Using Behavioral Risk Factor Surveillance System Data as an Occupational Health Profile: Washington State Janitors, 2011 to 2017.

OBJECTIVE: Janitorial workers have a high burden of occupational injury and illness, but little information exists on their overall health. METHODS: Data from the Washington State Behavioral Risk Factor Surveillance System (BRFSS) were analyzed to characterize the working population of Janitors in Washington State from 2011 to 2017 (n = 490) as compared with all other workers (n = 38,885). RESULTS: Compared with other workers, Janitors were significantly more diverse, had lower socioeconomic status, and reported poorer general health and higher rates of arthritis and depression. Janitors were less likely to have adequate sleep, health insurance, and access to technology. Janitors reported higher rates of smoking and marijuana use. CONCLUSIONS: Multiple risk factors compound the vulnerability of Janitors. BRFSS data can be used to characterize the health of occupational groups. Identifying overall health needs can better inform policy and help formulate strategies to improve workers' health.

Injury Rate Comparisons for Nonmechanized and Mechanized Logging Operations, Washington State, 2005-2014.

OBJECTIVES: Current industry classification systems in the United States do not differentiate mechanized and nonmechanized logging operations. The objectives of this article are to quantify injury risk differences between mechanized and nonmechanized logging operations in Washington State and to evaluate for potential injury risk tradeoffs, such as decreasing traumatic injuries while increasing nontraumatic injuries that might occur when mechanized logging operations are substituted for nonmechanized logging operations. METHODS: Using Washington State workers' compensation insurance risk classes to differentiate mechanized and nonmechanized logging operations, injury and illness claims data and employer reported hours were used to compare claim rates and to characterize injuries by type of logging operation. RESULTS: From 2005 to 2014, the accepted Washington State worker's compensation claim rate for nonmechanized logging was 46.4 per 100 full-time equivalent employees compared to 6.7 per 100 full-time equivalent (FTE) for mechanized logging activities. The rate ratio for comparing nonmechanized to mechanized logging claims rates for all accepted claims was 6.9 (95% Confidence Interval 6.4-7.5). Claim rates for traumatic injury and nontraumatic injuries in nonmechanized logging exceeded comparable rates in mechanized logging activities, although the distribution of types of injury differed by type of logging operation. A greater percentage of accepted claims in nonmechanized logging were traumatic injuries than in mechanized logging (92.2% vs. 85.0%, respectively). In addition, nonmechanized logging had higher total claim and medical costs per FTE and had a higher proportion of claims with lost work time than mechanized logging. CONCLUSION: Mechanized logging offers a considerable safety advantage over nonmechanized logging operations. Continued efforts to increase the mechanization of logging operations will result in decreased injury rates.

Victim, Allegation, and Investigation Characteristics Associated With Substantiated Reports of Sexual Abuse of Adults in Residential Care Settings.

The purpose of this study was to identify characteristics of investigations of sexual abuse concerning vulnerable adults residing in facility settings that were associated with case substantiation. Data on 410 reports of sexual abuse were collected prospectively from Adult Protective Services (APS) and state licensure agency staff in New Hampshire, Oregon, Tennessee, Texas, and Wisconsin over a six-month period. Specifically, we examined differences between reports that were substantiated and those that were not by comparing characteristics of alleged victims, alleged perpetrators, and aspects of investigation using logistic regression. We found that a relatively low proportion of cases (18%) were substantiated overall. Compared to cases that were not substantiated, cases that were substantiated were more likely to feature nursing home residents, older victims, female victims, and allegations of physical contact between the alleged perpetrator and victim. Despite the high proportion of alleged perpetrators who were facility staff (51%) compared to resident perpetrators (25%), cases with resident-to-resident allegations of abuse were much more likely to be substantiated, accounting for 63% of substantiated cases. In light of these findings, we believe it is important that investigators are trained to handle sexual abuse cases appropriately and that they are able to investigate the case thoroughly, promptly, and with as much information as possible. It is also critical that investigators make substantiation decisions using the appropriate standard for confirmation (e.g., preponderance of the evidence, beyond a reasonable doubt, clear and convincing evidence) as state law dictates.

The Economic Effect of Chronic Comorbidities in Carpal Tunnel Syndrome Workers' Compensation Claimants, Washington State.

OBJECTIVE: Assess the effect of chronic comorbidities on hours and earnings recovery following a carpal tunnel syndrome (CTS) claim. METHODS: The hours and earnings profiles of Washington State workers' compensation claimants with CTS and controls, upper extremity fractures (UEF) claimants, were collected by linking to unemployment insurance data during 2007 to 2014. Chronic comorbidity status was determined from workers' compensation bills. RESULTS: More (43%) CTS claimants had diagnosed chronic comorbidities than UEF (24%). CTS claimants and claimants with multiple chronic comorbidities had significantly higher odds of not working post injury and poorer hours and earnings recovery compared with UEF claimants and those with no chronic comorbidities. CONCLUSIONS: This research suggests that chronic conditions should be considered as barriers to return to work among injured workers.

Characteristics of construction firms at risk for future workers' compensation claims using administrative data systems, Washington State.

INTRODUCTION: Construction is high-hazard industry, and continually ranks among those with the highest workers' compensation (WC) claim rates in Washington State (WA). However, not all construction firms are at equal risk. We tested the ability to identify those construction firms most at risk for future claims using only administrative WC and unemployment insurance data. METHODS: We collected information on construction firms with 10-50 average full time equivalent (FTE) employees from the WA unemployment insurance and WC data systems (n=1228). Negative binomial regression was used to test the ability of firm characteristics measured during 2011-2013 to predict time-loss claim rates in the following year, 2014. RESULTS: Claim rates in 2014 varied by construction industry groups, ranging from 0.7 (Land Subdivision) to 4.6 (Foundation, Structure, and Building Construction) claims per 100 FTE. Construction firms with higher average WC premium rates, a history of WC claims, increasing number of quarterly FTE, and lower average wage rates during 2011-2013 were predicted to have higher WC claim rates in 2014. CONCLUSIONS: We demonstrate the ability to leverage administrative data to identify construction firms predicted to have future WC claims. This study should be repeated to determine if these results are applicable to other high-hazard industries. Practical Applications: This study identified characteristics that may be used to further refine targeted outreach and prevention to construction firms at risk.

Impact of Work Organizational Factors on Carpal Tunnel Syndrome and Epicondylitis.

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.

Determinants of work hours among a cohort of male and female farmers 50 years and older in Kentucky and South Carolina (2002-2005).

The average age of United States farmers has been increasing for 20 years. The objective is to examine the factors associated with hours worked among farmers age 50 and older. A cohort of Kentucky and South Carolina farmers (n = 1394) over age 50 were surveyed annually during 2002-2005. Of those that reported any farm work, males worked 24 mean hours/week and females worked 14 mean hours/week. Greater satisfaction and more experience farming, increased acreage, and presence of animals significantly increased estimated hours farmed, whereas chronic health problems, although prevalent, had a minor role in determining work hours.

Vitamin E and all-cause mortality: a meta-analysis.

The current analysis reexamines the relationship between supplemental vitamin E and all-cause mortality. All randomized, controlled trials testing the treatment effect of vitamin E supplementation in adults for at least one year were sought. MEDLINE, the Cochrane Library, and Biological Abstracts databases were searched using the terms "vitamin E," "alpha-tocopherol," "antioxidants," "clinical trial," and "controlled trial" for studies published through April 2010; results were limited to English, German, or Spanish language articles. Studies were also obtained through reference mining. All randomized controlled trials using vitamin E, with a supplementation period of at least one year, to prevent or treat disease in adults were identified and abstracted independently by two raters. Mortality data from trials with a supplementation period of at least one year were pooled. The selected trials (n = 57) were published between 1988 and 2009. Sample sizes range from 28 to 39,876 (median = 423), yielding 246,371 subjects and 29,295 all-cause deaths. Duration of supplementation for the 57 trials range from one to 10.1 years (median = 2.6 years). A random effects meta-analysis produce an overall risk ratio of 1.00 (95% confidence interval: 0.98, 1.02); additional analyses suggest no relationship between dose and risk of mortality. Based on the present meta-analysis, supplementation with vitamin E appears to have no effect on all-cause mortality at doses up to 5,500 IU/d.

Sexual predators who target elders: findings from the first national study of sexual abuse in care facilities.

This article reports research findings concerning 119 alleged sexual perpetrators who were reported to state authorities for abusing elderly individuals residing in care facilities. The largest group of accused was employees of the facilities, followed by facility residents. Family members of the alleged victims and visitors to the facilities also were among those reported as sexually abusive. Investigation of the allegations by Adult Protective Services and regulatory staff resulted in 32 of these individuals being confirmed as sexual perpetrators against vulnerable elders. Male and female alleged and confirmed sexual perpetrators were identified as well as both male and female elderly sexual abuse victims. Perpetrator characteristics, victim vulnerabilities, abuse acts, locations of assaults, and available case outcomes are presented. Implications of the findings are discussed.

Oxidation of thiol-proteases in the hippocampus of Alzheimer's disease.

The hippocampus of Alzheimer's disease brain has been shown to be highly oxidized compared to age-matched controls. One of the most sensitive targets of oxidation is anionic sulfur which can be found within the active site of members of the cysteine-protease family. Thus, while members of the cysteine-protease family such as the calpains and caspases have been found to be in an active conformation in vulnerable brain regions in AD it is possible that their proteolytic activity is hampered due to the robust oxidative stress found at these locations. To address this issue, the amount of caseinolytic activity present in the hippocampus from post-mortem brain samples of AD and age-matched controls was determined. No difference in caseinolytic activity in the absence of exogenous reducing agent was observed between AD and control. However, after addition of the thiol-specific reducing agent, dithiothreitol (DTT), the amount of caseinolytic activity was significantly increased in AD compared to the DTT-mediated increase in control. This suggests that the cysteine proteases are more oxidized in AD brain and that latent proteolytic activity in AD brain can be released by antioxidants. Further testing revealed that the calcium-dependent caseinolytic activity was significantly lower in AD brain compared to controls. This is despite the fact that the major calcium-dependent thiol protease, calpain, is threefold more activated in AD brain based on autolytic activation measured by Western blotting. This calcium-dependent protease difference between AD and control brains was negated by addition of DTT. These data suggest that cysteine protease activity in AD brain is inactivated by oxidants, which is evident by the ability of thiol-specific reducing agents such as DTT to rescue and recover activity.