Factors Associated with Leguminous Green Manure Incorporation and Fusarium Wilt Suppression in Watermelon

Fall-planted Vicia villosa or Trifolium incarnatum cover crops, incorporated in spring as a green manure, can suppress Fusarium wilt (Fusarium oxysporum f. sp. niveum) of watermelon. During cover crop growth, termination, and incorporation into the soil, many factors such as arbuscular mycorrhizae colonization, leachate, and soil respiration differ. How these cover-crop-associated factors affect Fusarium wilt suppression is not fully understood. Experiments were conducted to evaluate how leachate, soil respiration, and other green-manure-associated changes affected Fusarium wilt suppression, and to evaluate the efficacy of the biocontrol product Actinovate AG (Streptomyces lydicus WYEC 108). General and specific suppression was examined in the field by assessing the effects of cover crop green manures (V. villosa, T. incarnatum, Secale cereale, and Brassica juncea) on soil respiration, presence of F. oxysporum spp., and arbuscular mycorrhizal colonization of watermelon. Cover crop treatments V. villosa, T. incarnatum, and S. cereale and no cover crop were evaluated both alone and in combination with Actinovate AG in the greenhouse. Additionally, in vitro experiments were conducted to measure the effects of cover crop leachate on the mycelial growth rates of F. oxysporum f. sp. niveum race 1 and Trichoderma harzianum. Soil microbial respiration was significantly elevated in V. villosa and Trifolium incarnatum treatments both preceding and following green manure incorporation, and was significantly negatively correlated with Fusarium wilt, suggesting that microbial activity was higher under the legumes, indicative of general suppression. Parallel to this, in vitro growth rates of F. oxysporum f. sp. niveum and Trichoderma harzianum on V. villosa leachate amended media were 66 and 213% greater, respectively, than on nonamended plates. The F. oxysporum spp. population (based on CFU and not differentiated into formae specialis or races) significantly increased in V. villosa-amended field plots. Additionally, the percentage of watermelon roots colonized by arbuscular mycorrhizae following V. villosa and Trifolium incarnatum green manures was significantly higher than in watermelon following bare ground (58 and 44% higher, respectively). In greenhouse trials where cover crops were amended to soil, Actinovate AG did not consistently reduce Fusarium wilt. Both general and specific disease suppression play a role in reducing Fusarium wilt on watermelon.

Improving the physician role in evaluating work ability and managing disability: a survey of primary care practitioners

PURPOSE

In the US health care system, most work-related issues are addressed by primary care practitioners (PCP's). Prior investigations of PCP's have focused on disability claims, whereas evaluations of work status and work capacity are more common. This study was conducted to identify challenges and opportunities for improvement in this area from a physician perspective.

METHODS

A validated survey was mailed to a random sample of 423 Massachusetts PCP's, with a 43% response rate.

RESULTS

On average, PCP's were requested to provide opinions regarding work ability in 9% (range, 1-100%) of all visits, about half of which involved non-work-related conditions. Their assessments were largely based on patient input and observations; direct communication with employers was rare. Only 6% agreed that PCP's should not have a role in facilitating safe return to work (RTW). However, 25% believed they had little influence over disability outcomes. While patient-specific factors were viewed as significant barriers to providers' efforts to successfully encourage RTW, lack of alternative work at the workplace was seen as the most significant problem.

CONCLUSIONS

Evaluations of work status and work ability are common PCP activities, but little formal training has been provided in this area. Rehabilitation professionals can have a significant role through provider education, developing improved systems for communication with employers, and encouraging employers to provide more alternative duty assignments.

Advent of occupational health services research

After lagging behind health services research in general health care, research is now examining health services provided to workers suffering occupational injuries and illnesses. The National Institute for Occupational Safety and Health, the Robert Wood Johnson Foundation Workers' Compensation Health Initiative, the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality), and the Canadian Institute for Work and Health co-sponsored a June, 1999, conference to explore research needs in this area. Fundamental tenets for advancing occupational health services research include: adopting the goal of improving occupational health care, including better integration of preventive and curative care; creating standardized interstate occupational health care data sets that include medical, economic, and patient perspectives; better defining quality in occupational care and developing appropriate performance measures; in addition to medical costs, assessing social, economic, medical and functional outcomes of care; considering the connections between work and health, including general health services; and addressing the need to train qualified occupational health services researchers. Am. J. Ind. Med. 40:291-294, 2001. Published 2001 Wiley-Liss, Inc.

Outcomes in work-related upper extremity and low back injuries: results of a retrospective study

BACKGROUND

The outcomes of treatment for work-related injuries and illnesses are multidimensional and complex, but have rarely been explored in detail. This study was intended to provide information on a sample of workers representing a range of jobs and employers typical of the workers compensation system.

METHODS

A mailed, self-report survey measuring multiple dimensions was conducted. Identified through the New Hampshire Division of Workers' Compensation First Report of Injury database, a sample of workers with injuries to their lower back (60%) or upper extremities (40%) a year prior to the study were surveyed. Response rate was 80% (N=169; upper extremity cases=70; low back cases=99).

RESULTS

Most (82.8%) were working one year post-injury. Over half reported residual effects of the injury on work or activities of daily living. Many working subjects reported persistent injury-related anxiety and pain at the end of the work day, worse in those with low back pain compared to those with upper extremity injuries. Almost 40% of those who returned to work suffered a reinjury. Forty-four percent of respondents suffered significant injury-related financial problems, which were worse in those who had been out of work for longer periods.

CONCLUSIONS

Occupational musculoskeletal injuries do result in significant, long-term adverse physical, economic, and psychological consequences, as demonstrated in self-reported surveys.

Recommendations to guide revision of the Guides to the Evaluation of Permanent Impairment. American Medical Association

The American Medical Association's Guides to the Evaluation of Permanent Impairment, Fourth Edition, is the most commonly used tool in the United States for rating permanent impairments for disability systems. The Guides, currently undergoing revision, has been the focus of considerable controversy. Criticisms have focused on 2 areas: internal deficiencies, including the lack of a comprehensive, valid, reliable, unbiased, and evidence-based system for rating impairments; and the way in which workers' compensation systems use the ratings, resulting in inappropriate compensation. We focus on the internal deficiencies and recommend that the Guides remains a tool for evaluation of permanent impairment, not disability. To maintain wide acceptance of the Guides, its authors need to improve the validity, internal consistency, and comprehensiveness of the ratings; document reliability and reproducibility of the results; and make the Guides easily comprehensible and accessible to physicians.

Work-related upper-extremity disorders: prospective evaluation of clinical and functional outcomes

The purpose of this study was to describe the demographic, vocational, medical, workplace, and psychosocial characteristics of patients treated for work-related upper-extremity disorders, to document treatment patterns in a community-practice setting, and to determine which of these factors predicts subsequent employment and functional status outcomes. A questionnaire was administered by mail or telephone to 112 patients seen at the University of Massachusetts Occupational Upper Extremities Disorders Clinic and included measures of disease-specific functional status, pain, reactions to pain, employer-employee relations, and number and type of interventions used to treat the disorder. Results were compared with baseline data obtained, on average, 16 months prior to follow-up. Of the original cohort (n = 124), 112 participated in the prospective study. Although most patients reported improvement in pain severity, fear of pain, life situation, and functional status, there was little change in employment status. Patients' self-reported intentions of return to work at baseline did not predict work status at follow-up. In general, those who were employed at baseline remained employed, had a greater reduction in symptom severity over time, and were significantly more likely to report improvement in their problem than those who were unemployed. The efficacy of various interventions was examined by type, mix, and intensity (number of different interventions undergone by the patient). No positive relationship was found between these measures and employment status, self-reported change in the problem, or self-reported improvement in functional status. Significant negative relationships were found between surgery, psychotherapeutic interventions, and outcomes. This was likely to have occurred because of a selection bias toward the more chronic and severely disabled patients for these treatments. However, the relative ineffectiveness of such intensive interventions as surgery in improving the work and health status of chronically symptomatic work-related upper-extremity patients cannot be overlooked. The findings suggest that more emphasis be placed on interventions aimed at resolving differences between employers and injured employees. More careful selection of patients for expensive and invasive procedures is recommended.

Health services research in workers' compensation medical care: policy issues and research opportunities

OBJECTIVE

To describe some of the unique aspects of medical care offered under workers' compensation insurance systems and discuss the major policy considerations relevant to health services researchers undertaking investigations in this area.

BACKGROUND AND FINDINGS

State-based workers' compensation (WC) insurance systems requiring employers to pay for medical care and wage replacement for workplace injuries and illnesses were first developed between 1910 and 1920 in the United States. Employers are generally required to purchase state-regulated workers' compensation insurance that includes first-dollar payment for all medical and rehabilitative services and payment of lost wages to workers with work-related illness or injury. Injured workers have variable but usually limited latitude in choosing their health care provider. Employers and workers' compensation insurers have incentives for controlling both the cost of medical care and lost wages.

CONCLUSION

The major policy issues in WC medical care--the effect of patient choice of provider and delivery system structure, the ensuring of high-quality care, the effect of integrating benefits, and investigation of the interrelationships between work, health, and productivity--can be informed by current studies in health services research and by targeted future studies of workers' compensation populations. These studies must consider the extent of patient choice of physician, the regulatory environment, the unique role of the workplace as a risk and modifying factor, and the complex interaction between health and disability insurance benefits.

Under-reporting of work-related disorders in the workplace: a case study and review of the literature

Accurate reporting of work-related conditions is necessary to monitor workplace health and safety, and to identify the interventions that are most needed. Reporting systems may be designed primarily for external agencies (OSHA or workers' compensation) or for the employer's own use. Under-reporting of workplace injuries and illnesses is common due to a variety of causes and influences. Based on previous reports, the authors were especially interested in the role of safety incentive programmes on under-reporting. Safety incentive programmes typically reward supervisors and employees for reducing workplace injury rates, and thus may unintentionally inhibit proper reporting. The authors describe a case study of several industrial facilities in order to illustrate the extent of under-reporting and the reasons for its occurrence. A questionnaire and interview survey was administered to 110 workers performing similar tasks and several managers, health, and safety personnel at each of three industrial facilities. Although less than 5% of workers had officially reported a work-related injury or illness during the past year, over 85% experienced work-related symptoms, 50% had persistent work-related problems, and 30% reported either lost time from work or work restrictions because of their ailment. Workers described several reasons for not reporting their injuries, including fear of reprisal, a belief that pain was an ordinary consequence of work activity or ageing, lack of management responsiveness after prior reports, and a desire not to lose their usual job. Interviews with management representatives revealed administrative and other barriers to reporting, stemming from their desire to attain a goal of no reported injuries, and misconceptions about requirements for recordability. The corporate and facility safety incentives appeared to have an indirect, but significant negative influence on the proper reporting of workplace injuries by workers. A variety of influences may contribute to under-reporting; because of under-reporting, worker surveys and symptom reports may provide more valuable and timely information on risks than recordable injury logs. Safety incentive programmes should be carefully designed to ensure that they provide a stimulus for safety-related changes, and to discourage under-reporting. A case-control study of similar establishments, or data before and after instituting safety incentives, would be required to more clearly establish the role of these programmes in under-reporting.

The effects of a health promotion-health protection intervention on behavior change: the WellWorks Study

OBJECTIVES

This study assessed the effects of a 2-year integrated health promotion-health protection work-site intervention on changes in dietary habits and cigarette smoking.

METHODS

A randomized, controlled intervention study used the work site as the unit of intervention and analysis; it included 24 predominantly manufacturing work sites in Massachusetts (250-2500 workers per site). Behaviors were assessed in self-administered surveys (n = 2386; completion rates = 61% at baseline, 62% at final). Three key intervention elements targeted health behavior change: (1) joint worker-management participation in program planning and implementation, (2) consultation with management on work-site environmental changes, and (3) health education programs.

RESULTS

Significant differences between intervention and control work sites included reductions in the percentage of calories consumed as fat (2.3% vs 1.5% kcal) and increases in servings of fruit and vegetables (10% vs 4% increase). The intervention had a significant effect on fiber consumption among skilled and unskilled laborers. No significant effects were observed for smoking cessation.

CONCLUSIONS

Although the size of the effects of this intervention are modest, on a populationwide basis effects of this size could have a large impact on cancer-related and coronary heart disease end points.

Measuring functional outcomes in work-related upper extremity disorders. Development and validation of the Upper Extremity Function Scale

Questionnaire-based measures of function have been validated extensively in studies of chronic illness and work-related low back pain. These measures have only recently been developed for upper extremity disorders (UEDs), and there is little information on their utility in evaluation of injured workers. We developed the Upper Extremity Function Scale (UEFS), an eight-item, self-administered questionnaire, to measure the impacts of UEDs on function. This instrument was tested in a cohort of 108 patients with work-related UEDs and 165 patients with the carpal tunnel syndrome (CTS); both groups were enrolled in prospective follow-up studies. The UEFS demonstrated excellent psychometric properties, including good internal consistency (Cronbach's alpha > 0.83), relative absence of floor effects, and excellent convergent and discriminant validity, compared with measures of symptom severity and clinical findings. In the CTS group, the UEFS was more responsive to significant improvements over time than clinical measures such as grip and pinch strength. These data support the use of a self-reported functional scale as a measure of outcome in studies of work-related UEDs. Further investigations in working populations are needed to substantiate its utility in workers with UEDs who have not yet sought medical care.

Screening for carpal tunnel syndrome in the workplace. An analysis of portable nerve conduction devices

Several devices have been developed for rapid motor or sensory median nerve conduction testing. We evaluated the validity and reliability of the Neurosentinel (NS) and NervePace (NP) electroneurometer for sensory and motor testing, respectively, compared with formal electrodiagnostic studies (EDS), and examined their potential role in workplace screening for carpal tunnel syndrome (CTS). Thirty-two working subjects without CTS were examined and tested with the NS, NP, and EDS, and retested one week later. Subjects were selected who did not have CTS, other hand or nerve problems, or jobs with significant ergonomic risks, in order to decrease the likelihood of changes over time in median nerve function. Mean correlations of NP and NS with EDS latencies ranged from r = 0.069 to r = 0.85, with somewhat better correlation for NS (sensory) than NP (motor). Test-retest reliability was greatest for motor EDS (r = 0.86 to 0.91) and similar for sensory EDS, NS, and NP (r = 0.72 to 0.79); mean results were very similar. Based on the observed relationship between NS or NP and EDS results, confidence intervals were calculated to represent the range of EDS results consistent with a single NS or NP measurement. These intervals ranged from +/- 0.3 milliseconds (ms) for NS to +/- 0.6 msec for NP, with similar ranges for change over time in an individual. The magnitude of these intervals for a single test or individual implies that the NS and NP are unlikely to identify individuals with CTS or to detect changes over time that are not accompanied by symptoms or signs. The screening devices are not likely to be useful in confirming early CTS, when single latency values may be normal, and detailed EDS may be necessary to detect nerve entrapment. Compared with EDS, these devices have moderate validity and similar reliability; they are probably most useful for cross-sectional or longitudinal studies of groups, but care must be taken in using them for pre-placement or surveillance tests of individual workers. False-positive results may lead to discrimination, inappropriate referrals and interventions; false-negative tests can result in inappropriate reassurance and missed opportunities for intervention.

Outcomes research: implications for occupational health

Concerns about quality, cost, and unnecessary medical care have led to substantial interest and growth in outcomes research with studies to determine the full range of effects of disease and comparative effectiveness of treatments. Investigators have developed new conceptual models of health-related quality of life and associated questionnaires, study designs that maximize use of administrative databases and the generalizability of results, and methods to control for severity and co-morbidity. As similar concerns about occupational health care have emerged, these approaches are being adapted for use in the occupational setting, and studies are beginning to address the concerns of working populations. These investigations will require development of new models of outcome, interdisciplinary research teams, adaptation of data collection methods to address the unique concerns of workers and the unique aspects of the workplace, use of new information databases, and methods of analysis. The implications of these concepts for a hypothetical study of carpal tunnel syndrome and a proposed agenda for future studies in occupational health outcomes research are presented.

Working on reform. How workers' compensation medical care is affected by health care reform

The medical component of workers' compensation programs-now costing over $24 billion annually-and the rest of the nation's medical care system are linked. They share the same patients and providers. They provide similar benefits and services. And they struggle over who should pay for what. Clearly, health care reform and restructuring will have a major impact on the operation and expenditures of the workers' compensation system. For a brief period, during the 1994 national health care reform debate, these two systems were part of the same federal policy development and legislative process. With comprehensive health care reform no longer on the horizon, states now are tackling both workers' compensation and medical system reforms on their own. This paper reviews the major issues federal and state policy makers face as they consider reforms affecting the relationship between workers' compensation and traditional health insurance. What is the relationship of the workers' compensation cost crisis to that in general health care? What strategies are being considered by states involved in reforming the medical component of workers compensation? What are the major policy implications of these strategies?

Development of a multidisciplinary research clinic for patients with work-related upper extremity disorders

The health care reform debate has focused attention on the need for outcomes research performed in ambulatory care settings. In this article, the authors describe the development of a research clinic focusing on symptomatic, functional, and vocational outcomes of patients with work-related upper extremity disorders. The authors describe the programmatic and research challenges associated with performing such research and emphasize the need for balancing the research and clinical agendas. Research efforts in this setting require careful consideration of the patient selection process and allocation of sufficient time for the clinical staff to collect and record essential research data.

Reducing the risk of cancer through worksite intervention

This chapter examines existing activities reported in the literature in the areas of smoking, nutrition, and screening; explores the prominent theories of behavior change that have guided some of these activities; and presents a model for worksite cancer prevention programs that is currently being tested in a large trial. A major theme of this chapter is the need for simultaneous changes in individual behaviors and the worksite environment. For each factor (smoking, nutrition, and screening) the discussion is divided into interventions for individuals and those for the environment or organization.

Ocular infections and the industrial use of microscopes

A cluster of ocular infections occurred in one area of a computer fabrication facility that relied on the use of industrial microscopes. A questionnaire was administered to all employees in this area. Microscope oculars were cultured and compared with control microscopes from a nonindustrial setting. Risk of infection was correlated with the number of hours of microscope use per day and subjective indicators of cleanliness. Bacterial cultures confirmed increased colony counts in industrial oculars compared with control oculars. Hygienic practices were instituted similar to those employed in medical settings. No further outbreaks of conjunctivitis have been reported in a 1-year follow-up.

Reproductive hazards in the workplace: what the practitioner needs to know about chemical exposures

A growing body of scientific evidence implicates occupational chemical exposures in the etiology of human adverse reproductive outcomes. Most reproductive toxins that have been investigated in sufficient detail have been shown to exert multiple effects on and through both men and women. In the face of growing public awareness, it is essential that clinicians develop a knowledgeable and effective approach to patient concerns about reproductive hazards in the workplace. Of vital importance is the accurate characterization of exposure at the worksite. Intervention strategies for worrisome situations include amelioration of worksite exposure or, as a last resort, temporary, compensated job modification or transfer. The clinician can obtain assistance in addressing the problem from several resources, including local regulatory agencies and occupational health clinics. Widespread involvement of knowledgeable health professionals can have a dramatic impact on improving this important contemporary public health problem.