This qualitative study explored common and divergent perceptions of caregivers and managers regarding occupational health and safety, work organization, and psychosocial concerns in long-term care centers. Both common and differing issues were identified. Both groups agreed on the importance of ergonomic concerns, the high prevalence of stress, and receptiveness to participatory health promotion programs. However, numerous work organization issues and physical and psychosocial workplace hazards were identified by certified nursing assistants but were not mentioned by managers. The results suggest that different perceptions naturally arise from people's varying positions in the occupational hierarchy and their consequent exposures to health and safety hazards. Improved systems of communication that allow frontline workers to express their concerns would make it possible to create solutions to these problems.

CaseOn a very hot and hum id afternoon, a 19-year-old male, who was employe d as a landscaper, was found uncons cious, by a co-worker, lying next to his lawnm ow er. This had been the ® rst day on the job for this young man. Em ergency room and hospital records revealed that the employee displayed classic signs and symptom s of heat stroke including an extremely elevated body temperature (108 ± F rectal), m inim al perspiration, anuria, and unresponsiveness. Despite the use of a cooling blanket and iced intravenous¯uids, he experienced seizures, began sponta neously bleeding, and required respiratory support. Little m ore than 36 hours after the incident, he experienced ventricular ® brillation and died.The case was investigated by the Occupational Safety and Health Adm inistration (OSH A). M eteorological data from the day of the incident indicated borderline exposure (various indexestemperature, hum idity), but more importantly, the worker was not acclimatized nor was water available (at least the worker was not aware of where to get it). The inspection resulted in the issuance of citations to the employer; the employer settled the case at an inform al conference. EpidemiologyHeat-related conditions range from heat stroke and heat exhaustion, to heat cramps and heat rash. An estimated six m illion workers in the United States are exposed to occupational heat stress; how ever, estimates of the deaths and illnesses associated with occupational heat exposures are dif® cult to obtain. This is re¯ected by the general problem of identifying work-related illnesses because there is no systematic method in the United States to record their occurrence. M ore often than not, neither the worker nor the physician makes the conne ction between workplace exposures and adverse health events. (1) Also, the criteria to de® ne a heat-related death differ by state and among individual physicians, m edical exam iners, and coroners. (2) From 1979±1995 the annual num ber of deaths due to heat varied widely (148± 1700) in the United States. (3) During this period, a total of 6615 deaths in the United States were attributed to excessive heat exposure; of these, 2792 (42 percent) were ª due to weather conditionsº ; 327 (5 percent) were ª of m anm ade originº ; and 3496 (53 percent) were ª of unspeci® ed origin.º (3,4)