Ole Carstensen

Incidence of unintentional injuries in farming based on one year of weekly registration in Danish farms.

BACKGROUND In Denmark, farming ranks as the industry with the highest incidence rate of fatal injuries. For nonfatal injuries, insufficient registration practices prevent valid comparisons between occupations. This study examines the occurrence of farm accidents and injuries, as well as work-specific factors, via weekly registration in a representative sample of 393 farms in one county during 1 year. METHODS From a random sample of 794 farms, (10% of farms in the county of Ringkoebing, Denmark) 393 farms with 1,597 residents and employees participated in a 1-year self-registration of work-related unintentional incidents. The procedure included a detailed registration of hours spent on all main working tasks. Weekly recording of incident occurrence or nonoccurrence resulted in the completion of 19,782 registration forms. Three months after incident occurrence, a telephone interview was conducted about the related work situation and resulting injuries. RESULTS During the 12-month period, 479 occupational accidents were reported, of which 389 resulted in an injury. The absolute number of injuries increased with number of work hours, but there was no relative increase of incidence by work hours. Persons below the age of 50 had slightly less than a doubled risk compared with those over 50 years of age. No other marked, reliable age effect was found. There was, however, a seasonal variation, with summer and autumn having a double relative incidence compared with winter and spring. Among farm owners, 35% experienced at least one injury per year, while this was the case for 17% of farm laborers. When adjusting for work hours, the increased frequency of injuries among farm owners was reduced to a factor of 1.5. Animal-related work was the most common injury mechanism. Repair and maintenance work was found to be the most dangerous task relative to the number of task-specific work hours. Subgroups of tasks with a markedly increased injury rate were moving animals within the farm, veterinary procedures, and repair of field machinery and stable equipment. CONCLUSIONS Farm injuries occur among 32% of full-time farmers and farm laborers each year. A quarter of these require professional treatment. This area calls for preventive action.

Psychosocial factors and safety behaviour as predictors of accidental work injuries in farming

Abstract Farming is one of the most hazardous occupations in terms of the incidence and seriousness of accidental injuries. Research with other occupational groups has drawn attention to the role of psychosocial factors and stress. Such research needs to be extended to agriculture. Since stress may be a problem faced by farmers, there is a particular need to investigate the associations between farm accidents and work stressors and stress reactions. Using multivariate logistic regression analyses, this study aimed to uncover the best psychosocial predictors of injury, while controlling for exposure-related confounders. From a randomly selected sample of 794 farms, 10% of all farms in Ringkoebing County, Denmark, 393 farmers completed completed weekly accident registration over 12 months. The study sample consisted of 310 farmers who also completed questionnaires on psychosocial factors. Results indicated that farm stressors (including perceived economic problems), stress symptoms, and safety behaviour were predictors of occupational farm accidents. Higher levels of stressors and stress symptoms and poor safety behaviour were all associated with an elevated risk of injury. In the case of stress symptoms, the relation with accidents occurred via an interaction with safety behaviour. The combination of high levels of stress symptoms and poor safety behaviour was associated with a particularly high accident risk.

Epoxy-based production of wind turbine rotor blades: occupational contact allergies.

BACKGROUND An industry producing rotor blades for wind turbines with an epoxy-based technology had experienced an increasing number of workers with dermatitis, among whom the frequency of occupational contact allergy (OCA) was suspected to be underestimated. OBJECTIVE To investigate the frequency of OCA by patch-testing with a specially profiled occupational patch test series. METHODS In a blinded study design, 603 workers were first interviewed and thereafter clinically examined. Based on a history of work-related skin disease, clinical findings of dermatitis, or both, 325 (53.9%) of the workers were patch-tested with an occupational patch test series and the European Standard patch test series. RESULTS Of the 603 investigated workers, 10.9% had OCA and 5.6% had contact allergy to epoxy resin in the standard test series. Contact allergy to amine hardeners/catalysts was found in 4.1% of the workers. Among the workers with OCA, 48.5% reacted to work material other than epoxy resin in the European Standard patch test series. CONCLUSION Approximately 50% of the workers with OCA would not have been detected if only the European Standard patch test series had been used.

Epoxy-based production of wind turbine rotor blades: occupational dermatoses.

Occupational dermatoses were investigated in a factory producing rotor blades for wind turbines by an epoxy‐based process. In a blinded study design, 603 workers were first interviewed and thereafter clinically examined. Based on a history of work‐related skin disease, clinical findings of dermatitis, or both, 325 (53.9%) of the workers were patch tested with a specially profiled occupational patch‐test series and the European standard patch‐test series. Calculated on all investigated workers, 17.1% of the workers were diagnosed with occupational dermatoses caused by work. Occupational allergic contact dermatitis was found in 10.9% of the workers. The estimated frequency of irritant contact dermatitis caused by work was 6.1%. Dermatitis on the hands was associated with contact allergy to epoxy resin (P = 0.017). The number of days on leave before the clinical examination was negatively associated with the presence of dermatitis (P = 0.001). Among workers employed 7–12 months, the frequency of occupational contact allergy was higher than that among workers employed for ≤6 months (P = 0.004). Females both washed their hands more often (P < 0.001) and used more moisturizers/protection creams at work (P < 0.001) than males. No sex differences were found concerning dermatitis on the hands.

THE WEST JUTLAND STUDY OF FARM ACCIDENTS: A MODEL FOR PREVENTION

This article summarizes the main elements of the West Jutland Study on the Prevention of Farm Accidents, that was presented in four separate papers at the 1996 Occupational Injury Symposium in Sydney, Australia. The objective of the study is to develop and conduct an intervention on the basis of an initial investigation of risk factors, aimed at reducing the number of occupational accidents in a randomly selected, representative sample of Danish farms. The article focuses on the underlying model used in the study, the methods and design employed, and the form and content of the intervention that is currently underway. Results will be presented at a later date.

The validity of a questionnaire-based epidemiological study of occupational dermatosis

The aim of this study was to evaluate the validity of a questionnaire and medical anamnesis to identify persons with dermatitis in an occupational setting. The design was a clinical epidemiological cross‐sectional study. The study was performed between the second and fourth week of January 2001. A questionnaire was followed a week later by a medical occupational interview and a clinical dermatological examination, including a comprehensive patch test with potential workplace chemicals. The anamnesis and the clinical examination were made independently by occupational and dermatological physicians, and the skin examination was performed blinded to anamnestic data. The setting was the mother plants of a Danish‐based international company producing wind turbine systems. The study population was a workplace cohort, highly exposed to epoxy resin systems and other chemicals, and totalled 724 production workers at 4 facilities. The rate of participation was 84.7%. Using enquete questions of current skin rash against the clinical presence of dermatitis, we found a sensitivity of 22% and a specificity of 89%, compared to 45% and 87%, respectively, when the anamnestic work history, taken by an occupational physician, was the screening parameter. Using ‘workplace periodic prevalence’ of dermatitis, we found sensitivities in the range of 63–76% by a questionnaire and 70–83% by medical anamnesis. Questionnaire screening by skin symptoms gave the highest values for redness, a sensitivity of 33% and a specificity of 76%, and decreasing validity parameters as more symptoms were added to the list of screening questions. We found that the use of a questionnaire and medical anamnesis were problematic, when the purpose was screening for contact dermatitis and allergy, in this industrial cohort manufacturing reinforced plastic products. But these instruments might be useful for epidemiological surveillance, when the questionnaire has been validated in the given occupational setting.

The West-Jutland Study on Prevention of Farm Accidents, Phase 1: A Study ofWork Specific Factors in 257 Hospital-treated Agricultural Injuries

The aim of the present study was to obtain detailed knowledge of fatal and nonfatal unintentional injuries and working conditions related to farming for purposes of designing possible preventive interventions. The study is geographically restricted to one county in Denmark with 270,000 inhabitants, 13,835 of whom are engaged in fulltime farming on 7,922 farms. Most farms are owned and operated by single families. Production is focused on only one of three types: swine, dairy or crop. The study is based on injuries treated at local hospitals. A total of 257 farm injuries were reported during the period 1 January to 31 December 1992. The results do not indicate any single preventive effort, but some aspects are considered important. The majority of injuries occurred near or in production buildings during work with animals and machinery. Approximately one-third of the injured persons were employed part-time in farming. A three times higher incidence was seen among 15- to 29-year-old farmers than among older farmers. Fractures were seen more often after injuries in which animals were involved. Seventy-four cases (30.7%) reported “unusual” conditions on the day of the incident. When asked directly 73 (30.3%) stated that they had changed routines of work or equipment as a consequence of the injury. Comparisons with other studies indicate the necessity of careful data collection on both etiology and injury statistics.

Changes in self-reported sleep and cognitive failures: a randomized controlled trial of a stress management intervention.

OBJECTIVES This study evaluated the effectiveness of a stress management intervention combining individual cognitive behavioral therapy (CBT) with a brief workplace intervention on self-reported measures of sleep and cognitive functioning among patients on sick leave due to work-related stress complaints. METHODS Participants were patients referred to the regional Department of Occupational Medicine. Inclusion criteria were (i) sick leave due to work-related stress complaints and (ii) a diagnosis of adjustment disorder/reactions to stress or mild depression. Participants (N=137) were randomized to either an intervention (N=57) or control (N=80) group. The intervention comprised six sessions with a psychologist and the offer of a small workplace intervention. Questionnaires were answered at baseline and after 4, and 10 months. RESULTS Symptoms were significantly reduced over time in both groups but there was no significant treatment effect on sleep or cognitive outcomes at any time point. From 0-4 months, there was a tendency for larger improvements in the intervention group with regards to sleep and cognitive failures in distraction. Although neither was significant, the results came close to significance depicting a small effect size (Cohens d) on sleep complaints and distractions (but not memory). CONCLUSIONS The specific intervention was not superior to the control condition in reducing symptoms of sleep problems and cognitive difficulties at any time point during the 10-month follow-up period. Substantial improvements in symptoms over time were seen in both groups.

Associations between contact allergy to epoxy resin and fragrance mix

Sir, A Danish industry producing rotor blades for wind turbines with an epoxy-based technology had experienced an increased number of workers with dermatitis. To estimate the frequencies of work-related dermatitis, 603 workers were interviewed and clinically examined and 325 (82% men and 18% women) with suspected work-related dermatitis were patch-tested (to be published). As part of the results of the investigation, an association was found between contact allergy to epoxy resin and fragrance mix in the European standard series (odds ratio 5.5, 95% confidence interval (CI) 1.5‐17; p~0.009, Table I). No obvious gender differences were discerned, but the number of female workers was limited. To investigate whether the association between these allergens was restricted to the workers or indicated a possible, general phenomenon, the patch-test population of our department was analysed with respect to the corresponding association. RESULTS Among 4857 consecutively patch-tested patients (39% men and 61% women) with dermatitis 1995‐2002, simultaneous contact allergies to epoxy resin and fragrance mix were found in 11 patients (Table I). The odds ratio for simultaneous contact allergies among the patients was 2.8 (95% CI 1.3‐5.4; p~0.009 exact method provided by Stat Xact-5, Cytel Software Corp). Among our patients, the association between contact allergy to epoxy resin and fragrance mix was restricted to men. The odds ratio among the men was 6.2 (95% CI, 2.3‐15; pv0.001), while among women it was 1.1 (95% CI 0.22‐3.7; pw0.3). When testing the homogeneity of the odds ratios, the difference between men and women was statistically significant (p~0.02, Zelen’s test).

Return to work after work-related stress: A randomized controlled trial of a work-focused cognitive behavioral intervention

Objectives This study aimed to evaluate the effect of a stress management intervention (SMI) on lasting return to work (RTW) among patients with work-related stress complaints. Methods Sickness benefit departments from three local municipalities referred patients on sick leave with work-related adjustment disorders or mild depression to the Department of Occupational Medicine, Regional Hospital West Jutland. A 2× randomization procedure allocated patients into one of three groups: intervention (N=58), control A (which received a clinical assessment; N=56), or control B (no assessment; N=49). Treatment comprised individual work-focused cognitive behavioral therapy (CBT) with an optional workplace intervention. The outcome was time until lasting RTW (16 and 44 weeks follow-up) using register data. Results Median number of weeks until lasting RTW was 15, 19, and 32 for the intervention group, control A, and control B respectively. However, for group B, clinical assessment was not part of the inclusion process, which may have introduced selection bias. In the fully-adjusted Cox regression model, the intervention group exhibited significantly faster lasting RTW at 44 weeks; hazard ratio (HR) 1.57 [95% confidence interval (95% CI) 1.01-2.44] relative to control group A, with a non-significant trend evident at 16 weeks; HR 1.70 (95% CI 0.94-3.10), when controlling for age, gender, occupation, sick leave during previous year, full or partial sick leave, and diagnosis. Unadjusted analyses remained directionally consistent but were reduced to marginal significance. Conclusions There was a tendency towards faster lasting RTW in the intervention group compared to control A, which received clinical assessment, in all analyses. The intervention group returned to work about 4 weeks earlier than control A, which could translate into substantial financial gains.