title: The effect of rest breaks on time to injury - a study on work-related ladder-fall injuries in the         United States.
abstract: OBJECTIVE
  Rest breaks and other work-related temporal factors, such as time spent on task, influence the         accumulation of fatigue, and thus impact occupational injury risk. The aim of this study was to investigate the effect         of rest breaks on "time to injury" (the time between start of work and injury) for injured workers treated         in a nationally representative sample of US emergency departments.
  
  
  METHODS
  Using the National Electronic Injury         Surveillance System (NEISS), we identified 629 workers who had experienced a work-related ladder-fall. Of these, 306         were interviewed by telephone using a standardized questionnaire about the circumstances surrounding the injury.         Survival analyses were used to estimate time to injury, and hazard ratios (HR) for time to injury were compared between         workers who reported no rest break (reference) and workers who reported rest break(s) prior to the injury (accumulated         break time categorized into 0, 1-15, 16-30, and >30 minutes). Age, gender, time of work start, injury         time of day, and workload were included as covariates to control for demographic, circadian, and work-related factors,         respectively.
  
  
  RESULTS
  A clear dose-response relation indicated that longer accumulated break time was associated         with a significantly longer time to injury when compared to workers without rest breaks [total break time 1-15         minutes: HR 0.60, 95% confidence interval (95% CI) 0.44-0.83; 16-30 minutes: HR 0.50, 95% CI         0.33-0.75; >30 minutes: HR 0.34, 95% CI 0.23-0.51], adjusted for all covariates.
  
  
  CONCLUSIONS
  The         results showed that longer total rest break time allowed for a significantly prolonged time spent on task without an         injury. These findings suggest that rest break design could be used as a tool to enhance fatigue management and         workplace safety.
authors.affiliation: Gesellschaft für Arbeits-, Wirtschafts- und Organisationspsychologische Forschung (GAWO) e.V., Achterdiek 50, 26131 Oldenburg, Germany. anna.arlinghaus@gawo-ev.de
authors.forename: Anna
authors.initials: A
authors.lastname: Arlinghaus
authors.forename: David A
authors.initials: DA
authors.lastname: Lombardi
authors.forename: Theodore K
authors.initials: TK
authors.lastname: Courtney
authors.forename: David C
authors.initials: DC
authors.lastname: Christiani
authors.forename: Simon
authors.initials: S
authors.lastname: Folkard
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Perry
mesh_terms: D000058:Accidental Falls; D000062:Accidents, Occupational; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D014481:United States / Q000453:epidemiology; D014940:Work Schedule Tolerance