from the Healthcare and Cost Utilization Project (HCUP)(1) was used. Identification of relevant injuries from the sample was performed using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9 CM) code E849.3 (industrial place and premises)(8). A total of 307,586 (weighted) patients with industrial related injuries were discharged from hospitals in the United States during the period 1998-2009. They were largely male (81.8% vs. 16.6% female) and made up of 48.6% Non-Hispanic Whites, 18.2% Hispanic, and 6.2% Non-Hispanic Black. Two-thirds of patients were within the [25-54] years age group, broken down as 20.4%, 24.8% and 22.1% in the 25-34, 35-44, and 45-54 years age group respectively. Persons in the ≥65 age group also represented a sizable proportion at 7.3%. The patients were mostly admitted from an Emergency Department (61.2%), followed by routine/standard admissions (22.2%). While they were for the most part discharged home (81.7%), 7.2% were released to a home care facility, 7.9% to another type of facility, and 0.7% died during their stay in the hospital. As for the geographical distribution, 38.9% were admitted in the West, 24.6% in the South, 19.5% in the Midwest, and 17% in the Northeast United States. Furthermore, 88.6% were admitted in a hospital in urban settings vs. 11.2% in rural settings. The common injury sites were lower and upper extremities (52.6%), multiple locations (14.2%), trunk (9.3%), and head (8.9%). Of all admissions, 48.4% involved fractures, followed by open wounds (25.7%), internal crush injuries (19.4%), and superficial contusions (10.1%). "Foreign Body Entering through Orifice" (0.5%) and poisoning (2.3%) scored the lowest, while burns (5.8%), dislocations (3.9%), and crushing (5%) were noted as well. The mean length of stay was 4.09 days (95% CI 3.92 - 4.22), while the 95th percentile was ≤13 days. When analyzed by injury site, persons with multiple injuries stayed the longest, averaging 6.21 days (95% CI 5.85 - 6.57) while those with injuries at extremities stayed the shortest, 3.53 days (95% CI 3.42 - 3.65). Patients admitted for burns stayed 7.21 days on average (95% CI 6.52 - 7.9) while those with sprain/strain injuries (2.87 days, 95% CI 2.71 - 3.02) and poisoning (2.92 days, 95% CI 2.69 - 3.16) stayed the shortest. Overall, the mean cost of care (crude 2001-2009) was $10,153 per admission. Viewed from the injury site angle, the "multiple" category was the most costly at $17,518 and "extremity" the lowest ($8,269). Diagnostics of "Foreign Body Entering through Orifice" were the most expensive, costing on average ($17,036), closely followed by "burns" ($16,495), while "poisoning" was the least costly, with a mean cost of $6,077. Using Joinpoint regression modeling, we found an overall annual percentage rate change (APC) decrease (-1.73%) over the course of the study. While this improvement was noted in most study sub-segments, it was reversed for women (1.53%), government insurance (Medicare/Medicaid) recipients (7.72%), and older workers (9.16%). The results also revealed a high annual percentage rate (APC) decrease for Hispanics (-9.65%) for the period 1998-2004, jumping to (-18.65%) from 2007 to 2009. A similar pattern with two models was noted for the younger [18-24] age group where the annual percentage rate decreased constantly by (-2.08%) during the period 1998-2007 and drastically jumped to (-18.34%) from 2007 to 2009. In conclusion, a comprehensive trend analysis of industry-related occupational injuries recorded nationwide within the United States as presented in this study is useful to policy makers in formulating targeted strategies and allocation of resources as needed to address disparities found at various levels. Disparities found in trends observed from a gender angle calls for action to reverse the positive rate recorded for females (1.53%) when compared to males (-2.74%). Similarly, there is a call for action to address the age demographic disparity for older worker, the "≥65" age group exhibiting an alarming rate of occupational injuries (9.16%), bucking an across-the-board general negative trend.

The purpose of this dissertation is to examine both the gendered and racialized nature of workplace risk and compensation in the manufacturing industry of apparel. The author selects this industry because of its low-wage, labor intensive, and "deskilled" work, performed in often unsafe employment environments with minimal governmental regulations and limited unionization. The apparel industry is also characterized by its large percentage of racial and ethnic minorities, especially immigrant employees, that further disadvantage them in terms of communication barriers, threat of deportation, and the multiple and intersecting marginalizations associated with occupying a low-wage, minority and/or immigrant status. The gendered effects of workplace risk are addressed in the garment industry, as women and girls largely comprise these workers. Using governmental data, including Occupational Safety and Health Administration (OSHA) and Bureau of Labor Statistics (BLS) data, the author measures the incidences, rates, and demographic characteristics associated with workplace injuries and illnesses for the years 1993-2002. In addition to occupational injuries and illnesses in these industries, the author examines Department of Labor, Wage and Hour Division data to examine the incidences and types of compensation violations from the years 1993-2002. Finally, the author examines the limitations of government safety and compensation regulations and enforcement, and the corrective measures that are needed to uphold and safeguard the occupational health, safety, and compensation rights of these workers.

Syftet med denna studie var att analysera anmälda arbetsolyckor inom sjöfarten utefter frekvens och konsekvens och således kunna dra slutsatser om vilka arbetsolyckor som är allvarligast. Studiens syfte var också att finna eventuella samband mellan dessa olyckor. Efter kontakt med Sjöfartens arbetsmiljönämnd beställdes statistik från Arbetsmiljöverket. Denna statistik bearbetades på olika vis, bland annat genom att stora avgränsningar gjordes gällande typ av befattning ombord. Efter att ha studerat hur förutsättningarna för anmälan av arbetsskada förändrats valdes relevanta år. Resultatet av studien visar att när en person snubblar, halkar, trampar snett eller går tungt leder det i många fall till lång sjukfrånvaro. Det är också denna typ av olyckor som sker oftast. Att en person förlorar kontroll över föremål eller utrustning för förflyttning av material är också något som sker ofta och leder till lång sjukfrånvaro. Det enda riktiga samband som hittats är att den yttre faktorn tross (förtöjningslina/grovt tågvirke) förekommer i flera arbetsolyckor med olika konsekvens och orsak. / The purpose of this thesis was to analyse the reported work-related accidents in shipping by using frequency combined with consequence. Thereafter the purpose was to reach conclusions regarding which work-related accident was the most serious. The thesis also aimed to find if there were any connections between these accidents. Statistics were ordered from the Swedish Work Environment Authority. These statistics were processed in several ways, for instance demarcations regarding position onboard was made. Since the conditions of reporting workrelated accidents had changed during time, relevant years was chosen after consideration. The result of the study shows that when a person experiences an accident where he or she stumbles, trips, slips or treads heavily, the person is more likely to have a long sick-leave. These types of accidents are also the most common ones. To lose control of equipment or to lose control of equipment used to move material is also a common accident leading to a long sickleave. The only connection found is that the external factor hawser is present at several accidents with different consequences and cause.