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Melhorn JM, Gelinas B, Martin DW, Hegmann KT, Thiese MS. Advancements in AMA Guides Musculoskeletal Impairment Evaluations: Improved Reliability and Ease of Use. J Occup Environ Med 2024:00043764-990000000-00572. [PMID: 38729185 DOI: 10.1097/jom.0000000000003145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
OBJECTIVE Describe and evaluate methodological improvements in AMA Guides to the Evaluation of Permanent Impairment (Guides) Sixth Edition 2024, including an updated sequential method and enhanced diagnosis-based impairment tables, compared to the Guides Sixth 2008. METHODS Three physician experts and three pre-medical students, respectively, completed two rounds of impairment ratings using the AMA Guides Sixth 2008 vs. 2024 methods. Impairment values and completion times using each method were compared for both groups. RESULTS Time to complete an impairment rating by experts averaged 3.5 minutes using Guides 2024 compared with 13.9 minutes using Guides 2008, with 100% accuracy and reliability for both. Students' time averaged 5.3 minutes and 15.9 minutes, respectively, with increased accuracy and reliability with Guides 2024. CONCLUSIONS The Guides Sixth 2024 allowed more-efficient impairment ratings while retaining accuracy, consistency, reliability, and reproducibility.
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Affiliation(s)
- J Mark Melhorn
- Department of Orthopaedics, University of Kansas School of Medicine Wichita, Kansas, U.S
| | - Barry Gelinas
- International Academy of Independent Medical Evaluators, Vancouver, Washington, U.S
| | | | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Weber State University, Utah, U.S
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Weber State University, Utah, U.S
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2
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Rivers P, Porter C, LeClair LB, Jeddy Z, Fowlkes AL, Lamberte JM, Herder K, Smith M, Rai R, Grant L, Hegmann KT, Jovel K, Vaughan M, Mathenge C, Phillips AL, Khan S, Britton A, Pilishvili T, Burgess JL, Newes-Adeyi G, Gaglani M, Caban-Martinez A, Yoon S, Lutrick K. Longitudinal parental perception of COVID-19 vaccines for children in a multi-site, cohort study. Vaccine 2024; 42:1512-1520. [PMID: 38307743 DOI: 10.1016/j.vaccine.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVES Pediatric COVID-19 vaccine hesitancy and uptake is not well understood. Among parents of a prospective cohort of children aged 6 months-17 years, we assessed COVID-19 vaccine knowledge, attitudes, and practices (KAP), and uptake over 15 months. METHODS The PROTECT study collected sociodemographic characteristics of children at enrollment and COVID-19 vaccination data and parental KAPs quarterly. Univariable and multivariable logistic regression models were used to test the effect of KAPs on vaccine uptake; McNemar's test for paired samples was used to evaluate KAP change over time. RESULTS A total of 2,837 children were enrolled, with more than half (61 %) vaccinated by October 2022. Positive parental beliefs about vaccine safety and effectiveness strongly predicted vaccine uptake among children aged 5-11 years (aOR 13.1, 95 % CI 8.5-20.4 and aOR 6.4, 95 % CI 4.3-9.6, respectively) and children aged 12+ years (aOR 7.0, 95 % CI 3.8-13.0 and aOR 8.9, 95 % CI 4.4-18.0). Compared to enrollment, at follow-up parents (of vaccinated and unvaccinated children) reported higher self-assessed vaccine knowledge, but more negative beliefs towards vaccine safety, effectiveness, and trust in government. Parents unlikely to vaccinate their children at enrollment reported more positive beliefs on vaccine knowledge, safety, and effectiveness at follow-up. CONCLUSION The PROTECT cohort allows for an examination of factors driving vaccine uptake and how beliefs about COVID-19 and the COVID-19 vaccines change over time. Findings of the current analysis suggest that these beliefs change over time and policies aiming to increase vaccine uptake should focus on vaccine safety and effectiveness.
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Affiliation(s)
| | | | | | - Zuha Jeddy
- Abt Associates, Rockville, MD, United States
| | - Ashley L Fowlkes
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | - Ramona Rai
- Abt Associates, Rockville, MD, United States
| | - Lauren Grant
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | | | | | - Sana Khan
- University of Arizona, Tucson, AZ, United States
| | - Amadea Britton
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Tamara Pilishvili
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | | | | | - Sarang Yoon
- Utah University, Salt Lake City, UT, United States
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Feldstein LR, Britton A, Grant L, Wiegand R, Ruffin J, Babu TM, Briggs Hagen M, Burgess JL, Caban-Martinez AJ, Chu HY, Ellingson KD, Englund JA, Hegmann KT, Jeddy Z, Lauring AS, Lutrick K, Martin ET, Mathenge C, Meece J, Midgley CM, Monto AS, Newes-Adeyi G, Odame-Bamfo L, Olsho LEW, Phillips AL, Rai RP, Saydah S, Smith N, Steinhardt L, Tyner H, Vandermeer M, Vaughan M, Yoon SK, Gaglani M, Naleway AL. Effectiveness of Bivalent mRNA COVID-19 Vaccines in Preventing SARS-CoV-2 Infection in Children and Adolescents Aged 5 to 17 Years. JAMA 2024; 331:408-416. [PMID: 38319331 PMCID: PMC10848053 DOI: 10.1001/jama.2023.27022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/11/2023] [Indexed: 02/07/2024]
Abstract
Importance Bivalent mRNA COVID-19 vaccines were recommended in the US for children and adolescents aged 12 years or older on September 1, 2022, and for children aged 5 to 11 years on October 12, 2022; however, data demonstrating the effectiveness of bivalent COVID-19 vaccines are limited. Objective To assess the effectiveness of bivalent COVID-19 vaccines against SARS-CoV-2 infection and symptomatic COVID-19 among children and adolescents. Design, Setting, and Participants Data for the period September 4, 2022, to January 31, 2023, were combined from 3 prospective US cohort studies (6 sites total) and used to estimate COVID-19 vaccine effectiveness among children and adolescents aged 5 to 17 years. A total of 2959 participants completed periodic surveys (demographics, household characteristics, chronic medical conditions, and COVID-19 symptoms) and submitted weekly self-collected nasal swabs (irrespective of symptoms); participants submitted additional nasal swabs at the onset of any symptoms. Exposure Vaccination status was captured from the periodic surveys and supplemented with data from state immunization information systems and electronic medical records. Main Outcome and Measures Respiratory swabs were tested for the presence of the SARS-CoV-2 virus using reverse transcriptase-polymerase chain reaction. SARS-CoV-2 infection was defined as a positive test regardless of symptoms. Symptomatic COVID-19 was defined as a positive test and 2 or more COVID-19 symptoms within 7 days of specimen collection. Cox proportional hazards models were used to estimate hazard ratios for SARS-CoV-2 infection and symptomatic COVID-19 among participants who received a bivalent COVID-19 vaccine dose vs participants who received no vaccine or monovalent vaccine doses only. Models were adjusted for age, sex, race, ethnicity, underlying health conditions, prior SARS-CoV-2 infection status, geographic site, proportion of circulating variants by site, and local virus prevalence. Results Of the 2959 participants (47.8% were female; median age, 10.6 years [IQR, 8.0-13.2 years]; 64.6% were non-Hispanic White) included in this analysis, 25.4% received a bivalent COVID-19 vaccine dose. During the study period, 426 participants (14.4%) had laboratory-confirmed SARS-CoV-2 infection. Among these 426 participants, 184 (43.2%) had symptomatic COVID-19, 383 (89.9%) were not vaccinated or had received only monovalent COVID-19 vaccine doses (1.38 SARS-CoV-2 infections per 1000 person-days), and 43 (10.1%) had received a bivalent COVID-19 vaccine dose (0.84 SARS-CoV-2 infections per 1000 person-days). Bivalent vaccine effectiveness against SARS-CoV-2 infection was 54.0% (95% CI, 36.6%-69.1%) and vaccine effectiveness against symptomatic COVID-19 was 49.4% (95% CI, 22.2%-70.7%). The median observation time after vaccination was 276 days (IQR, 142-350 days) for participants who received only monovalent COVID-19 vaccine doses vs 50 days (IQR, 27-74 days) for those who received a bivalent COVID-19 vaccine dose. Conclusion and Relevance The bivalent COVID-19 vaccines protected children and adolescents against SARS-CoV-2 infection and symptomatic COVID-19. These data demonstrate the benefit of COVID-19 vaccine in children and adolescents. All eligible children and adolescents should remain up to date with recommended COVID-19 vaccinations.
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Affiliation(s)
- Leora R. Feldstein
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amadea Britton
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren Grant
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ryan Wiegand
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jasmine Ruffin
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tara M. Babu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle
| | - Melissa Briggs Hagen
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Helen Y. Chu
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle
| | | | | | | | | | - Adam S. Lauring
- Division of Infectious Diseases, Department of Internal Medicine, University of Michigan, Ann Arbor
| | | | - Emily T. Martin
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | | | - Jennifer Meece
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Claire M. Midgley
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Arnold S. Monto
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor
| | | | | | | | | | | | - Sharon Saydah
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ning Smith
- Kaiser Permanente Center for Health Research, Portland, Oregon
| | - Laura Steinhardt
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Harmony Tyner
- St Luke’s Regional Health Care System, Duluth, Minnesota
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Hollister J, Caban-Martinez AJ, Ellingson KD, Beitel S, Fowlkes AL, Lutrick K, Tyner HL, Naleway AL, Yoon SK, Gaglani M, Hunt D, Meece J, Mayo Lamberte J, Schaefer Solle N, Rose S, Dunnigan K, Khan SM, Kuntz JL, Fisher JM, Coleman A, Britton A, Thiese MS, Hegmann KT, Pavuk M, Ramadan FA, Fuller S, Nematollahi A, Sprissler R, Burgess JL. Serum per- and polyfluoroalkyl substance concentrations and longitudinal change in post-infection and post-vaccination SARS-CoV-2 antibodies. Environ Res 2023; 239:117297. [PMID: 37816422 PMCID: PMC10842580 DOI: 10.1016/j.envres.2023.117297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/17/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023]
Abstract
Per- and polyfluoroalkyl substances (PFAS) are ubiquitous throughout the United States. Previous studies have shown PFAS exposure to be associated with a reduced immune response. However, the relationship between serum PFAS and antibody levels following SARS-CoV-2 infection or COVID-19 vaccination has not been examined. We examined differences in peak immune response and the longitudinal decline of antibodies following SARS-CoV-2 infection and COVID-19 vaccination by serum PFAS levels in a cohort of essential workers in the United States. We measured serum antibodies using an in-house semi-quantitative enzyme-linked immunosorbent assay (ELISA). Two cohorts contributed blood samples following SARS-CoV-2 infection or COVID-19 vaccination. We used linear mixed regression models, adjusting for age, race/ethnicity, gender, presence of chronic conditions, location, and occupation, to estimate differences in immune response with respect to serum PFAS levels. Our study populations included 153 unvaccinated participants that contributed 316 blood draws over a 14-month period following infection, and 860 participants and 2451 blood draws over a 12-month period following vaccination. Higher perfluorooctane sulfonic acid (PFOS), perfluorohexane sulfonic acid (PFHxS), and perfluorononanoic acid (PFNA) concentrations were associated with a lower peak antibody response after infection (p = 0.009, 0.031, 0.015). Higher PFOS, perfluorooctanoic acid (PFOA), PFHxS, and PFNA concentrations were associated with slower declines in antibodies over time after infection (p = 0.003, 0.014, 0.026, 0.025). PFOA, PFOS, PFHxS, and PFNA serum concentrations prior to vaccination were not associated with differences in peak antibody response after vaccination or with differences in decline of antibodies over time after vaccination. These results suggest that elevated PFAS may impede potential immune response to SARS-CoV-2 infection by blunting peak antibody levels following infection; the same finding was not observed for immune response to vaccination.
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Affiliation(s)
- James Hollister
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
| | - Alberto J Caban-Martinez
- Department of Public Health Sciences and Physical Medicine and Rehabilitation, University of Miami, Miller School of Medicine, USA
| | - Katherine D Ellingson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Shawn Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Karen Lutrick
- College of Medicine - Tucson, University of Arizona, Tucson, AZ, USA
| | | | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | - Sarang K Yoon
- University of Utah Health, Rocky Mountain Center for Occupational and Environmental Health, USA
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, TX, USA; Texas A&M University College of Medicine, Temple, TX, USA
| | | | | | | | - Natasha Schaefer Solle
- Department of Public Health Sciences and Physical Medicine and Rehabilitation, University of Miami, Miller School of Medicine, USA
| | | | | | - Sana M Khan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA
| | | | - Alissa Coleman
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, UT, USA
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, UT, USA
| | - Marian Pavuk
- Agency for Toxic Substances and Disease Registry, CDC, Atlanta, GA, USA
| | - Ferris A Ramadan
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, USA
| | | | - Amy Nematollahi
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Ryan Sprissler
- University of Arizona Genetics Core, Office for Research, Innovation and Impact, University of Arizona, Tucson, AZ, USA
| | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Hegmann KT, Thiese MS, Wood EM, Kapellusch J, Foster JC, Drury DL, Kendall R, Merryweather AS. Cardiovascular Disease Risk Factors Predict the Development and Numbers of Common Musculoskeletal Disorders in a Prospective Cohort. J Occup Environ Med 2023; 65:e527-e533. [PMID: 37264528 PMCID: PMC10417266 DOI: 10.1097/jom.0000000000002895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of the study is to assess risk of common musculoskeletal disorders (MSDs) based on cardiovascular disease (CVD) risk scores. METHODS Data from a 9-year prospective cohort of 1224 workers in three states were analyzed. Baseline data included questionnaires, structured interviews, physical examinations, anthropometric measurements, nerve conduction studies, and individualized measurement of job physical factors. Monthly follow-ups were conducted. Framingham risk scores were calculated. A priori case definitions were constructed for carpal tunnel syndrome, lateral epicondylopathy, medial epicondylopathy, and rotator cuff tendinopathy. RESULTS Adjusted RRs for one or more MSDs increased to 3.90 (95% confidence interval, 2.20-6.90) among those with 10-year cardiovascular disease risk scores greater than 15% and 17.4 (95% confidence interval, 3.85-78.62) among those with more than 4 disorders. CONCLUSIONS Cardiovascular disease factors are strongly associated with the subsequent development of common MSDs. Risks among those with multiple MSDs are considerably stronger.
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Lyski ZL, Porter C, Uhrlaub JL, Ellingson KD, Jeddy Z, Gwynn L, Rivers P, Sprissler R, Hegmann KT, Coughlin M, Fowlkes A, Hollister J, LeClair L, Mak J, Beitel SC, Fuller S, Grant L, Newes-Adeyi G, Yoo YM, Olsho L, Burgess JL, Caban-Martinez A, Yoon S, Britton A, Gaglani M, Lutrick K. Humoral Immune Response to Messenger RNA Coronavirus Disease 2019 Vaccination Among Children Aged 5-11 Years in a Multisite Prospective Cohort Study, September 2021-September 2022. Open Forum Infect Dis 2023; 10:ofad431. [PMID: 37663086 PMCID: PMC10468733 DOI: 10.1093/ofid/ofad431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/09/2023] [Indexed: 09/05/2023] Open
Abstract
Background The PROTECT study is a longitudinal cohort study initiated in July 2021 with weekly testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in 4 states: Arizona, Florida, exas, and Utah. This study aims to examine vaccine-elicited antibody response against postvaccination SARS-CoV-2 infections. Methods Children aged 5-11 years had serum collected 14-59 days after their second dose of monovalent Pfizer-BioNTech coronavirus disease 2019 messenger RNA vaccine. Vaccine-elicited antibodies were measured using the area under the curve (AUC) and end-point titer using enzyme-linked immunosorbent assay (receptor-binding domain [RBD] and S2) and surrogate neutralization assays against ancestral (WA1) and Omicron (BA.2). Results 79 vaccinated participants (33 [41.7%] female; median age, 8.8 years [standard deviation, 1.9 years]), 48 (60.8%) were from Tucson, Arizona; 64 (81.0%) were non-Hispanic white; 63 (80.8%) attended school in person; 68 (86.1%) did not have any chronic conditions; and 47 (59.5%) were infected after vaccination. Uninfected children had higher AUCs against WA1 (P = .009) and Omicron (P = .02). The geometric mean and surrogate neutralization titer above the limit of detection was 346.0 for WA1 and 39.7 for Omicron, an 8.7-fold decrease (P < .001). After adjustment of covariates in the WA1-specific model, we observed a 47% reduction in the odds of postvaccination infection for every standard deviation increase in RBD AUC (aOR, 0.53 [95% confidence interval, .29-.97) and a 69% reduction in the odds of infection for every 3-fold increase in RBD end titer (0.31 [.06-1.57]). Conclusions Children with higher antibody levels experienced a lower incidence of postvaccination SARS-CoV-2 infection.
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Affiliation(s)
- Zoe L Lyski
- Immunobiology, College of Medicine–Tucson, University of Arizona, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Cynthia Porter
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Jennifer L Uhrlaub
- Immunobiology, College of Medicine–Tucson, University of Arizona, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Katherine D Ellingson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Zuha Jeddy
- Abt Associates, Rockville, Maryland, USA
| | - Lisa Gwynn
- Leonard M. Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Patrick Rivers
- Family and Community Medicine, College of Medicine–Tucson, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Ryan Sprissler
- University of Arizona Genetics Core—Center for Applied Genetics and Genomic Medicine, University of Arizona, Tucson, Arizona, USA
| | - Kurt T Hegmann
- Department of Family and Preventive Medicine, Rocky Mountain Center for Occupational and Environmental Health, University of Utah Health, Salt Lake City, Utah, USA
| | - Melissa Coughlin
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ashley Fowlkes
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - James Hollister
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | - Josephine Mak
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Shawn C Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | - Lauren Grant
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Young M Yoo
- Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | - Sarang Yoon
- Department of Family and Preventive Medicine, Rocky Mountain Center for Occupational and Environmental Health, University of Utah Health, Salt Lake City, Utah, USA
| | - Amadea Britton
- Coronavirus and Other Respiratory Viruses Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manjusha Gaglani
- Baylor Scott & White Health, Texas A&M University School of Medicine, Temple, Texas, USA
| | - Karen Lutrick
- Family and Community Medicine, College of Medicine–Tucson, University of Arizona Health Sciences, Tucson, Arizona, USA
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7
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Ellingson KD, Hollister J, Porter CJ, Khan SM, Feldstein LR, Naleway AL, Gaglani M, Caban-Martinez AJ, Tyner HL, Lowe AA, Olsho LEW, Meece J, Yoon SK, Mak J, Kuntz JL, Solle NS, Respet K, Baccam Z, Wesley MG, Thiese MS, Yoo YM, Odean MJ, Miiro FN, Pickett SL, Phillips AL, Grant L, Romine JK, Herring MK, Hegmann KT, Lamberte JM, Sokol B, Jovel KS, Thompson MG, Rivers P, Pilishvili T, Lutrick K, Burgess JL, Midgley CM, Fowlkes AL. Risk Factors for Reinfection with SARS-CoV-2 Omicron Variant among Previously Infected Frontline Workers. Emerg Infect Dis 2023; 29:599-604. [PMID: 36703252 PMCID: PMC9973698 DOI: 10.3201/eid2903.221314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
In a cohort of essential workers in the United States previously infected with SARS-CoV-2, risk factors for reinfection included being unvaccinated, infrequent mask use, time since first infection, and being non-Hispanic Black. Protecting workers from reinfection requires a multipronged approach including up-to-date vaccination, mask use as recommended, and reduction in underlying health disparities.
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8
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Lemke MK, Thiese MS, Hege A, Ogbonnaya UC, Hegmann KT. Metabolic syndrome among commercial truck drivers: The relationship between condition prevalence and crashes. Am J Ind Med 2023; 66:54-64. [PMID: 36268908 DOI: 10.1002/ajim.23437] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 09/27/2022] [Accepted: 10/03/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Metabolic syndrome (MetS) is especially prevalent among US truck drivers. However, there has been limited research exploring associations between MetS conditions with roadway crashes among truck drivers. The objective of this paper is to assess relationships between specific combinations of individual MetS components and crashes and near-misses. METHODS Survey, biometric, and anthropometric data were collected from 817 truck drivers across 6 diverse US states. Survey data focused on demographics and roadway safety outcomes, and anthropometric/biometric data corresponded to five MetS conditions (waist circumference blood pressure, hemoglobin A1c, triglycerides, and high-density lipoprotein [HDL] cholesterol). Logistic regression was used to calculate odds ratios of lifetime crashes and near-miss 1-month period prevalence associated with: 1) specific MetS conditions regardless of presence or absence of other MetS conditions, and 2) specific MetS conditions and counts of other accompanying MetS conditions. RESULTS Hypertension was the MetS characteristic most strongly associated with lifetime crash and 1-month near-miss outcomes, while high triglycerides, low HDL cholesterol, and large waist circumference were most commonly present among groups of conditions associated with crashes and near-misses. Overall, an increasing number of specific co-occurring MetS conditions were associated with higher reporting of roadway crashes. CONCLUSIONS Specific combinations and higher prevalence of MetS conditions were associated with increased frequency of reported crashes. Moreover, when the co-occurrence of MetS conditions is aggregated, a dose-response relationship with crashes appears. These results suggest that policy changes and interventions addressing MetS may increase driver health and reduce crash risk.
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Affiliation(s)
- Michael K Lemke
- Department of Social Sciences, University of Houston-Downtown, Houston, Texas, USA
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, School of Medicine, University of Utah and Weber State University, Salt Lake City, Utah, USA
| | - Adam Hege
- Department of Public Health & Exercise Science, Appalachian State University, Boone, North Carolina, USA
| | - Uchenna C Ogbonnaya
- Rocky Mountain Center for Occupational and Environmental Health, School of Medicine, University of Utah and Weber State University, Salt Lake City, Utah, USA
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, School of Medicine, University of Utah and Weber State University, Salt Lake City, Utah, USA
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Thompson MG, Yoon SK, Naleway AL, Meece J, Fabrizio TP, Caban-Martinez AJ, Burgess JL, Gaglani M, Olsho LEW, Bateman A, Lundgren J, Grant L, Phillips AL, Groom HC, Stefanski E, Solle NS, Ellingson K, Lutrick K, Dunnigan K, Wesley MG, Guenther K, Hunt A, Mak J, Hegmann KT, Kuntz JL, Bissonnette A, Hollister J, Rose S, Morrill TC, Respet K, Fowlkes AL, Thiese MS, Rivers P, Herring MK, Odean MJ, Yoo YM, Brunner M, Bedrick EJ, Fleary DE, Jones JT, Praggastis J, Romine J, Dickerson M, Khan SM, Lamberte JM, Beitel S, Webby RJ, Tyner HL. Association of mRNA Vaccination With Clinical and Virologic Features of COVID-19 Among US Essential and Frontline Workers. JAMA 2022; 328:1523-1533. [PMID: 36255426 PMCID: PMC9579910 DOI: 10.1001/jama.2022.18550] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/20/2022] [Indexed: 11/14/2022]
Abstract
Importance Data on the epidemiology of mild to moderately severe COVID-19 are needed to inform public health guidance. Objective To evaluate associations between 2 or 3 doses of mRNA COVID-19 vaccine and attenuation of symptoms and viral RNA load across SARS-CoV-2 viral lineages. Design, Setting, and Participants A prospective cohort study of essential and frontline workers in Arizona, Florida, Minnesota, Oregon, Texas, and Utah with COVID-19 infection confirmed by reverse transcriptase-polymerase chain reaction testing and lineage classified by whole genome sequencing of specimens self-collected weekly and at COVID-19 illness symptom onset. This analysis was conducted among 1199 participants with SARS-CoV-2 from December 14, 2020, to April 19, 2022, with follow-up until May 9, 2022, reported. Exposures SARS-CoV-2 lineage (origin strain, Delta variant, Omicron variant) and COVID-19 vaccination status. Main Outcomes and Measures Clinical outcomes included presence of symptoms, specific symptoms (including fever or chills), illness duration, and medical care seeking. Virologic outcomes included viral load by quantitative reverse transcriptase-polymerase chain reaction testing along with viral viability. Results Among 1199 participants with COVID-19 infection (714 [59.5%] women; median age, 41 years), 14.0% were infected with the origin strain, 24.0% with the Delta variant, and 62.0% with the Omicron variant. Participants vaccinated with the second vaccine dose 14 to 149 days before Delta infection were significantly less likely to be symptomatic compared with unvaccinated participants (21/27 [77.8%] vs 74/77 [96.1%]; OR, 0.13 [95% CI, 0-0.6]) and, when symptomatic, those vaccinated with the third dose 7 to 149 days before infection were significantly less likely to report fever or chills (5/13 [38.5%] vs 62/73 [84.9%]; OR, 0.07 [95% CI, 0.0-0.3]) and reported significantly fewer days of symptoms (10.2 vs 16.4; difference, -6.1 [95% CI, -11.8 to -0.4] days). Among those with Omicron infection, the risk of symptomatic infection did not differ significantly for the 2-dose vaccination status vs unvaccinated status and was significantly higher for the 3-dose recipients vs those who were unvaccinated (327/370 [88.4%] vs 85/107 [79.4%]; OR, 2.0 [95% CI, 1.1-3.5]). Among symptomatic Omicron infections, those vaccinated with the third dose 7 to 149 days before infection compared with those who were unvaccinated were significantly less likely to report fever or chills (160/311 [51.5%] vs 64/81 [79.0%]; OR, 0.25 [95% CI, 0.1-0.5]) or seek medical care (45/308 [14.6%] vs 20/81 [24.7%]; OR, 0.45 [95% CI, 0.2-0.9]). Participants with Delta and Omicron infections who received the second dose 14 to 149 days before infection had a significantly lower mean viral load compared with unvaccinated participants (3 vs 4.1 log10 copies/μL; difference, -1.0 [95% CI, -1.7 to -0.2] for Delta and 2.8 vs 3.5 log10 copies/μL, difference, -1.0 [95% CI, -1.7 to -0.3] for Omicron). Conclusions and Relevance In a cohort of US essential and frontline workers with SARS-CoV-2 infections, recent vaccination with 2 or 3 mRNA vaccine doses less than 150 days before infection with Delta or Omicron variants, compared with being unvaccinated, was associated with attenuated symptoms, duration of illness, medical care seeking, or viral load for some comparisons, although the precision and statistical significance of specific estimates varied.
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Affiliation(s)
- Mark G Thompson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Sarang K Yoon
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | - Jennifer Meece
- Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | | | | | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, Texas
- Texas A&M University College of Medicine, Temple
| | | | | | | | - Lauren Grant
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Andrew L Phillips
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Holly C Groom
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | | | | | - Katherine Ellingson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Karen Lutrick
- College of Medicine - Tucson, University of Arizona, Tucson
| | | | | | | | - Angela Hunt
- St Luke's Regional Health Care System, Duluth, Minnesota
| | - Josephine Mak
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, Oregon
| | | | - James Hollister
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | | | | | - Karley Respet
- St Luke's Regional Health Care System, Duluth, Minnesota
| | - Ashley L Fowlkes
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Patrick Rivers
- College of Medicine - Tucson, University of Arizona, Tucson
| | | | - Marilyn J Odean
- Whiteside Institute for Clinical Research, St Luke's, Duluth, Minnesota
| | - Young M Yoo
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Matthew Brunner
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - Edward J Bedrick
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | | | - John T Jones
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Jenna Praggastis
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah
| | - James Romine
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Monica Dickerson
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Sana M Khan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Julie Mayo Lamberte
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia
| | - Shawn Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
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Pugh T, Harris J, Jarnagin K, Thiese MS, Hegmann KT. Impacts of the Statewide COVID-19 Lockdown Interventions on Excess Mortality, Unemployment, and Employment Growth. J Occup Environ Med 2022; 64:726-730. [PMID: 35753081 PMCID: PMC9426308 DOI: 10.1097/jom.0000000000002597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study is to determine relationships between lockdowns and excess mortality, unemployment, and employment growth. METHODS Each US states' mortality data for 2020 were compared with the prior 3 years to determine excess mortality. Data were compared using measures of lockdowns, or state openness scores and adjusted for age, sex, race/ethnicity, and cardiovascular disease. Comparisons were made with unemployment rates and employment growth rates. RESULTS The 2020 excess mortality ranged from -9% to 46%. The average openness score was not significant ( P = 0.20). However, openness was strongly associated with both unemployment ( P = 0.01) and employment growth ( P = 0.0008). CONCLUSIONS There was no statistical relationship between excess mortality and openness scores, while there were strong relationships with employment measures. These results suggest that lockdowns are not sufficiently beneficial for future use in this pandemic and raise concerns for use in future pandemics.
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Tang R, Kapellusch JM, Hegmann KT, Thiese MS, Wang I, Merryweather AS. Evaluating Different Measures of Low Back Pain Among U.S. Manual Materials Handling Workers: Comparisons of Demographic, Psychosocial, and Job Physical Exposure. Hum Factors 2022; 64:973-996. [PMID: 33300376 DOI: 10.1177/0018720820971101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To examine differences in demographic, psychosocial, and job physical exposure risk factors between multiple low back pain (LBP) outcomes in a prospective cohort of industrial workers. BACKGROUND LBP remains a leading cause of lost industrial productivity. Different case definitions involving pain (general LBP), medication use (M-LBP), seeking healthcare (H-LBP), and lost time (L-LBP) are often used to study LBP outcomes. However, the relationship between these outcomes remains unclear. METHOD Demographic, health status, psychosocial, and job physical exposure risk factors were quantified for 635 incident-eligible industrial workers. Incident cases of LBP outcomes and pain symptoms were quantified and compared across the four outcomes. RESULTS Differences in age, gender, medical history, and LBP history were found between the four outcomes. Most incident-eligible workers (67%) suffered an LBP outcome during follow-up. Cases decreased from 420 for LBP (25.4 cases/100 person-years) to 303 for M-LBP (22.0 cases/100 person-years), to 151 for H-LBP (15.6 cases/100 person-years), and finally to 56 for L-LBP (8.7 cases/100 person-years). Conversely, pain intensity and duration increased from LBP to H-LBP. However, pain duration was relatively lower for L-LBP than for H-LBP. CONCLUSION Patterns of cases, pain intensity, and pain duration suggest the influence of the four outcomes. However, few differences in apparent risk factors were observed between the outcomes. Further research is needed to establish consistent case definitions. APPLICATION Knowledge of patterns between different LBP outcomes can improve interpretation of research and guide future research and intervention studies in industry.
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Affiliation(s)
- Ruoliang Tang
- 12530 Sichuan University-Pittsburgh Institute, Chengdu, China
- 14751 University of Wisconsin-Milwaukee, USA
| | | | | | | | - Inga Wang
- 14751 University of Wisconsin-Milwaukee, USA
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12
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Burns J, Rivers P, LeClair LB, Jovel KS, Rai RP, Lowe AA, Edwards LJ, Khan SM, Mathenge C, Ferraris M, Kuntz JL, Lamberte JM, Hegmann KT, Odean MJ, McLeland-Wieser H, Beitel S, Odame-Bamfo L, Schaefer Solle N, Mak J, Phillips AL, Sokol BE, Hollister J, Ochoa JS, Grant L, Thiese MS, Jacoby KB, Lutrick K, Pubillones FA, Yoo YM, Rentz Hunt D, Ellingson K, Berry MC, Gerald JK, Lopez J, Gerald LB, Wesley MG, Krupp K, Herring MK, Madhivanan P, Caban-Martinez AJ, Tyner HL, Meece JK, Yoon SK, Fowlkes AL, Naleway AL, Gwynn L, Burgess JL, Thompson MG, Olsho LE, Gaglani M. Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT): Protocol for a Multisite Longitudinal Cohort Study. JMIR Res Protoc 2022; 11:e37929. [PMID: 35635842 PMCID: PMC9377426 DOI: 10.2196/37929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/24/2022] [Accepted: 05/25/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Assessing the real-world effectiveness of COVID-19 vaccines and understanding the incidence and severity of SARS-CoV-2 illness in children are essential to inform policy and guide health care professionals in advising parents and caregivers of children who test positive for SARS-CoV-2. OBJECTIVE This report describes the objectives and methods for conducting the Pediatric Research Observing Trends and Exposures in COVID-19 Timelines (PROTECT) study. PROTECT is a longitudinal prospective pediatric cohort study designed to estimate SARS-CoV-2 incidence and COVID-19 vaccine effectiveness (VE) against infection among children aged 6 months to 17 years, as well as differences in SARS-CoV-2 infection and vaccine response between children and adolescents. METHODS The PROTECT multisite network was initiated in July 2021, which aims to enroll approximately 2305 children across four US locations and collect data over a 2-year surveillance period. The enrollment target was based on prospective power calculations and accounts for expected attrition and nonresponse. Study sites recruit parents and legal guardians of age-eligible children participating in the existing Arizona Healthcare, Emergency Response, and Other Essential Workers Surveillance (HEROES)-Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) network as well as from surrounding communities. Child demographics, medical history, COVID-19 exposure, vaccination history, and parents/legal guardians' knowledge and attitudes about COVID-19 are collected at baseline and throughout the study. Mid-turbinate nasal specimens are self-collected or collected by parents/legal guardians weekly, regardless of symptoms, for SARS-CoV-2 and influenza testing via reverse transcription-polymerase chain reaction (RT-PCR) assay, and the presence of COVID-like illness (CLI) is reported. Children who test positive for SARS-CoV-2 or influenza, or report CLI are monitored weekly by online surveys to report exposure and medical utilization until no longer ill. Children, with permission of their parents/legal guardians, may elect to contribute blood at enrollment, following SARS-CoV-2 infection, following COVID-19 vaccination, and at the end of the study period. PROTECT uses electronic medical record (EMR) linkages where available, and verifies COVID-19 and influenza vaccinations through EMR or state vaccine registries. RESULTS Data collection began in July 2021 and is expected to continue through the spring of 2023. As of April 13, 2022, 2371 children are enrolled in PROTECT. Enrollment is ongoing at all study sites. CONCLUSIONS As COVID-19 vaccine products are authorized for use in pediatric populations, PROTECT study data will provide real-world estimates of VE in preventing infection. In addition, this prospective cohort provides a unique opportunity to further understand SARS-CoV-2 incidence, clinical course, and key knowledge gaps that may inform public health. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/37929.
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Affiliation(s)
- Joy Burns
- Abt Associates, Atlanta, GA, United States
| | - Patrick Rivers
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Krystal S Jovel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Ashley A Lowe
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Sana M Khan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Clare Mathenge
- College of Medicine, Texas A&M University, Temple, TX, United States
| | - Maria Ferraris
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States
| | - Julie Mayo Lamberte
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Marilyn J Odean
- St. Luke's Regional Health Care System, Duluth, MN, United States
- Whiteside Institute for Clinical Research, St. Luke's, Duluth, MN, United States
| | | | - Shawn Beitel
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Leah Odame-Bamfo
- College of Medicine, Texas A&M University, Temple, TX, United States
| | | | - Josephine Mak
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Andrew L Phillips
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | | | - James Hollister
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Jezahel S Ochoa
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Lauren Grant
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | | | - Karen Lutrick
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Felipe A Pubillones
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Young M Yoo
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Katherine Ellingson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Joe K Gerald
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Lynn B Gerald
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Karl Krupp
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Purnima Madhivanan
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | | | - Harmony L Tyner
- St. Luke's Regional Health Care System, Duluth, MN, United States
| | - Jennifer K Meece
- Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Sarang K Yoon
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, UT, United States
| | - Ashley L Fowlkes
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States
| | - Lisa Gwynn
- Leonard M Miller School of Medicine, University of Miami, Miami, FL, United States
| | - Jefferey L Burgess
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Mark G Thompson
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Manjusha Gaglani
- College of Medicine, Texas A&M University, Temple, TX, United States
- Baylor Scott and White Health, Temple, TX, United States
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Weames GG, Page GB, Thiese MS, Hegmann KT. Concerns regarding the publication "Powered-hand tools and vibration-related disorders in US-railway maintenance-of-way workers". Ind Health 2022; 60:284-287. [PMID: 34819406 PMCID: PMC9171124 DOI: 10.2486/indhealth.2021-0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 08/26/2021] [Indexed: 06/13/2023]
Affiliation(s)
| | | | - Matthew S Thiese
- University of Utah Health Ringgold standard institution, United States
| | - Kurt T Hegmann
- University of Utah Health Ringgold standard institution, United States
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Carragee EJ, Andersson GBJ, Belcourt RM, Eskay-Auerbach M, Goertz M, Haldeman S, Hegmann KT, Lessenger JE, Mayer T, Mueller KL, Murphy DR, Tellin WG, Thiese MS, Travis R, Weiss MS, Harris JS. Reply to Sayeed et al's Reply to Reply. J Occup Environ Med 2022; 64:e391-e392. [PMID: 35761429 DOI: 10.1097/jom.0000000000002548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Yoon SK, Hegmann KT, Thiese MS, Burgess JL, Ellingson K, Lutrick K, Olsho LEW, Edwards LJ, Sokol B, Caban-Martinez AJ, Schaefer-Solle N, Jones JM, Tyner H, Hunt A, Respet K, Gaglani M, Dunnigan K, Rose S, Naleway A, Groom H, Kuntz J, Fowlkes AL, Thompson MG, Yoo YM. Protection with a Third Dose of mRNA Vaccine against SARS-CoV-2 Variants in Frontline Workers. N Engl J Med 2022; 386:1855-1857. [PMID: 35385628 PMCID: PMC9006784 DOI: 10.1056/nejmc2201821] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Angela Hunt
- St. Luke's Regional Health Care System, Duluth, MN
| | | | | | | | | | | | | | | | | | | | - Young M Yoo
- Centers for Disease Control and Prevention, Atlanta, GA
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Naleway AL, Grant L, Caban‐Martinez AJ, Wesley MG, Burgess JL, Groover K, Gaglani M, Yoon SK, Tyner HL, Meece J, Kuntz JL, Yoo YM, Schaefer‐Solle N, Olsho LEW, Gerald JK, Rose S, Thiese MS, Lundgren J, Groom HC, Mak J, Louzado Feliciano P, Edwards LJ, Lutrick K, Dunnigan K, Phillips AL, Lamberte JM, Noriega R, Sokol BE, Odean M, Ellingson KD, Smith M, Hegmann KT, Respet K, Dickerson M, Cruz A, Fleary DE, Murthy K, Hunt A, Azziz‐Baumgartner E, Gallimore‐Wilson D, Harder JA, Odame‐Bamfo L, Viergutz J, Arvay M, Jones JM, Mistry P, Thompson MG, Fowlkes AL. Incidence of SARS-CoV-2 infection among COVID-19 vaccinated and unvaccinated healthcare personnel, first responders, and other essential and frontline workers: Eight US locations, January-September 2021. Influenza Other Respir Viruses 2022; 16:585-593. [PMID: 35023288 PMCID: PMC8983896 DOI: 10.1111/irv.12956] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND We sought to evaluate the impact of changes in estimates of COVID-19 vaccine effectiveness on the incidence of laboratory-confirmed infection among frontline workers at high risk for SARS-CoV-2. METHODS We analyzed data from a prospective frontline worker cohort to estimate the incidence of COVID-19 by month as well as the association of COVID-19 vaccination, occupation, demographics, physical distancing, and mask use with infection risk. Participants completed baseline and quarterly surveys, and each week self-collected mid-turbinate nasal swabs and reported symptoms. RESULTS Among 1018 unvaccinated and 3531 fully vaccinated workers, the monthly incidence of laboratory-confirmed SARS-CoV-2 infection in January 2021 was 13.9 (95% confidence interval [CI]: 10.4-17.4), declining to 0.5 (95% CI -0.4-1.4) per 1000 person-weeks in June. By September 2021, when the Delta variant predominated, incidence had once again risen to 13.6 (95% CI 7.8-19.4) per 1000 person-weeks. In contrast, there was no reportable incidence among fully vaccinated participants at the end of January 2021, and incidence remained low until September 2021 when it rose modestly to 4.1 (95% CI 1.9-3.8) per 1000. Below average facemask use was associated with a higher risk of infection for unvaccinated participants during exposure to persons who may have COVID-19 and vaccinated participants during hours in the community. CONCLUSIONS COVID-19 vaccination was significantly associated with a lower risk of SARS-CoV-2 infection despite Delta variant predominance. Our data demonstrate the added protective benefit of facemask use among both unvaccinated and vaccinated frontline workers.
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Affiliation(s)
| | - Lauren Grant
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | | | | | - Jefferey L. Burgess
- Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
| | | | - Manjusha Gaglani
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Sarang K. Yoon
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | | | - Jennifer Meece
- Marshfield Clinic Research InstituteMarshfieldWisconsinUSA
| | - Jennifer L. Kuntz
- Kaiser Permanente Northwest Center for Health ResearchPortlandOregonUSA
| | - Young M. Yoo
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | | | | | - Joe K. Gerald
- Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
| | - Spencer Rose
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Matthew S. Thiese
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | | | - Holly C. Groom
- Kaiser Permanente Northwest Center for Health ResearchPortlandOregonUSA
| | - Josephine Mak
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | | | | | - Karen Lutrick
- Mel and Enid Zuckerman College of Public HealthUniversity of ArizonaTucsonArizonaUSA
| | - Kayan Dunnigan
- Baylor Scott and White HealthTempleTexasUSA
- Texas A&M University College of MedicineTempleTexasUSA
| | - Andrew L. Phillips
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Julie Mayo Lamberte
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - Roger Noriega
- Leonard M. Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Marilyn Odean
- Whiteside Institute for Clinical Research, St. Luke'sDuluthMinnesotaUSA
| | | | | | - Kurt T. Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family and Preventive MedicineUniversity of Utah HealthSalt Lake CityUtahUSA
| | - Karley Respet
- St. Luke's Regional Health Care SystemDuluthMinnesotaUSA
| | - Monica Dickerson
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - Alexandra Cruz
- Leonard M. Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | | | - Angela Hunt
- St. Luke's Regional Health Care SystemDuluthMinnesotaUSA
| | | | | | | | | | | | - Melissa Arvay
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - John M. Jones
- Leonard M. Miller School of MedicineUniversity of MiamiMiamiFloridaUSA
| | | | - Mark G. Thompson
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
| | - Ashley L. Fowlkes
- Centers for Disease Control and Prevention COVID‐19 Response TeamAtlantaGeorgiaUSA
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17
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Fowlkes AL, Yoon SK, Lutrick K, Gwynn L, Burns J, Grant L, Phillips AL, Ellingson K, Ferraris MV, LeClair LB, Mathenge C, Yoo YM, Thiese MS, Gerald LB, Solle NS, Jeddy Z, Odame-Bamfo L, Mak J, Hegmann KT, Gerald JK, Ochoa JS, Berry M, Rose S, Lamberte JM, Madhivanan P, Pubillones FA, Rai RP, Dunnigan K, Jones JT, Krupp K, Edwards LJ, Bedrick EJ, Sokol BE, Lowe A, McLeland-Wieser H, Jovel KS, Fleary DE, Khan SM, Poe B, Hollister J, Lopez J, Rivers P, Beitel S, Tyner HL, Naleway AL, Olsho LE, Caban-Martinez AJ, Burgess JL, Thompson MG, Gaglani M. Effectiveness of 2-Dose BNT162b2 (Pfizer BioNTech) mRNA Vaccine in Preventing SARS-CoV-2 Infection Among Children Aged 5-11 Years and Adolescents Aged 12-15 Years - PROTECT Cohort, July 2021-February 2022. MMWR Morb Mortal Wkly Rep 2022; 71:422-428. [PMID: 35298453 PMCID: PMC8942308 DOI: 10.15585/mmwr.mm7111e1] [Citation(s) in RCA: 99] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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18
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Travis R, Andersson GBJ, Belcourt RM, Carragee EJ, Eskay-Auerbach M, Goertz M, Haldeman S, Hegmann KT, Lessenger JE, Mayer T, Mueller KL, Murphy DR, Tellin WG, Thiese MS, Weiss MS, Harris JS. Reply to Sayeed et al. J Occup Environ Med 2022; 64:e84-e86. [PMID: 34873136 DOI: 10.1097/jom.0000000000002453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Russell Travis
- RACOEM Evidence-based Practice Spine Panel University of Utah Salt Lake City, Utah
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19
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Harris-Adamson C, Eisen EA, Kapellusch J, Hegmann KT, Thiese MS, Dale AM, Evanoff B, Meyers AR, Bao S, Gerr F, Krause N, Rempel D. Occupational risk factors for work disability following carpal tunnel syndrome: a pooled prospective study. Occup Environ Med 2022; 79:442-451. [DOI: 10.1136/oemed-2021-107771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/09/2021] [Indexed: 11/04/2022]
Abstract
BackgroundAlthough recent studies have identified important risk factors associated with incident carpal tunnel syndrome (CTS), risk factors associated with its severity have not been well explored.ObjectiveTo examine the associations between personal, workplace psychosocial and biomechanical factors and incident work disability among workers with CTS.MethodsBetween 2001 and 2010 five research groups conducted coordinated prospective studies of CTS and related work disability among US workers from various industries. Workers with prevalent or incident CTS (N=372) were followed for up to 6.4 years. Incident work disability was measured as: (1) change in work pace or work quality, (2) lost time or (3) job change following the development of CTS. Psychosocial factors were assessed by questionnaire. Biomechanical exposures were assessed by observation and measurements and included force, repetition, duty cycle and posture. HRs were estimated using Cox models.ResultsDisability incidence rates per 100 person-years were 33.2 for changes in work pace or quality, 16.3 for lost time and 20.0 for job change. There was a near doubling of risk for job change among those in the upper tertile of the Hand Activity Level Scale (HR 2.17; 95% CI 1.17 to 4.01), total repetition rate (HR 1.75; 95% CI 1.02 to 3.02), % time spent in all hand exertions (HR 2.20; 95% CI 1.21 to 4.01) and a sixfold increase for high job strain. Sensitivity analyses indicated attenuation due to inclusion of the prevalent CTS cases.ConclusionPersonal, biomechanical and psychosocial job factors predicted CTS-related disability. Results suggest that prevention of severe disability requires a reduction of both biomechanical and organisational work stressors.
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20
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Edwards LJ, Fowlkes AL, Wesley MG, Kuntz JL, Odean MJ, Caban-Martinez AJ, Dunnigan K, Phillips AL, Grant L, Herring MK, Groom HC, Respet K, Beitel S, Zunie T, Hegmann KT, Kumar A, Joseph G, Poe B, Louzado-Feliciano P, Smith ME, Thiese MS, Schaefer-Solle N, Yoo YM, Silvera CA, Mayo Lamberte J, Mak J, McDonald LC, Stuckey MJ, Kutty P, Arvay ML, Yoon SK, Tyner HL, Burgess JL, Hunt DR, Meece J, Gaglani M, Naleway AL, Thompson MG. Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER): Protocol for a Multisite Longitudinal Cohort Study. JMIR Res Protoc 2021; 10:e31574. [PMID: 34662287 PMCID: PMC8647972 DOI: 10.2196/31574] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Workers critical to emergency response and continuity of essential services during the COVID-19 pandemic are at a disproportionally high risk of SARS-CoV-2 infection. Prospective cohort studies are needed for enhancing the understanding of the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, identifying risk factors, assessing clinical outcomes, and determining the effectiveness of vaccination. OBJECTIVE The Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) prospective cohort study was designed to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, examine the risk factors for infection and clinical spectrum of illness, and assess the effectiveness of vaccination among essential workers. METHODS The RECOVER multisite network was initiated in August 2020 and aims to enroll 3000 health care personnel (HCP), first responders, and other essential and frontline workers (EFWs) at 6 US locations. Data on participant demographics, medical history, and vaccination history are collected at baseline and throughout the study. Active surveillance for the symptoms of COVID-19-like illness (CLI), access of medical care, and symptom duration is performed by text messages, emails, and direct participant or medical record reports. Participants self-collect a mid-turbinate nasal swab weekly, regardless of symptoms, and 2 additional respiratory specimens at the onset of CLI. Blood is collected upon enrollment, every 3 months, approximately 28 days after a reverse transcription polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection, and 14 to 28 days after a dose of any COVID-19 vaccine. From February 2021, household members of RT-PCR-confirmed participants are self-collecting mid-turbinate nasal swabs daily for 10 days. RESULTS The study observation period began in August 2020 and is expected to continue through spring 2022. There are 2623 actively enrolled RECOVER participants, including 280 participants who have been found to be positive for SARS-CoV-2 by RT-PCR. Enrollment is ongoing at 3 of the 6 study sites. CONCLUSIONS Data collected through the cohort are expected to provide important public health information for essential workers at high risk for occupational exposure to SARS-CoV-2 and allow early evaluation of COVID-19 vaccine effectiveness. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/31574.
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Affiliation(s)
| | - Ashley L Fowlkes
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Jennifer L Kuntz
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States
| | - Marilyn J Odean
- Whiteside Institute for Clinical Research, Duluth, MN, United States
- St. Luke's Regional Health Care System, Duluth, MN, United States
| | | | - Kayan Dunnigan
- Baylor Scott and White Health, Temple, TX, United States
| | | | - Lauren Grant
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Holly C Groom
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States
| | - Karley Respet
- St. Luke's Regional Health Care System, Duluth, MN, United States
| | - Shawn Beitel
- University of Arizona, Tucson, AZ, United States
| | - Tnelda Zunie
- Baylor Scott and White Health, Temple, TX, United States
| | | | - Archana Kumar
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Gregory Joseph
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Brandon Poe
- Abt Associates, Inc, Atlanta, GA, United States
| | | | | | | | | | - Young M Yoo
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | | | - Josephine Mak
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Matthew J Stuckey
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Preeta Kutty
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Melissa L Arvay
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Sarang K Yoon
- University of Utah, Salt Lake City, UT, United States
| | - Harmony L Tyner
- St. Luke's Regional Health Care System, Duluth, MN, United States
| | | | | | - Jennifer Meece
- Marshfield Clinic Research Institute, Marshfield, WI, United States
| | - Manjusha Gaglani
- Baylor Scott and White Health, Temple, TX, United States
- Texas A&M University College of Medicine, Temple, TX, United States
| | - Allison L Naleway
- Kaiser Permanente Northwest Center for Health Research, Portland, OR, United States
| | - Mark G Thompson
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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21
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Kapellusch JM, Bao SS, Malloy EJ, Thiese MS, Merryweather AS, Hegmann KT. Validation of the Revised Strain Index for Predicting Risk of Incident Carpal Tunnel Syndrome in a Prospective Cohort. Ergonomics 2021; 64:1369-1378. [PMID: 34190679 DOI: 10.1080/00140139.2021.1940306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/03/2021] [Indexed: 06/13/2023]
Abstract
The Revised Strain Index (RSI), a model that quantifies physical exposure from individual hand/wrist exertions, tasks, and multi-task jobs, was used to quantify exposure for 1372 incident-eligible manufacturing, service and healthcare workers. Workers were followed for an average of 2.5 years (maximum 6 years) and had an average carpal tunnel syndrome (CTS) incidence rate of 4.6 per 100 person-years. Exceeding the a-priori RSI limit of 10.0 showed increased risk of CTS (Hazard Ratio (HR) = 1.45, 95% CI: 1.11-1.91, p = 0.01). There also was a dose-response relationship using proposed low (RSI ≤ 8.5, HR = 1.00), medium (HR = 1.42 (95% CI: 0.96-2.09, p = 0.08)), and high limits (RSI > 15, HR = 1.79 (95% CI: 1.19-2.69, p = 0.01), respectively. RSI as a continuous variable showed CTS risk increased steadily by between 1.9% and 3.3% per unit increase in RSI (p ≤ 0.03). These results suggest that the RSI is a useful tool for surveillance as well as for job intervention/design and continuous improvement processes.Practitioner Summary The Revised Strain Index (RSI) quantifies physical exposure from individual hand/wrist exertions, tasks, and multi-task jobs. Increased cumulative RSI scores (i.e. daily exposure score) are associated with increased risk of carpal tunnel syndrome (CTS). The RSI is potentially useful as a risk surveillance and intervention design tool.
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Affiliation(s)
- Jay M Kapellusch
- Department of Rehabilitation Sciences & Technology, College of Health Sciences, University of Wisconsin - Milwaukee, Milwaukee, WI, USA
| | - Stephen S Bao
- Washington State Department of Labor and Industries, Olympia, WA, USA
| | - Elizabeth J Malloy
- Department of Mathematics and Statistics, American University, Washington, DC, USA
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational & Environmental Health, University of Utah, Salt Lake City, UT, USA
| | - Andrew S Merryweather
- Rocky Mountain Center for Occupational & Environmental Health, University of Utah, Salt Lake City, UT, USA
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational & Environmental Health, University of Utah, Salt Lake City, UT, USA
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22
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Abstract
Background: The objective of this study was to investigate the prevalence of carpal tunnel syndrome (CTS) in workers with trigger digit. There are few cross-sectional studies that assess this relationship. Methods: A baseline examination of 1216 workers from 17 diverse manufacturing facilities was conducted. Worker demographics, medical history, and symptoms of trigger digit were assessed. Age, sex, and body mass index were obtained. Biomechanical factors were individually measured using the Strain Index (SI). Prevalence was assessed with univariate and multivariate logistic regression. Results: Unadjusted prevalence of trigger digit was 12.0%, and among those workers, there was an unadjusted CTS prevalence of 26.7%. The adjusted multivariate model found an odds ratio (OR) of CTS of 1.56 (95% confidence interval [CI], 1.03-2.36) among the workers with trigger digit. The ORs of CTS for SI (OR = 1.53 [95% CI, 1.04-2.23]), age (OR = 1.03 [95% CI, 1.01-1.04]), and current smoking (OR = 1.76 [95% CI, 1.12-2.75]) were also significant. Sex and diabetes were not statistically significant covariates. Conclusion: The prevalence of CTS is higher among workers with trigger digit.
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Affiliation(s)
| | | | | | | | - Kurt T. Hegmann
- The University of Utah, Salt Lake City, USA,Kurt T. Hegmann, Rocky Mountain Center for Occupational and Environmental Health, The University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT 84108, USA.
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23
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Thiese MS, Hegmann KT, Page GB, Weames GG. Letter to the Editor: Landsbergis et al (2019) Titled "Work Exposures and Musculoskeletal Disorders Among Railroad Maintenance-of-Way Workers". J Occup Environ Med 2021; 63:e745-e750. [PMID: 34238910 DOI: 10.1097/jom.0000000000002315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational & Environment Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah
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24
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Thiese MS, Hegmann KT, Weames GG, Page GB. Concerns re Landsbergis et al: Occupational risk factors for musculoskeletal disorders among railroad maintenance-of-way workers. Am J Ind Med 2021; 64:714-716. [PMID: 34105180 DOI: 10.1002/ajim.23264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/19/2021] [Accepted: 05/18/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew S. Thiese
- School of Medicine, Rocky Mountain Center for Occupational & Environmental Health University of Utah Salt Lake City Utah USA
| | - Kurt T. Hegmann
- School of Medicine, Rocky Mountain Center for Occupational & Environmental Health University of Utah Salt Lake City Utah USA
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25
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Thompson MG, Burgess JL, Naleway AL, Tyner HL, Yoon SK, Meece J, Olsho LEW, Caban-Martinez AJ, Fowlkes A, Lutrick K, Kuntz JL, Dunnigan K, Odean MJ, Hegmann KT, Stefanski E, Edwards LJ, Schaefer-Solle N, Grant L, Ellingson K, Groom HC, Zunie T, Thiese MS, Ivacic L, Wesley MG, Lamberte JM, Sun X, Smith ME, Phillips AL, Groover KD, Yoo YM, Gerald J, Brown RT, Herring MK, Joseph G, Beitel S, Morrill TC, Mak J, Rivers P, Harris KM, Hunt DR, Arvay ML, Kutty P, Fry AM, Gaglani M. Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers - Eight U.S. Locations, December 2020-March 2021. MMWR Morb Mortal Wkly Rep 2021; 70:495-500. [PMID: 33793460 DOI: 10.15585/mmwr.mm7013e3externalicon] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines have been shown to be effective in preventing symptomatic COVID-19 in randomized placebo-controlled Phase III trials (1,2); however, the benefits of these vaccines for preventing asymptomatic and symptomatic SARS-CoV-2 (the virus that causes COVID-19) infection, particularly when administered in real-world conditions, is less well understood. Using prospective cohorts of health care personnel, first responders, and other essential and frontline workers* in eight U.S. locations during December 14, 2020-March 13, 2021, CDC routinely tested for SARS-CoV-2 infections every week regardless of symptom status and at the onset of symptoms consistent with COVID-19-associated illness. Among 3,950 participants with no previous laboratory documentation of SARS-CoV-2 infection, 2,479 (62.8%) received both recommended mRNA doses and 477 (12.1%) received only one dose of mRNA vaccine.† Among unvaccinated participants, 1.38 SARS-CoV-2 infections were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) per 1,000 person-days.§ In contrast, among fully immunized (≥14 days after second dose) persons, 0.04 infections per 1,000 person-days were reported, and among partially immunized (≥14 days after first dose and before second dose) persons, 0.19 infections per 1,000 person-days were reported. Estimated mRNA vaccine effectiveness for prevention of infection, adjusted for study site, was 90% for full immunization and 80% for partial immunization. These findings indicate that authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection, regardless of symptom status, among working-age adults in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.
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26
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Thompson MG, Burgess JL, Naleway AL, Tyner HL, Yoon SK, Meece J, Olsho LE, Caban-Martinez AJ, Fowlkes A, Lutrick K, Kuntz JL, Dunnigan K, Odean MJ, Hegmann KT, Stefanski E, Edwards LJ, Schaefer-Solle N, Grant L, Ellingson K, Groom HC, Zunie T, Thiese MS, Ivacic L, Wesley MG, Lamberte JM, Sun X, Smith ME, Phillips AL, Groover KD, Yoo YM, Gerald J, Brown RT, Herring MK, Joseph G, Beitel S, Morrill TC, Mak J, Rivers P, Harris KM, Hunt DR, Arvay ML, Kutty P, Fry AM, Gaglani M. Interim Estimates of Vaccine Effectiveness of BNT162b2 and mRNA-1273 COVID-19 Vaccines in Preventing SARS-CoV-2 Infection Among Health Care Personnel, First Responders, and Other Essential and Frontline Workers - Eight U.S. Locations, December 2020-March 2021. MMWR Morb Mortal Wkly Rep 2021; 70:495-500. [PMID: 33793460 PMCID: PMC8022879 DOI: 10.15585/mmwr.mm7013e3] [Citation(s) in RCA: 488] [Impact Index Per Article: 162.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Messenger RNA (mRNA) BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) COVID-19 vaccines have been shown to be effective in preventing symptomatic COVID-19 in randomized placebo-controlled Phase III trials (1,2); however, the benefits of these vaccines for preventing asymptomatic and symptomatic SARS-CoV-2 (the virus that causes COVID-19) infection, particularly when administered in real-world conditions, is less well understood. Using prospective cohorts of health care personnel, first responders, and other essential and frontline workers* in eight U.S. locations during December 14, 2020-March 13, 2021, CDC routinely tested for SARS-CoV-2 infections every week regardless of symptom status and at the onset of symptoms consistent with COVID-19-associated illness. Among 3,950 participants with no previous laboratory documentation of SARS-CoV-2 infection, 2,479 (62.8%) received both recommended mRNA doses and 477 (12.1%) received only one dose of mRNA vaccine.† Among unvaccinated participants, 1.38 SARS-CoV-2 infections were confirmed by reverse transcription-polymerase chain reaction (RT-PCR) per 1,000 person-days.§ In contrast, among fully immunized (≥14 days after second dose) persons, 0.04 infections per 1,000 person-days were reported, and among partially immunized (≥14 days after first dose and before second dose) persons, 0.19 infections per 1,000 person-days were reported. Estimated mRNA vaccine effectiveness for prevention of infection, adjusted for study site, was 90% for full immunization and 80% for partial immunization. These findings indicate that authorized mRNA COVID-19 vaccines are effective for preventing SARS-CoV-2 infection, regardless of symptom status, among working-age adults in real-world conditions. COVID-19 vaccination is recommended for all eligible persons.
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27
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Hegmann KT, Travis R, Andersson GBJ, Belcourt RM, Carragee EJ, Eskay-Auerbach M, Galper J, Goertz M, Haldeman S, Hooper PD, Lessenger JE, Mayer T, Mueller KL, Murphy DR, Tellin WG, Thiese MS, Weiss MS, Harris JS. Invasive Treatments for Low Back Disorders. J Occup Environ Med 2021; 63:e215-e241. [PMID: 33769405 DOI: 10.1097/jom.0000000000001983] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE This abbreviated version of the American College of Occupational and Environmental Medicine's Low Back Disorders guideline reviews the evidence and recommendations developed for invasive treatments used to manage low back disorders. METHODS Comprehensive systematic literature reviews were accomplished with article abstraction, critiquing, grading, evidence table compilation, and guideline finalization by a multidisciplinary expert panel and extensive peer-review to develop evidence-based guidance. Consensus recommendations were formulated when evidence was lacking and often relied on analogy to other disorders for which evidence exists. A total of 47 high-quality and 321 moderate-quality trials were identified for invasive management of low back disorders. RESULTS Guidance has been developed for the invasive management of acute, subacute, and chronic low back disorders and rehabilitation. This includes 49 specific recommendations. CONCLUSION Quality evidence should guide invasive treatment for all phases of managing low back disorders.
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Affiliation(s)
- Kurt T Hegmann
- American College of Occupational and Environmental Medicine, Elk Grove Village, Illinois
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28
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Sinclair DC, Hegmann KT, Holland JP. Acceptable Risk of Sudden Incapacitation Among Safety Critical Transportation Workers: A Comprehensive Synthesis. J Occup Environ Med 2021; 63:329-342. [PMID: 33769399 DOI: 10.1097/jom.0000000000002140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Identify a risk threshold for sudden incapacitation for safety critical positions in transportation industries supporting medical fitness for duty standards. METHODS Systematic literature searches were performed examining acceptable risk criteria for medically related incapacitation using PubMed Central and Google Scholar databases. Websites for professional societies and national and international governmental agencies were also accessed. Article abstracts were reviewed and exhaustive searches were performed. RESULTS International regulatory bodies have adopted definitions of acceptable risk typically with a threshold of 1% to 2% absolute risk of sudden incapacitation per annum. Several "risk-of-harm" models have been proposed that incorporate factors modulating an absolute risk constant derived from epidemiological studies. CONCLUSION A 1% absolute annual risk of sudden incapacitation should be adopted as the threshold for determining medical fitness for duty among employees in safety critical positions in transportation industries.
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Affiliation(s)
- Donald C Sinclair
- Steptoe & Johnson PLLC, 1233 Main St., Ste. 3000, Wheeling, West Virginia (Mr Sinclair); Director Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, Utah (Dr Hegmann); Puyallup, Washington (Dr Holland)
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29
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Thiese MS, Moffitt G, Hanowski RJ, Kales SN, Porter RJ, Hartenbaum N, Hegmann KT. What Medical Conditions Limit or Medically Disqualify Truck Drivers: A Large Cross Sectional Study. J Occup Environ Med 2021; 63:139-146. [PMID: 33523617 DOI: 10.1097/jom.0000000000002101] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Commercial Motor Vehicle drivers must be medically certified to obtain/maintain a commercial driver license. 88,246 exams from 2005 to 2012 were analyzed for relationships between health and certification length. Relationships were quantified using adjusted odds ratios (ORs). Most conditions and/or examination findings had statically significantly limited medical certification. Obesity > 35 kg/m2, hypertension and diabetes mellitus requiring medication were most common. Significant and meaningful relationships were found for opioid or benzodiazepine use (OR = 7.30), heart disease (OR = 5.19), musculoskeletal conditions (OR = 5.13), seizures (10.18), stroke (OR = 6.73), neurological (OR = 18.51) and vascular (OR = 11.83). Drivers with 2 or more of 13 medical conditions were statistically significantly more likely to have limited medical certification (OR = 122.35) or disqualification (OR = 4.91). Drivers with any condition are more likely to have limited medical certification. There is variability in medical certification lengths related to medical conditions and differences between examiners.
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Affiliation(s)
- Matthew S Thiese
- Rocky Mountain Center for Occupational & Environment Health, Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah (Dr Thiese, Dr Hegmann); Arkansas Occupational Health Clinic, Springdale, Arkansas (Dr Moffitt); Center for Truck and Bus Safety, Virginia Tech Transportation Institute, Blacksburg, Virginia (Dr Hanowski); Department of Environmental Health, Harvard Chan School of Public Health, Boston, Massachusetts (Dr Kales); Occupational Medicine, Cambridge Health Alliance, Cambridge, Massachusetts (Dr Kales, Dr Porter); VHB - Vanasse Hangen Brustlin, Raleigh, North Carolina (Dr Kales, Dr Porter); Occumedix, Inc., Dresher, Pennsylvania (Dr Hartenbaum)
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30
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Owens JD, Hegmann KT, Thiese MS, Phillips AL. Impacts of Adherence to Evidence-Based Medicine Guidelines for the Management of Acute Low Back Pain on Costs of Worker's Compensation Claims. J Occup Environ Med 2020; 61:445-452. [PMID: 31167221 DOI: 10.1097/jom.0000000000001593] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE American College of Occupational and Environmental Medicine's (ACOEM's) evidence-based guidelines for acute low back pain (LBP) were used to assess relationships between guideline adherence and worker's compensation costs. METHODS Treatments at first appointments were abstracted. Two scoring tools were utilized to assess each patient's treatment plan. One score assessed ACOEM Guideline compliance while the second utilized mean expert scores of the perceived value of each treatment. Claim costs were log-transformed and compared with scores. RESULTS There is a significant trend between increased compliance and decreasing costs. Medical and total costs trended lower by an average $352.90 and $586.20 per unit of compliance score respectively. No outlier cost claims were in the best guidelines compliance groups. CONCLUSION This study shows a statistically significant trend in the relationship between adherence to ACOEM guidelines for initial management of work-related LBP and decreasing claim costs.
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Affiliation(s)
- James D Owens
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, Utah
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31
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Abstract
: COVID-19 illness can cause multiorgan illness. Some States have passed legislation granting a rebuttable presumption of causation by workplace exposure in certain occupations. This paper summarizes methodology for evaluating claimants utilizing known science and as well as information from the American Medical Association Guides resources.
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Affiliation(s)
- Mark H Hyman
- St. John's Hospital in Santa Monica, Santa Monica, California (Dr Hyman); Tennessee Bureau of Worker's Compensation, Tennessee (Dr Talmage); Dr. Paul S. Richards, Endowed Chair in Occupational Safety and Health, University of Utah, Utah (Dr Hegmann)
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Cheng M, Thiese MS, Wood EM, Kapellusch J, Foster J, Drury D, Merryweather A, Hegmann KT. Relationship Between Opioid Use and Pain Severity Ratings in Workers With Low Back Pain. J Occup Environ Med 2019; 61:836-840. [DOI: 10.1097/jom.0000000000001673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Yung M, Dale AM, Kapellusch J, Bao S, Harris-Adamson C, Meyers AR, Hegmann KT, Rempel D, Evanoff BA. Modeling the Effect of the 2018 Revised ACGIH ® Hand Activity Threshold Limit Value ® (TLV) at Reducing Risk for Carpal Tunnel Syndrome. J Occup Environ Hyg 2019; 16:628-633. [PMID: 31361578 PMCID: PMC7663429 DOI: 10.1080/15459624.2019.1640366] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Recent studies have shown the 2001 American Conference of Governmental Industrial Hygienists (ACGIH®) Threshold Limit Value (TLV®) for Hand Activity was not sufficiently protective for workers at risk of carpal tunnel syndrome (CTS). These studies led to a revision of the TLV and Action Limit. This study compares the effect of applying the 2018 TLV vs. the 2001 TLV to predict incident CTS within a large occupational pooled cohort study (n = 4,321 workers). Time from study enrollment to first occurrence of CTS was modeled using Cox proportional hazard regression. Adjusted and unadjusted hazard ratios for incident CTS were calculated using three exposure categories: below the Action Limit, between the Action Limit and TLV, and above the TLV. Workers exposed above the 2001 Action Limit demonstrated significant excess risk of carpal tunnel syndrome, while the 2018 TLV demonstrated significant excess risk only above the TLV. Of 186 total cases of CTS, 52 cases occurred among workers exposed above the 2001 TLV vs. 100 among those exposed above the 2018 value. Eliminating exposures above the 2001 TLV might have prevented 11.2% of all cases of CTS seen in our pooled cohort, vs. 25.1% of cases potentially prevented by keeping exposures below the 2018 value. The 2018 revision of the TLV better protects workers from CTS, a recognized occupational health indicator important to public health. A significant number of workers are currently exposed to forceful repetitive hand activity above these guidelines. Public health professionals should promulgate these new guidelines and encourage employers to reduce hand intensive exposures to prevent CTS and other musculoskeletal disorders.
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Affiliation(s)
- Marcus Yung
- Division of General Medical Sciences, Washington University School of Medicine, Saint Louis, MO, USA
| | - Ann Marie Dale
- Division of General Medical Sciences, Washington University School of Medicine, Saint Louis, MO, USA
| | - Jay Kapellusch
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Stephen Bao
- Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, Washington, USA
| | - Carisa Harris-Adamson
- Department of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
- Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
| | - Alysha R Meyers
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, CDC
| | - Kurt T Hegmann
- Department of Family and Preventive Medicine, University of Utah, Utah, USA
| | - David Rempel
- Department of Medicine, University of California at San Francisco, San Francisco, CA, USA
- Department of Bioengineering, University of California Berkeley, Berkeley, California, USA
| | - Bradley A. Evanoff
- Division of General Medical Sciences, Washington University School of Medicine, Saint Louis, MO, USA
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Ferguson SA, Merryweather A, Thiese MS, Hegmann KT, Lu ML, Kapellusch JM, Marras WS. Prevalence of low back pain, seeking medical care, and lost time due to low back pain among manual material handling workers in the United States. BMC Musculoskelet Disord 2019; 20:243. [PMID: 31118009 PMCID: PMC6530127 DOI: 10.1186/s12891-019-2594-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 04/26/2019] [Indexed: 12/13/2022] Open
Abstract
Background Low back pain (LBP) is a common and costly problem throughout the United States. To achieve a greater understanding of the occupational risk factors, the National Institute for Occupational Safety and Health (NIOSH) funded a low back health effects consortium, which performed several surveillance studies throughout the United States. This study combines data from the consortium research groups resulting in a data set with nearly 2000 workers in various regions of the country. The purpose of this paper is to examine prevalence and personal risk factors of low back health effects among these workers. Methods There were three common questions regarding history of low back health effects in the past 12 months including 1) have you had LBP lasting 7 days, 2) have you sought medical care for LBP, and 3) have you taken time off work due to LBP. The questionnaire included demographic questions. There were five data collections institutions or sites including NIOSH, Ohio State University, University of Wisconsin-Milwaukee, Texas A&M University, and University of Utah. Results The 12-month period prevalence of low back pain lasting 7 days, seeking medical care, and lost time due to LBP were 25, 14 and 10%, respectively. There were no statistically significant differences in gender, age or weight between cases and non-cases for any prevalence measure. The height of workers was significantly greater in the cases compared to non-cases for all three prevalence definitions. There were significant differences among the sites on the prevalence of seeking medical care for LBP and lost time due to LBP. The Ohio State University had significantly higher prevalence rates for seeking medical care and lost time due to LBP than University of Wisconsin, University of Utah, or Texas A&M University. Conclusion LBP, the least severe low back health effect studied, had the highest prevalence (25%) and lost time due to LBP, the most severe low back health effect studied, had the lowest prevalence (10%) among nearly 2000 US manual material handling workers. There was a significant site or regional influence in prevalence rates for seeking medical care and lost time due to LBP.
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Affiliation(s)
- Sue A Ferguson
- Spine Research Institute, The Ohio State University, 210 Baker Systems, 1971 Neil Avenue, Columbus, OH, 43210, USA.
| | - Andrew Merryweather
- Rocky Mountain Center for Occupational & Environmental Health, Department of Family and Preventive Medicine, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT, 84108, USA
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational & Environmental Health, Department of Family and Preventive Medicine, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT, 84108, USA
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational & Environmental Health, Department of Family and Preventive Medicine, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT, 84108, USA
| | - Ming-Lun Lu
- National Institute for Occupational Safety and Health, Taft Laboratories, 1090 Tusculum Ave. MS C-24, Cincinnati, OH, 45226, USA
| | - Jay M Kapellusch
- Occupational Science & Technology, University of Wisconsin-Milwaukee, P.O. Box 413, Milwaukee, WI, 53201, USA
| | - William S Marras
- Spine Research Institute, The Ohio State University, 210 Baker Systems, 1971 Neil Avenue, Columbus, OH, 43210, USA
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Holdaway LA, Hegmann KT, Thiese MS, Kapellusch J. Is sleep position associated with glenohumeral shoulder pain and rotator cuff tendinopathy: a cross-sectional study. BMC Musculoskelet Disord 2018; 19:408. [PMID: 30470225 PMCID: PMC6260856 DOI: 10.1186/s12891-018-2319-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 10/24/2018] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Glenohumeral pain and rotator cuff tendinopathy (RCT) are common musculoskeletal complaints with high prevalence among working populations. The primary proposed pathophysiologic mechanisms are sub-acromial RC tendon impingement and reduced tendon blood flow. Some sleep postures may increase subacromial pressure, potentially contributing to these postulated mechanisms. This study uses a large population of workers to investigate whether there is an association between preferred sleeping position and prevalence of: (1) shoulder pain, and (2) rotator cuff tendinopathy. METHODS A cross-sectional analysis was performed on baseline data from a multicenter prospective cohort study. Participants were 761 workers who were evaluated by questionnaire using a body diagram to determine the presence of glenohumeral pain within 30 days prior to enrollment. The questionnaire also assessed primary and secondary preferred sleep position(s) using 6 labeled diagrams. All workers underwent a structured physical examination to determine whether RCT was present. For this study, the case definition of RCT was glenohumeral pain plus at least one of a positive supraspinatus test, painful arc and/or Neer's test. Prevalence of glenohumeral pain and RCT were individually calculated for the primary and secondary sleep postures and odds ratios were calculated. RESULTS Age, sex, Framingham cardiovascular risk score and BMI had significant associations with glenohumeral pain. For rotator cuff tendinopathy, increasing age, Framingham risk score and Hand Activity Level (HAL) showed significant associations. The sleep position anticipated to have the highest risk of glenohumeral pain and RCT was paradoxically associated with a decreased prevalence of glenohumeral pain and also trended toward being protective for RCT. Multivariable logistic regression showed no further significant associations. CONCLUSION This cross-sectional study unexpectedly found a reduced association between one sleep posture and glenohumeral pain. This cross-sectional study may be potentially confounded, by participants who are prone to glenohumeral pain and RCT may have learned to avoid sleeping in the predisposing position. Longitudinal studies are needed to further evaluate a possible association between glenohumeral pain or RCT and sleep posture as a potential risk factor.
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Affiliation(s)
- Lincoln A Holdaway
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT, 84108, USA.
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT, 84108, USA
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, UT, 84108, USA
| | - Jay Kapellusch
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, 161 W Wisconsin Ave, Suite 6000, Milwaukee, WI, 53203-2602, USA
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Ott U, Thiese MS, Ronna BB, Hegmann K, Hegmann KT. Opioid use: Case-control analyses of worker's compensation data. J Opioid Manag 2018; 14:273-281. [PMID: 30234924 DOI: 10.5055/jom.2018.0459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Working-age adults are disproportionately impacted by opioid misuse. Factors associated with opioid misuse in people with workers compensation (WC) claims are not well studied. WC in some states is a "captured" market making it a more efficient site for researching the opioids epidemic. A pilot study was conducted to identify factors associated with opioid use using a large WC insurer's claims in Utah. METHODS This was a case-control study using a large WC insurer's database. We conducted secondary data analyses of a de-identified dataset originally obtained from the WC insurer. Cases were defined as claims with a morphine equivalent dose (MED)≥50 mg/d in the 30 days after the claim was filed while controls = 0 mg/d. RESULTS A total of 76 patient's claims (28 cases and 48 controls) were included in the final data analyses. The majority of claimants were male (N = 50, 65.8 percent), worked full time (N = 58, 76.3 percent) and had a mean age of 37.0±11.4 years. The majority of controls filed medical only claims (N = 40, 83.3 percent) while the majority of cases filed indemnity claims (N = 19, 67.9 percent). Cases were prescribed a mean MED of 126.4 (SD = 93.3) within the first month after filing the claim. Most cases visited>3 medical providers (N = 13, 46.4 percent) in the first month after filing the claim while the majority of controls only visited one provider (N = 28, 58.3 percent). Remarkably, the mean number of providers visited within the first month for the cases was 3.8, which was 2-fold greater than the control group. Exploratory multivariate analyses showed that cases were 4.6 times more likely to have visited 2-3 medical providers (p = 0.025), and 41.8 times more likely to have visited more than three medical providers (p < 0.001). Cases had 3.6 higher odds of having been prescribed nonsteroidal anti-inflammatory prescription within the first month as compared to controls (p = 0.014). CONCLUSION This pilot study found risk factors, some of which may be modifiable. We aim to conduct a large study using existing WC data to create a scoring system that identifies those claimants at higher risk of adverse opioid-related events that may have preventive applications at a systems-level.
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Affiliation(s)
- Ulrike Ott
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Brenden B Ronna
- Mountain Center for Occupational and Environmental Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Kristine Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, Department of Family & Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah
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Dale AM, Ekenga CC, Buckner-Petty S, Merlino L, Thiese MS, Bao S, Meyers AR, Harris-Adamson C, Kapellusch J, Eisen EA, Gerr F, Hegmann KT, Silverstein B, Garg A, Rempel D, Zeringue A, Evanoff BA. Incident CTS in a large pooled cohort study: associations obtained by a Job Exposure Matrix versus associations obtained from observed exposures. Occup Environ Med 2018; 75:501-506. [PMID: 29599164 PMCID: PMC6035491 DOI: 10.1136/oemed-2017-104744] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 02/07/2018] [Accepted: 03/12/2018] [Indexed: 11/19/2022]
Abstract
Background There is growing use of a job exposure matrix (JEM) to provide exposure estimates in studies of work-related musculoskeletal disorders; few studies have examined the validity of such estimates, nor did compare associations obtained with a JEM with those obtained using other exposures. Objective This study estimated upper extremity exposures using a JEM derived from a publicly available data set (Occupational Network, O*NET), and compared exposure-disease associations for incident carpal tunnel syndrome (CTS) with those obtained using observed physical exposure measures in a large prospective study. Methods 2393 workers from several industries were followed for up to 2.8 years (5.5 person-years). Standard Occupational Classification (SOC) codes were assigned to the job at enrolment. SOC codes linked to physical exposures for forceful hand exertion and repetitive activities were extracted from O*NET. We used multivariable Cox proportional hazards regression models to describe exposure-disease associations for incident CTS for individually observed physical exposures and JEM exposures from O*NET. Results Both exposure methods found associations between incident CTS and exposures of force and repetition, with evidence of dose–response. Observed associations were similar across the two methods, with somewhat wider CIs for HRs calculated using the JEM method. Conclusion Exposures estimated using a JEM provided similar exposure-disease associations for CTS when compared with associations obtained using the ‘gold standard’ method of individual observation. While JEMs have a number of limitations, in some studies they can provide useful exposure estimates in the absence of individual-level observed exposures.
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Affiliation(s)
- Ann Marie Dale
- Division of General Medical Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Christine C Ekenga
- George Warren Brown School, Washington University in Saint Louis, St Louis, Missouri, USA
| | - Skye Buckner-Petty
- Division of General Medical Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Linda Merlino
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), University of Utah, Salt Lake City, Utah, USA
| | - Stephen Bao
- Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, Washington, USA
| | - Alysha Rose Meyers
- Division of Surveillance, Hazard Evaluations, and Field Studies, National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA
| | - Carisa Harris-Adamson
- Department of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
| | - Jay Kapellusch
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Ellen A Eisen
- Department of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
| | - Fred Gerr
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, Iowa, USA
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), University of Utah, Salt Lake City, Utah, USA
| | - Barbara Silverstein
- Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia, Washington, USA
| | - Arun Garg
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - David Rempel
- Division of Occupational and Environmental Medicine, University of California at San Francisco, San Francisco, California, USA.,Department of Bioengineering, University of California Berkeley, Berkeley, California, USA
| | | | - Bradley A Evanoff
- Division of General Medical Sciences, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
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Thiese MS, Hanowski RJ, Moffitt G, Kales SN, Porter RJ, Ronna B, Hartenbaum N, Hegmann KT. A retrospective analysis of cardiometabolic health in a large cohort of truck drivers compared to the American working population. Am J Ind Med 2018; 61:103-110. [PMID: 29114913 DOI: 10.1002/ajim.22795] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 11/08/2022]
Abstract
BACKGROUND Truck drivers face many health challenges, including lifestyle, diet, inactivity, stressors, and social support. METHODS A repeated cross-sectional analysis compared 88,246 truck drivers with data from (n = 11 918) the National Health and Nutrition Examination Survey (NHANES). Trends over time for body mass index (BMI), high blood pressure, diabetes mellitus, heart disease, and sleep disorders were analyzed, adjusting for potential confounders. RESULTS Truck drivers had significantly worsening health metrics between 2005 and 2012 compared to NHANES participants. Truck drivers were significantly more likely to be obese and morbidly obese with prevalence odds ratios (POR) and 95% confidence intervals (95%CI) of 1.99 (1.87, 2.13) and 2.34 (2.16, 2.54), respectively. Measured blood pressure, self-reported high blood pressure, diabetes mellitus, and heart disease all significantly increased. Also, sleep disorders increased among truck drivers from 2005 to 2012 (POR = 6.55, 95%CI 5.68, 7.55). CONCLUSION These data suggest disproportionate increases in poor health among truck drivers from 2005 to 2012.
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Affiliation(s)
- Matthew S. Thiese
- Department of Family and Preventive Medicine, Rocky Mountain Center for Occupational and Environment Health, School of Medicine; University of Utah; Salt Lake City Utah
| | - Richard J. Hanowski
- Center for Truck and Bus Safety; Virginia Tech Transportation Institute; Blacksburg Virginia
| | - Gary Moffitt
- Arkansas Occupational Health Clinic; Springdale Arkansas
| | - Stefanos N. Kales
- Department of Environmental Health; School of Public Health; Harvard University; Cambridge Massachusetts
| | - Richard. J. Porter
- Department of Civil and Environmental Engineering, Utah Traffic Lab; University of Utah; Salt Lake City Utah
| | - Brenden Ronna
- Department of Family and Preventive Medicine, Rocky Mountain Center for Occupational and Environment Health, School of Medicine; University of Utah; Salt Lake City Utah
| | | | - Kurt T. Hegmann
- Department of Family and Preventive Medicine, Rocky Mountain Center for Occupational and Environment Health, School of Medicine; University of Utah; Salt Lake City Utah
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Kapellusch JM, Silverstein BA, Bao SS, Thiese MS, Merryweather AS, Hegmann KT, Garg A. Risk assessments using the Strain Index and the TLV for HAL, Part II: Multi-task jobs and prevalence of CTS. J Occup Environ Hyg 2018; 15:157-166. [PMID: 29157154 DOI: 10.1080/15459624.2017.1401709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Strain Index (SI) and the American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit value for hand activity level (TLV for HAL) have been shown to be associated with prevalence of distal upper-limb musculoskeletal disorders such as carpal tunnel syndrome (CTS). The SI and TLV for HAL disagree on more than half of task exposure classifications. Similarly, time-weighted average (TWA), peak, and typical exposure techniques used to quantity physical exposure from multi-task jobs have shown between-technique agreement ranging from 61% to 93%, depending upon whether the SI or TLV for HAL model was used. This study compared exposure-response relationships between each model-technique combination and prevalence of CTS. Physical exposure data from 1,834 workers (710 with multi-task jobs) were analyzed using the SI and TLV for HAL and the TWA, typical, and peak multi-task job exposure techniques. Additionally, exposure classifications from the SI and TLV for HAL were combined into a single measure and evaluated. Prevalent CTS cases were identified using symptoms and nerve-conduction studies. Mixed effects logistic regression was used to quantify exposure-response relationships between categorized (i.e., low, medium, and high) physical exposure and CTS prevalence for all model-technique combinations, and for multi-task workers, mono-task workers, and all workers combined. Except for TWA TLV for HAL, all model-technique combinations showed monotonic increases in risk of CTS with increased physical exposure. The combined-models approach showed stronger association than the SI or TLV for HAL for multi-task workers. Despite differences in exposure classifications, nearly all model-technique combinations showed exposure-response relationships with prevalence of CTS for the combined sample of mono-task and multi-task workers. Both the TLV for HAL and the SI, with the TWA or typical techniques, appear useful for epidemiological studies and surveillance. However, the utility of TWA, typical, and peak techniques for job design and intervention is dubious.
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Affiliation(s)
- Jay M Kapellusch
- a Department of Occupational Science & Technology , University of Wisconsin-Milwaukee , Milwaukee , Wisconsin
| | - Barbara A Silverstein
- b SHARP Program, Washington State Department of Labor and Industries , Olympia , Washington
| | - Stephen S Bao
- b SHARP Program, Washington State Department of Labor and Industries , Olympia , Washington
| | - Mathew S Thiese
- c Rocky Mountain Center for Occupational and Environmental Health , University of Utah , Salt Lake City , Utah
| | - Andrew S Merryweather
- c Rocky Mountain Center for Occupational and Environmental Health , University of Utah , Salt Lake City , Utah
| | - Kurt T Hegmann
- c Rocky Mountain Center for Occupational and Environmental Health , University of Utah , Salt Lake City , Utah
| | - Arun Garg
- a Department of Occupational Science & Technology , University of Wisconsin-Milwaukee , Milwaukee , Wisconsin
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Gaspar FW, Kownacki R, Zaidel CS, Conlon CF, Hegmann KT. Reducing Disability Durations and Medical Costs for Patients With a Carpal Tunnel Release Surgery Through the Use of Opioid Prescribing Guidelines. J Occup Environ Med 2017; 59:1180-1187. [PMID: 28937443 PMCID: PMC5732647 DOI: 10.1097/jom.0000000000001168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The impacts of compliance with opioid prescribing guidelines on disability durations and medical costs for carpal tunnel release (CTR) were examined. METHODS Using a dataset of insured US employees, opioid prescriptions for 7840 short-term disability cases with a CTR procedure were identified. Opioids prescriptions were compared with the American College of Occupational and Environmental Medicine (ACOEM)'s opioid prescribing guidelines for postoperative, acute pain, which recommends no more than a 5-day supply, a maximum morphine equivalent dose of 50 mg/day, and only short-acting opioids. RESULTS Most cases (70%) were prescribed an opioid and 29% were prescribed an opioid contrary to ACOEM's guidelines. Cases prescribed an opioid contrary to guidelines had disability durations 1.9 days longer and medical costs $422 higher than cases prescribed an opioid according to guidelines. CONCLUSIONS The use of opioid prescribing guidelines may reduce CTR disability durations and medical costs.
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Affiliation(s)
- Fraser W Gaspar
- ReedGroup, Ltd., Westminster, Colorado (Dr Gaspar, Ms Zaidel); Kaiser Permanente, Oakland, California (Dr Kownacki, Dr Conlon); and Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, Utah (Dr Hegmann)
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Kapellusch JM, Bao SS, Silverstein BA, Merryweather AS, Thiese MS, Hegmann KT, Garg A. Risk assessments using the Strain Index and the TLV for HAL, Part I: Task and multi-task job exposure classifications. J Occup Environ Hyg 2017; 14:1011-1019. [PMID: 28825893 DOI: 10.1080/15459624.2017.1366037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The Strain Index (SI) and the American Conference of Governmental Industrial Hygienists (ACGIH) Threshold Limit Value for Hand Activity Level (TLV for HAL) use different constituent variables to quantify task physical exposures. Similarly, time-weighted-average (TWA), Peak, and Typical exposure techniques to quantify physical exposure from multi-task jobs make different assumptions about each task's contribution to the whole job exposure. Thus, task and job physical exposure classifications differ depending upon which model and technique are used for quantification. This study examines exposure classification agreement, disagreement, correlation, and magnitude of classification differences between these models and techniques. METHODS Data from 710 multi-task job workers performing 3,647 tasks were analyzed using the SI and TLV for HAL models, as well as with the TWA, Typical and Peak job exposure techniques. Physical exposures were classified as low, medium, and high using each model's recommended, or a priori limits. Exposure classification agreement and disagreement between models (SI, TLV for HAL) and between job exposure techniques (TWA, Typical, Peak) were described and analyzed. RESULTS Regardless of technique, the SI classified more tasks as high exposure than the TLV for HAL, and the TLV for HAL classified more tasks as low exposure. The models agreed on 48.5% of task classifications (kappa = 0.28) with 15.5% of disagreement between low and high exposure categories. Between-technique (i.e., TWA, Typical, Peak) agreement ranged from 61-93% (kappa: 0.16-0.92) depending on whether the SI or TLV for HAL was used. CONCLUSIONS There was disagreement between the SI and TLV for HAL and between the TWA, Typical and Peak techniques. Disagreement creates uncertainty for job design, job analysis, risk assessments, and developing interventions. Task exposure classifications from the SI and TLV for HAL might complement each other. However, TWA, Typical, and Peak job exposure techniques all have limitations. Part II of this article examines whether the observed differences between these models and techniques produce different exposure-response relationships for predicting prevalence of carpal tunnel syndrome.
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Affiliation(s)
- Jay M Kapellusch
- a Department of Occupational Science & Technology , University of Wisconsin - Milwaukee , Milwaukee , Wisconsin
| | - Stephen S Bao
- b SHARP Program , Washington State Department of Labor and Industries , Olympia , Washington
| | - Barbara A Silverstein
- b SHARP Program , Washington State Department of Labor and Industries , Olympia , Washington
| | - Andrew S Merryweather
- c Rocky Mountain Center for Occupational and Environmental Health , University of Utah , Salt Lake City , Utah
| | - Mathew S Thiese
- c Rocky Mountain Center for Occupational and Environmental Health , University of Utah , Salt Lake City , Utah
| | - Kurt T Hegmann
- c Rocky Mountain Center for Occupational and Environmental Health , University of Utah , Salt Lake City , Utah
| | - Arun Garg
- a Department of Occupational Science & Technology , University of Wisconsin - Milwaukee , Milwaukee , Wisconsin
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Thiese MS, Merryweather A, Koric A, Ott U, Wood EM, Kapellusch J, Foster J, Garg A, Deckow-Schaefer G, Tomich S, Kendall R, Drury DL, Wertsch J, Hegmann KT. Association between wrist ratio and carpal tunnel syndrome: Effect modification by body mass index. Muscle Nerve 2017; 56:1047-1053. [PMID: 28500660 DOI: 10.1002/mus.25692] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 05/04/2017] [Accepted: 05/07/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Previous studies have reported higher wrist ratios (WR) related to carpal tunnel syndrome (CTS) but have not assessed effect modification by obesity and may have inadequately controlled for confounders. METHODS Baseline data of a multicenter prospective cohort study were analyzed. CTS was defined by nerve conduction study (NCS) criteria and symptoms. RESULTS Among the 1,206 participants, a square-shaped wrist was associated with CTS after controlling for confounders (prevalence ratio = 2.27; 95% confidence interval [95% CI], 1.33-3.86). Body mass index (BMI) was a strong effect modifier on the relationship between WR and both CTS and abnormal NCS results, with normal weight strata of rectangular versus square wrists = 8.18 (95% CI, 1.63-49.96) and 7.12 (95% CI, 2.19-23.16), respectively. DISCUSSION A square wrist is significantly associated with CTS after controlling for confounders. Effect modification by high BMI masked the eightfold magnitude adjusted relationship seen between WR and CTS among normal weight participants. Muscle Nerve 56: 1047-1053, 2017.
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Affiliation(s)
- Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108, USA
| | - Andrew Merryweather
- Department of Mechanical Engineering, University of Utah, Salt Lake City, Utah, USA
| | - Alzina Koric
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108, USA
| | - Ulrike Ott
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108, USA
| | - Eric M Wood
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108, USA
| | - Jay Kapellusch
- Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - James Foster
- Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Arun Garg
- Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | | | - Richard Kendall
- Department of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | | | - Jacqueline Wertsch
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health, University of Utah, 391 Chipeta Way, Suite C, Salt Lake City, Utah, 84108, USA
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Hegmann KT, Thiese MS, Kapellusch J, Merryweather A, Bao S, Silverstein B, Wood EM, Kendall R, Foster J, Drury DL, Garg A. Association between Epicondylitis and Cardiovascular Risk Factors in Pooled Occupational Cohorts. BMC Musculoskelet Disord 2017; 18:227. [PMID: 28558776 PMCID: PMC5450050 DOI: 10.1186/s12891-017-1593-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 05/22/2017] [Indexed: 01/10/2023] Open
Abstract
Background The pathophysiology of lateral epicondylitis (LE) is unclear. Recent evidence suggests some common musculoskeletal disorders may have a basis in cardiovascular disease (CVD) risk factors. Thus, we examined CVD risks as potential LE risks. Methods Workers (n = 1824) were enrolled in two large prospective studies and underwent structured interviews and physical examinations at baseline. Analysis of pooled baseline data assessed the relationships separately between a modified Framingham Heart Study CVD risk score and three prevalence outcomes of: 1) lateral elbow pain, 2) positive resisted wrist or middle finger extension, and 3) a combination of both symptoms and at least one resisted maneuver. Quantified job exposures, personal and psychosocial confounders were statistically controlled. Odds ratios (ORs) and 95% Confidence Intervals (CIs) were calculated. Results There was a strong relationship between CVD risk score and lateral elbow symptoms, resisted wrist or middle finger extension and LE after adjustment for confounders. The adjusted ORs for symptoms were as high as 3.81 (95% CI 2.11, 6.85), for positive examination with adjusted odds ratios as high as 2.85 (95% CI 1.59, 5.12) and for combined symptoms and physical examination 6.20 (95% CI 2.04, 18.82). Relationships trended higher with higher CVD risk scores. Conclusions These data suggest a potentially modifiable disease mechanism for LE.
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Affiliation(s)
- Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), School of Medicine, University of Utah, 391 Chipeta Way Suite C, Salt Lake City, UT, 84108, USA.
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), School of Medicine, University of Utah, 391 Chipeta Way Suite C, Salt Lake City, UT, 84108, USA
| | - Jay Kapellusch
- Department of Occupational Science & Technology, College of Health Sciences, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI, 53201, USA
| | - Andrew Merryweather
- Department of Mechanical Engineering, University of Utah, 1495 East 100 South, Salt Lake City, UT, 84112, USA
| | - Stephen Bao
- Safety and Health Assessment and Research for Prevention (SHARP) Program, 243 Israel Road SE Bldg 3, Tumwater, WA, 98501, USA
| | - Barbara Silverstein
- Safety and Health Assessment and Research for Prevention (SHARP) Program, 243 Israel Road SE Bldg 3, Tumwater, WA, 98501, USA
| | - Eric M Wood
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), School of Medicine, University of Utah, 391 Chipeta Way Suite C, Salt Lake City, UT, 84108, USA
| | - Richard Kendall
- Physical Medicine and Rehabilitation, University of Utah, 30 North 1900 East, Salt Lake City, UT, 84132, USA
| | - James Foster
- United Occupational Medicine, 9555 76th St., Pleasant Prairie, WI, 53158, USA
| | - David L Drury
- Clement J Zablocki VA Medical Center, Compensation & Pension Department, 5000 W National Avenue, Milwaukee, WI, 53295, USA
| | - Arun Garg
- Department of Occupational Science & Technology, College of Health Sciences, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI, 53201, USA
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Bao SS, Kapellusch JM, Merryweather AS, Thiese MS, Garg A, Hegmann KT, Silverstein BA, Marcum JL, Tang R. Impact of Work Organizational Factors on Carpal Tunnel Syndrome and Epicondylitis. J Occup Environ Med 2016; 58:760-4. [PMID: 27414007 PMCID: PMC4980299 DOI: 10.1097/jom.0000000000000790] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to identify relationships between work organizational variables (job rotation, overtime work, having a second job, and work pacing) (These work organizational variables and their relationships with biomechanical and psychosocial exposures were studied previously and published in a separate paper.) and health outcome measures [carpal tunnel syndrome (CTS), lateral and medial epicondylitis (LEPI/MEPI)]. METHODS Using a pooled baseline cohort of 1834 subjects, the relationships were studied using logistic regression models. RESULTS Varied degrees of associations between the work organizational and outcomes variables were found. Job rotation was significantly associated with being a CTS case [odds ratio (OR) = 1.23, 95% confidence interval (95% CI): 1.00 to 1.50]. Overtime work was significantly associated with lower LEPI prevalence (OR = 0.48, 95% CI: 0.28 to 0.84). No statistically significant associations were found between having a second job and different work pacing and any of the three health outcome measures. CONCLUSIONS Work organizational variables were only partially associated with the studied health outcomes.
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Affiliation(s)
- Stephen S Bao
- Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries, Olympia (Drs Bao, Silverstein, Marcum); Department of Occupational Science & Technology, University of Wisconsin-Milwaukee (Drs Kapellusch, Garg, Tang); Department of Mechanical Engineering (Dr Merryweather), and Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), University of Utah, Salt Lake City (Drs Thiese, Hegmann)
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Harris-Adamson C, Eisen EA, Neophytou A, Kapellusch J, Garg A, Hegmann KT, Thiese MS, Dale AM, Evanoff B, Bao S, Silverstein B, Gerr F, Burt S, Rempel D. Biomechanical and psychosocial exposures are independent risk factors for carpal tunnel syndrome: assessment of confounding using causal diagrams. Occup Environ Med 2016; 73:727-734. [PMID: 27466616 DOI: 10.1136/oemed-2016-103634] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Accepted: 07/01/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Between 2001 and 2010, six research groups conducted coordinated prospective studies of carpal tunnel syndrome (CTS) incidence among US workers from various industries to estimate exposure-response relationships. OBJECTIVE This analysis examined the presence and magnitude of confounding between biomechanical and workplace psychosocial factors and incidence of dominant-hand CTS. METHODS 1605 participants, without CTS at enrolment, were followed for up to 3.5 years (2471 person-years). Demographic information, medical history and workplace psychosocial stress measures were collected at baseline. Individual workplace biomechanical exposures were collected for each task and combined across the workweek using time-weighted averaging (TWA). CTS case criteria were based on symptoms and results of electrophysiological testing. HRs were estimated with Cox proportional hazard models. Confounding was assessed using causal diagrams and an empirical criterion of 10% or greater change in effect estimate magnitude. RESULTS There were 109 incident CTS cases (IR=4.41/100 person-years; 6.7% cumulative incidence). The relationships between CTS and forceful repetition rate, % time forceful hand exertion and the Threshold Limit Value for Hand Activity Level (TLV-HAL) were slightly confounded by decision latitude with effect estimates being attenuated towards the null (10-14% change) after adjustment. The risk of CTS among participants reporting high job strain was attenuated towards the null by 14% after adjusting for the HAL Scale or the % time forceful hand exertions. CONCLUSIONS Although attenuation of the relationships between CTS and some biomechanical and work psychosocial exposures was observed after adjusting for confounding, the magnitudes were small and confirmed biomechanical and work psychosocial exposures as independent risk factors for incident CTS.
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Affiliation(s)
- Carisa Harris-Adamson
- Division of Occupational and Environmental Medicine, University of California, San Francisco, San Francisco, California, USA Department of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
| | - Ellen A Eisen
- Department of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
| | - Andreas Neophytou
- Department of Environmental Health Sciences, University of California Berkeley, Berkeley, California, USA
| | - Jay Kapellusch
- Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Arun Garg
- Center for Ergonomics, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Kurt T Hegmann
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), University of Utah, Salt Lake City, Utah, USA
| | - Matthew S Thiese
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH), University of Utah, Salt Lake City, Utah, USA
| | - Ann Marie Dale
- Division of General Medical Science, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Bradley Evanoff
- Division of General Medical Science, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Stephen Bao
- Washington State Department of Labor and Industries, Safety and Health Assessment and Research for Prevention (SHARP) Program, Olympia, Washington, USA
| | - Barbara Silverstein
- Washington State Department of Labor and Industries, Safety and Health Assessment and Research for Prevention (SHARP) Program, Olympia, Washington, USA
| | - Fred Gerr
- Department of Occupational and Environmental Health, University of Iowa, College of Public Health, Iowa City, Iowa, USA
| | - Susan Burt
- formerly with National Institute of Occupational Safety & Health, Atlanta, Georgia, USA
| | - David Rempel
- Division of Occupational and Environmental Medicine, University of California, San Francisco, San Francisco, California, USA Department of Bioengineering, University of California, Berkeley, Berkeley, California, USA
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Thiese MS, Moffitt G, Hanowski RJ, Kales SN, Porter RJ, Hegmann KT. Commercial Driver Medical Examinations: Prevalence of Obesity, Comorbidities, and Certification Outcomes. J Occup Environ Med 2016; 57:659-65. [PMID: 25710607 PMCID: PMC4448672 DOI: 10.1097/jom.0000000000000422] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Supplemental Digital Content is Available in the Text. Objective: The objective of this study was to assess relationships between body mass index (BMI) and comorbid conditions within a large sample of truck drivers. Methods: Commercial driver medical examination data from 88,246 commercial drivers between 2005 and 2012 were analyzed for associations between BMI, medical disorders, and driver certification. Results: Most drivers were obese (53.3%, BMI >30.0 kg/m2) and morbidly obese (26.6%, BMI >35.0 kg/m2), higher than prior reports. Obese drivers were less likely to be certified for 2 years and more likely to report heart disease, hypertension, diabetes mellitus, nervous disorders, sleep disorders, and chronic low back pain (all P < 0.0001). There are relationships between multiple potentially disqualifying conditions and increasing obesity (P < 0.0001). Morbid obesity prevalence increased 8.9% and prevalence of three or more multiple conditions increased fourfold between 2005 and 2012. Conclusions: Obesity is related to multiple medical factors as well as increasing numbers of conditions that limit driving certification.
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Affiliation(s)
- Matthew S Thiese
- From the Rocky Mountain Center for Occupational & Environment Health (Drs Thiese and Hegmann), Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City; Arkansas Occupational Health Clinic (Dr Moffitt), Springdale; Center for Truck and Bus Safety (Dr Hanowski), Virginia Tech Transportation Institute, Blacksburg; Department of Environmental Health (Dr Kales), School of Public Health, Harvard, Cambridge, Mass; and Utah Traffic Lab (Dr Porter), Department of Civil & Environmental Engineering, University of Utah, Salt Lake City
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Bao SS, Kapellusch JM, Merryweather AS, Thiese MS, Garg A, Hegmann KT, Silverstein BA. Relationships between job organisational factors, biomechanical and psychosocial exposures. Ergonomics 2015; 59:179-194. [PMID: 26102483 DOI: 10.1080/00140139.2015.1065347] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/17/2015] [Indexed: 06/04/2023]
Abstract
UNLABELLED The relationships between work organisational, biomechanical and psychosocial factors were studied using cross-sectional data from a pooled dataset of 1834 participants. The work organisational factors included: job rotation, overtime work, having second jobs and work pace. Task and job level biomechanical variables were obtained through sub-task data collected in the field or analysed in the laboratory. Psychosocial variables were collected based on responses to 10 questions. The results showed that job rotations had significant effects on all biomechanical and most psychosocial measures. Those with job rotations generally had higher job biomechanical stressors, and lower job satisfaction. Overtime work was associated with higher job biomechanical stressors, and possibly self-reported physical exhaustion. Those having second jobs reported getting along with co-workers well. Work pace had significant influences on all biomechanical stressors, but its impact on job biomechanical stressors and psychosocial effects are complicated. PRACTITIONER SUMMARY The findings are based on a large number of subjects collected by three research teams in diverse US workplaces. Job rotation practices used in many workplaces may not be effective in reducing job biomechanical stressors for work-related musculoskeletal disorders. Overtime work is also associated with higher biomechanical stressors.
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Affiliation(s)
- Stephen S Bao
- a Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries , Olympia , USA
| | - Jay M Kapellusch
- b Department of Occupational Science & Technology , University of Wisconsin-Milwaukee , Milwaukee , USA
| | - Andrew S Merryweather
- c Department of Mechanical Engineering , University of Utah , Salt Lake City , Utah , USA
| | - Matthew S Thiese
- d Rocky Mountain Center for Occupational and Environmental Health (RMCOEH) , University of Utah , Salt Lake City , Utah , USA
| | - Arun Garg
- b Department of Occupational Science & Technology , University of Wisconsin-Milwaukee , Milwaukee , USA
| | - Kurt T Hegmann
- d Rocky Mountain Center for Occupational and Environmental Health (RMCOEH) , University of Utah , Salt Lake City , Utah , USA
| | - Barbara A Silverstein
- a Safety and Health Assessment and Research for Prevention (SHARP) Program, Washington State Department of Labor and Industries , Olympia , USA
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Fan ZJ, Harris-Adamson C, Gerr F, Eisen EA, Hegmann KT, Bao S, Silverstein B, Evanoff B, Dale AM, Thiese MS, Garg A, Kapellusch J, Burt S, Merlino L, Rempel D. Associations between workplace factors and carpal tunnel syndrome: A multi-site cross sectional study. Am J Ind Med 2015; 58:509-18. [PMID: 25778111 DOI: 10.1002/ajim.22443] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND Few large epidemiologic studies have used rigorous case criteria, individual-level exposure measurements, and appropriate control for confounders to examine associations between workplace psychosocial and biomechanical factors and carpal tunnel syndrome (CTS). METHODS Pooling data from five independent research studies, we assessed associations between prevalent CTS and personal, work psychosocial, and biomechanical factors while adjusting for confounders using multivariable logistic regression. RESULTS Prevalent CTS was associated with personal factors of older age, obesity, female sex, medical conditions, previous distal upper extremity disorders, workplace measures of peak forceful hand activity, a composite measure of force and repetition (ACGIH Threshold Limit Value for Hand Activity Level), and hand vibration. CONCLUSIONS In this cross-sectional analysis of production and service workers, CTS prevalence was associated with workplace and biomechanical factors. The findings were similar to those from a prospective analysis of the same cohort with differences that may be due to recall bias and other factors.
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Affiliation(s)
- Z. Joyce Fan
- Washington Traffic Safety Commission; Olympia Washington
| | - Carisa Harris-Adamson
- Department of Environmental Health Sciences; University of California Berkeley; Berkeley California
- Department of Physical Therapy; Samuel Merritt University; Oakland California
| | - Fred Gerr
- Department of Occupational and Environmental Health; College of Public Health; University of Iowa; Iowa City Iowa
| | - Ellen A. Eisen
- Department of Environmental Health Sciences; University of California Berkeley; Berkeley California
| | - Kurt T. Hegmann
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH); University of Utah; Salt Lake City Utah
| | - Stephen Bao
- Safety and Health Assessment and Research for Prevention (SHARP) Program; Washington State Department of Labor and Industries; Olympia Washington
| | - Barbara Silverstein
- Safety and Health Assessment and Research for Prevention (SHARP) Program; Washington State Department of Labor and Industries; Olympia Washington
| | - Bradley Evanoff
- Division of General Medical Science; Washington University School of Medicine; Saint Louis Missouri
| | - Ann Marie Dale
- Division of General Medical Science; Washington University School of Medicine; Saint Louis Missouri
| | - Matthew S. Thiese
- Rocky Mountain Center for Occupational and Environmental Health (RMCOEH); University of Utah; Salt Lake City Utah
| | - Arun Garg
- Center for Ergonomics; University of Wisconsin-Milwaukee; Milwaukee Wisconsin
| | - Jay Kapellusch
- Center for Ergonomics; University of Wisconsin-Milwaukee; Milwaukee Wisconsin
| | - Susan Burt
- National Institute for Occupational Safety and Health (NIOSH); Cincinnati Ohio
| | - Linda Merlino
- Department of Occupational and Environmental Health; College of Public Health; University of Iowa; Iowa City Iowa
| | - David Rempel
- Division of Occupational and Environmental Medicine; University of California at San Francisco; San Francisco California
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Dale AM, Zeringue A, Harris-Adamson C, Rempel D, Bao S, Thiese MS, Merlino L, Burt S, Kapellusch J, Garg A, Gerr F, Hegmann KT, Eisen EA, Evanoff B. General population job exposure matrix applied to a pooled study of prevalent carpal tunnel syndrome. Am J Epidemiol 2015; 181:431-9. [PMID: 25700886 DOI: 10.1093/aje/kwu286] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
A job exposure matrix may be useful for the study of biomechanical workplace risk factors when individual-level exposure data are unavailable. We used job title-based exposure data from a public data source to construct a job exposure matrix and test exposure-response relationships with prevalent carpal tunnel syndrome (CTS). Exposures of repetitive motion and force from the Occupational Information Network were assigned to 3,452 active workers from several industries, enrolled between 2001 and 2008 from 6 studies. Repetitive motion and force exposures were combined into high/high, high/low, and low/low exposure groupings in each of 4 multivariable logistic regression models, adjusted for personal factors. Although force measures alone were not independent predictors of CTS in these data, strong associations between combined physical exposures of force and repetition and CTS were observed in all models. Consistent with previous literature, this report shows that workers with high force/high repetition jobs had the highest prevalence of CTS (odds ratio = 2.14-2.95) followed by intermediate values (odds ratio = 1.09-2.27) in mixed exposed jobs relative to the lowest exposed workers. This study supports the use of a general population job exposure matrix to estimate workplace physical exposures in epidemiologic studies of musculoskeletal disorders when measures of individual exposures are unavailable.
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Rempel D, Gerr F, Harris-Adamson C, Hegmann KT, Thiese MS, Kapellusch J, Garg A, Burt S, Bao S, Silverstein B, Merlino L, Dale AM, Evanoff B. Personal and workplace factors and median nerve function in a pooled study of 2396 US workers. J Occup Environ Med 2015; 57:98-104. [PMID: 25563546 PMCID: PMC4440794 DOI: 10.1097/jom.0000000000000312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Evaluate associations between personal and workplace factors and median nerve conduction latency at the wrist. METHODS Baseline data on workplace psychosocial and physical exposures were pooled from four prospective studies of production and service workers (N = 2396). During the follow-up period, electrophysiologic measures of median nerve function were collected at regular intervals. RESULTS Significant adjusted associations were observed between age, body mass index, sex, peak hand force, duration of forceful hand exertions, Threshold Limit Value for Hand Activity Limit, forceful repetition rate, wrist extension, and decision latitude on median nerve latencies. CONCLUSIONS Occupational and nonoccupational factors have adverse effects on median nerve function. Measuring median nerve function eliminates possible reporting bias that may affect symptom-based carpal tunnel syndrome case definitions. These results suggest that previously observed associations between carpal tunnel syndrome and occupational factors are not the result of such reporting bias.
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Affiliation(s)
- David Rempel
- From the Division of Occupational and Environmental Medicine (Drs Rempel and Harris-Adamson), University of California at San Francisco; Department of Occupational and Environmental Health (Dr Gerr and Ms Merlino), College of Public Health, University of Iowa; the Rocky Mountain Center for Occupational and Environmental Health (Drs Hegmann and Thiese), University of Utah, Salt Lake City; Department of Occupational Science and Technology (Drs Kapellusch and Garg), University of Wisconsin-Milwaukee; the National Institute for Occupational Safety and Health (Dr Burt), Cincinnati, Ohio; the Safety and Health Assessment and Research for Prevention Program (Drs Bao and Silverstein), Washington State Department of Labor and Industries, Olympia; and the Division of General Medical Science (Drs Dale and Evanoff), Washington University School of Medicine, Saint Louis
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