Abstract Background Limited knowledge regarding the relative effectiveness of workplace accident prevention approaches creates barriers to informed decision‐making by policy makers, public health practitioners, workplace, and worker advocates. Objectives The objective of this review was to assess the effectiveness of broad categories of safety interventions in preventing accidents at work. The review aims to compare effects of safety interventions to no intervention, usual activities, or alternative intervention, and if possible, to examine which constituent components of safety intervention programs contribute more strongly to preventing accidents at work in a given setting or context. Date Sources Studies were identified through electronic bibliographic searches, government policy databanks, and Internet search engines. The last search was carried out on July 9, 2015. Gray literature were identified by searching OSH ROM and Google. No language or date restrictions were applied. Searches done between February and July of 2015 included PubMed (1966), Embase (1980), CINAHL (1981), OSH ROM (NIOSHTIC 1977, HSELINE 1977, CIS‐DOC 1974), PsycINFO (1806), EconLit (1969), Web of Science (1969), and ProQuest (1861); dates represent initial availability of each database. Websites of pertinent institutions (NIOSH, Perosh) were also searched. Study Eligibility Criteria, Participants, and Interventions Included studies had to focus on accidents at work, include an evaluation of a safety intervention, and have used injuries at work, or a relevant proxy, as an outcome measure. Experimental, quasi‐experimental, and observational study designs were utilized, including randomized controlled trials (RCTs), controlled before and after (CBA) studies, and observational designs using serial measures (interrupted time series, retrospective cohort designs, and before and after studies using multiple measures). Interventions were classified by approach at the individual or group level, and broad categories based on the prevention approach including modification of: Attitudes (through information and persuasive campaign messaging). Behaviors (through training, incentives, goal setting, feedback/coaching). Physiological condition (by physical training). Climate/norms/culture (by coaching, feedback, modification of safety management/leadership). Structural conditions (including physical environment, engineering, legislation and enforcement, sectorial‐level norms). When combined approaches were used, interventions were termed “multifaceted,” and when an approach(es) is applied to more than one organizational level (e.g., individual, group, and/or organization), it is termed “across levels.” Study Appraisal and Synthesis Methods Narrative report review captured industry (NACE), work setting, participant characteristics, theoretical basis for approach, intervention fidelity, research design, risk of bias, contextual detail, outcomes measures and results. Additional items were extracted for studies with serial measures including approaches to improve internal validity, assessments of reasonable statistical approaches (Effective Practice of Organization of Care [EPOC] criteria) and overall inference. Random‐effects inverse variance weighted meta‐analytic methods were used to synthesize odds ratios, rate ratios, or standardized mean differences for the outcomes for RCT and CBA studies with low or moderate levels of heterogeneity. For studies with greater heterogeneity and those using serial measures, we relied on narrative analyses to synthesize findings. Results In total 100 original studies were included for synthesis analysis, including 16 RCT study designs, 30 CBA study designs, and 54 studies using serial measures (ITS study designs). These studies represented 120 cases of safety interventions. The number of participants included 31,971,908 individuals in 59 safety interventions, 417,693 groups/firms in 35 safety interventions, and 15,505 injuries in 17 safety interventions. Out of the 59 safety interventions, two were evaluating national prevention measures, which alone accounted for 31,667,110 individuals. The remaining nine safety interventions used other types of measures, such as safety exposure, safety observations, gloves or claim rates. Strong evidence supports greater effects being achieved with safety interventions directed toward the group or organization level rather than individual behavior change. Engineering controls are more effective at reducing injuries than other approaches, particularly when engineered changes can be introduced without requiring “decision‐to‐use” by workplaces. Multifaceted approaches combining intervention elements on the organizational level, or across levels, provided moderate to strong effects, in particular when engineering controls were included. Interventions based on firm epidemiologic evidence of causality and a strong conceptual approach were more effective. Effects that are more modest were observed (in short follow‐up) for safety climate interventions, using techniques such as feedback or leadership training to improve safety communication. There was limited evidence for a strong effect at medium‐term with more intense counseling approaches. Evidence supports regulation/legislation as contributing to the prevention of accidents at work, but with lower effect sizes. Enforcement appears to work more consistently, but with smaller effects. In general, the results were consistent with previous systematic reviews of specific types of safety interventions, although the effectiveness of economic incentives to prevent accidents at work was not consistent with our results, and effectiveness of physiological safety intervention was only consistent to some extent. Limitations Acute musculoskeletal injuries and injuries from more long‐time workplace exposures were not always clearly distinguished in research reports. In some studies acute and chronic exposures were mixed, resulting in inevitable misclassification. Of note, the classification of these events also remains problematic in clinical medicine. It was not possible to conduct meta‐analyses on all types of interventions (due to variability in approach, context, and participants). The findings presented for most intervention types are from limited sources, and assessment of publication bias was not possible. These issues are not surprising, given the breadth of the field of occupational safety. To incorporate studies using serial measures, which provide the only source of information for some safety interventions such as legislation, we took a systematic, grounded approach to their review. Rather than requiring more stringent, specific criteria for inclusion of ITS studies, we chose to assess how investigators justified their approach to design and analyses, based on the context in which they were working. We sought to identify measures taken to improve external validity of studies, reasonable statistical inference, as well as an overall appropriate inferential process. We found the process useful and enlightening. Given the new approach, we may have failed to extract points others may find relevant. Similarly, to facilitate the broad nature of this review, we used a novel categorization of safety interventions, which is likely to evolve with additional use. The broad scope of this review and the time and resources available did not allow for contacting authors of original papers or seeking translation of non‐English manuscripts, resulting in a few cases where we did not have sufficient information that may have been possible to obtain from the authors. Conclusions and Implications of Key Findings Our synthesis of the relative effectiveness of workplace safety interventions is in accordance with the Public Health Hierarchy of Hazard Control. Specifically, more effective interventions eliminate risk at the source of the hazard through engineering solutions or the separation of workers from hazards; effects were greater when these control measures worked independently of worker “decision‐to‐use” at the worksite. Interventions based on firm epidemiological evidence of causality and clear theoretical bases for the intervention approach were more effective in preventing injuries. Less effective behavioral approaches were often directed at the prevention of all workplace injuries through a common pathway, such as introducing safety training, without explicitly addressing specific hazards. We caution that this does not mean that training does not play an essential function in worker safety, but rather that it is not effective in the absence of other efforts. Due to the potential to reach large groups of workers through regulation and enforcement, these interventions with relatively modest effects, could have large population‐based effects.

Background Devices to lift, transfer, and reposition patients are recommended for healthcare workers' and patients' safety, but their intended use has yet to be fully realized. Objective The aim of this study was to describe hospital nursing staff use of lift/transfer devices and the presence of factors at the time of lifts/transfers with potential to influence whether devices are used. Methods Participants were 108 US nursing staff in a university-based medical center and two community hospitals. A self-completed questionnaire was used to collect demographic and work characteristics, typical frequency of patient lifts/transfers, training in and typical use of lift equipment, and specific factors that could influence use. Proportional distributions of lifting/transferring and repositioning frequencies in a typical shift, amount of equipment use, and factors present were examined overall and across worker and work-related characteristics. Results Although trained in equipment use, only 40% used equipment for at least half of lifts/transfers. During lifts/transfers, factors often present included patient unable to help with lift/transfer (91.3%) or of a size/weight where participant needed assistance to help lift/transfer (87.5%); availability of others who could assist with manual lift (86.3%) or use of lift equipment (82.4%); and equipment functioning properly (86.4%), having supplies available (82.5%), and being easy to retrieve from storage (81.6%). During repositioning tasks, physical assistance was “always/almost always” provided from coworkers (83.3%) and often perceived as “very helpful” (92.6%) in reducing physical demands. Physical assistance from patients was less common (14.0% “always/almost always”) yet perceived as “very helpful” by 66.3%. One fifth always used friction-reducing devices. Discussion Despite training in their use, nursing staff use of available lift equipment and assistive devices is limited. Factors present at the time of lifts/transfers that may influence equipment/device use reflect a complex mix of patient, worker, equipment, and situational characteristics.

While there is a growing body of literature on assessing perceptions of safety climate, many of these studies report a company's safety climate as a worker-based phenomenon. Discrepancies in perceptions of safety across different hierarchical groups in an organization may increase barriers to the development and implementation of effective ways to mitigate workplace hazards. This study examines and compares the perceptions of safety climate among three groups of construction personnel: (1) construction workers, (2) field supervisors, and (3) site managers; as well as evaluating the relationships among discrepancies in perceptions of safety and reported injury rates. The Nordic Occupational Safety Climate Questionnaire (NOSACQ-50), which consists of 50 items across seven dimensions, was used to assess safety climate perceptions across construction site personnel. In total, 266 workers, 55 supervisors and 32 site managers from 26 Colombian construction companies were surveyed. Results confirmed differences in overall perceptions as well as across safety climate dimensions. Managers reported higher safety climate scores than supervisors and construction workers. There were no statistically significant relationships between each group's perceptions of safety climate and the company's 3-year injury rate. However, worker-manager discrepancies in perceptions of safety were positively correlated with the 3-year injury rate of construction companies. Better understanding of the differences in perceptions of safety climate across construction personnel, may make it possible to design comprehensive safety interventions that involve managers, supervisors, and workers. Targeting each group with initiatives customized to bridge their particular gaps can identify opportunities to improve workplace safety and health.

There is broad agreement that precarious work is a growing problem, and that it is highly prevalent among young employees. The financial crisis in 2008 has reinforced the need for knowledge about how precarious work affects young employees. This paper explores how the concept of precarious work may apply differentially to different groups of young people at work and whether this challenges the term 'transition', which until now has been one of the core elements within contemporary youth research. We examine discursive representations of precarious work, vulnerability and risks among young Danish employees aged 18-24 in the healthcare sector, the metal industry and retail trade captured in 46 interviews involving 74 participants. Results are discussed taking into consideration the Nordic welfare model with an active labour marked policy. We conclude that precarious work is not, in fact, simply a characteristic of young employees' work as such, but rather it is related to their position in the labour market and the type of jobs in which they are employed. While some are in transition, others are at risk of being trapped in precarious and risky working conditions.

Context: Health care workers have high rates of musculoskeletal injuries, but many of these injuries go unreported to workers' compensation and national surveillance systems. Little is known regarding the work-related injuries of certified athletic trainers (ATs). Objective: To determine the 12-month incidence and prevalence of work-related injuries and describe injury-reporting and -management strategies. Design: Cross-sectional study. Setting: Population-based online survey. Patients or Other Participants: Of the 29 051 ATs currently certified by the Board of Certification, Inc, who “opted in” to research studies, we randomly selected 10 000. Of these, 1826 (18.3%) ATs currently working in the clinical setting were eligible and participated in the baseline survey. Main Outcome Measure(s): An online survey was e-mailed in May of 2012. We assessed self-reported work-related injuries in the previous 12 months and management strategies including medical care, work limitations or modifications, and time off work. Statistics (frequencies and percentages) were calculated to describe injury rates per 200 000 work hours, injury prevalence, injury characteristics, and injury-reporting and -management strategies. Results: A total of 247 ATs reported 419 work-related injuries during the previous 12 months, for an incidence rate of 21.6 per 200 000 hours (95% confidence interval = 19.6, 23.7) and injury prevalence of 13.5% (95% confidence interval = 12.0%, 15.1%). The low back (26%), hand/fingers (9%), and knee (9%) were frequently affected body sites. Injuries were most often caused by bodily motion/overexertion/repetition (52%), contact with objects/equipment/persons (24%), or slips/trips/falls (15%). More than half of injured ATs (55.5%) sought medical care, 25% missed work, and most (77%) did not file a workers' compensation claim for their injury. Half of injured ATs were limited at work (n = 125), and 89% modified or changed their athletic training work as a result of the injury. Conclusions: More than half of AT work-related injuries required medical care or work limitations and were not reported for workers' compensation. Understanding how ATs care for and manage their work-related injuries is important given that few take time off work.

BACKGROUND:Despite wide availability of patient lift equipment in hospitals to promote worker and patient safety, nursing staff do not consistently use equipment. OBJECTIVE:To determine the influence of factors on the use or non-use of lift equipment during patient lifts/transfers. DESIGN:Prospective observational cohort study. SETTING:One university teaching hospital and two community hospitals in a large health system in southeastern United States. PARTICIPANTS:77 nurses and nursing care assistants with patient handling duties in critical care, step-down and intermediate care units. METHODS:Participants recorded information about all patient lifts/transfers during their shifts during a 1 week period per month for three months: type of lift/transfer, equipment use, type of equipment, and presence of 20 factors at the time of the lift/transfer. With the patient lift/transfer as the unit of analysis, the association (risk ratios (RR) and 95% confidence intervals (CI)) between factors and equipment use was examined using multivariate Poisson regression with generalized estimating equations. RESULTS:Seventy-seven participants (465 person-shifts) reported 3246 patient lifts/transfers. Frequent lifts/transfers included bed-to-toilet (21%), toilet-to-bed (18%), bed-to-chair (13%), chair-to-bed (13%), chair-to-toilet (6%), and toilet-to-chair (6%). Equipment was used for 21% of lifts/transfers including powered floor based dependent lift (41%), powered sit-to-stand lift (29%), non-powered sit-to-stand lift (17%), air-assisted lateral transfer device (6%), ceiling lift (3%), and air-assist patient lift (3%). Factors associated with equipment use included: availability of equipment supplies (RR = 9.61 [95%CI: 6.32, 14.63]), staff availability to help with equipment (6.64 [4.36, 10.12]), staff preference to use equipment (3.46 [2.48, 4.83]), equipment required for patient condition (2.38 [1.74, 3.25]), patient inability to help with lift/transfer (2.38 [1.71, 3.31]), equipment located in/by patient room (1.82 [1.08, 3.06]), sling already under patient (1.79 [1.27, 2.51]), and patient size/weight (1.38 [0.98, 1.95]). Lower patient mobility score (3.39 [2.19, 5.26]) and presence of physical or mental impairments (2.00 [1.40, 2.86]) were also associated with lift equipment use. Factors associated with non-use of equipment included: patient/family preference (0.31 [0.12, 0.80]), staff assisting with lift did not want to use equipment 0.34 ([0.17, 0.68]), patient condition (0.48 [0.20, 1.20]), and patient almost fell (0.66 [0.45, 0.97]). CONCLUSIONS:Patient, worker, equipment, and situational factors influence whether nursing staff used equipment to lift/transfer a patient. Quantifying and understanding these factors associated with lift equipment use and non-use provides specific information for hospitals and safety professionals to enhance effectiveness of future organizational and ergonomic intervention efforts to prevent work-related patient-handling injuries.

BACKGROUND Safety climate, a group-level measure of workers' perceptions regarding management's safety priorities, has been suggested as a key predictor of safety outcomes. However, its relationship with actual injury rates is inconsistent. We posit that safety climate may instead be a parallel outcome of workplace safety practices, rather than a determinant of workers' safety behaviors or outcomes. METHODS Using a sample of 25 commercial construction companies in Colombia, selected by injury rate stratum (high, medium, low), we examined the relationship between workers' safety climate perceptions and safety management practices (SMPs) reported by safety officers. RESULTS Workers' perceptions of safety climate were independent of their own company's implementation of SMPs, as measured here, and its injury rates. However, injury rates were negatively related to the implementation of SMPs. CONCLUSIONS Safety management practices may be more important than workers' perceptions of safety climate as direct predictors of injury rates.

INTRODUCTION:A rate-based understanding of home care aides' adverse occupational outcomes related to their work location and care tasks is lacking.METHODS:Within a 30-month, dynamic cohort of 43 394 home care aides in Washington State, injury rates were calculated by aides' demographic and work characteristics. Injury narratives and focus groups provided contextual detail.RESULTS:Injury rates were higher for home care aides categorized as female, white, 50 to <65 years old, less experienced, with a primary language of English, and working through an agency (versus individual providers). In addition to direct occupational hazards, variability in workload, income, and supervisory/social support is of concern.CONCLUSIONS:Policies should address the roles and training of home care aides, consumers, and managers/supervisors. Home care aides' improved access to often-existing resources to identify, manage, and eliminate occupational hazards is called for to prevent injuries and address concerns related to the vulnerability of this needed workforce.

INTRODUCTION:Despite the size and breadth of OSHA's Outreach Training program for construction, information on its impact on work-related injury rates is limited.METHODS:In a 9-year dynamic cohort of 17,106 union carpenters in Washington State, the effectiveness of OSHA Outreach Training on workers' compensation claims rate was explored. Injury rates were calculated by training status overall and by carpenters' demographic and work characteristics using Poisson regression.RESULTS:OSHA Outreach Training resulted in a 13% non-significant reduction in injury claims rates overall. The protective effect was more pronounced for carpenters in their apprenticeship years, drywall installers, and with increasing time since training.CONCLUSIONS:In line with these observed effects and prior research, it is unrealistic to expect OSHA Outreach Training alone to have large effects on union construction workers' injury rates. Standard construction industry practice should include hazard awareness and protection training, coupled with more efficient approaches to injury control. Am. J. Ind. Med. 60:45-57, 2017. © 2016 Wiley Periodicals, Inc.

Femke Abma Linda Ahlstrom Ann-Beth Antonsson Nancy Baker Marjorie Baldwin Ann Barr-Gillespie Paul Beattie Deborah R. Becker Janneke Berecki-Gisolf Elyssa Besen Hendrik Bieleman Malachy Bishop Annette Bishop Gary Bond Cécile Boot Eleanor Boyle Soren Brage Elisabeth Björk Brämberg Ute Bultmann Alex Burdorf Paul Campbell Carl Castro Chetwyn Chan Fong Chan Andy, Shu-kei Cheng Manuel Cifuentes Liza Conyers Juliette Cooper Marc Corbiere Katia Costa-Black Julie Cote Marie-France Coutu Amy Darragh Angelique De Rijk Haitze de Vries Patricia Dekkers-Sanchez Caitlin Demsky Eva Denison Alexis Descatha Sarah Detaille Clermont Dionne Marie-José Durand Christopher Eccleston Kerstin Ekberg Nieke Elbers Silje Endresen Reme Gülsen Erden Gail Eva Joanna Fadyl Sophie Fantoni Leah Farrell-Carnahan Sue Ferguson Elena Maria Fiabane Patricia Findley Anncristine Fjellman-Wiklund Michael Frain Alfred Franzblau Robert Fraser Deborah Fulton-Kehoe Fabian Gander Robert Gatchel Elizabeth Gibson Monique Gignac Genevieve Grant Wim Grooten Mark Hancock Cherise Harrington Yonghua He Gunnel Hensing Jonathan Hill Sheilah Hogg-Johnson Grant Huang Mohd Awang Idris Carole James Chris Jensen Arif Jetha Gun Johansson Venerina Johnston Jaranit Kaewkungwal Kathryn Kanzler Anne Kennedy Taro Kishi Marit Knapstad Agnieszka Kosny Vicki Kristman Valérie Lederer Yafa Levanon Allen Lewis Youxin Liang Michael Linden Hester Lipscomb Karen Liu Patrick Loisel John Lui François Luthi Joy MacDermid Ellen Maceachen Chris Main Angela Ka Ying Mak Cindy Malachowksi Ajay Malviya Serena McCluskey

BACKGROUND Under-reporting of type II (patient/visitor-on-worker) violence by workers has been attributed to a lack of essential event details needed to inform prevention strategies. METHODS Mixed methods including surveys and focus groups were used to examine patterns of reporting type II violent events among ∼11,000 workers at six U.S. hospitals. RESULTS Of the 2,098 workers who experienced a type II violent event, 75% indicated they reported. Reporting patterns were disparate including reports to managers, co-workers, security, and patients' medical records-with only 9% reporting into occupational injury/safety reporting systems. Workers were unclear about when and where to report, and relied on their own "threshold" of when to report based on event circumstances. CONCLUSIONS Our findings contradict prior findings that workers significantly under-report violent events. Coordinated surveillance efforts across departments are needed to capture workers' reports, including the use of a designated violence reporting system that is supported by reporting policies. Am. J. Ind. Med. 59:853-865, 2016. © 2016 Wiley Periodicals, Inc.

Despite touted improvements in workplace safety over time, occupational injuries remain a significant burden world-wide. In the changing economy, the organisation of work is influencing our understanding of workplace safety problems and their amelioration by creating challenges to accurate injury surveillance and research approaches. Further, work organisation factors and organisational decision-making can influence injury risk directly, but also through more insidious indirect channels. The public health hierarchy of hazard control has long been a guiding principle for our occupational injury research and serving to focus research questions on the higher, more efficient tiers that are more likely to have lasting effects on larger populations of workers. While this approach serves to very appropriately direct attention away from a focus on individual worker behaviours, sometimes a focus on the control of hazards using this traditional prevention model can contribute to failure to consider broader root cause organisational factors. Using examples from empirical work, we describe important organisational factors that ultimately influenced worker safety and well-being. These structural processes were not always included in our original variables of interest, but were identified as we sought to improve our understanding of the context in which workers of interest were being injured. A variety of qualitative methods provided insight into our original quantitative analyses. The examples demonstrate the importance of careful consideration of downstream effects of organisational decisions on worker safety.

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BACKGROUND Little is known about the work-related injury and illnesses experienced by certified athletic trainers (AT). METHODS The incidence and characteristics of injury/illness claims filed in two workers' compensation systems were described from 2001 to 2011. Yearly populations at risk were estimated from National Athletic Trainers' Association membership statistics. Incidence rate ratios (IRR) were reported by job setting. RESULTS Claims were predominantly for traumatic injuries and disorders (82.7%: 45.7% sprains/strains, 12.0% open wounds, 6.5% bruises) and at these body sites (back 17.2%, fingers 12.3%, and knee 9.6%) and over half were caused by body motion and overexertion (51.5%). Compared with school settings, clinic/hospital settings had modestly higher claim rates (IRR = 1.29, 95% CI: 1.06-1.52) while other settings (e.g., professional or youth sport, nursing home) had lower claim rates (IRR = 0.63, 95% CI: 0.44-0.70). CONCLUSIONS These first known estimates of work-related injuries/illnesses among a growing healthcare profession help identify occupational tasks and settings imposing injury risk for ATs. Am. J. Ind. Med. 59:1156-1168, 2016. © 2016 Wiley Periodicals, Inc.

Falls from height remain the leading cause of fatalities in residential construction. We used results from a comprehensive needs assessment to guide changes in fall prevention training in a joint union-contractor carpenter apprenticeship program; including surveys of 1018 apprentice carpenter and observational audits at 197 residential construction sites. The revised training utilized hands-on, participatory training methods preferred by the learners to address the safety gaps in the curriculum; including ladder use, leading edge work, truss setting, and use of scaffolding and personal fall arrest. We compared apprentice surveys (n = 1273) and residential worksite audits (n = 207) 1-2 years post-training with baseline measures. Apprentices working residential construction were more likely to fall from heights (OR = 2.26, 95% Cl 1.59-3.21) than those working commercial construction. The revised training resulted in improved fall safety knowledge, self-reported worksite behaviors, risk perceptions, and safety climate, even after adjusting for temporal trends. We also observed significant improvements in fall safety compliance in most domains of the worksite audit, with larger changes observed in areas emphasized in the training, demonstrating specificity of the effect. Greater effects were noted in small and medium-sized contractors, who often have limited resources to devote to safety. Self-reported falls fell from 18.2 to 14.5 per 100 person-years of work. This research supports growing evidence that worksite safety can be improved by training. This curriculum could be readily adapted to other union apprenticeship programs. Fall safety of inexperienced residential construction workers' should remain a focus of future research. (C) 2016 Elsevier Ltd. All rights reserved.

BACKGROUND:An elevated risk of patient/visitor perpetrated violence (type II) against hospital nurses and physicians have been reported, while little is known about type II violence among other hospital workers, and circumstances surrounding these events.METHODS:Hospital workers (n = 11,000) in different geographic areas were invited to participate in an anonymous survey.RESULTS:Twelve-month prevalence of type II violence was 39%; 2,098 of 5,385 workers experienced 1,180 physical assaults, 2,260 physical threats, and 5,576 incidents of verbal abuse. Direct care providers were at significant risk, as well as some workers that do not provide direct care. Perpetrator circumstances attributed to violent events included altered mental status, behavioral issues, pain/medication withdrawal, dissatisfaction with care. Fear for safety was common among worker victims (38%). Only 19% of events were reported into official reporting systems.CONCLUSIONS:This pervasive occupational safety issue is of great concern and likely extends to patients for whom these workers care for.

BACKGROUND Hospital sitters provide continuous observation of patients at risk of harming themselves or others. Little is known about sitters' occupational safety and well-being, including experiences with patient/visitor-perpetrated violence (type II). METHODS Data from surveys, focus groups, individual interviews at six U.S. hospitals were used to characterize the prevalence of and circumstance surrounding type II violence against sitters, as well as broader issues related to sitter use. RESULTS Sitter respondents had a high 12-month prevalence of physical assault, physical threat, and verbal abuse compared to other workers in the hospital setting. Sitters and other staff indicated the need for clarification of sitters' roles regarding patient care and sitter well-being (e.g., calling for assistance, taking lunch/restroom breaks), training of sitters in personal safety and de-escalation, methods to communicate patient/visitor behaviors, and unit-level support. CONCLUSIONS The burden of type II violence against hospital sitters is concerning. Policies surrounding sitters' roles and violence prevention training are urgently needed.

Use of a pneumatic nail gun with a sequential actuation trigger (SAT) significantly diminishes the risk for acute traumatic injury compared to use of a contact actuation trigger (CAT) nail gun. A theoretically-based increased risk of work-related musculoskeletal disorders from use of a SAT nail gun, relative to CAT, appears unlikely and remains unproven. Based on current knowledge, the use of CAT nail guns cannot be justified as a safe alternative to SAT nail guns. This letter provides a perspective of ergonomists and occupational safety researchers recommending the use of the sequential actuation trigger for all nail gun tasks in the construction industry.

BACKGROUND Numerous aspects of construction place workers at risk of musculoskeletal disorders and injuries (MSDIs). Work organization and the nature of MSDIs create surveillance challenges. METHODS By linking union records with workers' compensation claims, we examined 20-year patterns of MSDIs involving the upper extremity (UE) and the knee among a large carpenter cohort. RESULTS MSDIs were common and accounted for a disproportionate share of paid lost work time (PLT) claims; UE MSDIs were three times more common than those of the knee. Rates declined markedly over time and were most pronounced for MSDIs of the knee with PLT. Patterns of risk varied by extremity, as well as by age, gender, union tenure, and predominant work. Carpenters in drywall installation accounted for the greatest public health burden. CONCLUSIONS A combination of factors likely account for the patterns observed over time and across worker characteristics. Drywall installers are an intervention priority.

•In construction there is increased injury risk for apprentices in small companies (<50 employees).•Risk-factors likely differ due to differences in trade and size-specific differences in exposure.•Apprentices in the electrical trade were at greatest risk in companies with 10–19 employees.•Apprentices in building were at greatest risk in companies with 20–49 employees.•Apprentices in microbusinesses seem not to be at particularly high risk of injury.