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Recent research suggests that heat exposure may increase the risk of traumatic injuries. Published heat-related epidemiological studies have relied upon exposure data from individual weather stations. To evaluate the association between heat exposure and traumatic injuries in outdoor agricultural workers exposed to ambient heat and internal heat generated by physical activity using modeled ambient exposure data. A case-crossover study using time-stratified referent selection among 12,213 outdoor agricultural workers with new Washington State Fund workers' compensation traumatic injury claims between 2000 and 2012 was conducted. Maximum daily Humidex exposures, derived from modeled meteorological data, were assigned to latitudes and longitudes of injury locations on injury and referent dates. Conditional logistic regression was used to estimate odds ratios of injury for a priori daily maximum Humidex categories. The mean of within-stratum (injury day and corresponding referent days) standard deviations of daily maximum Humidex was 4.8. The traumatic injury odds ratio was 1.14 (95% confidence interval 1.06, 1.22), 1.15 (95% confidence interval 1.06, 1.25), and 1.10 (95% confidence interval 1.01, 1.20) for daily maximum Humidex of 25-29, 30-33, and ≥34, respectively, compared to < 25, adjusted for self-reported duration of employment. Stronger associations were observed during cherry harvest duties in the June and July time period, compared to all duties over the entire study period. Agricultural workers laboring in warm conditions are at risk for heat-related traumatic injuries. Combined heat-related illness and injury prevention efforts should be considered in high-risk populations exposed to warm ambient conditions in the setting of physical exertion.

Objectives The aim was to explore whether \"adjustment\" for gender masks important exposure differences between men and women in a study of rotator cuff syndrome (RCS) and carpal tunnel syndrome (CTS) and work exposures. Methods This cross-sectional study of 733 subjects in 12 healthcare and manufacturing workplaces used detailed individual health and work exposure assessment methods. Multiple logistic regression analysis was used to compare gender stratified and adjusted models. Results Prevalence of RCS and CTS among women was 7.1% and 11.3% respectively, and among men 7.8% and 6.4%. In adjusted (gender, age, body mass index) multivariate analyses of RCS and CTS, gender was not statistically significantly different. For RCS, upper arm flexion ≥45° and forceful pinch increased the odds ratio (OR) in the gender-adjusted model (OR 2.66, 95% CI 1.26-5.59) but primarily among women in the stratified analysis (OR 6.68, 95% CI 1.81-24.66 versus OR 1.45, 95% CI 0.53-4.00). For CTS, wrist radial/ulnar deviation ≥4% time and lifting ≥4.5kg >3% time, the adjusted OR was higher for women (OR 4.85, 95% CI 2.12-11.11) and in the gender stratified analyses, the odds were increased for both genders (female OR 5.18, 95% CI 1.70-15.81 and male OR 3.63, 95% CI 1.08-12.18). Conclusions Gender differences in response to physical work exposures may reflect gender segregation in work and potential differences in pinch and lifting capacity. Reduction in these exposures may reduce prevalence of upper extremity disorders for all workers.

Objective: We quantified the underreporting of work-related injury or illness to workers' compensation (WC). Methods: Using data from 2612 wage-earning respondents who participated in the 2002 Washington State Behavioral Risk Factor Surveillance System, we assessed work-related injury or illness in the previous year and identified the factors associated with WC claim filing by logistic regression. Results: The self-reported rate of work-related injury or illness of respondents was 13%. Among those who had a work-related injury or illness, 52 % filed a WC claim. After adjustment for age, gender, and race, those who filed WC claims were more likely to be overweight and married. WC claim filing vanes considerably across industry and occupation groups hold all other measured factors constant. Conclusions: Individual and industry/occupation factors are related to underreporting of workrelated injury or illness to the WC system.

We aim to estimate the prevalence of influenza-like illness (ILI) by occupation and to identify occupations associated with increased ILI prevalence. Between September 2009 and August 2010, the Centers for Disease Control (CDC) included questions on ILI symptoms on the Behavioral Risk Factor Surveillance System (BRFSS). Washington State collects the occupation of all employed BRFSS respondents. ILI prevalence and prevalence ratios (PR) were calculated by occupational group. There were 8,758 adult, currently employed, non-military respondents to the Washington BRFSS during the study period. The ILI prevalence for all employed respondents was 6.8% (95% Confidence Interval (95% CI) = 6.1, 7.6). PRs indicated a lower prevalence of ILI in Technicians (PR = 0.4, 95% CI = 0.2, 0.9) and Truck Drivers (PR = 0.2, 95% CI = 0.1, 0.7) and higher prevalence in Janitors and Cleaners (PR = 2.5, 95% CI = 1.3, 4.7) and Secretaries (PR = 2.4, 95% CI = 1.1, 5.4). Some occupations appear to have higher prevalence of ILI than others. These occupational differences may be explained, in part, by differing levels of social contact with the public or contact with contaminated surfaces at work, or by other occupational factors such as stress or access to health care resources.

Background The Services Sector, as defined by the National Occupational Research Agenda (NORA), is comprised of a diverse industry mix and its workers face a variety of occupational exposures and hazards. The objective of this study was to identify high-risk industry groups within the Services Sector for prevention targeting. Methods Compensable Washington State workers’ compensation claims from the Services Sector from 2002 through 2010 were analyzed. A “prevention index” (PI), the average of the rank orders of claim count and claim incidence rate, was used to rank 87 Services Sector industry groups by seven injury types: Work- Related Musculoskeletal Disorders (WMSDs), Fall to Lower Level, Fall on Same Level, Struck By/Against, Caught In/Under/Between, Motor Vehicle, and Overexertion. In the PI rankings, industry groups with high injury burdens appear higher ranked than industry groups with low counts or low rates of injury, indicating a need for prioritizing injury prevention efforts in these groups. Results In the Services Sector, these 7 injury types account for 84% of compensable claims in WA. The industry groups highest ranked by PI across the injury types included: Services to Buildings and Dwellings; Executive, Legislative, and Other General Government Support; and Waste Collection. WMSDs had the highest compensable claims rates. Conclusions Services is a large sector of the economy, and the substantial number, rate, and cost of occupational injuries within this sector should be addressed. Several Services Sector industry groups are at high risk for a variety of occupational injuries. Using a PI to rank industry groups based on their injury risk provides information with which to guide prevention efforts.

Purpose Little is known about the independent effect of workers’ residential location and work-commuting on their long-term disability due to work-related injuries. We examined 149,110 incident claims while adjusting for multiple risk factors in a large, population-based sample of Washington State workers’ compensation State Fund claims during 2002–2008. Methods Claimants’ residential addresses were geocoded with census tract and aggregated into four category classification of the Rural Urban Commuting Area Codes (RUCAs) which takes into account for tract-level work-commuting. We used logistic regressions to assess the association between RUCAs and whether or not a person was off work for more than 180 days due to injury; Quantile regressions to predict various percentiles of cumulative lost workdays by RUCAs. Results Compared to those who live in the Urban Core, workers in other areas experienced longer average paid time loss days due to work-related injury. The association between residential location and long-term disability was significant, odds ratio (OR) 1.19 (95 % confidence interval (CI) 1.11–1.27) for residents of Small Town and Isolated Rural and OR 1.17 (95 % CI 1.12–1.22) for those of Sub Urban, and persisted after controlling for injury nature, socio-demographic, employment-related, and claim administrative characteristics. The impact of residential location and work-commuting elevated as the duration of disability increased. Conclusions This study shows that residential location and work-commuting has a significant and time-varying impact on duration of work disability. Workers living in Sub Urban and Small Town and Isolated Rural areas represent a particularly vulnerable group with respect to risk of long-term work disability.

: We aim to estimate the prevalence of influenza-like illness (ILI) by occupation and to identify occupations associated with increased ILI prevalence. Between September 2009 and August 2010, the Centers for Disease Control (CDC) included questions on ILI symptoms on the Behavioral Risk Factor Surveillance System (BRFSS). Washington State collects the occupation of all employed BRFSS respondents. ILI prevalence and prevalence ratios (PR) were calculated by occupational group. There were 8,758 adult, currently employed, non-military respondents to the Washington BRFSS during the study period. The ILI prevalence for all employed respondents was 6.8% (95% Confidence Interval (95% CI) = 6.1, 7.6). PRs indicated a lower prevalence of ILI in Technicians (PR = 0.4, 95% CI = 0.2, 0.9) and Truck Drivers (PR = 0.2, 95% CI = 0.1, 0.7) and higher prevalence in Janitors and Cleaners (PR = 2.5, 95% CI = 1.3, 4.7) and Secretaries (PR = 2.4, 95% CI = 1.1, 5.4). Some occupations appear to have higher prevalence of ILI than others. These occupational differences may be explained, in part, by differing levels of social contact with the public or contact with contaminated surfaces at work, or by other occupational factors such as stress or access to health care resources.

Objective: The objective of this study was to identify work-related asthma (WRA) workers' compensation claims associated with methylene diphenyl diisocyanate (MDI) exposure in the spray-on truck bed lining industry and estimate the asthma incidence rate in this industry. Methods: The authors conducted a descriptive study of workers' compensation claims meeting an established surveillance case definition for WRA. Results: Eight WRA workers' compensation claims were identified in the truck bed lining industry in Washington State for a claims incidence rate of 200 per 10,000 full-time equivalent. The medical evaluation of the cases was inadequate because none of the truck bed lining cases had medical testing to objectively link their asthma to the workplace. Conclusions: The rate of work-related asthma in the truck bed lining industry is excessive and suggests a need for significant intervention, including improvements in the clinical assessment provided to MDI-exposed workers.

Objective: To test the inter-rater reliability of physical examinations for upper extremity musculoskeletal disorders. Methods: A total of 111 subjects were examined by both an occupational medicine physician and a physical therapist, who were blinded to each others' tests results and subjects' current symptoms and health histories. Results: Inter-rater reliability was moderate to excellent (0.52 to 0.88) for shoulder tests but required the inclusion of symptoms for increased inter-rater reliability of fair to excellent (0.27 to 0.57) for the elbow and hand/wrist tests. Conclusions: With the lack of \"gold standard\" tests, it is important that epidemiologic field studies conduct and report inter-rater reliability testing results between study examiners. It is important for researchers to report the results of inter-rater reliability, so that practitioners can weigh the results of study findings to improve both their diagnosis and treatment of these costly injuries.

Work-related injuries and illnesses account for an estimated $250 billion annually in medical expenses and indirect costs, such as lost earnings and benefits, and reduced productivity at home; these costs are 12% more than the cost of all cancers and 30% more than costs for diabetes. Traditional state-wide surveillance systems often rely on employer-reported data to describe work-related injury and illness, which underestimate the magnitude. Studies estimate that the Bureau of Labor Statistics' Survey of Occupational Injuries and Illnesses (BLS SOII) undercount 20%-70% of cases compared with workers' compensation, which has also been shown to underestimate cases. These surveillance systems also lack information on potential individual-level risk factors, such as health status and risk behaviors. Data were analyzed from the Washington State Behavioral Risk Factor Surveillance System (WA BRFSS) to demonstrate an opportunity to enhance current occupational health surveillance systems.