research – Page 163 – SafetyAtWorkBlog

The economic costs of a heart attack

A new Australian report estimates the total costs of heart attack and chest pain (Acute Coronary Syndrome or ACS) to the Australian economy – “total economic cost of $17.9 billion.” This Access Economics report, released in June 2009, has broad application for public policy but has some relevant information for safety and health management in the workplace.

If we take “productivity” as applying to work, as is reasonable, the report states that for 2009

“Indirect [health care system] costs [from ACS] are expected to account for $A3.8 billion, primarily due to lost productivity.”

This is a useful statistic for those workplace health advocates. In fact, the report specifically identified the workplace as

“…an excellent environment to facilitate the ongoing rehabilitation and lifestyle changes to prevent the re-occurrence of ACS event”.

One gap it identified in the treatment and monitoring of ACS was something that many have been advocating for some years, particularly with the aging population and increasing obesity rates:

“a standardised national program to support employees and employers and the extension of rehabilitation practices.”

Much of the report advocates important rehabilitation resources and services for when the patient is discharged from hospital. The report includes the following graphic but also recommends the basic elements of post-hospital care after an ACS event.

Costofheartattackandchestpain-261-2 rehab table

“For rehabilitation to be effective, comprehensive patient follow-up interviews after discharge are essential. At these follow-up interviews, the patient should undergo both physical assessments (e.g. blood pressure, cholesterol tests, ECGs) and emotional and psychological assessments (e.g. signs of depression, anxiety, stress, financial hardships). The psychological impact following an ACS event is an important, but often neglected, area in the management of ACS. Thus, if patients can better understand their conditions, it can empower them to cope with their anxieties caused by ACS.”

In specific reference to workplaces, the report says:

“Returning to work can require an adjustment in duties and the conditions under which the employee works.”

It is up to OHS and return-to-work professionals to determine exactly what strategies should be applied in these circumstances.

There were a couple of references in the report that may be worth following up:

Bhattacharyya MR, Perkins-Porras L, Whitehead DL, and A Steptoe (2007), Psychological and clinical predictors of return to work after acute coronary syndrome, European Heart Journal, Vol 28, Iss. 2, pp. 160-165.

Kovoor P, Lee AKY, Carrozzi F, Wiseman V, Byth K, Zecchin R, Dickson C, King M, Hall J, Ross DL, Uther JB, and AR Denniss (2006), Return to full normal activities including work at two weeks after acute myocardial infarction, American Journal of Cardiology, Vol 97, No. 7, pp. 952-958.

Kevin Jones

New research on casino worker risks from secondhand smoke

The yet-to-be-released August 2009 edition of the American Journal of Public Health has an interesting report into the health risks of casino workers in Pennsylvania from second hand tobacco smoke. The research report is quite complex for the casual readerr but the increased level of risk to casino workers seems convincing.

According to the report, secondhand smoke

“in Pennsylvania casinos produces an estimated excess mortality of approximately 6 deaths per year per 10000 workers at risk”.

People in the casinos for 8 hours would be breathing air that would match the “unhealthy air” definition of the US Air Quality Index.

The reseacrh concludes

“It is clear, however, that Pennsylvania casino workers and patrons are put at significant excess risk of heart disease and lung cancer from SHS through a failure to include casinos in the state’s smoke-free-workplace law.”

Randy Dotinga wrote for the Health Behavior News Services on the research report and asked questions of a gambling industry representative:

“Holly Thomsen, a spokesperson for the American Gaming Association, a trade group for the casino industry, said its members are committed to “the highest level of safety and comfort” inside casinos.

Casinos serve both smoking and nonsmoking customers, she said, and “we realize that balancing the needs of these two distinct sets of patrons, as well as those of our employees who don’t smoke, is of paramount importance.”

The AJPH article reference is

Repace, J. Secondhand smoke in Pennsylvania casinos: A study of nonsmokers’ exposure, dose, and risk. Am J Public Health 99(8), 2009.

Kevin Jones

Sleep disorders and workplace safety – new research grant

Recently, the Australian Government awarded some research grants of which at least one is relevant to workplace safety. $2.5 million was given for the establishment of a Centre for Clinical Research Excellence in Interdisciplinary Sleep Health (CRISH).

When the grant was announced Professor Ron Grunstein of the Woolcock Institute of Medical Research said,

“Adequate sleep is as important as exercise and diet. Sleep loss and sleep disorders contribute to mortality, chronic disease, mental health problems and the economic health burden.

“This funding will allow us to establish a network of leading sleep researchers and physicians in different specialties to investigate the biology of sleep, and look at ways to prevent and treat sleep disorders.”

Amongst several social benefits of the research, the issue of shiftwork health was mentioned. There are many contributory factors to the health of shiftworker and sleep disorders is only one, but an important one.

The most recent Australian data on the costs of sleep disorders was from 2004 by Access Economics, an organisation that the government often relies on for data. Its report, Wake Up Australia, estimates that sleep disorders such as obstructive sleep apnea and insomnia underlie 9.1 per cent of work related injuries.

The origin of this statistic needs to be closely examined in the body of the report (page 23) as there is quite a bit of statistical magic applied however the 9.1% figure has been referred to in relation to the potential benefit of the CRISH project. The statistic is not invalid but it is also not so simple.

Kevin Jones

Safety culture improvements in Spain

The improved safety status in workplaces that have an active union presence has been verified through research, but what of the efforts on safety management from outside the union research efforts.

Below is the abstract of an article that was published online late-2008 (and is available for purchase). The research was conducted in a country with a negative safety culture so the improvements may be more marked than from outside Spain. However, the full study (not accessed by SafetyAtWorkBlog) may provide an interesting before-and-after story.

“Occupational accidents severely deteriorate human capital, and hence negatively affect the productivity and competitiveness of countries. But despite this, we still observe a scarcity of preventive practices, an unsatisfactory management commitment and an absence of safety culture among Spanish firms. The result is evident in firms’ high accident rates. This situation is a consequence of the general belief among firms that investing in safety is a cost, and hence has negative repercussions for their competitiveness. The current work aims to identify good practices in safety management, and analyse the effect of these practices on a set of indicators of organisational performance. For this, we first carry out an exhaustive literature review, and then formulate a series of hypotheses. We then test the proposed model on a sample of 455 Spanish firms. Our findings show that safety management has a positive influence on safety performance, competitiveness performance, and economic-financial performance. Hence they provide evidence of the compatibility between worker protection and corporate competitiveness.”

The full article is available in Safety Science (Volume 47, Issue 7, August 2009, Pages 980-991).

Kevin Jones

B Fernández-Muñiz, J Montes-Peón and C Vázquez-Ordás, ‘Relation between occupational safety management and firm performance’ (2009) Safety Science 47: 980-991.

Evidence, subjectivity and myth

There is a big push for occupational safety and health decisions to be made on evidence. OHS academics in Australia are particularly big on this and there is considerable validity in the lobbying but as academics can have a vested interest in research, the calls are often dismissed.

There is also, around the world, a questioning of the value and validity of the risk assessment process related to workplace safety. In Europe, in particular, the business groups see risk assessment as a major unnecessary business cost (but then again, how many businesses even perform OHS risk assessments?). Risk assessment has often been criticised because of its subjectivity. In some circumstances, risk assessment may perpetuate workplace and safety myths.

In the absence of evidence, myths fill the gap. Sometimes assessments, investigations, estimates and FOAFs (friend of a friend) add to the tenuous credibility of those myths.

Peter Sandman has talked about dispelling myths through risk communication. One myth he discusses, the risks of flu vaccinations, is also touched on in an interview with Dr Aaron E. Carroll of the Indiana University School of Medicine on the ABC’s Life Matters program.

OHS professionals must seek evidence on workplace hazards so that their advice is sound but equally, myths must be countered. The links in the paragraph above, along with the excellent website, www.snopes.com, can provide some assistance in how we can reduce the transmission of myths.

I am a big advocate of the “contrary”. Only by asking questions about established beliefs and tenets can the flaws in our decision-making be illustrated. Sometimes this is dismissed as being a “Devil’s Advocate” but the process does not advocate bad behaviours, it questions the basis for established behaviours – a process that many people, organisations AND business find enormously threatening.

As we get older or become socialised, we tend to forget the tale most of us heard as a child, The Emperor’s New Clothes. This tale should be read regularly to remind us of how the contrary position, the quizzical, can be constructive and sometimes, revolutionary (even though in the tale the Emperor ignores the child’s spoken truth) but still provide evidence.

Kevin Jones

UK workplace fatality data

New UK workplace fatality data was released by the Health and Safety Executive (HSE) this week. It provides an interesting comparison to the recent Australian data.

The HSE says that

“The provisional figure for the number of workers fatally injured in 2008/09 is 180, and corresponds to a rate of fatal injury of 0.6 per 100 000 workers.

The figure of 180 worker deaths is 22% lower than the average for the past five years (231). In terms of the rate of fatal injuries, the latest figure of 0.59 per 100 000 workers is 23% lower than the five-year average rate of 0.77.

Comparison with data from other EU countries over a number of years reveals that the fatal injury rate for Great Britain is consistently one of the lowest in Europe.

There were 94 members of the public fatally injured in accidents connected to work in 2008/09 (excluding railways-related incidents).”

The industries with the highest number of fatalities, in descending order, are:

Services sector 63
Construction 53
Manufacturing 32
Agriculture 26

Agriculture has the highest rate of death per 100,000 workers at 5.7

Kevin Jones

Nanotechnology safety – literature review

Earlier in June 2009 The European Agency for Safety and Health at Work released a literature review entitled “Workplace exposure to nanoparticles”

The EU-OSHA says

“Nanomaterials possess various new properties and their industrial use creates new opportunities, but they also present new risks and uncertainties. Growing production and use of nanomaterials result in an increasing number of workers and consumers exposed to nanomaterials. This leads to a greater need for information on possible health and environmental effects of nanomaterials.”

The report is available for download by clicking on the image in this post.

Kevin Jones

Category: research

The economic costs of a heart attack

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New research on casino worker risks from secondhand smoke

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Sleep disorders and workplace safety – new research grant

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Safety culture improvements in Spain

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Evidence, subjectivity and myth

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UK workplace fatality data

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Nanotechnology safety – literature review

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