Cameron A Mustard

Institute for Work and Health, Toronto, Ontario, Canada

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Publications (147)568.55 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: A number of jurisdictions have introduced regulation to accelerate the adoption of safety-engineered needles (SENs). This study examined the transition to SENs in three acute care hospitals prior to and following the implementation of a regulatory standard in Ontario. This paper focuses on the ongoing barriers to the prevention of needlestick injuries among healthcare workers. Methods: Information from document review and 30 informant interviews were used to prepare three case studies detailing each organization's implementation activities and outcomes. Results: All three hospitals responded to the regulatory requirements with integrity and needlestick injuries declined. However, needlestick injuries continued to occur during the activation of safety devices, during procedures and during instrument disposal. The study documented substantial barriers to further progress in needlestick injury prevention. Conclusions: Healthcare organizations should focus on understanding their site-specific challenges that contribute to ongoing injury risk to better understand issues related to product limitations, practice constraints and the work environment.
    No preview · Article · Nov 2015 · Healthcare policy = Politiques de sante
  • Imelda S Wong · Peter M Smith · Cameron A Mustard · Monique A.M. Gignac
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    ABSTRACT: Objective: This study compares health and occupational outcomes following a work-related injury for nonstandard and day-shift workers. Methods: National Population Health Survey data were used to explore outcomes 2 years post-work injury. Retrospective-matched cohort analyses examined main effects and interactions of shift schedule and work injury with changes in health, shift schedule, and labor force status. Models were adjusted for respondent characteristics, baseline health status, and occupational strength requirements. Results: Injured nonstandard shift workers reported lower health utility index scores, compared with uninjured and injured daytime workers and uninjured nonstandard-shift workers. No significant interactions between shift and injury were found with schedule change and leaving the labor force. Conclusions: Injured nonstandard-shift workers are as likely to remain employed as other groups, but may be vulnerable in terms of diminished health.
    No preview · Article · Nov 2015 · Journal of occupational and environmental medicine / American College of Occupational and Environmental Medicine
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    ABSTRACT: Objectives: This study sought to: (i) explore the impact of mood disorders (such as depression, bipolar disorder, mania, or dysthymia) and five age-related chronic physical conditions (arthritis, back pain, diabetes, heart disease, and hypertension) on presenteeism (as indicated by self-reported activity limitations at work), and (ii) examine how mood disorders interact with each physical condition to affect this work outcome. Methods: Using Canadian Community Health Survey (CCHS) data, we modeled the relationships between self-reported restrictions at work and each health condition. We then calculated synergy indices (SI) for the interaction between mood disorders and each of the five physical conditions. Results: All six health conditions were associated with presenteeism. The strongest association was observed for back pain [prevalence ratio (PR) 2.70, 95% confidence interval (95% CI) 2.57-2.83] and the weakest for hypertension (PR 1.18, 95% CI 1.11-1.25). The unadjusted SI indicated no interactions between mood disorders and any of the physical conditions, while the adjusted SI indicated statistically significant interactions between mood disorders and each of the five physical conditions. The statistically significant adjusted interactions were in a negative direction, such that having a mood disorder concurrent with a chronic physical condition was associated with a lower burden of presenteeism than expected. Post-hoc analyses revealed that this unexpected finding was attributable to adjustment for other co-morbid health conditions, particularly arthritis and back pain. Conclusions: Our results suggest that targeting chronic physical conditions or mood disorders may be productive in reducing presenteeism. The combined effect on presenteeism when the two types of conditions occur simultaneously is similar to the additive effect of these conditions when each occurs in isolation.
    No preview · Article · Sep 2015 · Scandinavian Journal of Work, Environment & Health
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    Andrea Chambers · Cameron A Mustard · Jacob Etches
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    ABSTRACT: Background A number of jurisdictions have used regulation to promote the adoption of safety-engineered needles as a primary solution to reduce the risk of needlestick injuries among healthcare workers. Regulatory change has not been complemented by ongoing efforts to monitor needlestick injury trends which limits opportunities to evaluate the need for additional investment in this area. The objective of this study was to describe trends in the incidence of needlestick injuries in Ontario prior to and following the establishment of regulation to promote the adoption of safety-engineered needles. Methods An observational study of needlestick injuries obtained from two independent administrative data sources (emergency department records for the treatment of work-related disorders and workers' compensation claims) for a population of occupationally-active adults over the period 2004–2012. Results Comparing the year prior to the regulation being established (2006) to three years after the regulation came into effect (2011), needlestick injury rates in the health and social services sector that were captured by workers’ compensation claims declined by 31% and by 43% in the work-related emergency department records. Rates of workers’ compensation claims associated with needlestick injuries declined by 31% in the hospital sector, by 67% in the long-term care sector and have increased by approximately 1% in nursing services over the period 2004–2012. Conclusions Two independent administrative data sources documented an overall reduction in needlestick injuries in the province of Ontario following a regulatory requirement to adopt safety-engineered needles; however, a substantial burden of occupational needlestick injuries persists in this setting.
    Preview · Article · Apr 2015 · BMC Health Services Research
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    ABSTRACT: Background The objective of this study was to examine individual, occupational, and workplace level factors associated with time loss following a similar injury.Methods Seven thousand three hundred and forty-eight workers’ compensation claims that did not require time off work were matched with up to four claims that required time off work on the event, nature, and part of body injured as well as injury year. Conditional logistic regression models examined individual, occupational, and workplace level factors that were associated with the likelihood of not requiring time off work.ResultsEmployees from firms with higher premium rates were more likely to report no time loss from work and workers in more physically demanding occupations were less likely to report no time loss from work. We observed no association between age or gender and the probability of a time loss claim submission.Conclusions Our results suggest that insurance costs are an incentive for workplaces to adopt policies and practices that minimize time loss following a work injury. Am. J. Ind. Med. © 2015 Wiley Periodicals, Inc.
    No preview · Article · Jan 2015 · American Journal of Industrial Medicine
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    ABSTRACT: Objectives: We describe trends in occupational and nonoccupational injury among working-age adults in Ontario. Methods: We conducted an observational study of adults aged 15 to 64 over the period 2004 through 2011, estimating the incidence of occupational and nonoccupational injury from emergency department (ED) records and, separately, from survey responses to 5 waves of a national health interview survey. Results: Over the observation period, the annual percentage change (APC) in the incidence of work-related injury was -5.9% (95% confidence interval [CI] = -7.3, -4.6) in ED records and -7.4% (95% CI=-11.1, -3.5) among survey participants. In contrast, the APC in the incidence of nonoccupational injury was -0.3% (95% CI=-0.4, 0.0) in ED records and 1.0% (95% CI=0.4, 1.6) among survey participants. Among working-age adults, the percentage of all injuries attributed to work exposures declined from 20.0% in 2004 to 15.2% in 2011 in ED records and from 27.7% in 2001 to 16.9% in 2010 among survey participants. Conclusions: Among working-age adults in Ontario, nearly all of the observed decline in injury incidence over the period 2004 through 2011 is attributed to reductions in occupational injury.
    Preview · Article · Dec 2014 · American Journal of Public Health
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    ABSTRACT: Objective Work-related musculoskeletal disorders (MSDs) are the leading cause of work disability in the developed economies. The objective of this study was to describe trends in the incidence of MSDs attributed to work exposures in Ontario over the period 2004–2011. Methods An observational study of work-related morbidity obtained from three independent sources for a complete population of approximately six million occupationally active adults aged 15–64 in the largest Canadian province. We implemented a conceptually concordant case definition for work-related non-traumatic MSDs in three population-based data sources: emergency department encounter records, lost-time workers’ compensation claims and representative samples of Ontario workers participating in consecutive waves of a national health interview survey. Results Over the 8-year observation period, the annual per cent change (APC) in the incidence of work-related MSDs was −3.4% (95% CI −4.9% to −1.9%) in emergency departments’ administrative records, −7.2% (−8.5% to −5.8%) in lost-time workers’ compensation claims and −5.3% (−7.2% to −3.5%) among participants in the national health interview survey. Corresponding APC measures for all other work-related conditions were −5.4% (−6.6% to −4.2%), −6.0% (−6.7% to −5.3%) and −5.3% (−7.8% to −2.8%), respectively. Incidence rate declines were substantial in the economic recession following the 2008 global financial crisis. Conclusions The three independent population-based data sources used in this study documented an important reduction in the incidence of work-related morbidity attributed to non-traumatic MSDs. The results of this study are consistent with an interpretation that the burden of non-traumatic MSDs arising from work exposures is declining among working-age adults.
    Preview · Article · Oct 2014 · Occupational and Environmental Medicine
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    ABSTRACT: Background While companies talk about the importance of management and organizational initiatives, such as the presence of a strong safety culture or disability management system to promote good occupational health and safety (OHS) and disability management systems (DMS) there is little scientific evidence to support which leading indicators, among many, to use. There is little evidence on the distribution of disability management systems across industrial sectors and firm size, and whether disability policies and practices co-vary with businesses with strong safety cultures. Methods A random selection of organizations registered with the Workplace Safety and Insurance Board (WSIB) were recruited in collaboration with the Ontario Health and Safety Associations (HSA). The sample was representative of all sectors except forestry and mining. Participants completed an online questionnaire about their firms’ organizational policies and practices (OPP), using the organizational policies and practices questionnaire. The disability policy and practice (DPP) scale was measured with seven items. Firm survey data was linked to their WSIB claims data. Results A sample of over 1,900 firms completed an on-line questionnaire. The disability policy and practice (DPP) scale has strong internal consistency (α= 0.92) and test-retest reliability (ICC = 0.84), and reasonable structural validity (CHISQ=1462, df= 311, p< 0.0001, CFI= 0.93, TLI= 0.92, RMSEA (95% CI)= 0.048 (0.046, 0.051)). While it was expected that the DPP scale would co-vary with injuries and illnesses in a negative way, it was positive, suggesting that organizations with problematic workers compensation claims rates implement DPPs to redress these problems. How the DPP scale co-varies with the other OPP scales and by industrial sector will be reported. Conclusions This is the first study to report the variability in DPPs at the organizational level in a representative sample of firms in a jurisdiction. The DPP scale is shown to have high reliability and validity and may represent a useful leading indicator for jurisdictions interested in managing sustainable return to work. The DPP does not always co-vary in accordance with other OPP scales for managing occupational health & safety in an organization which has implications for benchmarking.
    Full-text · Conference Paper · Sep 2014
  • Imelda S Wong · Peter M Smith · Cameron A Mustard · Monique Am Gignac
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    ABSTRACT: Objectives: The aim of this study was to examine the risk of work injury associated with changes in shift schedules and identify whether work injury risks differ between men and women. Methods: Longitudinal panels from the Survey of Labor and Income Dynamics were used to describe work schedule patterns over a 6-year period among a representative sample of Canadian workers (N=19 131). Cox regression was used to estimate the risk of work injury among workers who (i) switched from regular day to nonstandard shifts, (ii) switched from nonstandard to day shifts and (iii) remained in nonstandard shifts, compared with (iv) those who worked regular day shifts only. Gender differences were examined in separate stratified analyses. Adjustments were made for potential respondent and occupational confounders. Results: Increased injury risk was observed among those who: switched from day to nonstandard shifts [hazard ratio (HR) 2.60, 95% confidence interval (95% CI) 1.79-3.77], switched from nonstandard to days (HR 2.36, 95% CI 1.62-3.49), and worked nonstandard shifts only (HR 1.44, 95% CI 1.23-1.70). For women, work injury risk was higher among those who switched shifts (days to nonstandard HR 3.10, 95% CI 1.76-5.46; nonstandard to days HR 2.31, 95% CI 1.36-3.91), or worked nonstandard shifts only (HR 1.85, 95% CI 1.44-2.37) compared to day schedules. However, for men the risk of injury was elevated only among those who switched shifts (days to nonstandard HR 2.18, 95% CI 1.35-3.51; nonstandard to days HR 2.38, 95% CI 1.41-3.95). The only significant difference between men and women were among nonstandard shift workers. Conclusions: Our results suggest that changing shift types may increase work injury risk among men and women, and that the risk remains increased among women who work nonstandard shifts for a prolonged period of time. This highlights the need for awareness and implementation of health and safety programs when workers initially change shift schedules and on a regular basis to maintain worker health.
    No preview · Article · Sep 2014 · Scandinavian Journal of Work, Environment & Health
  • Imelda S Wong · Peter M Smith · Cameron A Mustard · Monique A M Gignac
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    ABSTRACT: Background: The purpose of this study is to examine the risk of a work-injury absence and the likelihood of receiving compensation among partnered and lone mothers and fathers. Methods: This study utilized data from an annual survey of Canadian residents. Logistic regression models examined the association between family status and the receipt of workers' compensation, and absences due to work-related injury or illnesses of 7 or more days. Results: Being a lone mother was significantly associated with the risk of work-injury absence. Gender differences were observed for workers' compensation: mothers were half as likely as fathers to receive workers' compensation benefits, which may be attributed to differences in work experiences between men and women. Conclusions: Findings may help in understanding whether some parental situations are more vulnerable than others and may contribute to identifying policies that could help workers sustain employment or return to work following an injury.
    No preview · Article · Aug 2014 · American Journal of Industrial Medicine
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    Melanie Fortune · Cameron Mustard · Patrick Brown
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    ABSTRACT: Purpose: To assess the associations of occupational heat and cold-related illnesses presenting in emergency departments in south western Ontario, Canada, with daily meteorological conditions using Bayesian inference. Methodology: Meteorological and air pollution data for the south western economic region of Ontario were gathered from Environment Canada and the Ministry of Environment. Daily heat and cold-related emergency department visits clinically attributed to work from 2004 to 2010 were tabulated. A novel application of Bayesian inference on a flexible Poisson time series model was undertaken to examine linear and non-linear associations between average, regional meteorological conditions and daily morbidity rates, to adjust for relevant confounders and temporal trends, and to consider potential interactions. Results: Bilinear associations were observed between regional temperatures and morbidities resulting from extreme temperature exposures. The median increase in the daily rate of emergency department visits for heat illness was 75% for each degree above 22°C (posterior 95% credible interval (CI) relative rate=1.56-1.99) in the daily maximum temperature. Below 0°C, rates of occupational cold illness increased by a median of 15% for each degree decrease in the minimum temperature (posterior 95% CI 0.80-0.91); wind speed also had a significant effect. Conclusions: The observed associations can inform occupational surveillance and injury prevention programming, as well as public health efforts targeting vulnerable populations. Methodologically, the use of Bayesian inference in time series analyses of meteorological exposures is feasible and conducive to providing accurate advice for policy and practice.
    Preview · Article · May 2014 · Environmental Research
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    ABSTRACT: To examine if age differences in the consequences of work injury are exacerbated when occupational physical demands are higher. A secondary analysis of workers' compensation claims in British Columbia (N = 373,672). Regression models examined the relationship between age and health care expenditures, days of wage replacement and the occurrence of long-term-disability following a work-related injury in occupations with lower and higher physical demands. Models were adjusted for individual and injury related covariates. Older age and higher occupational physical demands were associated with worse work-injury outcomes. The relationship between age and each outcome was not exacerbated when occupational physical demands were higher compared to when they were lower. Counter to our hypotheses age differences in health care expenditures were smaller among women in more demanding occupations. In this study, we found no evidence that the relationship between age and the consequences of work injury is exacerbated when physical occupational demands are high. Am. J. Ind. Med. © 2014 Wiley Periodicals, Inc.
    No preview · Article · Apr 2014 · American Journal of Industrial Medicine
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    Melanie Fortune · Cameron Mustard · Patrick Brown
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    ABSTRACT: Purpose To assess the associations of occupational heat and cold-related illnesses presenting in emergency departments in south western Ontario, Canada, with daily meteorological conditions using Bayesian inference. Methodology Meteorological and air pollution data for the south western economic region of Ontario were gathered from Environment Canada and the Ministry of Environment. Daily heat and cold-related emergency department visits clinically attributed to work from 2004 to 2010 were tabulated. A novel application of Bayesian inference on a flexible Poisson time series model was undertaken to examine linear and non-linear associations between average, regional meteorological conditions and daily morbidity rates, to adjust for relevant confounders and temporal trends, and to consider potential interactions. Results Bilinear associations were observed between regional temperatures and morbidities resulting from extreme temperature exposures. The median increase in the daily rate of emergency department visits for heat illness was 75% for each degree above 22 °C (posterior 95% credible interval (CI) relative rate=1.56–1.99) in the daily maximum temperature. Below 0 °C, rates of occupational cold illness increased by a median of 15% for each degree decrease in the minimum temperature (posterior 95% CI 0.80–0.91); wind speed also had a significant effect. Conclusions The observed associations can inform occupational surveillance and injury prevention programming, as well as public health efforts targeting vulnerable populations. Methodologically, the use of Bayesian inference in time series analyses of meteorological exposures is feasible and conducive to providing accurate advice for policy and practice.
    Preview · Article · Jan 2014
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    ABSTRACT: Reducing health inequalities has become a major public health priority internationally. However, how best to achieve this goal is not well understood. Population health intervention research has the potential to address some of this knowledge gap. This review argues that simulation studies can produce unique evidence to build the population health intervention research evidence base on reducing social inequalities in health. To this effect, the advantages of using simulation models over other population health intervention research methods are discussed. Key questions regarding the potential challenges of developing simulation models to investigate population health intervention research on reducing social inequalities in health and the types of population health intervention research questions that can be answered using this methodology are reviewed. We use the example of social inequalities in coronary heart disease to illustrate how simulation models can elucidate the effectiveness of a number of 'what-if' counterfactual population health interventions on reducing social inequalities in coronary heart disease. Simulation models are a flexible, cost-effective, evidence-based research method with the capacity to inform public health policy-makers regarding the implementation of population health interventions to reduce social inequalities in health.
    Full-text · Article · Dec 2013 · Journal of epidemiology and community health
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    ABSTRACT: To estimate the contribution of preexisting chronic conditions on age differences in health care expenditures for the management of work-related musculoskeletal injuries in British Columbia. A secondary analysis of workers' compensation claims submitted over the 5-year period between January 1, 2002 and December 31, 2006 (N=55,827 claims among men and 32,141 claims among women). Path models examined the relationships between age and health care expenditures, and the extent to which age differences in health care expenditures were mediated by preexisting chronic conditions. Models were adjusted for individual, injury, occupational, and industrial covariates. The relationship between age and health care expenditures differed for men and women, with a stronger age gradient observed among men. Preexisting osteoarthritis and coronary heart disease were associated with elevated health care expenditures among men and women. Diabetes was associated with elevated health care expenditures among men only, and depression was associated with elevated health care expenditures among women only. The percentage of the age effect on health care expenditures that was mediated through preexisting chronic conditions increased from 12.4% among 25-34-year-old men (compared with 15-24 y) to 26.6% among 55+-year-old men; and 14.6% among 25-34-year-old women to 35.9% among women 55 and older. The results of this study demonstrate that differences in preexisting chronic conditions have an impact on the relationship between older age and greater health care expenditures after a work-related musculoskeletal injury. The differing prevalence of preexisting osteoarthritis, coronary heart disease, and to a lesser extent diabetes (among men) and depression (among women) across age groups explain a nontrivial proportion of the age effect in health care expenditures after injury. However, approximately two thirds or more of the age effect in health care expenditures remains unexplained.
    No preview · Article · Nov 2013 · Medical care
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    ABSTRACT: To describe the incidence of occupational heat illness in Ontario. Heat illness events were identified in two population-based data sources: work-related emergency department (ED) records and lost time claims for the period 2004-2010 in Ontario, Canada. Incidence rates were calculated using denominator estimates from national labour market surveys and estimates were adjusted for workers' compensation insurance coverage. Proportional morbidity ratios were estimated for industry, occupation and tenure of employment. There were 785 heat illness events identified in the ED encounter records (incidence rate 1.6 per 1,000,000 full-time equivalent (FTE) months) and 612 heat illness events identified in the lost time claim records (incidence rate 1.7 per 1,000,000 FTE months) in the seven-year observation period with peak incidence observed in the summer months. The risk of heat illness was elevated for men, young workers, manual workers and those with shorter employment tenure. A higher proportion of lost time claims attributed to heat illness were observed in the government services, agriculture and construction sectors relative to all lost time claims. Occupational heat illnesses are experienced in Ontario's population and are observed in ED records and lost time claims. The variation of heat illness incidence observed with worker and industry characteristics, and over time, can inform prevention efforts by occupational health services in Ontario.
    No preview · Article · Nov 2013
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    ABSTRACT: Relatively little attention has been paid to understanding and addressing the potential health-related barriers faced by older workers to stay at work. Using three representative samples from the Canadian Community Health Survey, we examined the relationship between seven physical chronic conditions and labour market participation in Canada between 2000 and 2005. We found that all conditions were associated with an increased probability of not being able to work due to health reasons. In our adjusted models, heart disease was associated with the greatest probability of not working due to health reasons. Arthritis was associated with the largest population attributable fraction. Other variables associated with not being able to work due to health reasons included older age, female gender and lower educational attainment. We also found particular combinations of chronic conditions (heart disease and diabetes; and arthritis and back pain) were associated with a greater risk than the separate effects of each condition independently. The results of this study demonstrate that chronic conditions are associated with labour market participation limitations to differing extents. Strategies to keep older workers in the labour market in Canada will need to address barriers to staying at work that result from the presence of chronic conditions, and particular combinations of conditions.
    No preview · Article · Nov 2013 · Ageing and Society
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    ABSTRACT: This study aims to examine the extent to which a greater prevalence of pre-existing chronic conditions among older workers explains why older age is associated with longer duration of sickness absence (SA) following a musculoskeletal work-related injury in British Columbia. A secondary analysis of workers' compensation claims in British Columbia over three time periods (1997-1998; 2001-2002, and 2005-2006), the study comprised 102 997 and 53 882 claims among men and women, respectively. Path models examined the relationships between age and days of absence and the relative contribution of eight different pre-existing chronic conditions (osteoarthritis, rheumatoid arthritis, hypertension, coronary heart disease, diabetes, thyroid conditions, hearing problems, and depression) to this relationship. Models were adjusted for individual, injury, occupational, and industrial covariates. The relationship between age and length of SA was stronger for men than women. A statistically significant indirect effect was present between older age, diabetes, and longer days of SA among both men and women. Indirect effects between age and days of SA were also present through osteoarthritis, among men but not women, and coronary heart disease, among women but not men. Depression was associated with longer duration of SA but was most prevalent among middle-aged claimants. Approximately 70-78% of the effect of age on days of SA remained unexplained after accounting for pre-existing conditions. Pre-existing chronic conditions, specifically diabetes, osteoarthritis and coronary heart disease, represent important factors that explain why older age is associated with more days of SA following a musculoskeletal injury. Given the increasing prevalence of chronic conditions among labor market participants (and subsequently injured workers) moderate reductions in age differences in SA could be gained by better understanding the mechanisms linking these conditions to longer durations of SA.
    Preview · Article · Oct 2013 · Scandinavian Journal of Work, Environment & Health
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    ABSTRACT: The study sought to identify gender differences in work-related repetitive strain injuries (RSI), as well as examine the degree to which non-work factors such as family roles interact with gender to modify RSI risk. Another aim is to examine whether there are potential provincial differences in work-related RSI risk. The 2003/2005 Canadian Community Health Survey included over 89,000 respondents who reported working in the past 12 months. Separate multi-level models for men and women were used to identify the correlates of work-related RSIs. Women reported sustaining more work-related RSIs than men. Also, having one or more children in the household was associated with lower work-related RSI risk for females. Both men and women in British Columbia reported higher work-related RSI rates than in Ontario. Gender contributes to RSI risk in multiple and diverse ways based on labor market segregation, non-work exposures, and possibly biological vulnerability, which suggests more tailored interventions. Also, the provincial differences indicate that monitoring and surveillance of work injury across jurisdictions can assist in province-wide prevention and occupational health and safety evaluation. Am. J. Ind. Med. © 2013 Wiley Periodicals, Inc.
    Preview · Article · Oct 2013 · American Journal of Industrial Medicine
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    Peter M Smith · Cameron A Mustard

    Preview · Article · Oct 2013 · Canadian Medical Association Journal

Publication Stats

4k Citations
568.55 Total Impact Points

Institutions

  • 2000-2015
    • Institute for Work and Health
      Toronto, Ontario, Canada
    • Statistics Canada
      Ottawa, Ontario, Canada
  • 1996-2015
    • University of Toronto
      • • Faculty of Medicine
      • • Department of Psychiatry
      Toronto, Ontario, Canada
  • 2005-2008
    • McMaster University
      • • Department of Economics
      • • Department of Clinical Epidemiology and Biostatistics
      Hamilton, Ontario, Canada
    • Institute for Clinical Evaluative Sciences
      Toronto, Ontario, Canada
  • 1993-2003
    • University of Manitoba
      • • Manitoba Centre for Health Policy
      • • Department of Community Health Sciences
      • • Faculty of Medicine
      Winnipeg, Manitoba, Canada
  • 1994-1999
    • Health Sciences Centre Winnipeg
      Winnipeg, Manitoba, Canada
  • 1995
    • The University of Winnipeg
      Winnipeg, Manitoba, Canada