A case-crossover study of transient risk factors for occupational hand trauma by gender

Selection bias in follow-up interviews with individuals attending the emergency department for occupational injuries

OBJECTIVE

To examine whether supplementary interview participation was comparable for occupationally injured patients attending two hospital emergency departments and to investigate the magnitude of selection bias in relation to sex, age, severity, job tasks and industry risk level.

METHODS

Workers aged 18-70 years who contacted the two emergency departments for an acute occupational injury in 2013 were eligible and given a short questionnaire. Following written consent, a semi-structured interview concerning health and transient risk factors was conducted by telephone. The two departments were compared for study recruitment by age and sex. Respondents and non-respondents to the interview were compared for age, sex, injury severity, job tasks and industry risk level.

RESULTS

Of 4002 patients attending the two hospitals, 1693 (42%) participated in the interview. One hospital had a markedly higher response rate to the questionnaire, but the proportions of participation in the interview were similar in the two hospitals. Patients aged <30 years were over-represented among non-respondents whereas sex, injury severity, job task and industry risk level were not significantly different between respondents and non-respondents.

CONCLUSIONS

Despite a relatively low interview participation rate among injured individuals attending the emergency department, selection bias was limited. This indicates that results regarding injury risk patterns may be more widely generalisable when examining the causality of occupational injuries. However, the study also showed that young injured workers were less likely to participate in follow-up interviews, which is an important factor when interpreting age-related risk of injury.

Comparison of Shoulder Management Strategies after Stage I of Fingertip Skin Defect Repair with a Random-Pattern Abdominal Skin Flap

BACKGROUND

In the absence of scientific evidence regarding the effectiveness of shoulder management strategies after stage I of fingertip reconstruction, the purpose of this study was to compare the clinical outcomes of various rehabilitation procedures.

MATERIAL AND METHODS

Patients who underwent fingertip reconstruction with a random-pattern abdominal skin flap between March 2007 and February 2013 were enrolled in the study (n=95). Thirty performed only active exercise (group A), 29 performed only passive exercise (group B), and 32 received a combination of active exercise and pulsed electromagnetic field (PEMF) (group C). The mean age at the time of treatment was 30.2 years in group A, 29.6 years in group B, and 31.8 years in group C.

RESULTS

At the final follow-up, there were significant differences between group A and B in terms of Constant score (P=.001), VAS (P=.047), forward flexion of the shoulder (P=0.049), and muscle strength with forward flexion and external rotation (P=0.049 and P=0.042, respectively). A higher Constant score was observed in group C compared to group A, and although there were no differences in the other evaluations between groups A and C, a trend toward better function of the shoulder was demonstrated in group C.

CONCLUSIONS

The most important findings in our study are that a combination of active exercise and PEME produces superior patient-reported outcomes regarding relief of shoulder signs and symptoms. Given the limitations of this study, better-designed studies with large sample sizes and long-term follow-up are required.

Use of Gloves and Reduction of Risk of Injury Caused by Needles or Sharp Medical Devices in Healthcare Workers: Results from a Case-Crossover Study

Objective.

Standard precautions are advocated for reducing the number of injuries caused by needles and sharp medical devices (“sharps injuries”), but the effectiveness of gloves in preventing such injuries has not been established. We evaluated factors associated with gloving practices and identified associations between gloving practices and sharps-injury risk.

Design.

Usual-frequency case-crossover study.

Setting.

Thirteen medical centers in the United States and Canada.

Participants.

Six hundred thirty-six healthcare workers who presented to employee health clinics after sharps injury.

Methods.

Structured telephone questionnaires were administered to assess usual behaviors and circumstances at the time of injury.

Results.

Of 636 injured healthcare workers, 195 were scrubbed in an operating room or procedure suite when injured, and 441 were injured elsewhere. Nonscrubbed individuals were more commonly gloved when treating patients who were perceived to have a high risk of human immunodeficiency virus, hepatitis B virus, or hepatitis C virus infection than when treating other patients (adjusted odds ratio [aOR], 2.53 [95% confidence interval {CI}, 1.30-4.91]). Nurses (aOR, 0.11 [95% CI, 0.04-0.32]) and other employees (aOR, 0.24 [95% CI, 0.07-0.77]) were less commonly gloved at injury than were physicians and physician trainees. Gloves reduced injury risk in case-crossover analyses (incidence rate ratio [IRR], 0.33 [95% CI, 0.22-0.50]). In scrubbed individuals, involvement in an orthopedic procedure was associated with double gloving at injury (aOR, 13.7 [95% CI, 4.55-41.3]); this gloving practice was associated with decreased injury risk (IRR, 0.20 [95% CI, 0.10-0.42]).

Conclusions.

Although the use of gloves reduces the risk of sharps injuries in health care, use among healthcare workers is inconsistent and may be influenced by risk perception and healthcare culture. Glove use should be emphasized as a key element of multimodal sharps-injury reduction programs.

A case-crossover study of transient risk factors influence on occupational injuries: a study protocol based on a review of previous studies

BACKGROUND

The occupational injury incident rate remains relatively high in the European Union. The case-crossover study gives a unique opportunity to study transient risk factors that normally would be very difficult to approach. Studies like this have been carried out in both America and Asia, but so far no relevant research has been conducted in Europe.

METHOD

Case-crossover studies of occupational injuries were collected from PubMed and Embase and read through. Previous experiences concerning method, exposure and outcome, time-related measurements and construction of the questionnaire were taken into account in the preparation of a pilot study. Consequently, experiences from the pilot study were used to design the study protocol. Approximately 2000 patients with an occupational injury will be recruited from the emergency departments in Herning and Odense, Denmark. A standardised questionnaire will be used to collect basic demographic data and information on eight transient risk factors. Based on previous studies and knowledge on occupational injuries the transient risk factors we chose to examine were: time pressure, performing a task with a different method/using unaccustomed technique, change in working surroundings, using a phone, disagreement, feeling ill, being distracted and using malfunctioning machinery/tools or work material. Exposure time 'just before the injury' will be compared with two control periods, 'previous day at the same time of the injury' (pair match) and the previous work week (usual frequency).

DISCUSSION

This study protocol describes a unique opportunity to calculate the effect of transient risk factors on occupational injuries in a European setting.

A case-crossover study of transient risk factors for occupational traumatic hand injuries in Incheon, Korea

OBJECTIVES

A case-crossover study was conducted to identify transient risk factors for occupational acute hand injuries.

METHODS

In total, 98 subjects were recruited from a hospital specializing in occupational accidents and trauma. Patients who had injured fingers, hands or wrists during work were interviewed within 30 days after their accidents.

RESULTS

The relative risks for each factor were as follows: 22.9 for unusual or malfunctioning machines (95% confidence interval [CI] 14.4-36.4), 3.3 for wearing gloves (95% CI 1.9-5.7), 5.7 for unusual tasks (95% CI 3.8-8.8), 12.1 for altered work methods (95% CI 8.4-17.6), 4.1 for rushing (95% CI 2.6-6.3), 12.9 for being distracted (95% CI 7.9-20.9), 1.2 for feeling ill (95% CI 0.4-3.6) and 1.0 for working overtime (95% CI 0.6-1.6).

CONCLUSION

The results suggest that some transient risk factors were associated with occupational acute hand injuries. These risk factors are probably preventable, and modifying unsafe or unusual conditions is important to reduce occupational traumatic hand injuries.

Interaction of occupational and personal risk factors in workforce health and safety

Most diseases, injuries, and other health conditions experienced by working people are multifactorial, especially as the workforce ages. Evidence supporting the role of work and personal risk factors in the health of working people is frequently underused in developing interventions. Achieving a longer, healthy working life requires a comprehensive preventive approach. To help develop such an approach, we evaluated the influence of both occupational and personal risk factors on workforce health. We present 32 examples illustrating 4 combinatorial models of occupational hazards and personal risk factors (genetics, age, gender, chronic disease, obesity, smoking, alcohol use, prescription drug use). Models that address occupational and personal risk factors and their interactions can improve our understanding of health hazards and guide research and interventions.

Alcohol and risk of admission to hospital for unintentional cutting or piercing injuries at home: a population-based case-crossover study

Background

Cutting and piercing injuries are among the leading causes of unintentional injury morbidity in developed countries. In New Zealand, cutting and piercing are second only to falls as the most frequent cause of unintentional home injuries resulting in admissions to hospital among people aged 20 to 64 years. Alcohol intake is known to be associated with many other types of injury. We used a case-crossover study to investigate the role of acute alcohol use (i.e., drinking during the previous 6 h) in unintentional cutting or piercing injuries at home.

Methods

A population-based case-crossover study was conducted. We identified all people aged 20 to 64 years, resident in one of three regions of the country (Greater Auckland, Waikato and Otago), who were admitted to public hospital within 48 h of an unintentional non-occupational cutting or piercing injury sustained at home (theirs or another's) from August 2008 to December 2009. The main exposure of interest was use of alcohol in the 6-hour period before the injury occurred and the corresponding time intervals 24 h before, and 1 week before, the injury. Other information was collected on known and potential confounders. Information was obtained during face-to-face interviews with cases, and through review of their medical charts.

Results

Of the 356 participants, 71% were male, and a third sustained injuries from contact with glass. After adjustment for other paired exposures, the odds ratio for injury after consuming 1 to 3 standard drinks of alcohol during the 6-hour period before the injury (compared to the day before), compared to none, was 1.77 (95% confidence interval 0.84 to 3.74), and for four or more drinks was 8.68 (95% confidence interval 3.11 to 24.3). Smokers had higher alcohol-related risks than non-smokers.

Conclusions

Alcohol consumption increases the odds of unintentional cutting or piercing injury occurring at home and this risk increases with higher levels of drinking.

Occupational injuries in automobile repair workers

Mechanics are exposed to varied work stressors such as hot noisy environments, strenuous postures, improperly designed tools and machinery and poor psycho-social environments which may exert an influence on their health and safety. The study aimed to examine the occupational injury patterns and identify work stressors associated with injury amongst automobile mechanics. A descriptive ergonomic checklist and questionnaire on general health and psycho-social issues were administered to male workers (N=153). The relative risk factors and correlation statistics were used to identify the work stressors associated with occupational injury. 63% of the workers reported injuries. Cuts were the chief injuries being reported. Poor work environment, machinery and tool characteristics, suffering from poor health and psycho-social stressors were associated with injury occurrence amongst automobile repair workers.

A case-crossover study of sleep and work hours and the risk of road traffic accidents

STUDY OBJECTIVES

Sleepiness, prolonged wakefulness, and extended work hours have been associated with increased risk of injuries and road accidents. The authors' objective was to study the relation between those factors and road accidents using a case-crossover design, effective in estimating the risk of acute events associated with transient, short effect exposures.

DESIGN

Five hundred seventy-four injured drivers presenting for care after road accidents to the Emergency Room of Udine, Italy, were enrolled in the study from March 2007 to March 2008. Sleep, work, and driving patterns in the 48 h before the accident were assessed through an interview.

MEASUREMENTS AND RESULTS

The relative risk (RR) of accident associated with each exposure was estimated using the case-crossover matched pair interval approach. Sleeping > or = 11 h daily was associated with a decrease of the RR, as was sleeping less than usual. Being awake > or = 16 h and, possibly, working > 12 h daily were associated with increases in the RR.

CONCLUSIONS

Extended work hours and prolonged wakefulness increase the risk of road accidents and suggest that awareness should be raised among drivers. The findings regarding acute sleep amount are less clear, possibly due to an effect of chronic sleep loss.