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Biomedical subjects

Barbara Silverstein

Publications and source records attributed to Barbara Silverstein.

14 recordsLinked to original sources
PubMed2007

The economic burden of carpal tunnel syndrome: long-term earnings of CTS claimants in Washington State.

BACKGROUND: The long-term earnings losses borne by injured workers, beyond those covered by workers' compensation insurance, are rarely estimated. The post-claim earnings of a cohort of carpal tunnel syndrome (CTS) claimants are tracked over a period of 6 years and compared to the earnings of claimants with either upper extremity fractures or dermatitis. METHODS: Quarterly earnings records of 4,443 workers in Washington State who filed claims with the State Fund in 1993 or 1994 for CTS are compared to those of 2,544 with upper-extremity fracture claims and 1,773 with medical-only dermatitis claims. Multivariate regression was used to identify the effect of injury type on earnings from that of other potential predictors. RESULTS: CTS claimants recover to about half of their pre-injury earnings level relative to that of comparison groups after 6 years; they also endured periods on time-loss three times longer than claimants with upper extremity fractures. CTS surgery claimants had better outcomes than those who did not have surgery. Earnings recovery fractions among CTS claimants were better for workers who: (1) were younger; (2) had stable pre-claim employment; (3) lived in the Puget sound area; (4) worked for large businesses; (5) worked in non-construction/transportation industries; or (6) were in the higher pre-injury earnings categories. Cumulative excess loss of earnings of the 4,443 CTS claimants was 197 million dollars to 382 million dollars over 6 years, a loss of 45,000-89,000 dollars per claimant. This underscores the importance of prevention, early diagnosis, and accommodation for return to work.

Adult↗
PubMed2006

Work-related deaths in Washington State, 1998-2002.

INTRODUCTION: In Washington State, 87 workers are killed each year, on average, while in work status. To understand these incidents and to assist in focusing on and development of potential prevention measures, they must be well characterized. METHODS: Work-related fatalities between the years 1998 and 2002 are described by the demographics of the victims, types of incidents, the victims' occupations, and industries and location in which they worked. RESULTS: Motor vehicle- and machinery-related incidents accounted for nearly 33% and 14% of the incidents, respectively. Agriculture, forestry, fishing, hunting, and mining (n=87), and construction (n=83) had the most fatalities. Fatality rates per 100,000 workers for these industries were 25.7 and 8.7, respectively, compared to the state-wide average of 3.1 fatalities/100,000 workers. DISCUSSION: These data indicate numerous areas for prevention of work-related traumatic injuries and fatalities.

Accidents, Occupational↗
PubMed2006

Prioritizing industries for occupational injury and illness prevention and research, Washington State Workers' compensation claims, 1999-2003.

OBJECTIVE: The objective of this study was to identify high-risk industry groups for effective allocation of occupational safety and health prevention and research resources. METHODS: We used all compensable Washington state workers' compensation claims to rank North American Industry Classification System (NAICS) industry groups by a "prevention index" (PI). The PI is the average of the rank orders of each industry group's claim count and claim incidence rate. RESULTS: Of the 274 industry groups ranked by PI for all compensable workers' compensation claims, the following industry groups ranked the highest: NAICS 2381 Foundation, Structure, and Building Exterior Contractors, NAICS 4841 General Freight Trucking, and NAICS 2361 Residential Building Construction. Industry group PI rankings are reported for the seven most common costly occupational injury types. CONCLUSIONS: Use of a PI can focus prevention and research resources where they can be of most benefit.

Accidental Falls↗
PubMed2005

Estimation of hand force in ergonomic job evaluations.

The aims of the present study were: (1) to collect normative data of pinch and power grip strength with a newer digital dynamometer; (2) to study the ability of hand grip force matching using a hand dynamometer where the validity and reliability issues were studied; and (3) to study the relationship between hand grip force matching and muscle activities of three forearm and hand muscles. This study consisted of two experiments. One hundred and twenty subjects volunteered in the first experiment, where hand grip strength and hand force estimation data were collected. The second experiment had 14 volunteers, where muscle activities of the hand and forearm were collected during the tests of hand grip strength and hand force matching estimations. Results showed that the power grip and pinch grip strengths collected with a newer digital dynamometer were comparable to similar studies using older equipment. At the group level, the force matching method was largely accurate and consistent. Instructions to the subjects about force matching estimation were important to the accuracy and consistency of the estimated forces. Estimation in force matching might depend on perceptions of several major muscle activities.

Adult↗
PubMed2005

Workers' compensation claims for needlestick injuries among healthcare workers in Washington State, 1996-2000.

OBJECTIVES: To characterize accepted workers' compensation claims for needlestick injuries filed by healthcare workers (HCWs) in non-hospital compared with hospital settings in Washington State. DESIGN: Descriptive study of all accepted workers' compensation claims filed between 1996 and 2000 for needlestick injuries. PARTICIPANTS: All Washington State HCWs eligible to file a state fund workers' compensation claim and those who filed a workers' compensation claim for a needlestick injury. RESULTS: There were 3,303 accepted state fund HCW needlestick injury claims. The incidence of needlestick injury claims per 10,000 full-time-equivalent HCWs in hospitals was 158.6; in dental offices, 104.7; in physicians' offices, 87.0; and in skilled nursing facilities, 80.8. The most common mechanisms of needlestick injury by work location were as follows: for hospitals, suturing and other surgical procedures (16.7%), administering an injection (12.7%), and drawing blood (10%); for dentists' offices, recapping (21.3%) and cleaning trays and instruments (18.2%); for physicians' offices, disposal (22.2%) and administering an injection (10.2%); and for skilled nursing facilities, disposal (23.7%) and administering an injection (14.9%). Nurses accounted for the largest (29%) proportion of HCWs involved, followed by dental assistants (17%) and laboratory technicians and phlebotomists (12%) in non-hospital settings. Rates of needlestick injury claims increased for non-hospital settings by 7.5% annually (95% confidence interval [CI95], 4.89% to 10.22%; P < .0001). Rates decreased for hospital settings by 5.8% annually, but the decline was not statistically significant (CI95, -12.50% to 1.34%; P < .1088). HCWs were exposed to hepatitis B, hepatitis C, and human immunodeficiency viruses in non-hospital settings. CONCLUSION: There was a difference in the incidence rate and mechanisms of needlestick injuries on review of workers' compensation claim records for HCWs in non-hospital and hospital settings.

Cost of Illness↗
PubMed2004

Interventions to reduce work-related musculoskeletal disorders.

Work-related Musculoskeletal Disorders (WMSDs) continue to present a major challenge to workers and their employers in virtually every industry sector. Many disciplines have been involved in providing advice and working on interventions to prevent WMSDs or reduce their consequences. Since the early 1990s, 15 systematic reviews (excluding specific treatment modalities) have appeared in the peer-reviewed literature addressing musculoskeletal disorder reduction. The National Research Council-Institute of Medicine summarized many of these efforts in 2001. Using a systematic literature search strategy, we identified 20 randomized controlled studies, 17 quasi-experimental studies with control groups, and 36 paper reporting case studies with in the peer-reviewed literature between 1999-2003. Evidence is continuing to build that demonstrates combinations of measures appear to have the greatest effect in reducing WMSDs, although individual engineering and administrative controls can also have positive effects.

Humans↗
PubMed2003

Workplace health and safety regulations: Impact of enforcement and consultation on workers' compensation claims rates in Washington State.

BACKGROUND: There has been considerable debate in the public policy arena about the appropriate mix of regulatory enforcement and consultation in achieving desired health and safety behavior across industries. Recently there has been a shift in federal policy toward voluntary approaches and constraining the scope of enforcement programs, although there is little evidence that this might improve health and safety outcomes. To address this, we examined changes in lost time workers compensation claims rates for Washington State employers who had (1) no OSHA State Plan (WISHA) activity, (2) enforcement, (3) consultation, and (4) both types of visits. METHODS: Compensable claims rates, hours, and WISHA activity were determined for each employer account with a single business location that had payroll hours reported for every quarter from 1997-2000 and more than 10 employees. We used a generalized estimating equations (GEE) approach to Poisson regression to model the association between WISHA activity and claims rate controlling for other external factors. RESULTS: Controlling for previous claims rate and average size, claims rates for employers with WISHA enforcement activity declined 22.5% in fixed site industry SIC codes compared to 7% among employers with no WISHA activity (P < 0.05), and in non-fixed site SICs (e.g., construction) claims rates declined 12.8% for employers with enforcement activity compared to a 7.4% decline for those with no WISHA activity (P > 0.10). WISHA consultation activity was not associated with a greater decline in compensable claims rates (-2.3% for fixed sites and +3.5% for non-fixed sites). WISHA activity did not adversely affect worksite survivability through the study period. CONCLUSIONS: Enforcement inspections are significantly associated with decreasing compensable workers compensation claims rates especially for fixed site employers. We were unable to identify an association between consultation activities and decreasing claims rates.

Government Regulation↗
PubMed2003

Injuries and illnesses from wood framing in residential construction, Washington State, 1993-1999.

The construction industry is associated with high rates of work-related injury. We used workers compensation data to describe the injuries and illnesses, claim rates, and claim costs associated with wood framing activities in construction. From 1993 to 1999, there were 33,021 accepted state fund workers compensation claims with direct costs of over $197 million. The average annual claim rate was 45 per 100 full-time equivalent. Statistically significant downward trends were noted in claim rates for all injuries and illnesses, compensable time loss claims, eye and fall injuries. However, these trends were not statistically significantly different from those observed in all other construction risk classes combined. The information in this report can be used to guide prevention efforts and to evaluate the effectiveness of Washington state initiatives to reduce injury and illness rates in wood frame construction.

Accidental Falls↗
PubMed2002

Use of a prevention index to identify industries at high risk for work-related musculoskeletal disorders of the neck, back, and upper extremity in Washington state, 1990-1998.

BACKGROUND: The prevention of work-related musculoskeletal disorders such as carpal tunnel syndrome and low back disorders has been a focus of international prevention efforts including regulation. This study examines workers compensation claims in Washington State to provide baseline data from which to assess the need and the effects of prevention activities. METHODS: Washington State Fund workers compensation claims for general and selected specific hand/wrist, elbow, shoulder, and back disorders in 1990-1998 as well as general self-insured compensable (four or more lost workdays) claims data were examined. Payroll hours were used to calculate claims incidence rates per 10,000 full-time equivalent employees (FTEs). We created a prevention index (PI) to rank industries by averaging the ranks of their number of claims and their claims incidence rate. The focus was on non-traumatic soft tissue musculoskeletal disorders (NTST-MSDs). RESULTS: Between 1990-1998, there were 392,925 State Fund accepted claims for NTST-MSDs of the neck, back, and upper extremity resulting in $2.6 billion in direct costs and 20.5 million lost workdays. The average claims incidence rate (CIR) was 355 NTST-MSDs per 10,000 FTEs. The NTST-MSD CIR decreased significantly less than that for all other claims (P = 0.05) but the CIR for upper extremity NTST-MSDs did not significantly decrease over the study period. There were no significant changes in the CIRs for sciatica (4.9 per 10,000 FTEs) and rotator cuff syndrome (15.3 per 10,000 FTEs), whereas the CIR for epicondylitis (10.6 per 10,000 FTEs) increased and for carpal tunnel syndrome (24.5 per 10,000 FTEs) decreased significantly over the study period. Based on the prevention index, the top five industries for combined State Fund and Self-Insured Compensable NTST-MSDs were Trucking and Courier Services (SIC 421), Nursing Homes (SIC 805), Masonry (SIC 174), Air Transportation (SIC 451), and Residential Construction (SIC 152). Using Washington Industrial Classes (WIC), temporary workers in assembly and administrative services were also high on the prevention index. CONCLUSIONS: NTST-MSDs continue to be a large and costly problem in Washington State. While the incidence rates for some NTST-MSDs are decreasing, the overall rate is not decreasing as fast as the rate for all other claims. In some cases, the rate is stable (sciatica, rotator cuff syndrome) or increasing (epicondylitis). Heavy manual handling and repetitive work characterize the industries with the highest risk.

Adult↗
PubMed2002

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.

Adult↗
PubMed2002

Work-related burns in Washington State, 1994 to 1998.

This article describes an investigation of work-related burns in Washington State during 1994-1998. Workers' compensation data were used to describe the general characteristics of burn injuries, estimate industrial claims rates, and compare nonhospitalized and hospitalized burn cases. The completeness of workers' compensation data as a source for surveillance was evaluated. During 1994-1998, a total of 20,213 burn claims were accepted by the workers' compensation system. Hospitalized burn cases represented only 1.5% of burn claims but incurred 55% of the costs. In addition, workers' compensation data underestimated the frequency and rate of burns. Although workers' compensation claims rates decreased during 1994-1998, work-related burns remain a problem in Washington State. Several industries (e.g., roofing, foundries, and aluminum smelting) were identified as priorities for prevention of burn hospitalizations, which incur the greater cost and time loss.

Adult↗
PubMed2002

Perspectives on legal strategies to prevent workplace violence.

Workplace violence is a continuing problem in the United States, accounting for approximately 1,000 deaths each year and for more than 1.5 million incidents of nonfatal injuries. State and federal agencies have published guidelines for preventing workplace assaults, but there is a need for a strong research agenda to address the effectiveness of intervention strategies. After an overview, this article provides a discussion of workplace violence from three perspectives. One section discusses the process used in a manufacturing setting to install a workplace violence prevention program. A second section provides insight into the processes used to fully implement a workplace violence prevention program in a health care setting. A final section provides insight to the processes brought to bear in one state to mandate prevention of workplace violence in the health care setting. There is a critical need to evaluate alternative strategies to address workplace violence, to make the findings available to legislative and executive branches of government, and to implement effective strategies to counter violence in the workplace.

Humans↗
PubMed2002

The dimensions of public health law research.

Applied public health law research is an essential element for improving the legal foundation of public health practice. This article focuses on the proper scope and the methodology related to conducting public health law research. In addition to considering the issue of translating research into practice, the article provides overviews of three current public health law research projects and the lessons they provide for researchers.

Evidence-Based Medicine↗