Work-related burns

Work-related upper extremity burns often occur. The cause directs the course of action. Thermal burns should be assessed for system alterations, and depth of burn should be determined. Deep partial-thickness burns and more severe burns require a specialist evaluation. Chemical burns must be irrigated and the agent identified. Some chemical burns, such as those that involve phenols and metal fragments, require specific topical applications before water lavage. Hydrofluoric acid burns can cause life-threatening electrolyte abnormalities with a small, highly concentrated acid burn. The goal with any extremity burn is to provide the patient with a multidisciplinary team approach to achieve a functional, usable extremity.     

Work-related traumatic brain injury in Washington State, 1988 through 1990.

OBJECTIVES. Brain trauma is a major cause of disability in the United States, especially among young adults. Work-related brain trauma cases represent a subpopulation that may be amenable to intervention efforts, but largely because of unavailability of data, this group has not previously been studied. METHODS. Washington State workers'' compensation data were used to identify brain trauma cases and to describe incidence rates with respect to age, gender, and industrial classification. Cause of injury was evaluated for industrial classifications with numerous cases. RESULTS. Washington State workers experienced 301 brain traumas over a 3-year period (9.4/100,000 full-time equivalent workers per year). One third of all traumatic brain injury claims were concentrated among seven industrial classifications. Cause of injury was highly correlated with specific industrial classifications. CONCLUSIONS. This study demonstrates the usefulness of diagnosis-related group codes to identify cases of traumatic brain injury. These injuries are concentrated among a few industries, with a dominant specific cause for each industry. This suggests that intervention methods may be efficiently introduced to reduce traumatic brain injuries in the workplace.     

Occupational carbon monoxide poisoning in the State of Washington, 1994-1999

Carbon monoxide poisonings continue to be significant and preventable for a number of work operations. This study assesses occupational carbon monoxide morbidity and mortality for the state of Washington based on a review of workers' compensation records for the years 1994-1999. The study characterizes sources, industries, and causative factors, and further attempts to identify work operations most at risk. Records were identified by both injury source and diagnostic codes. The study limits itself to non-fire-related carbon monoxide poisonings and primarily those from acute exposure. A decline in the number of claims was not evident, but the number of incidents per year showed a slight decline. Carbon monoxide poisonings were found to occur throughout all types of industries. The greatest number of claims was found in agriculture, followed by construction and wholesale trade, with these three accounting for more than half the claims and nearly half of the incidents. The more severe poisonings did not necessarily occur in industries with the greatest number of incidents. The major source for carbon monoxide poisoning was forklift trucks, followed by auto/truck/bus, portable saws, and more than 20 other sources. Fruit packing and storage had the highest number of incidents mostly due to fuel-powered forklift activity, with nearly half of the incidents occurring in cold rooms. Adverse health effects as measured by carboxyhemoglobin, hyperbaric oxygen treatment, unconsciousness, and number and cost of claims were indexed by source. Though several specific work operations were identified, the episodic nature of carbon monoxide poisonings, as well as the diverse industries and sources, and the opportunity for a severe poisoning in any number of operations, poses challenges for effective intervention.     

Occupational carbon monoxide violations in the State of Washington, 1994-1999

Occupational exposure to carbon monoxide continues to cause a number of injuries and deaths. This study reviewed the State of Washington OSHA inspection records for occupational safety or health violations related to carbon monoxide for the time period 1994-1999 to assess the agency's efforts and further identify and characterize causative factors. Inspection data were also compared with carbon monoxide claims data from a companion study to determine if the agency was visiting the most at risk work operations. Inspections were identified by searching computerized violation texts for "carbon monoxide" or "CO." The study found 142 inspections with one or more carbon monoxide violations. Inspections were spread over 84 different 4-digit Standard Industrial Classification codes. Most inspections were initiated as a result of a complaint or other informant. Inspections were predominantly in construction and manufacturing, whereas carbon monoxide claims were mores evenly distributed between the major industries. Inspections also may have failed to find violations for some types of equipment responsible for carbon monoxide claims. Forklifts were the source of carbon monoxide most often associated with a violation, followed by compressors for respirators, auto/truck/bus, and temporary heating devices. Inspections in response to poisonings found common factors associated with lack of recognition and failure to use or maintain equipment and ventilation. Some work sites with one or more poisonings were not being inspected. Only 10 of the 51 incidents with industrial insurance claim reports of carboxyhemoglobin at or above 20 percent were inspected. Further, it was found more preventive efforts should be targeted at cold storage operations and certain warehouse and construction activities. It is proposed that more specific standards, both consensus and regulatory, would provide additional risk reduction. Reliance upon safe work practices as a primary method of control in the use of fuel-powered equipment in cold storage or other enclosed and unventilated environments needs to be prohibited. The study further demonstrates how inspection and industrial insurance records can assist with preventive efforts and better focus an agency's efforts.     

Work-related carpal tunnel syndrome in Washington State workers' compensation: temporal trends, clinical practices, and disability

BACKGROUND: Work-related carpal tunnel syndrome (CTS) is a leading cause of disability. There is a need for information about temporal trends, clinical practices, and treatment outcomes. METHODS: A population based, retrospective cohort study of Washington State workers' compensation claims for CTS was initiated focusing on claims filed during 1990-1994, followed through 2000 (n = 16,710). RESULTS: Half of the claims were filed for conditions other than CTS, but were eventually identified to be or include CTS. The first CTS diagnosis occurred more than 3 months after claim filing in 20% of claims. The longer that the CTS diagnosis occurred after claim filing, the more likely that CTS was accompanied by other problems, and disability tended to be longer. CONCLUSIONS: Making an accurate diagnosis of CTS and initiating appropriate actions earlier than might otherwise occur could reduce the disability and costs in a large fraction of claims that are ultimately determined to involve CTS.     

Abortion services in rural Washington State, 1983-1984 to 1993-1994: availability and outcomes

CONTEXT: Fewer rural health providers offer abortion services than a decade ago. It is unknown how the reduction in service availability has affected women's pregnancy outcomes, the extent to which they must travel to obtain an abortion or whether abortions are delayed as a result. METHODS: Population, birth and fetal death data, as well as pregnancy termination reports, obtained from Washington State were used to calculate abortion rates and ratios and birthrates for Washington residents in 1983-1984 and in 1993-1994. Residence of abortion patients was classified by county only, and location of providers was recorded as large urban county, small urban county, large rural county or small rural county. Distances that women traveled to obtain an abortion were calculated. Chi-square tests were used to compare urban and rural rates and ratios within time periods, and to compare changes that occurred between time periods. RESULTS: Birthrates and abortion rates decreased for both rural and urban Washington women between 1983-1984 and 1993-1994, but the magnitude of the decrease was greater for rural women. The rural abortion rate fell 27%, from 14.9 abortions per 1,000 women to 10.9 per 1,000, while the urban rate dropped 17%, from 21.8 to 18.2 per 1,000. The decline in the abortion rate was larger for adolescents than it was for other age-groups. In rural areas, the abortion rate decreased from 16.5 per 1,000 adolescents aged 10-19 in 1983-1984 to 10.8 per 1,000 in 1993-1994, while it declined from 23.3 per 1,000 to 16.9 per 1,000 in urban areas. From the earlier to the later time period, rural women traveled on average 12 miles farther each way to obtain an abortion, and the proportion who obtained the procedure in a rural county decreased from 25% to 3%. In the earlier time period, 62% of rural women traveled 50 miles or more to obtain an abortion, compared with 73% in 1993-1994. From 1983-1984 to 1993-1994, the proportion of rural women who traveled out of state for an abortion increased from 8% to 14%. The proportion of rural women terminating their pregnancy after the first trimester increased from 8% in 1983-1984 to 15% in 1993-1994. CONCLUSION: Rural Washington women are traveling farther and more often to urban and out-of-state locations for abortion services, and are obtaining their abortions at a later gestational age, which is associated with a decade-long decline in the number of abortion providers.     

Work-related falls among union carpenters in Washington State before and after the Vertical Fall Arrest Standard

BACKGROUND: Washington State enacted a change in their fall standard for the construction industry in 1991, preceding the Safety Standard for Fall Protection in the Construction Industry promulgated by Federal OSHA in 1994. METHODS: We evaluated changes in the rate of falls from elevations and measures of severity among a large cohort of union carpenters after the fall standard change in Washington State, taking into account the temporal trends in their overall injury rates. RESULTS: There was a significant decrease in the rate of falls from height after the standard went into effect, even after adjusting for the overall decrease in work-related injuries among this cohort. Much of the decrease was immediate, likely representing the publicity surrounding fatal falls and subsequent promulgation of the standard. The greatest decrease was seen between 3 and 3(1/2) years after the standard went into effect. There was a significant reduction in mean paid lost days per event after the standard change and there was a significant reduction in mean cost per fall when adjusting for age and the temporal trend for costs among non-fall injuries. CONCLUSIONS: Through the use of observational methods we have demonstrated significant effects of the Washington State Vertical Fall Arrest Standard among carpenters in the absence of a control or comparison group. Without controlling for the temporal trend in overall injury rates, the rate of decline in falls appeared significantly greater, but the more pronounced, but delayed, decline was not seen. The analyses demonstrate potential error in failing to account for temporal patterns or assuming that a decline after an intervention is related to the intervention.     

Differences in fertility patterns between urban and rural women in Washington State, 1983-1984 to 1993-1994

We use data on Washington State abortions and births for 1983-1984 and 1993-1994 to analyze trends for urban and rural women, using the demographic measures total abortion and total fertility rates. These express pacing of childbearing in a single number which is simple to calculate and interpret, and is age-standardized. We find significant urban-rural differences. Total abortion rates decline and total fertility rates increase in both areas. However, the relative magnitudes of pacing decreases in abortions for rural women and increases in births for urban women are striking. The demographic measures are useful interpretive tools, and can be applied to a broad range of questions.     

Progress toward poliomyelitis eradication--Pakistan, 1994-1998

Since the 1988 World Health Assembly resolution to eradicate poliomyelitis by 2000, polio cases reported globally have decreased by approximately 85%. Despite a strong commitment to polio eradication, polio remains endemic in Pakistan. In 1997, Pakistan reported 1147 polio cases, representing widespread poliovirus circulation nationally and constituting 22% of cases reported worldwide. However, surveillance and laboratory data from 1998 indicate that previous widespread poliovirus circulation was geographically localized for the first time. This report describes polio eradication activities in Pakistan, including the impact of routine and supplementary vaccination on polio incidence.     

Babesia divergens-like infection, Washington State

Most reported U.S. zoonotic cases of babesiosis have occurred in the Northeast and been caused by Babesia microti. In Washington State, three cases of babesiosis have been reported previously, which were caused by WA1 (for "Washington 1")-type parasites. We investigated a case of babesiosis in Washington in an 82-year-old man whose spleen had been removed and whose parasitemia level was 41.4%. The complete 18S ribosomal RNA gene of the parasite was amplified from specimens of his whole blood by polymerase chain reaction. Phylogenetic analysis showed the parasite is most closely related, but not identical, to B. divergens (similarity score, 99.5%), a bovine parasite in Europe. By indirect fluorescent-antibody testing, his serum reacted to B. divergens but not to B. microti or WA1 antigens. This case demonstrates that babesiosis can be caused by novel parasites detectable by manual examination of blood smears but not by serologic or molecular testing for B. microti or WA1-type parasites.     

Childhood asthma hospitalizations--King County, Washington, 1987-1998

Since 1980, asthma prevalence, hospitalization, and mortality have been increasing in the United States (1). Because of concern about asthma morbidity in children in King County, Washington (2), Public Health-Seattle and King County (PH-SKC) conducted a study that analyzed trends in local hospitalizations for childhood asthma during 1987-1998. This report summarizes the results of this analysis, which indicate that the youngest children and the poorest communities have the highest rates of asthma hospitalization.     

Repeat Chlamydia trachomatis infection in women: analysis through a surveillance case registry in Washington State, 1993-1998

Repeat infections with Chlamydia trachomatis are associated with increased risk for long-term sequelae. The authors analyzed the frequency and predictors of repeat chlamydial infection by using a population-based chlamydia registry in Washington State and evaluated whether women would seek care at the same clinic for repeat infections. Among 32,698 women with an appropriately treated initial chlamydial infection during 1993-1998, 15% developed one or more repeat infections during a mean follow-up time of 3.4 years. Among women less than age 20 years at the time of initial infection, 6% were reinfected by 6 months, 11% by 1 year, and 17% by 2 years. Young age was the strongest predictor for one and two or more repeat infections after controlling for the length of follow-up and other variables. Only 36% of the repeat infections were diagnosed at the same clinical setting as the initial infection, and 50% were diagnosed at the same type of clinic. Adolescent girls had the least consistency in the source of care for chlamydia. This study suggests that efforts to prevent repeat chlamydial infection in young women remain an urgent public health priority and that the burden of repeat infection may be substantially higher than estimates from clinic-based studies.     

北京市1994～1998年梅毒流行病学分析

通过５年来北京市梅毒流行特性的分析，探讨导致梅毒发病大幅增加的因素，为今后的防治工作提供参考依据，方法收集近５年来北京市梅毒毒疫情资料进行分析。结果５年来北京市梅毒的发病率呈大幅度上升趋势，年平均增长速度高达３８７．６８％，年平均发病专率３．８１／１０万。     

Occupational heat illness in Washington State, 1995-2005

BACKGROUND: Little information exists describing the incidence of heat-related illness (HRI) among non-military working populations. An analysis of HRI cases utilizing workers' compensation data has not been previously reported. METHODS: We used both ICD-9 and ANSI Z16.2 codes with subsequent medical record review to identify accepted Washington State Fund workers' compensation claims for HRI over the 11-year time period from 1995-2005. RESULTS: There were 480 Washington workers' compensation claims for HRI during the 11-year study period. NAICS industries with the highest workers' compensation HRI average annual claims incidence rate were Fire Protection 80.8/100,000 FTE, Roofing Construction 59.0/100,000 FTE, and Highway, Bridge and Street Construction 44.8/100,000 FTE. HRI claims were associated with high outdoor ambient temperatures. Medical risk factors for HRI were present in some cases. CONCLUSIONS: HRI cases occur in employed populations. HRI rates vary by industry and are comparable to those previously published for the mining industry.