Effect of recall period on the reporting of occupational injuries among older workers in the Health and Retirement Study

Accuracy of self-reported injuries compared to medical record data

BACKGROUND

Self-reported injury data are frequently used in epidemiologic investigations. These data provide useful information about the activities and mechanisms of injuries because injury cause-coding is often not required for outpatient medical visits.

OBJECTIVES

The purpose of this evaluation is to determine the accuracy of self-reported military injuries when compared to injuries in outpatient medical records.

METHOD

Injuries reported by survey were compared to diagnoses for injuries (International Classification of Diseases (ICD-9-CM 800-999)) and injury-related musculoskeletal disorders (selected ICD-9-CM 710-739) obtained from medical records. Self-reported injury responses from military personnel were matched to diagnoses by date and body part. A new methodology for including secondary matching body parts was proposed and implemented.

RESULTS

Infantry Soldiers (n = 5490) completed surveys that requested details about their most recent injury. About one-quarter (24%, n = 1336) reported injuries on the survey and had an injury diagnosis in their medical record in a six month period. Seventy-five percent of the self-reported injuries (n = 996 of 1336) were confirmed by medical records with a date match within 3 months and an identical or nearby body part. Common self-reported injuries were ankle sprains (10%), knee sprains (9%), lower back strains (4%), shoulder strains (3%), and lower back pain (3%).

CONCLUSIONS

A high percentage of self-reported injuries were accurate when compared with medical records, substantiating the use of survey data for the evaluation of injury outcomes. This is the first effort to validate self-reported injuries and musculoskeletal disorders with medical records in a large military population.

Modelling memory decay after injuries using household survey data from Khartoum State, Sudan

BACKGROUND

Injuries represent an important cause of morbidity and mortality worldwide. In retrospective epidemiological studies, estimated rates of reported injuries often decline considerably when information is included from periods more than a few months before the data collection. Such low rates are usually regarded as a consequence of memory decay. It is largely unknown whether the extent of memory decay depends on external factors otherwise affecting injury rates.

METHODS

A statistical model was introduced to separate the influence of external factors on true injury rates from effects on memory decay. The relationship between apparent rates and time elapsed between injury occurrence and data collection was described by a parametric regression model. Relationships between memory decay and external factors were modelled by effect modification of the relationship with time. The procedure was applied to data collected in a retrospective household survey, carried out in Khartoum State in 2010, which elicited information about injuries that had occurred during the last year. The survey included 5661 individuals in 973 households, reporting a total of 481 non-fatal injuries.

RESULTS

In the data from Khartoum State, differences in memory recall were observed between socioeconomic groups, with considerably faster memory decay in the lower socioeconomic tertile. In this tertile the estimated probability that an injury which occurred 6 months ago was reported was only 18%, compared to probabilities of about 35% in the remainder of the population. In the lower socioeconomic tertile, in contrast to other groups, a simple exponential model was not sufficient for describing memory decay. Memory decay did not depend on sex, age, urban/rural status or education. Road traffic injuries were subject to less memory decay than injuries due to falls, mechanical causes and burns. Memory decay seriously affected crude overall injury rates and also to some degree estimated relative rates.

CONCLUSION

In the statistical analysis of retrospective injury data it is important to take into account the effects of memory decay.

Accuracy of recall of musculoskeletal injuries in elite military personnel: a cross-sectional study

BACKGROUND

Self-reported data are often used in research studies among military populations.

OBJECTIVE

The accuracy of self-reported musculoskeletal injury data among elite military personnel was assessed for issues with recall.

DESIGN

Cross-sectional study.

SETTING

Applied research laboratory at a military installation.

PARTICIPANTS

A total of 101 subjects participated (age 28.5±5.6 years). Study participants were active duty military personnel, with no conditions that precluded them from full duty.

PRIMARY AND SECONDARY OUTCOME MEASURES

Self-reported and medical record reviewed injuries that occurred during a 1-year period were matched by anatomic location, injury side (for extremity injuries), and injury year and type. The accuracy of recall was estimated as the per cent of medical record reviewed injuries correctly recalled in the self-report. The effect of injury anatomic location, injury type and severity and time since injury, on recall, was also assessed. Injuries were classified as recent (≤4 years since injury) or old injuries (>4 years since injury). Recall proportions were compared using Fisher's exact tests.

RESULTS

A total of 374 injuries were extracted from the subjects' medical records. Recall was generally low (12.0%) and was not different between recent and old injuries (P=0.206). Injury location did not affect recall (P=0.418). Recall was higher for traumatic fractures as compared with less severe non-fracture injuries (P values 0.001 to <0.001). Recall for non-fracture injuries was higher for recent as compared with old injuries (P=0.033). This effect of time since injury on recall was not observed for fractures (P=0.522).

CONCLUSIONS

The results of this study highlight the importance of weighing the advantages and disadvantages of self-reported injury data before their use in research studies in military populations and the need for future research to identify modifiable factors that influence recall.

Law enforcement officers' risk perceptions toward on-duty motor-vehicle events

PURPOSE

Motor-vehicle-related events (MVEs) are the leading cause of on-duty death for law enforcement officers, yet little is known about how officers view this significant job hazard. The purpose of this paper is to explore officers' motor-vehicle risk perception and examine how prior on-duty MVEs and the death or injury of a fellow officer influences this perception.

DESIGN/METHODOLOGY/APPROACH

A state-wide random sample of 136 law enforcement agencies was drawn using publically accessible databases, stratified on type and size of agency. In total, 60 agencies agreed to participate and a cross-sectional questionnaire was distributed to 1,466 officers. Using six-point Likert scales, composite scores for motor-vehicle and intentional violence risk perception were derived. A linear regression multivariable model was used to examine factors affecting motor-vehicle risk perception.

FINDINGS

Motor-vehicle risk perception scores were significantly higher than intentional violence scores. A prior on-duty motor-vehicle crash, prior roadside incident, or knowledge of fellow officer's injury or death from a MVE significantly increased motor-vehicle risk perception scores. After controlling for potential confounders though, only prior on-duty crashes and roadside incidents impacted motor-vehicle risk perception.

RESEARCH LIMITATIONS/IMPLICATIONS

The study comprised primarily small, rural agencies and generalizability may be limited. Also, although the data were collected anonymously, reporting and response biases may affect these findings.

ORIGINALITY/VALUE

This study involved a large and diverse cohort of officers and explored motor-vehicle risk perception. A better understanding of officers' risk perceptions will assist in the development and implementation of occupational injury prevention programs, training, and policy.

A population-based study on road traffic injuries in Pune City, India

OBJECTIVE

The annual mortality of road traffic injuries (RTIs) is estimated to be over 80,000 in India; however, there is not enough information about the magnitude, pattern, and factors associated with RTIs in a population-based scenario, where the police and hospital records suffer from severe underreporting. This study was conducted with the aim of identifying the burden, pattern, and risk factors of RTIs in the population of Pune City.

METHOD

A population-based cross-sectional study was conducted among 9014 individuals in a randomly selected and representative sample of the population from 14 administrative wards of the city from March 2008 to April 2009.

RESULTS

The annual incidence rate of RTIs was 93.2 (95% confidence interval [CI], 83.2-103.2) per 1000 individuals and after adjustment for age it was 76.4 per 1000 individuals. Injury occurrence was significantly more among the age group 15-30, males, and students and workers. Univariate analysis showed a significant association between RTIs and age, gender, occupation, mode of transport, driving a vehicle, and alcohol abuse. Multivariate analysis showed that only age, driving a vehicle, and alcohol abuse were the factors associated with RTIs.

CONCLUSION

The magnitude of RTIs in India is very high, which is not reflected in police registration reports.

Insomnia, comorbidity, and risk of injury among insured Americans: results from the America Insomnia Survey

STUDY OBJECTIVES

To estimate associations of broadly defined insomnia (i.e., meeting inclusion criteria for International Classification of Diseases, Tenth Revision (ICD-10), Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), or Research Diagnostic Criteria/International Classification of Sleep Disorders, Second Edition (RDC/ICSD-2) diagnosis) with workplace/nonworkplace injuries controlling for comorbid conditions among workers in the America Insomnia Survey (AIS).

DESIGN/SETTING

Cross-sectional telephone survey.

PARTICIPANTS

National sample of 4,991 employed health plan subscribers (age 18 yr and older).

INTERVENTIONS

None.

MEASUREMENTS AND RESULTS

Broadly defined insomnia with duration of at least 12 mo was assessed with the Brief Insomnia Questionnaire (BIQ). Injuries in the 12 mo before interview were assessed with a standard self-report measure of injuries causing role impairment or requiring medical attention. Eighteen comorbid condition clusters were assessed with medical/pharmacy claims records and self-reports. Insomnia had significant gross associations (odds ratios, ORs) with both workplace and nonworkplace injuries (OR 2.0 and 1.5, respectively) in logistic regression analyses before controlling for comorbid conditions. The significant population attributable risk proportions (PARPs) of total injuries with insomnia was 4.6% after controlling for comorbid conditions. Only 2 other conditions had PARPs exceeding those of insomnia. The associations of insomnia with injuries did not vary significantly with worker age, sex, or education, but did vary significantly with comorbid conditions. Specifically, insomnia was significantly associated with workplace and nonworkplace injuries (OR 1.8 and 1.5, respectively) among workers having no comorbid conditions, with workplace but not nonworkplace injuries (OR 1.8 and 1.2, respectively) among workers having 1 comorbid condition, and with neither workplace nor nonworkplace injuries (OR 0.9 and 1.0, respectively) among workers having 2 or more comorbid conditions.

CONCLUSIONS

The associations of insomnia with injuries vary with comorbid conditions in ways that could have important implications for targeting workplace interventions.

Injury rates and injury risk factors among Federal Bureau of Investigation new agent trainees

BACKGROUND

A one-year prospective examination of injury rates and injury risk factors was conducted in Federal Bureau of Investigation (FBI) new agent training.

METHODS

Injury incidents were obtained from medical records and injury compensation forms. Potential injury risk factors were acquired from a lifestyle questionnaire and existing data at the FBI Academy.

RESULTS

A total of 426 men and 105 women participated in the project. Thirty-five percent of men and 42% of women experienced one or more injuries during training. The injury incidence rate was 2.5 and 3.2 injuries/1,000 person-days for men and women, respectively (risk ratio (women/men) = 1.3, 95% confidence interval = 0.9-1.7). The activities most commonly associated with injuries (% of total) were defensive tactics training (58%), physical fitness training (20%), physical fitness testing (5%), and firearms training (3%). Among the men, higher injury risk was associated with older age, slower 300-meter sprint time, slower 1.5-mile run time, lower total points on the physical fitness test (PFT), lower self-rated physical activity, lower frequency of aerobic exercise, a prior upper or lower limb injury, and prior foot or knee pain that limited activity. Among the women higher injury risk was associated with slower 300-meter sprint time, slower 1.5-mile run time, lower total points on the PFT, and prior back pain that limited activity.

CONCLUSION

The results of this investigation supported those of a previous retrospective investigation emphasizing that lower fitness and self-reported pain limiting activity were associated with higher injury risk among FBI new agents.

Blurring the distinctions between on and off the job injuries: similarities and differences in circumstances

OBJECTIVES

To compare the causes of non-fatal work and non-work injuries and the places or environments where they occur. It has been suggested that many injuries may have similar etiologies on and off the job and thus involve some common prevention strategies. However lack of comparable data on work relatedness has prevented testing this proposition.

METHODS

The National Health Interview Survey (NHIS) now collects information on the cause, location, and work relatedness of all medically attended injuries. National US estimates of non-fatal work and non-work injuries were compared by cause and place/location for working age adults (18-64 years).

RESULTS

Overall 28.6% of injuries to working age adults were work related (37.5% among employed people). The causes and locations of many work and non-work injuries were similar. Falls, overexertion, and struck/caught by were leading causes for work and non-work injuries. Motor vehicle injuries were less likely to be work related (3.4% at work v 19.5% non-work) and overexertion injuries more likely to be work related (27.1% v 13.8%). Assaults were less than 1% of work injuries and 1.8% of non-work injuries. Both work and non-work injuries occurred in every location examined-including the home where 3.5% of injuries were work related.

CONCLUSIONS

Work and non-work injuries share many similarities suggesting opportunities to broaden injury prevention programs commonly restricted to one setting or the other. Comprehensive efforts to prevent both non-work and work injuries may result in considerable cost savings not only to society but also directly to employers, who incur much of the associated costs.

A comparison of information on motor vehicle crashes as reported by written or telephone interviews

OBJECTIVE

To compare information about traffic crash injuries and kilometers driven reported in a written questionnaire with information reported in a telephone interview.

DESIGN

Telephone and paper surveys.

SETTING

The Seguimiento Universidad de Navarra (SUN, University of Navarra Follow-up) study, in Spain. The SUN study is an open enrollment cohort study with 17 000 enrolled graduates followed through biennial mailed questionnaires.

SUBJECTS

A sample of 542 individuals from the SUN study participants.

MAIN OUTCOME MEASURE

Agreement on information about traffic crash injuries and mileage driven in a mailed questionnaire and a telephone survey.

RESULTS

Participation was 90.4%. Considering the phone survey as the gold standard, data on traffic crash injuries in the mailed questionnaire had 83% sensitivity (95% CI 77% to 89%), 77% specificity (95% CI 71% to 82%), 74% positive predictive value (95% CI 67% to 80%), and 89% negative predictive value (95% CI 83% to 93%). Agreement beyond chance, measured by the kappa statistic, was 0.63 (95% CI 0.56 to 0.70). Correlation between questionnaire and telephone surveys and kilometers driven on average during a year assessed by the intraclass correlation coefficient was 0.64 (95% CI 0.57 to 0.70), p<0.001.

CONCLUSIONS

Information on sustained traffic crash injuries and traveled mileage over the previous two years as reported through mailed questionnaires in a highly educated population could be used in the study of associations between traffic crash injuries and a variety of risk factors.

Hip fractures, nocturia, and nocturnal polyuria in the elderly

This study was undertaken to evaluate the relation between hip fractures and nocturnal micturition habits in elderly men and women. A questionnaire survey was undertaken among 10,216 elderly subjects. The mean (+/-S.D.) ages of the men and women were 73.0+/-6.0 and 72.6+/-6.7 years, respectively. A hip fracture during the past five years had occurred in 97 (3.9%) of the men and 175 (4.6%) of the women and the occurrence increased with increasing age in both sexes. In both men and women nocturnal micturition increased with age. Among men, passing of subjectively large amounts of urine at night was reported to occur never or very seldom in 63.3% and rather seldom, rather often, and very often in 21.9%, 12.7%, and 2.1%, respectively. The corresponding frequencies in women were 65.1%, 17.2%, 13.7%, and 3.9%, respectively. Multiple logistic regression analysis with sex, nocturia, and nocturnal voided volumes as independent variables and occurrence of hip fracture during the last five years as the dependent variable showed that the risk of having had a hip fracture was increased by nocturia three or more episodes versus two or fewer; odds ratio (OR) 1.8, confidence interval (CI) 1.1-3.0, and by large nocturnal urine volumes, very often versus very seldom or never; (OR 3.5; CI 1.8-7.3). One can conclude that in these elderly subjects the risk of hip fractures during a five-year period was increased independently by increased nocturnal micturition and increased nocturnal urine output.

The effects of recall on reporting injury and poisoning episodes in the National Health Interview Survey

OBJECTIVE

To examine effects of length of time between injury or poisoning and interview on the number of reported injury and poisoning episodes in the National Health Interview Survey (NHIS). (Hereinafter, both injuries and poisonings will be referred to as "injuries".)

DESIGN

The NHIS collects data continuously on medically attended injuries occurring to family members during the three months before interview. Time between injury and interview was established by subtracting the reported injury date from the interview date. Values were multiply imputed for the 25% of the episodes for which dates were only partially reported.

MAIN OUTCOME MEASURES

An analysis of mean square error (MSE) was used to quantify the extent of errors in estimated annual numbers of injuries and to compare the contributions of bias and variance to these errors.

RESULTS

The lowest estimated MSEs for annualized estimates for all injuries and for less severe injuries were attained when the annualized estimates were based on 3--6 elapsed cumulative weeks between injury and interview. The average weighted number of injuries reported per week per year was 8% lower in later weeks (weeks 6--13) than in earlier weeks (weeks 1--5) for all episodes, and 24% lower in later weeks than in earlier weeks for contusions/superficial injuries, with both differences being statistically significant. For fractures, however, the averages in the two periods were statistically similar.

CONCLUSIONS

The error associated with the estimated annual number of injuries was large with a three month reference period for all injuries and for less severe injuries. Limiting analysis to episodes with up to five weeks between injury and interview has statistical, intuitive, and analytic appeal for all injuries and for less severe injuries.

Injuries at work in the US adult population: contributions to the total injury burden

OBJECTIVES

We estimated the contribution of nonfatal work-related injuries on the injury burden among working-age adults (aged 18-64 years) in the United States.

METHODS

We used the 1997-1999 National Health Interview Survey (NHIS) to estimate injury rates and proportions of work-related vs non-work-related injuries.

RESULTS

An estimated 19.4 million medically treated injuries occurred annually to working-age adults (11.7 episodes per 100 persons; 95% confidence interval [CI]=11.3, 12.1); 29%, or 5.5 million (4.5 per 100 persons; 95% CI=4.2, 4.7), occurred at work and varied by gender, age, and race/ethnicity. Among employed persons, 38% of injuries occurred at work, and among employed men aged 55-64 years, 49% of injuries occurred at work.

CONCLUSIONS

Injuries at work comprise a substantial part of the injury burden, accounting for nearly half of all injuries in some age groups. The NHIS provides an important source of population-based data with which to determine the work relatedness of injuries. Study estimates of days away from work after injury were 1.8 times higher than the Bureau of Labor Statistics (BLS) workplace-based estimates and 1.4 times as high as BLS estimates for private industry. The prominence of occupational injuries among injuries to working-age adults reinforces the need to examine workplace conditions in efforts to reduce the societal impact of injuries.

Factors associated with preterm delivery in mothers of children with Beckwith-Wiedemann syndrome: a case cohort study from the BWS registry

Pregnancy that results in a child with Beckwith-Wiedemann syndrome (BWS) is associated with preterm delivery. Based on previous case series, we hypothesized that preterm delivery of a child with BWS was due to known risk factors for preterm delivery such as polyhydramnios and gestational hypertension. A case cohort study using the BWS Registry at Washington University School of Medicine was undertaken. Cases were pregnancies that resulted in the birth of a child with BWS, controls were pregnancies resulting in the birth of siblings without BWS. Univariate analyses of maternal complications and logistic regression to predict preterm delivery were used. Children with BWS (n = 304) were delivered preterm at a significantly higher rate than their siblings (n = 269) odds ratio 19.1 (95% CI 9.1-40.2). Polyhydramnios, gestational hypertension, and vaginal bleeding also occurred at high rates in the BWS group with odds ratios of 31.6 (95% CI 12.6-79.1), 2.4 (95% CI 1.4-4.1), and 3.9 (95% CI 2.3-6.4), respectively. In a multivariate logistic regression model within the BWS group, polyhydramnios, vaginal bleeding, and gestational hypertension were significant predictors of preterm delivery, odds ratios of 2.9 (95% CI 1.6-5.4), 2.6 (95% CI 1.3-5.0), and 5.3 (2.3-12.0), respectively. However, a significant proportion, 6.5% (18 of 277), of patients in the BWS group delivered preterm without known risk factors. Preterm delivery of a child with BWS is associated with an increased frequency of polyhydramnios, gestational hypertension, and vaginal bleeding in the mother. However, preterm delivery also occurs in the absence of these risk factors.

Effect of recall on estimation of non-fatal injury rates: a community based study in Tanzania

STUDY OBJECTIVE

To investigate the effect of recall on estimation of non-fatal injury rates in Tanzania.

DESIGN

Retrospective population based survey.

SETTING

Eight branches in an urban area and six villages in a relatively prosperous rural area in Tanzania.

SUBJECTS

Individuals of all ages living in households selected by cluster sampling.

MAIN OUTCOME MEASURES

Estimated non-fatal injury rates calculated at each of the 12 recall periods (one to 12 months before the interview).

RESULTS

Out of a population of 15 223 persons, 509 individuals reported 516 injuries during the preceding year. Of these 313 (61.5%) were males and 196 (38.5%) females. The data showed notable declining incidence rates from 72 per 1000 person-years when based on a one month recall period to 32.7 per 1000 person-years for a 12 month recall period (55% decline). The decline was found for injuries resulting in fewer than 30 days of disability whereas rates for severe injuries (disability of 30 days or more) did not show a consistent variation with recall period. Decline in injury rates by recall period was higher in rural than in urban areas. Age, sex, and education did not notably affect recall.

CONCLUSIONS

Longer recall periods underestimate injury rates compared with shorter recall periods. For severe injuries, a recall period of up to 12 months does not affect the rate estimates. It is essential that a recall period of less than three months be used to calculate injury rates for less severe injuries.

Non-fatal occupational injuries related to slips, trips and falls in seafaring

BACKGROUND

Merchant seafaring often involves hazardous occupational operations and several studies have shown increased overall injury mortality. The aim of this study was to describe the risks involved in slip, trip and fall (STF) injuries in merchant seafaring, in order to point out areas for prevention.

METHODS

A questionnaire study was carried out in 11 countries with 6,461 participants. The seafarers gave information on whether they were injured during their latest tour of duty, and whether STF preceded the injury.

RESULTS

Of the total reported injuries 43% (n=467) were STF related. Fractures and sprains accounted for 42% of the STF injuries compared with 17% for non-STF injuries. The proportions of STF injuries for different types of ships and areas of the ships varied from < 30% to >60%, particularly work on passenger ship decks, where STF injuries were >60%. The proportions of STF injuries increased by age and by severity of the injury.

CONCLUSIONS

Injuries related to STF on merchant ships were more frequent than previous estimates. There is a need for improvements in defining, reporting, and preventing STF injuries in merchant seafaring.

Injury morbidity in an urban and a rural area in Tanzania: an epidemiological survey

Background

Injuries are becoming a major health problem in developing countries. Few population based studies have been carried out in African countries. We examined the pattern of nonfatal injuries and associated risk factors in an urban and rural setting of Tanzania.

Methods

A population-based household survey was conducted in 2002. Participants were selected by cluster sampling. A total of 8,188 urban and 7,035 rural residents of all ages participated in the survey. All injuries reported among all household members in the year preceding the interview and resulting in one or more days of restricted activity were included in the analyis.

Results

A total of 206 (2.5%) and 303 (4.3%) persons reported to have been injured in the urban and rural area respectively. Although the overall incidence was higher in the rural area, the incidence of major injuries (≥ 30 disability days) was similar in both areas. Males were at a higher risk of having an injury than females. Rural residents were more likely to experience injuries due to falls (OR = 1.6; 95% CI = 1.1 – 2.3) and cuts (OR = 4.3; 95% CI = 3.0 – 6.2) but had a lower risk of transport injuries. The most common causes of injury in the urban area were transport injuries and falls. In the rural area, cuts and stabs, of which two thirds were related to agriculture, formed the most common cause. Age was an important risk factor for certain types of injuries. Poverty levels were not significantly associated with experiencing a nonfatal injury.

Conclusion

The patterns of injury differ in urban and rural areas partly as a reflection of livelihoods and infrastructure. Rural residents are at a higher overall injury risk than urban residents. This may be important in the development of injury prevention strategies.

The occupational health of Southeast Asians in Lowell: a descriptive study

To assess the occupational health of a group of vulnerable workers, Southeast Asians, in Lowell, Massachusetts, researchers surveyed 160 residents of Cambodian or Lao ethnicity regarding working conditions, health problems, and use of medical services. Over 40% reported work in electronics and computer assembly. A fourth of those currently employed held temporary jobs. Workplace hazards included soldering fumes; inadequate ventilation; prolonged sitting or standing; awkward postures; unguarded machinery; shift work; long hours; and pressure to produce quickly. Common work-related health problems included sprains and strains, headache, dizziness, and flu-like symptoms. Less than a third of the respondents knew about workers' compensation. Household surveys can provide otherwise unavailable occupational health data for defined populations.

Acute healthcare utilization by children after motor vehicle crashes

This study, describing the overall patterns of acute healthcare resource utilization by child crash victims (age 15 years and younger), was conducted between 28 July 1999 and 30 November 2000 as part of an on-going large-scale, child-specific crash surveillance system, Partners for Child Passenger Safety: insurance claims from 15 states and the District of Columbia function as the source of subjects, with telephone survey and on-site crash investigations serving as the primary sources of data. A probability sample of 4862 eligible crashes with 7368 child occupants formed the study sample. Our results suggest that for every 1000 children involved in crashes, 3 are hospitalized; 108 are treated and released from an emergency department (ED); 48 are evaluated in a physician's office, urgent care center, or other facility; and 841 receive no care at all. Comprehensive surveillance systems for motor vehicle crashes must capture children treated in physicians' offices, emergency departments, and other healthcare facilities in order to provide accurate estimates of the impact on the health care system related to motor vehicle trauma.

Critical incidents of nonadherence with standard precautions guidelines among community hospital-based health care workers

OBJECTIVE

To identify, categorize, and assess critical incidents of nonadherence to standard precautions.

DESIGN

Qualitative and quantitative analysis of a written, mail-out survey.

SETTING

Community hospitals.

PARTICIPANTS

Statewide stratified random sample of community hospital-based health care workers at risk for blood exposure. MAIN VARIABLE: Responses to the question: "Think of an incident during the past year when you didn't adhere to universal precautions. Please describe the situation and why you didn't adhere."

RESULTS

Reasons given for not using precautions included: belief that stopping to use standard precautions would have put the patient at risk (22%); using precautions would have interfered with patient care (20%); precautions were not warranted in a specific situation (14%); did not anticipate the potential for exposure (14%); and high job demands that had caused respondent to be in a hurry (11%). Less often, equipment was not available (7%), respondent forgot (6%), respondent thought that the patient did not pose a risk (4%), or the available equipment was not effective (3%). In terms of overall exposure rates, 34% of those who described an incident had experienced a sharps injury during the previous 3 months and 42% had experienced a mucocutaneous exposure. In terms of overall nonadherence, 44% wore gloves less than 100% of the time, while 61% washed their hands less than 100% of the time. Needlestick injuries were lowest among those who had forgotten to use precautions, while mucocutaneous exposures were highest among those who had not anticipated potential exposure while performing the task. Failure to wear gloves routinely was highest among those who said that following precautions interfered with their ability to provide care and among those who believed a particular patient to be low risk; failure to wash hands routinely was also highest among the latter group and lowest among those who said necessary equipment was not available.

CONCLUSIONS

Using specific information about local incidents of nonadherence to standard precautions may enhance training, especially if the program identifies incidents of unanticipated exposure and helps workers plan for them in the future. Closer examination of job demands and responsibilities that interfere with standard precautions may increase the likelihood of adherence.

Estimating the Population Burden of Injuries

BACKGROUND

Injuries represent an important public health problem but their incidence is difficult to estimate.

METHODS

We conducted a population-based household survey in Greece covering 4079 interviewed individuals. The interviewees reported, for themselves and for cohabitating adults (age 15 years and older; n = 7157), injuries that occurred during the preceding year. Major injuries were defined as those requiring contact with a health institution. We compared these survey data with data obtained through a national Emergency Department Injury Surveillance System (EDISS).

RESULTS

For the month closest to the survey interview, the incidence reported for the responders was 5.9 per 100 person-year, whereas the incidence for cohabitating adults was 3.7 per 100 person-years. These incidence rates declined for months more remote to the interview. Comparison of survey and EDISS data suggested that survey reporting was less accurate for nontraffic-related injuries. Taking into account possible recall and telescoping biases, the best survey estimate of the national annual number of major injuries is 525,000 (5.9 per 100 person-year), whereas the EDISS data yielded an estimate of 1,150,000 major injuries (12.9 per 100 person-years)

CONCLUSIONS

Comparison of survey and EDISS data systems provides quantitative assessment of accuracy of the survey data in relation to time of injury before report date, to severity of injury, and to whether the injury is to the interviewee or to a cohabitant. The 2 systems could be used in a complementary way, although EDISS generates information that is medically more accurate and is a more cost-effective data collection system.

Self-reported injuries among seafarers. Questionnaire validity and results from an international study

International surveys of occupational injuries among seafarers have so far been missing. It was the aim to test the method of self-report of injuries and length of time at risk during the latest duty period and second to study the injury incidence rate among seafarers by use of the method. A pilot study was conducted (n = 1068) in Finland, Denmark, the Philippines, Croatia and Spain using self-completed questionnaires with questions about the person, the ship, the duration of latest duty period and injuries. The duration of the self-reporting duty period was in the Danish part compared with information from the crew register of the Maritime Authority. For seafarers from merchant ships in the Danish sub-study there was acceptable correspondence between the information from the seafarers and the Maritime Authority, but not when referring to ferries and non-specified types of ship. Unadjusted and adjusted injury incidence rates-ratios (IRRs) based on number of injuries per number of work hours were calculated. Adjusted IRRs for ordinary seamen/officers: IRR = 2.43 (95% CI: 1.25-4.72); for age < 35/35+ years: IRR = 1.97 (1.02-3.81); length of tour: 117 days or longer compared with < 117 days: IRR = 0.46 (95% CI: 0.22-0.95); 57-70 working hours per week compared with < 57 h: IRR = 1.26 (0.48-3.29), 71+h compared with < 57 h: IRR = 2.12 (0.84-5.36). Non-significant IRRs >1.00 were found for ships under 10,000 GT compared with larger ships and for own flagged ships compared with ships under flag of convenience. In conclusion, more than 70 h of work per week was related to a higher rate of injuries for seafarers on merchant ships, but the result was not statistically significant. Self-report of the duration of the latest tour of duty is useful for seafarers from merchant ships with short-term employments, but not for ferries and other, non-specified types of ship with other or permanent employment.

Percutaneous injury, blood exposure, and adherence to standard precautions: are hospital-based health care providers still at risk?

To examine factors associated with blood exposure and percutaneous injury among health care workers, we assessed occupational risk factors, compliance with standard precautions, frequency of exposure, and reporting in a stratified random sample of 5123 physicians, nurses, and medical technologists working in Iowa community hospitals. Of these, 3223 (63%) participated. Mean rates of hand washing (32%-54%), avoiding needle recapping (29%-70%), and underreporting sharps injuries (22%-62%; overall, 32%) varied by occupation (P<.01). Logistic regression was used to estimate the adjusted odds of percutaneous injury (aOR(injury)), which increased 2%-3% for each sharp handled in a typical week. The overall aOR(injury) for never recapping needles was 0.74 (95% CI, 0.60-0.91). Any recent blood contact, a measure of consistent use of barrier precautions, had an overall aOR(injury) of 1.57 (95% CI, 1.32-1.86); among physicians, the aOR(injury) was 2.18 (95% CI, 1.34-3.54). Adherence to standard precautions was found to be suboptimal. Underreporting was found to be common. Percutaneous injury and mucocutaneous blood exposure are related to frequency of sharps handling and inversely related to routine standard-precaution compliance. New strategies for preventing exposures, training, and monitoring adherence are needed.

Identification of risk factors for non-fatal child injury in a rural area: Keokuk County Rural Health Study

OBJECTIVE

To identify risk factors for non-fatal injury among rural children.

DESIGN

Cross sectional health interview survey, 1994-98.

SETTING

A rural Iowa county, not adjacent to a metropolitan area.

SUBJECTS

Stratified, random sample of households, including all resident children and adults.

MAIN OUTCOME MEASURES

Injury episodes in the past 12 months among children aged 0-17 years and the parental and child characteristics associated with these episodes.

RESULTS

Of the 621 children in participating households, 137 or 22.1% were injured during the past 12 months. Children age 5-17 on a sports team were 1.88 times (95% confidence interval (CI) 1.07 to 3.31) more likely than other children to be injured. Children age 12-17 who binge drink were 3.50 times (95% CI 1.31 to 9.50) more likely than other children to be injured. Compared with children not on sports teams, girls on teams were 2.26 times (95% CI 1.02 to 5.13) more likely while boys on teams were 1.60 times (95% CI 0.71 to 3.68) more likely to have an injury episode. Compared with children who did not binge drink, girls binge drinking were 8.11 times (95% CI 1.52 to 43.33) more likely while boys binge drinking were 2.19 times (95% CI 0.70 to 6.84) more likely to have an injury episode.

CONCLUSIONS

Local studies such as this can provide useful clues regarding the etiology of injury. Some known and some new potential risk factors including behavioral aspects for childhood non-fatal injury in a very rural area were investigated. It is planned to address these cross sectional findings in future longitudinal follow up of this population.

A prospective study on knee pain and its risk factors

OBJECTIVES

To evaluate the effects of work-related and individual factors as well as physical activity and sports on the incidence and persistence of knee pain among a working population.

DESIGN

Employees of a large Finnish forestry company replied to a questionnaire (a modified version of the Nordic Questionnaire) on musculoskeletal pain and its possible risk factors at the baseline of this study. A cohort of 2122 workers free of knee pain and another cohort of 333 workers with severe knee pain were followed up for one year. The effects of the risk factors on the incidence and persistence of knee pain were studied using multivariable logistic regression models.

RESULTS

A total of 214 (10%) workers developed knee pain during the follow-up. Significant predictors of incident knee pain in the multivariable model were higher age, overweight, smoking, and previous knee injuries. Also, working with the trunk forward flexed in kneeling or standing position and physically strenuous work were non-significant predictors of incident knee pain. Of those 333 workers with severe knee pain at baseline, 220 (66%) still reported severe knee pain after one year. Higher age and job dissatisfaction increased the risk of persistent symptoms. General physical exercise and different sports activities did not predict the incidence or persistence of knee pain.

CONCLUSIONS

In this large prospective study, the risk factors for self-reported knee pain seemed to be highly similar to the risk factors for knee osteoarthritis (OA) reported in other papers. Age, previous knee injuries, overweight, and knee-straining work were those risk factors, which contributed to the incidence of knee pain. Psychosocial elements of work were more involved in the persistence of the symptoms in the knee.

Time dependent memory decay

BACKGROUND

To estimate the rate of time dependent memory decay, injury rates from three independent studies were compared.

METHODS

The studies asked subjects to recall injuries during the previous 2 months, 12 months, or 10 years.

RESULTS

The annual injury rates obtained were 108/1,000, 66/1,000, and 19/1,000, respectively. These rates are all significantly different from one another at the 0.05 level.

CONCLUSIONS

Important methodological and demographic differences between the studies, such as those involving age, injury severity, and seasonality, were ruled out as causes of these differences. Results found in the literature for other studies are compared and contrasted. These data suggest that recall periods of greater than 2 months are likely to significantly underestimate injury rates.

A survey of forest workers in New Zealand. Do hours of work, rest, and recovery play a role in accidents and injury?

PROBLEM

A number of structural and organizational changes have occurred recently within the New Zealand Forestry Industry, with concerns being raised about the impact of these changes on the forestry worker in terms of fatigue, sleepiness, and compromised safety. This study explored the relationship of fatigue, and some of its key determinants, with accidents and injuries in a group of forestry industry workers in New Zealand.

METHOD

A total of 367 forestry workers responded to a self-administered questionnaire.

RESULTS

Fatigue was found to be commonly experienced at work in the forest, with 78% of workers reporting that they experienced fatigue at least "sometimes." This study found that certain groups of workers reported long working hours, reduced sleep, compromised recovery time, and intensely paced work. The results of logistic regression analysis showed that recent sleep, number of breaks taken during the workday, and specific job/tasks were independently associated with reporting of high fatigue levels at work. Near-miss injury events were significantly more common among those reporting a high level of fatigue at work. Accidents and lost-time injury were associated with length of time at work, ethnicity, and having had near-miss injury events.

DISCUSSION

Together, these results suggest that fatigue and aspects of work organization, which are likely to be fatiguing, may be associated with compromised safety for forest workers.

IMPACT ON INDUSTRY

With an already slim margin of error present in forest operations, an impairment due to increased fatigue may constitute a significant risk factor for accidents and injuries in this workforce. The results indicate the need for further examination of shift and workload management among forestry workers, as well as a role for improving industry awareness about the causes and consequences of fatigue.

Epidemiology of unintentional adult injury in a rural population

BACKGROUND

The purpose of this study was to describe the frequency, characteristics, and risk factors of unintentional adult injury in a rural population.

METHODS

We interviewed 1,644 adults representing an all-rural county in Iowa. Analyses used bivariate and multivariable logistic regression.

RESULTS

Participants' mean age was 53 years, and 54% were women. Twenty-three percent (n = 380) of participants reported an injury during the past 12 months, of which four fifths were treated. Overexertion (25%) and falls (22%) caused nearly half the injuries. Women with high levels of depression symptoms had 1.57 times (95% confidence interval, 1.05-2.33) the prevalence of injury occurrence as did women with low levels of depression symptoms. Men with a CAGE score of 2 or more had between 0.98 and 2.56 times (according to the range of values of the relevant odds ratio 95% confidence interval) the prevalence of injury episode of men without this exposure.

CONCLUSION

The association of injury occurrence with alcohol problems is consistent with prior research, but the increased prevalence of injury associated with high levels of symptoms of depression requires further study and explanation.

Risk factors for neck and upper limb disorders: results from 24 years of follow up

OBJECTIVES

To investigate associations between different potential risk factors, related and not related to work, and disorders of the neck and upper extremities occurring up to 24 years later.

METHODS

The study comprised 252 women and 232 men, Swedish citizens, 42-59 years of age and in a broad range of occupations. Information about potential risk factors was available from a former study conducted in 1969. Data on disorders of the neck, shoulder, and hand-wrist disorders were obtained retrospectively for the period 1970-93.

RESULTS

Risk factors were found to differ between the sexes. Among women over-time work, high mental workload, and unsatisfactory leisure time were associated with disorders in the neck-shoulder region. Interaction was found between high mental workload and unsatisfactory leisure time. Neck symptoms earlier in life were associated with recurrent disorders. Hand and wrist disorders were associated mainly with physical demands at work. Among men blue collar work and a simultaneous presence of high mental workload and additional domestic workload predicted disorders in the neck-shoulder region.

CONCLUSIONS

Factors related and not related to work were associated with disorders of the neck, shoulders, and hands and wrist up to 24 years later in life. These included factors related to working hours which previously have not been noted in this context. Interactions between risk factors both related and not related to work were commonly found.

Risk factors for occupational injuries among older workers: an analysis of the health and retirement study

OBJECTIVES

This study examined risk factors for occupational injury among older workers.

METHODS

We analyzed data on 6854 employed nonfarmers from the Health and Retirement Study (HRS), a population-based sample of Americans 51 through 61 years old.

RESULTS

Occupational injuries were associated with the following: the occupations of mechanics and repairers (odds ratio [OR] = 2.27), service personnel (OR = 1.68), and laborers (OR = 2.18); jobs requiring heavy lifting (OR = 2.75); workers' impaired hearing (OR = 1.60) and impaired vision (OR = 1.53); and jobs requiring good vision (OR = 1.43). Self-employment was associated with fewer injuries (OR = 0.47).

CONCLUSIONS

These results emphasize the importance of a good match between job demands and worker capabilities.