Workers' compensation reported injuries among distillery industry workers, 2010-2019

BACKGROUND

The objective of this study was to identify the most frequent type, nature, and cause of work-related injuries among distillery workers and the contributing factors for these events to target interventions to reduce injuries.

METHODS

Workers' compensation first reports of injury (FROI) from the years 2010 through 2019 were obtained. Variables were created for "occupational category" and "cause of injury" for evaluation of the injurious events. The ratchet circular scan test was used to assess seasonal variation in injury, and kernel density estimation to assess rates of injury by calendar year.

RESULTS

A total of 974 FROIs were recorded over these 10 years; 908 of the injuries resulted in lost time, 65 resulted in no lost time, and 1 resulted in a fatality. The most common injuries reported were strains or tears, lacerations, and contusions (33.4%, 14.7%, and 13.5%, respectively). The most frequent anatomical sites of injury were the shoulders, fingers, and low back area (11.8%, 11.4%, and 8.9%, respectively). Barreling operation activities experienced the greatest frequency of work-related injury at 28.5% of all FROIs. A seasonal peak of injuries was observed during May and June.

CONCLUSIONS

Implementing ergonomic and safety solutions for transportation and work tasks associated with barreling operations may significantly reduce the rate of work-related injuries in distillery workers. Injury prevention interventions should particularly target strain or tear injuries caused by repetitive motion or bodily reaction and overexertion. Contact with objects or machinery accounted for one-third of distillery industry FROIs.

Assessing waivered and non-waivered physician barriers to treating patients with substance use disorders: a cross-sectional Kentucky pilot

INTRODUCTION

Opioid and other substance use disorders (OUD/SUDs) have been and continue to be significant public health issues. The standard of care for OUD is the use of medication for opioid use disorder (MOUD) in conjunction with counseling or behavioral therapies, yet research has indicated that barriers exist for patients accessing MOUD as well as for physicians prescribing MOUD due to requirements associated with the DATA 2000 waiver.

METHODS

A pilot cross-sectional survey was conducted among Kentucky physicians in order to reassess common barriers as well as to explore barriers that non-waivered providers face to becoming waivered. Barriers were compared by waiver status (waiver vs. non-waivered) as well as geographic location (rural vs. non-rural).

RESULTS

Compared to waivered physicians, non-waivered physicians were significantly less likely to report positive personal beliefs related to the use of MOUD for OUD and reported significantly more barriers to treating OUD patients in the areas of physicians' practice and culture, auditing, and institutional support and resources (p < .05). The majority (69%) of all physicians indicated they would benefit from a tool kit with evidence-based clinical guidelines.

CONCLUSIONS

The barriers and beliefs identified in this pilot study indicate the need for policy action at the federal level to reduce barriers and incentivize more physicians to obtain waivers to treat OUD. Further, the development of brief educational resources tailored to physicians to treat OUD patients including pregnant patients with OUD is recommended.

Perceptions of opioid and other illicit drug exposure reported among first responders in the southeast, 2017 to 2018

BACKGROUND

Opioid use has risen dramatically in recent years, and its illegal use puts first responders at risk when intervening in overdoses. Synthetic opioids, like fentanyl with a potency 50 to 100 times greater than morphine, pose a great risk and accidental exposure via ingestion, inhalation, mucosal, or percutaneous routes, can potentially lead to fatal outcomes. Anecdotal media accounts in early 2017 of accidental occupational opioid exposure among first responders generated a national concern.

METHODS

To identify first responders' recollections, beliefs, and concerns about possible occupational exposure to opioids and other drugs, researchers in Kentucky, Virginia, Mississippi, and Georgia administered an emailed, anonymous convenience sample survey.

RESULTS

A total of 5955 surveys were analyzed with 15% of respondents reporting they believed they had been exposed to opioids, and of those, less than 1% reported experiencing health effects from perceived exposure. Over half (51%) of respondents reported being "very or somewhat concerned" about developing health effects from exposure to opioids. Half of respondents reported being unaware of Centers for Disease Control and Prevention (CDC)/National Institutes for Occupational Safety and Health (NIOSH) guidelines for preventing occupational-related opioid exposures.

CONCLUSIONS

Only a small fraction of first responders believed they had experienced symptoms related to opioid exposure in overdose response calls, but half were concerned about potential exposures and half were unaware of the educational guidance on prevention available. The high level of concern regarding potential exposure warrants the need for the development and or enhancement of targeted educational training interventions and further dissemination of pre-existing training interventions to ensure first responders have the knowledge and understanding of occupational opioid exposures and minimize stress associated with the potential rare exposures.

Assessing Technical Assistance Needs among Recovery Residence Operators in the United States

Recovery support services such as recovery housing assist individuals with increasing their access to social support, employment services, and systems of care. Lack of evidence-based practices and calls for increased oversight of these settings suggests a growing need for technical assistance and training for recovery residence owners and staff, yet little is known about their areas of greatest need for technical assistance. We developed and administered a survey to assess the technical assistance needs of recovery housing operators in the United States using a convenience sample of individuals who own or operate a recovery residence (N = 376). A total of 77 owners/operators completed the survey (20% response rate), representing urban, suburban, and rural communities. Differences were observed between number of owned residences: owners/operators of a single residence were interested in technical assistance on house-specific policies and linkage to established systems of care, whereas owners/operators of multiple residences were interested in technical assistance on building financial sustainability and incorporation of best practices into their recovery residences. As an increasing number of states move to implement voluntary certification or licensing for recovery residences, targeted training and technical assistance to owners/operators will facilitate the successful adoption of recovery residence best practices and quality standards.

Association Between Work-Related Hyperthermia Emergency Department Visits and Ambient Heat in Five Southeastern States, 2010-2012-A Case-Crossover Study

The objective of this study is to assess ambient temperatures' and extreme heat events' contribution to work-related emergency department (ED) visits for hyperthermia in the southeastern United States to inform prevention. Through a collaborative network and established data framework, work-related ED hyperthermia visits in five participating southeastern U.S. states were analyzed using a time stratified case-crossover design. For exposure metrics, day- and location-specific measures of ambient temperatures and county-specific identification of extreme heat events were used. From 2010 to 2012, 5,017 work-related hyperthermia ED visits were seen; 2,298 (~46%) of these visits occurred on days when the daily maximum heat index was at temperatures the Occupational Safety and Health Administration designates as having "lower" or "moderate" heat risk. A 14% increase in risk of ED visit was seen for a 1°F increase in average daily mean temperature, modeled as linear predictor across all temperatures. A 54% increase in risk was seen for work-related hyperthermia ED visits during extreme heat events (two or more consecutive days of unusually high temperatures) when controlling for average daily mean temperature. Despite ambient heat being a well-known risk to workers' health, this study's findings indicate ambient heat contributed to work-related ED hyperthermia visits in these five states. Used alone, existing OSHA heat-risk levels for ambient temperatures did not appear to successfully communicate workers' risk for hyperthermia in this study. Findings should inform future heat-alert communications and policies, heat prevention efforts, and heat-illness prevention research for workers in the southeastern United States.

Use of multiple data sources to identify specific drugs and other factors associated with drug and alcohol screening of fatally injured motor vehicle drivers

OBJECTIVE

Drugged driving crashes have significantly increased over the past two decades. The objectives of this study were to identify and characterize the drugs present in motor vehicle driver fatalities using multiple surveillance data sources; assess concordance of the data sources in identifying drug presence; and identify demographic and crash factors associated with drug and alcohol screening in fatally injured motor vehicle drivers.

METHODS

Fatality Analysis Reporting System (FARS), Collision Report Analysis for Safer Highways (CRASH), and mortality data sets were linked; drug screening and positive drug screens were identified. Chi-square and conditional logistic regression were performed.

RESULTS

The use of FARS data identified the majority of positive drug screens in the linked data set. Supplementation of FARS data with death certificate and CRASH data increased identification of specific drugs and drug classes detected among fatally injured motor vehicle drivers, although there was a low concordance among the data sources. Alcohol and depressants such as alprazolam had the highest frequencies among fatally injured drivers. Speeding, lack of occupant restraints, young age, commercial truck drivers, and speeding were all factors associated with increased odds of the fatally injured driver being drug or alcohol screened.

CONCLUSIONS

These findings indicate that FARS drug information data may be strengthened through increased autopsy and consultation with medical examiners to better understand and interpret decedent toxicology testing results, and that states with low driver drug testing rates should consider mandatory driver drug testing in fatal crashes.

Fusion Energy Output Greater than the Kinetic Energy of an Imploding Shell at the National Ignition Facility

A series of cryogenic, layered deuterium-tritium (DT) implosions have produced, for the first time, fusion energy output twice the peak kinetic energy of the imploding shell. These experiments at the National Ignition Facility utilized high density carbon ablators with a three-shock laser pulse (1.5 MJ in 7.5 ns) to irradiate low gas-filled (0.3  mg/cc of helium) bare depleted uranium hohlraums, resulting in a peak hohlraum radiative temperature ∼290  eV. The imploding shell, composed of the nonablated high density carbon and the DT cryogenic layer, is, thus, driven to velocity on the order of 380  km/s resulting in a peak kinetic energy of ∼21  kJ, which once stagnated produced a total DT neutron yield of 1.9×10^{16} (shot N170827) corresponding to an output fusion energy of 54 kJ. Time dependent low mode asymmetries that limited further progress of implosions have now been controlled, leading to an increased compression of the hot spot. It resulted in hot spot areal density (ρr∼0.3  g/cm^{2}) and stagnation pressure (∼360  Gbar) never before achieved in a laboratory experiment.

Fatal Work-Related Injuries: Southeastern United States, 2008-2011

In 2008, the work-related injury fatality rate was 3.8 per 100,000 workers in the United States but was 5.2 per 100,000 workers for the southeast region. Work-related fatalities in the southeast were examined for the period 2008 to 2011. Median work-related injury fatality rates are reported for the southeast region, each of the 12 states, and the United States. The percentages of employees in high fatality industries and work-related fatalities by cause were calculated. Finally, the Occupational Safety and Health Administration's database was searched for fatality reports. States with the highest rates (per 100,000 workers) included Arkansas (7.2), Louisiana (6.8), and West Virginia (6.6). Arkansas, Louisiana, Mississippi, and West Virginia each had more than 20% of their employees in high fatality industries. Forty percent of work-related injury fatalities were from transportation incidents in the southeast and the United States. Future analyses should include work-related injury fatality rates by industry and compare rates with other U.S. regions.

Proportion of dermatitis attributed to work exposures in the working population, United States, 2011 behavioral risk factor surveillance system

BACKGROUND

The US employer-based surveillance system for work-related health conditions underestimates the prevalence of work-related dermatitis.

OBJECTIVE

The authors sought to utilize information from workers to improve the accuracy of prevalence estimates for work-related dermatitis.

METHODS

Three state health departments included questions in the 2011 Behavioral Risk Factor Surveillance System survey designed to ascertain the prevalence of dermatitis in the working population, as well as healthcare experiences, personal perceptions of work-relatedness, and job changes associated with dermatitis.

RESULTS

The percentage of working respondents who reported receiving a clinician's opinion that their dermatitis was work-related was between 3.8% and 10.2%. When patients' perceptions were considered, the work-related dermatitis prevalence estimate increased to between 12.9% and 17.6%.

CONCLUSIONS

Including patients' perceptions of work-relatedness produced a larger prevalence estimate for work-related dermatitis than the previously published estimate of 5.6%, which included only those cases of dermatitis attributed to work by healthcare professionals.

Motor vehicle injuries among semi truck drivers and sleeper berth passengers

INTRODUCTION

Injuries and fatalities due to large truck and other vehicle crashes have decreased over the last decade, but motor vehicle injuries remain a leading cause of death for both the working and general populations. The present study was undertaken to determine semi truck driver and sleeper berth passenger injury risk in a moving semi truck collision using a matched-pair cohort study.

METHOD

Study data were obtained from the Kentucky Collision Report Analysis for Safer Highways (CRASH) electronic files for 2000-2010. A matched-pair cohort study was used to compare the odds of injury of both drivers and sleeper berth passengers within the same semi truck controlling for variables specific to the crash or the semi truck. The crude odds ratio of injury was estimated and a statistical model for a correlated outcome using generalized estimating equations was utilized.

RESULTS

In a moving semi truck collision, the odds for an injury were increased by 2.25 times for both semi truck drivers and sleeper berth passengers who did not use occupant safety restraints compared to semi truck drivers and sleeper berth passengers who used occupant safety restraints at the time of the collision. The driver seat or sleeper berth position in the vehicle was not a significant factor (p-value=0.31) associated with a moving semi truck collision injury.

CONCLUSION

Nonuse of occupant safety restraints by either drivers or sleeper berth passengers significantly increased the odds of an injury in a moving semi truck collision; semi truck seating position (driver's seat or sleeper berth) did not increase the odds for an injury in moving collisions.

IMPACT ON INDUSTRY

Trucking companies should include the mandatory use of occupant safety restraints by both semi truck drivers and sleeper berth passengers in their company safety policies.

Concordance of motor vehicle crash, emergency department, and inpatient hospitalization data sets in the identification of drugs in injured drivers

OBJECTIVE

Prescription drug overdoses, abuse, and sales have increased dramatically in the United States in the last decade. The purpose of the present study was to link crash data with emergency department (ED) and inpatient hospitalization data to assess the concordance between the data sets in the identification of the presence of drugs among injured motor vehicle drivers (passenger cars, passenger trucks, light trucks, and semi-trucks) in Kentucky.

METHODS

Kentucky CRASH data were probabilistically linked to ED data sets for years 2008-2010 and to inpatient hospitalization data sets for years 2000-2010. Statistical analyses were performed.

RESULTS

Of the 72,529 linked crash/ED visits, there were 473 drivers with an associated nondependent abuse of drugs diagnosis in the ED, and 930 drivers had drug involvement recorded in the CRASH data (only 163 cases overlapped with drug involvement both recorded in CRASH data and coded as nondependent abuse of drugs in the ED); 64 drivers had multiple drug types present in their system. Of the 20,860 total linked crash/inpatient hospitalization cases, there were 973 drivers diagnosed with nondependent abuse of drugs in the inpatient hospitalization record and 499 drivers had drug involvement recorded in the CRASH data (only 207 overlapped); 250 drivers were diagnosed with multiple drugs in their system.

CONCLUSIONS

Surveillance data from multiple public health data sets is necessary to identify the presence of drugs in injured drivers involved in motor vehicle crashes. The use of a single surveillance data set alone may significantly underreport the number of drugged drivers who were injured in a motor vehicle collision.

Identification and characterization of Kentucky self-employed occupational injury fatalities using multiple sources, 1995-2004

BACKGROUND

Identification and characterization of occupational injury fatalities in self-employed workers typically relies on a single data source and thus may miss some cases.

METHODS

Kentucky self-employed worker injury fatalities were identified using Fatality Assessment and Control Evaluation (FACE) program data (1995-2004) and compared to non self-employed worker data. Occupations and industries listed on death certificates were compared to those in which the decedent was actually engaged.

RESULTS

Of 1,281 Kentucky worker injury deaths, 28% were self-employed. Death certificates failed to identify 31% of these deaths as work-related; industry and occupation were incorrectly identified in 27% and 16%, respectively. Fifty-seven percent of the deaths were in agriculture, primarily tractor-related. For Kentucky, the self-employed crude death rate was higher (27.6/100,000) than the non self-employed worker (5.4/100,000) rate or the US (11.5/100,000) self-employed rate.

CONCLUSIONS

Multiple information sources improve identification of self-employed status in work-related injury fatalities. Effective prevention requires accurate surveillance and examination of contributing factors. Self-employed worker injuries in high-risk industries should be more fully examined for development of effective injury prevention programs.

Clinicopathological phenotype of codon 129 valine homozygote sporadic Creutzfeldt-Jakob disease

The naturally occurring polymorphism at codon 129 of the human prion protein gene (PRNP) influences susceptibility to sporadic Creutzfeldt-Jakob Disease (CJD); the majority of the patients are methionine homozygotes at this locus, while valine homozygotes represent only 10% of cases. The aim was to study the clinical and neuropathological phenotype of sporadic CJD in valine homozygotes, to estimate the reliability of current clinical diagnostic criteria, and to identify any consistent and distinct features. Twelve cases of sporadic CJD with a codon 129 valine homozygote genotype were identified at the National CJD Surveillance Unit in Edinburgh. In addition to a retrospective clinical analysis, tissue blocks were stained by conventional techniques and by immunocytochemistry for prion protein. Frozen brain tissue was available from five cases for Western blot analysis of PrPRES, which in all cases showed a type 2 mobility. The cases included four males and eight females, average age 63.6 years, with a mean duration of illness of 6 months. Eleven patients presented with ataxia, and none had the characteristic EEG changes found in sporadic CJD. The neuropathological phenotype comprised spongiform change and prion protein immunopositivity most marked in the subcortical grey matter and cerebellum, prion protein positive plaque-like deposits in all regions, laminar deposition of prion protein in the cerebral cortex, and hippocampal involvement (which is seldom reported in sporadic CJD). In conclusion, these cases exhibited a fairly uniform phenotype, which is relatively distinct from sporadic CJD in methionine homozygotes, and thus diagnosis may be difficult using existing clinical criteria.

Developmental exposure to lead causes persistent immunotoxicity in Fischer 344 rats

Lead has been shown to exert toxic effects during early development. In these in vivo and ex vivo experiments, the effect of lead on the immune system of the developing embryo was assessed. Nine-week-old female Fischer 344 rats were exposed to lead acetate (0, 100, 250, and 500 ppm lead) in their drinking water during breeding and pregnancy (exposure was discontinued at parturition). Offspring received no additional lead treatment after birth. Immune function was assessed in female offspring at 13 weeks of age. Dams in lead-exposed groups were not different from controls with respect to the immune endpoints used in these experiments; however, in the offspring, lead modulated important immune parameters at modest exposure levels. Macrophage cytokine and effector function properties (tumor necrosis factor-alpha and nitric oxide production) were elevated in the 250 ppm group, while cell-mediated immune function was depressed, as shown by a decrease in delayed-type hypersensitivity reactions in the 250 ppm group. Interferon-gamma levels were decreased in the 500 ppm treatment group. Serum levels of IgE were increased in rats exposed to 100 ppm lead. These results indicate that exposure of mothers to moderate levels of lead produces chronic immune modulation in their F344 rat offspring exposed in utero. Since the mothers were not susceptible to chronic immune alterations, a developmental bias to the immunotoxic effects of lead is indicated. The differences observed are consistent with the possibility that lead may bias T helper subset development and/or function, resulting in alterations in the balance among type 1 and type 2 immune responses.

Hippocampal ensemble activity during spatial delayed-nonmatch-to-sample performance in rats

Multiple-cell recording from specially designed arrays of microwire electrodes allowed analysis of anatomically defined ensemble activity from 10 different locations within the hippocampus of rats (n = 7) performing a two-lever operant version of a spatial delayed-nonmatch-to-sample task (DNMS). Application of population analysis procedures to ensembles of single-neuron activity within the CA1 and CA3 fields revealed firing patterns related to task-relevant events within a DNMS trial. The patterns were extracted via a canonical discriminant analysis in the form of "roots" that represented sources of variance in firing within the ensemble, such as phase of the task (Sample or Nonmatch), spatial position of the lever press response (left or right), and correct versus error trials. Comparison of the ensemble firing on correct versus error trials revealed important insight into ensemble information encoding, such as "miscoding" of the response position and lack of distinct encoding of the response in the Sample phase, which became increasingly vulnerable to error as a function of the duration of delay interval. The extracted discriminant scores were reflective of multiple representations within ensembles and suggested that "conjunctions" of task-relevant features could be represented effectively by small numbers of hippocampal neurons. The findings support the long-held supposition that hippocampal neurons play a critical role in the encoding and retrieval of information in recognition memory tasks.

Hippocampal place fields: relationship between degree of field overlap and cross-correlations within ensembles of hippocampal neurons

The capacity to record from multiple neurons in awake freely moving animals provides a means for characterizing organizational principles of place field encoding within ensembles of hippocampal neurons. In this study, cross-correlations between pairs of hippocampal place cells and degree of overlap between their respective place fields were analyzed during behavioral performance of delayed matching (DMS) or non-matching sample (DNMS) tasks, or while the same rats chased pellets in a different environment. The relationship between field overlap and cross-correlations of neural spike activity within ensembles was shown to be a positive, exponentially increasing, function. Place fields from the same neurons were markedly "remapped" between the Delay and Pellet-chasing tasks, with respect to physical location and size of fields. However individual pairs of place cells within each ensemble retained nearly the same degree of overlap and cross-correlation even though the spatial environment and the tasks differed markedly. This suggested that place cells were organized in functional "clusters" which exhibited the same inter-relations with respect to place field overlap and cross-correlations, irrespective of actual field of location. When cross-correlations between place cells were compared to placement of the array recording electrodes within the hippocampus, the strongest correlations were found along previously defined posterior-projecting fiber gradients between CA3 and CA1 subfields (Ishizuka et al. [1990], J Comp Neurol 295:580-623; Li et al. [1994] (J Comp Neurol 339:181-208). These findings suggest that the functional organization of place fields conforms to anatomical principles suspected to operate within hippocampal ensembles.