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Work related traumatic brain injury due to assault

Work related traumatic brain injury due to assault. Tatyana Mollayeva, MD, PhD ( cand ). Co-authors and funding. Co-authors: Shirin Mollayeva, BSc ( cand ), John Lewko , PhD, Angela Colantonio , PhD Funding:. Disclosure. The authors have no conflict of interest to disclose.

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Work related traumatic brain injury due to assault

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  1. Work related traumatic brain injury due to assault Tatyana Mollayeva, MD, PhD (cand)

  2. Co-authors and funding • Co-authors: • Shirin Mollayeva, BSc (cand), John Lewko, PhD, Angela Colantonio, PhD • Funding:

  3. Disclosure • The authors have no conflict of interest to disclose

  4. Traumatic brain injury: definition “an alteration in brain function, or other evidence of brain pathology, caused by an external force”1 • 1Brain Injury Association of America. About Brain Injury. 2011. Retrieved June 10, 2012, from http://www.biausa.org/about-brain-injury.htm.

  5. Background • ≈628,000 Canadians live w/ brain injury-related disability1 • Over 50% are under 20 years of age1 • Most traumatic brain injury (TBI) causes preventable (e.g. falls, motor vehicle accidents, assaults) • TBIs at work (wrTBI) may differ in patterns and risks from injuries outside the workplace2,3 • wrTBIs, 1993-2001: 3.6% assault-related, likely underestimate4 • Occupational Health and Safety Act wrt workplace violence5 - assault at work a broad public health concern • Physical and psychological effects severe, assoc. with great financial loss6 • NHCC and BIAC Election messaging. (2011, 3 29). Retrieved 04 04, 2014, from Brain injury Association of Canada: http://biac-aclc.ca/2011/03/29/nhcc-and-biac-election-messaging/. • Workplace Safety and Insurance Board’s (WSIB) 2005 Annual Report. Retrieved 01 01,2014, from http://www.wsib.on.ca/files/Content/Downloadable%20File2005StatisticalSupplement/2278A_StatSup.pdf • ColantonioA, Mroczek D, Patel J, Lewko J, Fergenbaum J, Brison R. Examining occupational traumatic brain injury in Ontario. Can J Pub Health. 2010; 101: S58-62. • Kim H, Colantonio A, Chipman M. Traumatic brain injury occuring at work. Neurorehabil, 2006; 21: 269-278. • Canadian Centre for Occupational Health and Safety Act. Retrieved 4 11, 2013, from http://www.gov.pe.ca/law/statutes/pdf/o-01_01.pdf.

  6. Gap in knowledge and study objectives • Despite evidence for risks of work-related assault, data on wrTBI due to assault in Canada is lacking • Objectives: • Assess extent of assault resulting in TBI by sex, across occupational sectors in Ontario • Examine related demographic and workplace characteristics • Provide better understanding of circumstances of incidents

  7. Data collection • Case series design, examined all claims with 2004 injury date and categorized as “intracranial injury” or “concussion”, also examined “traumatic” fatalities • 1,006 files met criteria, positive identification of TBI; accepted only with confirmed diagnosis by physician of “concussion”, “closed head injury”, “contusion”, “head injury with sequelae consistent with brain injury”1 • Qualitative and qualitative data analyses 1. Colantonio A, Mrockzek D, Patel J, Lewko J, Fergenbaum J, Brison R. Examining occupational traumatic brain injury. Can J of Public Health. 2010; 101(2): S58-62.

  8. Variables • Socio-demographic (i.e. sex, age, occupation type/sector, years employed) • Injury-related (i.e. mechanism of injury, shift worked, date/time of injury, day of week) • Event summaries to categorize cases by type and source of aggression

  9. Data analysis • Frequency distributions, central dispersion for demographic and injury variables • Denominator: Statistics Canada 2004 data on employment, by sex1 • Case categorization:2 • Type 1: external/intrusive violence (assailants have no relationship to workplace) • Type 2: consumer/client related offence (related to interaction w/ customer/patient/student) • Type 3: relationship violence (assailant a co-worker or partner) • Type 4: organizational violence (assault premeditated, carried out by coordinated force/group of people) • Government of Canada. Economic Data Tables. Retrieved 3 11, 2013, from Statistics Canada: Employment by age, sex, type of work, class of worker and province (monthly):http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/labr66g-eng.htm. • Bowie V. Workplace Violence. New South Wales: Work Cover; 2002.

  10. Results

  11. Demographic characteristics • Age range=20-64 (median 37 y.o.) • ≈assault-related wrTBI claim rate=9.85/1 million Ontario employees • Claim rate for women≈11.79/1 mil Ontario workers; men≈8.4/1 mil • Frequency of wrTBI caused by physical assault greater in female employees (59.1%), higher than that for all TBI cases of all mechanisms (42.3%)

  12. Demographic characteristics

  13. Sex differences within sectors Health care/social services sector: • Rate of wrTBI six-fold higher for female workers Education sector: • Rate of wrTBI four-fold higher for female workers Police/guard/law enforcement sector: • Rate of wrTBI 13-fold higher for male workers

  14. Work experience • 43% employed <1 year

  15. Temporal characteristics • Highest number of TBIs due to assault in 2004 occurred in March and November • Weekly peaks – Mondays and Fridays • Most injuries occurred in late morning and early afternoon

  16. Event-related characteristics Images: Yow Canada Inc.

  17. Event-related characteristics • >40% of assaults resulting in wrTBI occurred in one-on-one interactions with clients; >1/3 - dealing with irate/angry clients • 23% - attempts to restrain/follow suspicious individuals • 12% - dealing with disabled/special needs individuals or those with awareness issues • 7% - in mobile workplaces (i.e. taxi, bus, etc.) • Sex differences: additional injuries to other body parts (e.g. neck, arms, etc.) – more in women (79%)

  18. Cost of claims • 10 female and 5 male workers • Total days of disability=8,953 • Women accrued more disability days compared to men (5,166 vs. 3,787) • 75% off work for >2 months

  19. Limitations • Estimates yielded conservative as approximately 70% of Ontario workers are insured by WSIB • Remaining 30% may not have similar characteristics • wrTBI due to assault examined for a period of one year only; a longer period of time is needed to understand the full scope of the mechanism of wrTBI

  20. Implications for prevention • Workers with less experience (i.e. <3 years employed) overrepresented: training promoting awareness of workplace assault, testing on ability to identifying risks prior to release to independent duty. • Working with persons with cognitive and/or mental health challenges: conflict management, empathy, training to predict and react to aggression • One-on-one with client: self-defense, working in pairs • Guarding property, following suspect: restraint and self-defense training • Mobile workplace: training to recognize potentially threatening situations, client awareness of zero tolerance policy for aggression and assault toward workers

  21. Conclusions • First paper examining wrTBI due to assault; representative sample of workers; focus on sex • wrTBI due to assaultacross industries and types of physicalaggression • Results can serve as a basis for furtherwrTBI surveillance work; stimulatedevelopmentof appropriate control efforts in work-relatedassault

  22. Thank you!

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