Workplace Violence Prevention for Nurses.

An online NIOSH course raises awareness of workplace violence and offers preventive strategies.

Prevalence of carpal tunnel syndrome among employees at a poultry processing plant.

OBJECTIVE: To determine prevalence of carpal tunnel syndrome (CTS) among poultry processing employees while taking into account non-occupational factors and assess any association between CTS prevalence and exposure groups. METHODS: Performed a cross-sectional survey to assess CTS (n = 318). A CTS case was defined as an employee with self-reported CTS symptoms, an abnormal hand symptom diagram, and an abnormal nerve conduction study (NCS). Log-binomial regression was used to estimate prevalence ratios. RESULTS: Three hundred and one participants had sufficient symptom information or NCS data to be classified. 126 (42%) of 301 participants had evidence of CTS. In the adjusted analysis, the highest exposure group had CTS prevalence that was significantly higher than that for the lower exposure group [PR: 1.61; 95% CI = (1.20, 2.17)]. CONCLUSIONS: Increasing levels of hand activity and force were associated with increased CTS prevalence among participants. Recommendations were provided to reduce exposure to these risk factors.

Chronic obstructive pulmonary disease prevalence among nonsmokers by occupation in the United States.

OBJECTIVE: To examine the prevalence of chronic obstructive pulmonary disease (COPD) among nonsmokers by occupation in the United States. METHODS: The 1997 to 2004 National Health Interview Survey data for working adults aged 25 years or more were used to estimate the COPD prevalence and to examine change in COPD prevalence between 1997 to 2000 and 2001 to 2004 by occupational groups. RESULTS: During 1997 to 2004, COPD prevalence was 2.8%. The COPD prevalence was highest in financial records processing (4.6%) occupations. There was a slight increase in COPD prevalence during the two survey periods from 2.8% during 1997 to 2000 compared with 2.9% during 2001 to 2004. CONCLUSIONS: No significant changes in the COPD prevalence between the two periods were found. Nevertheless, the elevated COPD prevalence in certain occupational groups suggests that other risk factors play a role in developing COPD.

Coal dust exposure and mortality from ischemic heart disease among a cohort of U.S. coal miners.

BACKGROUND: Particulate exposure from air pollution increases the risk of ischemic heart disease (IHD) mortality. Although coal miners are highly exposed to coal dust particulate, studies of IHD mortality risk among coal miners have had inconsistent results. Previous studies may have been biased by the healthy worker effect. METHODS: We examined the dose-response relationship between cumulative coal dust exposure, coal rank, and IHD mortality among a cohort of underground coal miners who participated in the National Study of Coal Workers' Pneumoconiosis. RESULTS: After adjusting for age, smoking, and body mass index, risk of IHD mortality increased at higher levels of coal dust exposure. Mortality risk was also associated with coal rank region. CONCLUSION: There was an increased risk of mortality from IHD associated with cumulative exposure to coal dust, and with coal rank. The effect of coal rank may be due differences in the composition of coal mine dust particulate. The association of risk of IHD mortality with cumulative particulate exposure is consistent with air pollution studies.

Occupational risks for idiopathic pulmonary fibrosis mortality in the United States.

Metal and wood dust exposures have been identified as possible occupational risk factors for idiopathic pulmonary fibrosis (IPF). We analyzed mortality data using ICD-10 code J84.1--"Other interstitial pulmonary diseases with fibrosis," derived age-adjusted mortality rates for 1999-2003, and assessed occupational risks for 1999, by calculating proportionate mortality ratios (PMRs) and mortality odds ratios (MORs) using a matched case-control approach. We identified 84,010 IPF deaths, with an age-adjusted mortality rate of 75.7 deaths/million. Mortality rates were highest among males, whites, and those aged 85 and older. Three industry categories with potential occupational exposures recognized as risk factors for IPF were identified: "Wood buildings and mobile homes" (PMR = 4.5, 95% confidence interval (CI) 1.2-11.6 and MOR = 5.3, 95% CI 1.2-23.8), "Metal mining" (PMR = 2.4, 95% CI 1.3-4.0 and MOR = 2.2, 95% CI 1.1-4.4), and "Fabricated structural metal products" (PMR = 1.9, 95% CI 1.1-3.1 and MOR = 1.7, 95% CI 1.0-3.1). Workers in these industry categories may benefit from toxicological studies and improved surveillance for this disease.

Suspension tolerance in a full-body safety harness, and a prototype harness accessory.

Workers wearing full-body safety harnesses are at risk for suspension trauma if they are not rescued in 5 to 30 min after a successfully arrested fall. Suspension trauma, which may be fatal, occurs when a person's legs are immobile in a vertical posture, leading to the pooling of blood in the legs, pelvis, and abdomen, and the reduction of return blood flow to the heart and brain. To measure suspension tolerance time, 22 men and 18 women with construction experience were suspended from the chest D-ring (CHEST) and back D-ring (BACK) of full-body, fall-arrest harnesses. Fifteen men and 13 women from the original group of subjects were then suspended using a newly developed National Institute for Occupational Safety and Health harness accessory (ACCESS), which supports the upper legs. Midthigh circumference changes were 1.4 and 1.9 cm, changes in minute ventilation were 1.2 and 1.5 L/min, changes in heart rate (HR) were 15.1 and 21.6 bpm, and changes in mean arterial pressure were 5.1 and -2.6 mmHg (p < or = 0.05) for all subjects during CHEST and BACK, respectively. Kaplan-Meier median suspension time for all subjects for the CHEST condition was 29 min (range 4-60 min) and 31 min (range 5-56 min) for the BACK condition. The 95th percentile for suspension time was 7 min for CHEST and 11 min for BACK. Cox regression revealed that body weight had a statistically significant effect on the time until experiencing a medical end point (p < or = 0.05) during the BACK condition. Mean (+/- SD) suspension time was 58 +/- 6 min (range 39-60 min) for all subjects for the ACCESS condition. There were no terminations due to medical symptoms during the ACCESS suspension, changes in physiological variables were small, and 85% of ACCESS subjects completed 60-min suspensions. These data provide information on motionless suspension tolerance time to standards-setting organizations and demonstrate the potential of a prototype harness accessory to delay or prevent suspension trauma.

Change in permeation parameters and the decontamination efficacy of three chemical protective gloves after repeated exposures to solvents and thermal decontaminations.

BACKGROUND: Chemical protective clothing (CPC) and gloves, which provide adequate protection, are usually too expensive to be considered disposable. Repeated use of CPC without effective decontamination may result in secondary exposure and injury. However, decontamination may change the physical and/or chemical properties of the barrier material, causing variations in breakthrough time (BT) and steady-state permeation rate (SSPR). METHODS: Glove materials including neoprene, Guardian butyl rubber, and nitrile synthetic rubber were selected for this study. Toluene and acetone were chosen as the challenge chemicals. Permeation was measured in a closed loop system using a 2.5 cm permeation cell and a MIRAN infrared analyzer (Foxboro, MA). Following the permeation test, the samples were thermally decontaminated. After each exposure/decontamination cycle, BT and SSPR were measured. A total of 260 permeation tests were conducted. Permeation test results were collected on each material/chemical combination for up to 10 exposure/decontamination cycles. RESULTS: On average, changes in BT and SSPR in comparison with respect to new swatches were 11.5% and 13.7% after seven exposure/decontamination cycles. The percentages increased to 26.6% and 15.9% after 10 exposure/decontamination cycles, respectively. For at least seven cycles, the BT mean for four out of five material/chemical combinations tested (neoprene/acetone, neoprene/toluene, nitrile/acetone, and nitrile/toluene) was not significantly different from the original value of the BT for each corresponding swatch. Similarly, the SSPR mean for each of the five material/chemical combinations after at least five cycles was not significantly different from those for new swatches. The BT mean for the butyl/toluene combination, however, was significantly different from the new swatches even after the first exposure/decontamination. The SSPR mean was significantly different after five cycles compared to the new swatches. CONCLUSIONS: Except for the butyl/toluene combination, thermal decontamination was an effective method in removing the solvents from the matrix of selected glove materials. Multiple reuses of some chemical protective gloves could be safe if effective decontamination methods are used and the glove materials do not have significant degradation.

Sample size for K 2x2 tables in equivalence studies using Cochran's statistic.

This paper presents a new sample size formula for Cochran's test that uses additional information on stratum-specific success rates and requires fewer subjects for an equivalence study. Equivalence studies are common in clinical trials, where unlike superiority studies, the goal is to show whether a new drug therapy is as effective as a standard one. Stratification is typically used to adjust for differences among individual clinical trial centers with different success rates. The sample size is derived for a clinical trial design where two independent binomial proportions are compared within each stratum. Implementation of the sample size formula is described when the number of centers is large and the success rates of each individual center are not known exactly. The effect of variability of the success rates on the power of Cochran's test is shown through simulation. The variability of the success rates is measured by the intracluster correlation coefficient, which can be estimated by the ANOVA estimator of Donald and Donner. The simulation results show that the new sample size formula requires fewer subjects than sample size methods, which ignore stratification. The new method provides greater savings as the variability of success rates among centers increases.

Stressful psychosocial work environment increases risk for back pain among retail material handlers.

BACKGROUND: Back pain is a major source of lost work time. Occupational physical activity only accounts for a fraction of low back pain; therefore, there is growing interest in investigating other possible causes of back pain including the psychosocial work environment. METHODS: Material handlers (N = 6,311) in 160 newly opened stores were interviewed at study entry and approximately 6 months later. Factor analysis was used to reduce the 37 psychosocial questionnaire items to seven distinct factors. RESULTS: After adjusting for history of back problems and work-related lifting, risk of back pain was moderately increased among employees who reported high job intensity demands (odds ratio (OR) = 1.8), job dissatisfaction (OR = 1.7), and high job scheduling demands (OR = 1.6). CONCLUSIONS: Modification of the psychosocial work environment for material handlers in large retail stores may help reduce back pain among employees.