Risk factors for falls among Iowa farmers: a case-control study nested in the Agricultural Health Study

BACKGROUND: Farmers are at increased risk for fall-related injury compared with other occupations. Little is known about risk factors for non-fatal falls on the farm. This case-control study, nested within the Agricultural Health Study, aimed to assess risk factors for work-related falls among Iowa farmers. METHODS: A screener questionnaire sent to 6,999 farmers in 1998 identified 79 farmers who reported a fall-related farm injury that required medical advice or treatment in the previous year. Multivariable logistic regression analysis was used to assess several possible risk factors for injury among these farmers compared with 473 farmers with no injury in the previous year. RESULTS: There were significant associations between fall-related farm injury and age between 40 and 64 years (OR = 2.21; 95% CI = 1.20-4.07), doctor-diagnosed arthritis/rheumatism (OR = 2.05; 95% CI = 1.11-3.79), difficulty hearing normal conversation (even with a hearing aid, in the case of those who used one) (OR = 1.82; 95% CI = 1.07-3.08), and taking medications regularly (OR = 1.80; 95% CI = 1.02-3.18). CONCLUSIONS: Aging and health impairments, such as arthritis and hearing difficulties, are risk factors for which accommodations and preventive strategies can be devised to prevent fall-related injuries on the farm.     

Risk Factors for Machinery-related Injury among Iowa Farmers: A Case-Control Study Nested in the Agricultural Health Study

Abstract

Farm machinery is a major cause of injury morbidity and mortality among farmers. This case-control study assessed risk factors for machinery-related injuries among Iowa farmers. A screener questionnaire sent to 6,999 farmers in 1998 identified 205 farmers who had machinery-related injuries requiring medical advice/treatment in the previous year. Possible risk factors for injury were assessed among these farmers compared with 473 farmers with no injury in the previous year. A multiple logistic regression analysis showed significant associations between machinery-related injury and hours per week spent on farmwork (OR = 2.02; 95% CI 1.38–2.94), fewer years of farming experience (OR = 1.79; 95% CI 1.14–2.79), wearing a hearing aid (OR = 4.37; 95% CI 1.55–12.25), and a high CAGE score suggesting problem drinking (OR = 2.49; 95% CI 1.00–6.19). This is the first study to show associations between machinery-related injury and hearing impairment, problem drinking, and fewer years of farming experience. These findings may be useful for future interventions to decrease injuries related to farm machinery.     

Risk factors for machinery-related injury among Iowa farmers: a case-control study nested in the Agricultural Health Study

Farm machinery is a major cause of injury morbidity and mortality among farmers. This case-control study assessed risk factors for machinery-related injuries among Iowa farmers. A screener questionnaire sent to 6,999 farmers in 1998 identified 205 farmers who had machinery-related injuries requiring medical advice/treatment in the previous year. Possible risk factors for injury were assessed among these farmers compared with 473 farmers with no injury in the previous year. A multiple logistic regression analysis showed significant associations between machinery-related injury and hours per week spent on farmwork (OR = 2.02; 95% CI 1.38-2.94), fewer years of farming experience (OR = 1.79; 95% CI 1.14-2.79), wearing a hearing aid (OR = 4.37; 95% CI 1.55-12.25), and a high CAGE score suggesting problem drinking (OR = 2.49; 95% CI 1.00-6.19). This is the first study to show associations between machinery-related injury and hearing impairment, problem drinking, and fewer years of farming experience. These findings may be useful for future interventions to decrease injuries related to farm machinery.     

Risk factors for low back injury among farmers in Iowa: A case-control study nested in the agricultural health study

The aim of this study was to assess risk factors for low back injury requiring medical advice or treatment among Iowa farmers. Although farmers are at risk for low back injury, few studies have addressed risk factors for farm work-related low back injury. We screened 6999 participants in the Iowa portion of the Agricultural Health Study to identify 49 male farmers who reported farm work-related low back injury requiring medical advice or treatment in the previous year. We compared them with 465 uninjured male farmer controls. Multivariable modeling identified four risk factors significantly associated with low back injury: age less than 45 years (OR = 3.32; 95% CI 1.75-6.20), doctor-diagnosed asthma (OR = 4.26; 95% CI 1.49-12.10), education beyond high school (OR = 2.12; 95% CI 1.13-3.90), and difficulty hearing normal conversation (even with a hearing aid, in the case of those using one) (OR = 1.98; 95% CI 1.02-3.80). Although hearing difficulty may be a general risk factor for occupational injury, asthma may be a more specific risk factor for low back injury. Future research to assess the risk factors, asthma and difficulty hearing, may be particularly important, since farmers are at increased risk for hearing loss, and farmers come into contact with many inhaled agents that can cause asthma.     

Pain, medication, and injury in older farmers

BACKGROUND: Agricultural work continues to be a dangerous occupation. Older farmers experience high risks for work-related injury. The purpose of this research was to determine if there is a relationship between medication use and injury among older male farmers in Alberta. METHODS: Using probabilistic linkage between an Alberta Agriculture government registry of farm operators and the Alberta Health Plan registry file, older farmers (aged 66 and older) were identified. Farm related injuries were identified using an E-code search of both hospitalization and emergency department separations for a 3-year period. Cases were matched to controls on age, geographic health region, and index injury date at a ratio of 1:5. Co-morbidity and medication use for each of the cases and controls were derived from population based health system utilization files. Conditional logistic regression was used to determine which medications were related to injury. RESULTS: Overall, a total of 282 farm related injuries were suffered by the linked group. Controlling for co-morbidity, farmers who had stopped taking narcotic pain killers (OR = 9.37 [95% CI:4.95, 17.72]) and non-steroidal anti-inflammatories (OR = 2.40 [95% CI:1.43, 4.03]) 30 days prior to the date of injury were at risk of injury. Those farmers taking sedatives up until the date of injury were also at risk (OR = 3.01 [95 CI:1.39, 6.52]). In addition, those suffering from incontinence/urinary tract disorders (OR = 2.95 [95% CI:1.30, 6.71]), and prior injury (OR = 1.42 [95% CI:1.04, 1.95]) were also at greater risk of injury. CONCLUSIONS: The relationship of medication use and injury in this population is different from those observed in studies of falls in older persons. We hypothesize that distraction from either pain or co-morbidity may play an important role in the etiology of injuries suffered in this active older working population. Further investigations in this area are required to confirm these findings.     

Work-related injuries among Iowa farm operators: An analysis of the Iowa Farm Family Health and Hazard Surveillance Project

In 1994, the Iowa Farm Family Health and Hazard Surveillance Project carried out a two-stage, stratified, cluster survey of Iowa farms using a mail survey. With data from this representative sample of Iowa farmers, we examined the associations between farm-work–related injuries and possible risk factors for 390 principal farm operators. Forty (10.3%) of these operators reported being injured while doing farm work. We developed a logistic regression to assess associations between potential risk factors and injury. We found three factors significantly associated with injury: younger age (odds ratio [OR] = 3.1, confidence interval [CI] = 1.1–9.3), having an impairment or health problem that limits work (OR = 2.4, CI = 1.5–3.8), and hand or arm exposure to acids or alkalis (OR = 2.6, CI = 1.1–5.9). In the univariate analysis, safety training did not seem to protect farmers from injuries. Am. J. Ind. Med. 33:510–517, 1998. Published 1998 Wiley-Liss, Inc.     

Animal-Related Activities as Risk Factors for Injuries Among Youth on Agricultural Operations

ABSTRACT

Working with animals on agricultural operations is hazardous for youths. This study evaluated the associations between activities and injuries related to specific animal types. A case-control study within the Regional Rural Injury Study II included 425 youths (less than 20 years of age) with injuries related to their operation and 1,886 controls (randomly selected youths). Exposures of interest were collected for the months prior to injury events for cases and randomly selected months for controls, based on an injury incidence algorithm. Multivariate logistic regression characterized associations between specific animal-related activities and injury outcomes among youths who reported working with the same animals. Large proportions of cases and controls, respectively, worked with beef cattle (47%, 28%), followed by horses (28%, 14%), and dairy cattle (22%, 12%). Feeding was the primary activity associated with animals; over 80% of cases and controls were involved in this activity during relevant exposure months, followed by milking (63%, 44%) among those working with dairy cows and herding (81%, 61%) among beef cattle workers. Elevated risk of dairy cattle–related injury was associated with milking (odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.0–6.6) whereas beef cattle–related injuries were associated with calving (OR: 4.2; 95% CI: 2.1–8.6) and footwork (OR: 2.2; 95% CI: 1.0–4.9). Among youths working with animals, explicit activities can be identified that are associated with animal-specific injuries. The identification of relevant hazardous tasks is necessary for the development of effective prevention measures.     

Agricultural injuries among older Kentucky farmers: The farm family health and hazard surveillance study

This population-based study reports the cumulative incidence of agricultural injuries during a 1-year period in a sample of 998 farmers aged 55 years and older living in Kentucky. A total of 98 farm-related injuries were reported among 88 older farmers for a crude injury rate of 9.03 injured farmers per 100 farmers (95% confidence interval (CI) = 7.03–11.03) over a 1-year period. The leading external causes of farm injury were falls (24.9%), machinery (22.5%), wood-cutting (14.6%), and animal-related events (14.3%). Farmers working on farms with beef cattle (alone) (odds ratio = 1.90; 95% CI = 1.02–3.55) or farms with beef cattle and tobacco (odds ratio = 2.15; 95% CI = 1.00–4.59) had a statistically significant increased risk for a farm-related injury. Farmers reporting a prior injury that limited their ability to farm were at increased risk for a farm-related injury. Approaches to using farm injury surveillance data for injury control programs in the state are discussed. Am. J. Ind. Med. 33:341–353, 1998. © 1998 Wiley-Liss, Inc.     

Occupational injuries among workers with diabetes: the National Health Interview Survey, 1997-2005

OBJECTIVE:: To assess associations between diabetes and occupational injury. METHODS:: Data from the 1997 to 2005 National Health Interview Survey comprised a sample of 195,284 adult workers. Multivariate logistic regression analysis assessed associations between diabetes and occupational injuries, adjusting for age, sex, race, and education. Additional logistic regression analysis examined the effect of medical therapy and duration of diabetes with occupational injury. RESULTS:: There was no significant association between diabetes and occupational injury (adjusted OR = 1.18; 95% CI = 0.86 to 1.61). Subgroups of diabetics who reported no current diabetes therapy (OR = 1.87; 95% CI = 1.01 to 3.47) or duration of diabetes longer than 12 years (OR = 1.83; 95% CI = 1.05 to 3.18) were at increased risk for occupational injury. CONCLUSION:: The finding of no overall increased risk for occupational injury among workers with diabetes provides nationally representative results that may be useful to policymakers. Increased risk for occupational injury among untreated diabetics or those with long duration of disease may lead to focused efforts to prevent occupational injuries.     

Pesticide use and chronic bronchitis among farmers in the Agricultural Health Study

BACKGROUND: Farmers have increased risk for chronic bronchitis. Few investigators have considered pesticides. METHODS: We evaluated pesticides as risk factors for chronic bronchitis using the Agricultural Health Study enrollment data on lifetime pesticide use and history of doctor-diagnosed chronic bronchitis from 20,908 private pesticide applicators, primarily farmers. RESULTS: A total of 654 farmers (3%) reported chronic bronchitis diagnosed after age 19. After adjustment for correlated pesticides as well as confounders, 11 pesticides were significantly associated with chronic bronchitis. Heptachlor use had the highest odds ratio (OR=1.50, 95% Confidence Interval (CI)=1.19, 1.89). Increased prevalence for chronic bronchitis was also seen for individuals who had a history of a high pesticide exposure event (OR=1.85, 95% CI=1.51, 2.25) and for those who also applied pesticides in off-farm jobs (OR=1.40, 95% CI=1.04, 1.88). Co-morbid asthma and current farm activities did not explain these results. CONCLUSIONS: These results provide preliminary evidence that pesticide use may increase chronic bronchitis prevalence.     

Disparities in the prevalence of cognitive delay: how early do they appear?

Cognitively delayed children are at risk for poor mental and physical health throughout their lives. The economically disadvantaged and some race/ethnic groups are more likely to experience cognitive delay, but the age at which delays first emerge and the underlying mechanisms responsible for disparities are not well understood. The objective of this study was to determine when sociodemographic disparities in cognitive functioning emerge, and identify predictors of low cognitive functioning in early childhood. Data were from 7308 singleton and 1463 multiple births in the Early Childhood Longitudinal Study‐Birth Cohort (ECLS‐B), a nationally representative cohort of children born in the USA in 2001. Multiple logistic regression analyses examined associations between sociodemographic characteristics and low cognitive functioning at 9 and 24 months, and tested whether gestational and birth‐related factors mediate these associations. Sociodemographic characteristics were statistically significant predictors of low cognitive functioning among singletons at 24 months, including the three lowest quintiles of socio‐economic status [lowest quintile, odds ratio (OR) = 2.7, 95% confidence interval [CI][1.7, 4.1]], non‐white race/ethnicity (African American OR = 1.8 [95% CI 1.3, 2.5], Hispanic OR = 2.3 [95% CI 1.6, 3.2]), and gender (male OR = 2.1, [95% CI 1.7, 2.5]). Gestational and birth characteristics associated with low cognitive function at 9 months included very low and moderately low birthweight (OR = 55.0 [95% CI 28.3, 107.9] and OR = 3.6 [95% CI 2.6, 5.1]), respectively, and very preterm and moderately preterm delivery (OR = 3.6 [95% CI 2.0, 6.7] and OR = 2.4 [95% CI 1.7, 3.5]), respectively, but they had weaker effects by 24 months (ORs for birthweight: 3.7 [95% CI 2.3, 5.9] and 1.8 [95% CI 1.4, 2.3]; ORs for preterm: 1.8 [95% CI 1.1, 2.9] and 0.9 [95% CI 0.7, 1.3]). Results for multiple births were similar. Sociodemographic disparities in poor cognitive functioning emerged by 24 months of age, but were not mediated by gestational or birth characteristics. Further investigation of processes whereby social disadvantage adversely affects development prior to 24 months is needed.     

#65 Medication use,co-morbidity and injury in older male farmers

PURPOSE: The purpose of this research was to determine if there is a potentially causal relationship between medication use and injury among older male farmers in Alberta.METHODS: Using probabilistic linkage between an Alberta Agriculture government registry of farm operators and the Alberta Health Plan registry file, older farmers (aged 66 and older) were identified. Farm related injuries were identified using an E-code search of both hospitalization and emergency department separations for a 3-year period. Cases were matched to controls on age, geographic health region, and index injury date at a ratio of 5:1. Co-morbidity and medication use for each of the cases and controls were derived from population based health system utilization files. Conditional logistic regression was used to determine which medications were related to injury.RESULTS: Over a 3-year period, a total of 282 farm related injuries were suffered by the linked group. Controlling for co-morbidity, farmers who had stopped taking narcotic pain killers (OR = 9.85[95%CI:5.14,18.86]) and non-steroidal anti-inflammatories (OR = 2.36[95%CI:1.40,3.98]) 30 days prior to the date of injury were at increased risk. Those farmers taking sedatives and hypnotics right up until the date of injury were also at increased risk (OR = 3.12[95CI:1.41,6.89]).. In addition, those suffering from incontinence (OR = 3.71[95%CI:1.60,8.59]) and osteoporosis (OR = 4.78[95%CI:1.34,16.99]) were also at increased risk.CONCLUSION: The relationship of medication use and injury in this population is different from those observed in studies of falls in older persons. These data indicate that distraction from either pain or co-morbidity may play a factor in injuries suffered in this active older working population.     

成都青羊区老年居民伤害的流行病学特征 及危险因素分析

摘要:目的　了解成都青羊区老年居民伤害的流行病学特征及潜在危险因素,为老年居民伤害事件的预防控制提供流行病学依据。方法　选取 2010-2014年于成都青羊区到哨点医疗机构就诊并被诊断为伤害的60岁以上患者监测资料,并采用二分类多元logistic回归分析。结果　根据分析模型老年居民严重伤害事件的高危人群为:75以上老年居民（OR＝1.36,95%CI:1.21～1.54）;非本市老年居民（OR＝1.41,95%CI:1.28～1.67）;仅接受小学教育者（OR＝1.28,95%CI:1.10～1.48）;伤害发生于冬季者（OR＝1.17,95%CI:1.02～1.33）;伤害为车祸者（OR＝1.67,95%CI:1.37～2.00）;伤害发生于有偿工作时（OR＝3.27,95%CI:1.96～5.43）;伤害发生于患者多部位（OR＝2.32,95%CI:1.84～2.93）;伤害后每延迟1 h就医,伤害事件就越可能更严重（OR＝1.04,95%CI:1.03～1.05）;其低危人群为:女性（OR＝0.81,95%CI:0.74～0.89）;有工作的老年居民（OR＝0.84,95%CI:0.75～0.94））;伤害非为骨折者（OR＝0.12,95%CI:0.11～0.15））,相反的也就是,男性,无业退休的老年居民,伤害为骨折的老年居民为其高危人群。结论　多个因素与老年居民严重伤害相关,我区应针对老年居民制定具体有效的卫生政策,降低老年居民伤害事件的发生率和严重程度。     

Study of lung cancer histologic types, occupation, and smoking in Missouri

A case-control study of lung cancer was conducted to evaluate the relationship between lung cancer histologic types and occupation, adjusted for smoking. A total of 4,431 white male cases and 11,326 cancer controls, diagnosed between 1980 and 1985, were identified through the Missouri Cancer Registry. For all histologic types combined, excess risk was observed among many a priori suspected high-risk occupations. Lung cancer was elevated among men employed as insulators (odds ratio [OR] = 6.0; 95% confidence interval [CI] = 0.7, 137.8), carpenters (OR = 1.3; 95% CI = 1.0, 1.7), painters, plasterers, and wallpaper hangers (OR = 2.0; 95% CI = 1.2,3.3), structural metal workers (OR = 1.9; 95% CI = 0.6,6.0), mechanics and repairers (OR = 1.3; 95% CI = 1.0,1.7), motor vehicle drivers (OR = 1.5; 95% CI = 1.2,1.8), police and firefighters (OR = 1.6; 95% CI = 1.1,2.3), and food service personnel (OR = 1.8; 95% CI = 1.0,3.5). A deficit of lung cancer was observed among farmers (OR = 0.9; 95% CI = 0.7,1.0). Adenocarcinoma of the lung was elevated among carpenters (OR = 1.6; 95% CI = 1.0,2.5) and cabinet and furniture makers (OR = 2.0; 95% CI = 0.4,8.1), which is interesting because of the previous reports of excess adenocarcinoma of the nasal cavity associated with wood dust exposure. Adenocarcinomas were also elevated among plumbers (OR = 2.0; 95% CI = 1.0,3.8) and printers (OR = 1.8; 95% CI = 0.7,4.2). Electricians were at slightly increased risk for adenocarcinoma (OR = 1.5; 95% CI = 0.7,2.8) and "other" or mixed cell types of lung cancer (OR = 1.5; 95% CI = 0.8,2.9) but at decreased risk for small cell (OR = 0.8; 95% CI = 0.3,2.0) and squamous cell (OR = 0.8; 95% CI = 0.4,1.6) tumors. Among welders, adenocarcinoma (OR = 1.7; 95% CI = 0.7,3.8) and squamous cell (OR = 1.7; 95% CI = 0.9,3.3) cancers were elevated, but small cell and "other" lung cancers were not. Despite the limitations of the Cancer Registry data, some interesting associations were observed that merit further study, particularly the association between lung adenocarcinoma and occupational exposure to wood and wood dust.     

Occupational injuries and medication use

Recent medication use of 3,394 members of the Group Health Cooperative of Puget Sound (GHC) diagnosed with an incident work-related injury was compared to that of two controls selected from the GHC membership and matched on age, gender, and Standard Industrial Classification Code of their employer. Medication use was determined from the GHC pharmacy data base. The injuries of the cases included 496 fractures or dislocations, 2, 728 open wounds, crushing injuries, or superficial injuries, 176 burns, and 64 internal or intracranial injuries. The risk of injury was elevated among users of antihistamines [odds ratio (OR) = 1.5, 95% confidence interval (CI) = 1.1-1.9], antibiotics (OR = 1.2, 95C% Cl = 1.0-1.5), and diabetes medications (OR = 1.3, 95% CI = 0.9-1.9). The patterns of risk were similar for males and females, but varied by type of injury. No consistent associations between use of antidepressants, antianxiety medication, or narcotics and work-relaled injury were observed. The use of some medications, or conditions requiring medications, may contribute to the risk of a work-related injury. © 1996 Wiley-Liss, Inc.     

Circumstances of patient falls and injuries in 9 hospitals in a midwestern healthcare system.

OBJECTIVE: Preventing hospital falls and injuries requires knowledge of fall and injury circumstances. Our objectives were to determine whether reported fall circumstances differ among hospitals and to identify predictors of fall-related injury. DESIGN: Retrospective cohort study. Adverse event data on falls were compared according to hospital characteristics. Logistic regression was used to determine adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for risk factors for fall-related injury. SETTING: Nine hospitals in a Midwestern healthcare system. PATIENTS: Inpatients who fell during 2001-2003. RESULTS: The 9 hospitals reported 8,974 falls that occurred in patient care areas, involving 7,082 patients; 7,082 falls were included in our analysis. Assisted falls (which accounted for 13.3% of falls in the academic hospital and 9.8% of falls in the nonacademic hospitals; P<.001) and serious fall-related injuries (which accounted for 3.7% of fall-related injuries in the academic hospital and 2.2% of fall-related injuries in the nonacademic hospitals; P<.001) differed by hospital type. In multivariate analysis for the academic hospital, increased age (aOR, 1.006 [95% CI, 1.000-1.012]), falls in locations other than patient rooms (aOR, 1.53 [95% CI, 1.03-2.27]), and unassisted falls (aOR, 1.70 [95% CI, 1.23-2.36]) were associated with increased injury risk. Altered mental status was associated with a decreased injury risk (aOR, 0.72 [95% CI, 0.58-0.89]). In multivariate analysis for the nonacademic hospitals, increased age (aOR, 1.007 [95% CI, 1.002-1.013]), falls in the bathroom (aOR, 1.46 [95% CI, 1.06-2.01]), and unassisted falls (aOR, 1.83 [95% CI, 1.37-2.43]) were associated with injury. Female sex (aOR, 0.83 [95% CI, 0.71-0.97]) was associated with a decreased risk of injury. CONCLUSION: Some fall characteristics differed by hospital type. Further research is necessary to determine whether differences reflect true differences or merely differences in reporting practices. Fall prevention programs should target falls involving older patients, unassisted falls, and falls that occur in the patient's bathroom and in patient care areas outside of the patient's room to reduce injuries.     

Occupational determinants for rheumatoid arthritis

OBJECTIVES: The aim of the present study was to evaluate possible occupational determinants for rheumatoid arthritis according to lifetime occupational history. METHODS: The cases were identified retrospectively from 1980 to 1995 at the University Hospital in Link?ping, Sweden. The study comprised 422 cases and 859 randomly selected referents. Exposure data were collected through a postal questionnaire. RESULTS: For men, occupations with increased, although nonsignificant, odds ratios (OR) were farmers or farm workers [OR 1.8, 95% confidence interval (95% CI) 1.0-3.5], textile workers (OR 2.0, 95% CI 0.3-16.2), asphalters (OR 14.0, 95% CI 1.2-799.0 without latency requirement), and employees at service stations (OR 2.2, 95% CI 0.5-9.5). Among the women, hairdressers and beauticians (OR 2.7, 95% CI 0.8-8.6) had an increased risk for rheumatoid arthritis, as well as those exposed to hairdressing chemicals (OR 3.0, 95% CI 1.0-9.4) and meat products (OR 2.0, 95% CI 1.0-4.0). CONCLUSIONS: Several of the findings in this study are in accordance with those of previous studies. The increased risks of rheumatoid arthritis for asphalters and employees at service stations are however new associations previously not described in the literature.     

Comparative analysis of breast cancer risk factors among African-American women and White women

The authors assessed risk factor profiles among 1,505 African-American and 1,809 White women in the 1993-2001 Carolina Breast Cancer Study. Multiple logistic regression models for case-control data were used to estimate odds ratios for several factors. Racial differences were observed in the prevalence of many breast cancer risk factors among both younger (aged 20-49 years) and older (aged 50-74 years) women. For older women, the magnitude and direction of associations were generally similar for African-American and White women, but important racial differences were observed among younger women. In particular, multiparity was associated with increased risk of breast cancer among younger African-American women (for three or four pregnancies: adjusted odds ratio (OR) = 1.5, 95% confidence interval (CI): 0.9, 2.6; for five or more pregnancies: OR = 1.4, 95% CI: 0.6, 3.1) but not among younger White women (for three or four pregnancies: OR = 0.7, 95% CI: 0.4, 1.2; for five or more pregnancies: OR = 0.8, 95% CI: 0.2, 3.0). The relations with age at first full-term pregnancy and nulliparity also varied by race. Case-only analyses before and after further adjustment for tumor stage and hormone receptor status revealed little effect on results. Hence, racial variations in both prevalences of and risks associated with particular factors may contribute to the higher incidence of breast cancer among younger African-American women.     

Predictors of shoulder and back injuries in nursing home workers: a prospective study

BACKGROUND: Nursing assistants (NAs) working in nursing homes have among the highest back and shoulder injury rates in the US. Incidence, severity, and cost of non-traumatic soft tissue musculoskeletal disorders in the nursing home industry in Washington State are quite high. METHODS: To determine whether resident characteristics data reported on the Health Care Financing Administration Minimum Data Set (MDS) could be used as a surrogate measure of cumulative exposure to physical loads, we conducted an 18-month prospective study in one nursing home. RESULTS: The combined NA injury incidence rate (IR) was 45.8 self-reported back and shoulder injuries per 100 [FTE] workers per year. In general, MDS reported resident characteristics failed to predict risk with the exception of exposure to loss of voluntary leg mobility (OR = 1.11 per person-shifts of exposure, 95% CI [0.97-1.27]), with the highest risk on the day shift (OR = 1.15, 95% CI [0.95-1.40]). CONCLUSIONS: These findings suggest social integration and work organization issues may be more important predictors of back and shoulder injuries in nursing assistants than reported resident characteristics as measured by the MDS.