PubMed Health⌕ Search

Biomedical subjects

C Zwerling

Publications and source records attributed to C Zwerling.

At least 37 records · Page 2Linked to original sources
PubMed2000

The prevalence of depressive symptoms and risk factors among Iowa and Colorado farmers.

BACKGROUND: Farmers have been previously reported to have higher rates of depression and suicide compared to other occupations. Comparisons of depressive symptoms and risk factors for states should increase understanding of depression in farmers. METHODS: Representative samples of 385 Iowa and 470 Colorado male principal farm operators in the respective state Farm Family Health and Hazard Surveillance projects were evaluated for depressive symptoms by using the CES-D scale. Risk factors were determined by using weighted multiple logistic regression analyses. RESULTS: Iowa farmers were 1.74 times (P < 0.05) more likely to have had depressive symptoms than Colorado farmers. Being unmarried (odds ratio=3.46), having negative life events within the past year [legal problems (4.67), substantial income decline (2.71), loss of something of sentimental value (3.20)], and lower perceived general health status were risk factors (P < 0.05) for depressive symptoms for male Iowa and Colorado farmers. Higher levels of most risk factors for Iowa farmers, almost twice the frequency of substantial income decline, accounted for the majority of the difference in depressive symptoms between Iowa (12.2%) and Colorado (7.4%). CONCLUSIONS: Although Iowa farmers had 1.74 times higher level of depression symptoms than Colorado farmers, this difference was not significant after adjusting for the higher levels of most risk factors for Iowa farmers.

Age Factors↗
PubMed2000

Respiratory symptoms: associations with pesticides, silos, and animal confinement in the Iowa Farm Family Health and Hazard Surveillance Project.

BACKGROUND: Farmers are at risk for airways diseases resulting from exposures which include organic agents and chemicals on the farm. Few data on airways disease and farm exposures are available from population-based studies. The Iowa Farm Family Health and Hazard Surveillance Project provided the opportunity to assess associations between symptoms of airway disease and several farm exposures, including pesticides, grain dust, animal confinement, and exposures from silos, in a population-based study. METHODS: A stratified two-stage cluster sample was used to provide a representative farmer sample from the state. Participants provided questionnaire responses concerning demographic, respiratory symptoms, smoking, and exposure information. Associations between farm exposures and airways disease symptoms were assessed in the 385 farmer participants using chi(2) analysis and logistic regression analysis adjusting for age and smoking. RESULTS: The most frequently reported respiratory symptoms were flu-like symptoms in connection with dusty work (22%), dyspnea (21%), and phlegm (15%). Current smoking was uncommon (13%). Among farmers, applying pesticides to livestock was associated with significantly increased odds of phlegm (OR = 1.91, 95% CI 1.02-3.57), chest ever wheezy (OR = 3.92, 95% CI 1.76-8.72), and flu-like symptoms (OR = 2.93, 95% CI 1.69-5.12) in models adjusting for age and smoking. Conventional vertical silos were significantly associated with increased odds of chest ever wheezy (OR = 2.75, 95% CI 1.23-6.12) and flu-like symptoms (OR = 2.40, 95% CI 1.31-4.37). There were also significant associations between several respiratory symptoms and the presence of animal confinement facilities on the farm. CONCLUSIONS: The association between insecticide application to livestock and symptoms of airways disease is a new finding that could lead to further study of specific airway responses and exposures associated with this practice. Results confirming associations between respiratory symptoms and conventional vertical silos may be important in future studies aimed at prevention and control of exposures in those farm buildings.

Aged↗
PubMed2000

Administrative and behavioral interventions for workplace violence prevention.

BACKGROUND: Violence in the workplace accounts for 1000 fatalities and over 20,000 nonfatal events annually in the United States. The occupations with the most fatalities are taxicab drivers, employees in retail establishments, and law enforcement officers. Environmental strategies as well as behavioral and administrative measures could be employed to address violence. METHODS: This paper reports a critical review of the published literature on administrative and behavioral interventions directed at addressing workplace violence. Searching 17 different databases, we identified 137 papers that described workplace violence intervention strategies. Papers were further categorized according to whether they provided empirical data about an intervention or merely suggested intervention ideas. Suggested interventions were categorized according to applicability to types of workplace violence and organized according to the Haddon Matrix. RESULTS: Forty-one reports suggested intervention strategies but provided no empirical data; nine reported results of intervention evaluations. All intervention studies were based in the health care industry and addressed violent encounters between workers and patients. Overall, the research designs employed were weak and the results inconclusive. None used experimental designs. CONCLUSIONS: The lack of rigorous research to assess administrative and behavioral measures to address workplace violence represents a significant gap. Intervention research needs to draw on appropriate theoretical and conceptual frameworks, address the multiple contexts in which violence occurs, and employ strong evaluation research designs, including attention to process, impact, and outcome measures.

Behavior Therapy↗
PubMed1999

Evaluation of the effectiveness of low blood alcohol concentration laws for younger drivers.

OBJECTIVE: This study aimed to determine whether low blood alcohol concentration (BAC) laws among younger drivers reduce motor vehicle injuries. SEARCH STRATEGIES: We used Cochrane Collaboration search strategies of electronic databases, reference lists of past studies and reviews, governmental agency publications, and direct contacts with experts in the field. SELECTION CRITERIA: Studies were included if they provided objectively measured data on an injury outcome and if they used an appropriate comparison group to assess the impact of the law. DATA COLLECTION AND ANALYSIS: Six studies met selection criteria. We abstracted information using standard data collection sheets. Since the studies all were of ecologic designs, we did not carry out any pooled analyses. MAIN RESULTS: All six studies showed a reduction in injuries or crashes after the implementation of the law, although, for three studies, these reductions were not statistically significant. This study with the smallest reduction in injuries was also the study with the least power. This study only had a power of 70% to detect a hypothetical 10% decline in serious injuries. Reductions in outcome in the other studies ranged from 11% to 33% with a cluster of parameter estimates just under 20%. One study evaluated laws with differing levels of BAC and found a dose-response effect. The greatest reduction (22%) was reported for nighttime, single vehicle fatalities in those states with zero BAC laws. In states with 0.02% BAC laws, the reduction averaged 17% and in states with 0.04 to 0.06% BAC laws, the reduction was only 7%. CONCLUSIONS: Despite the methodologic difficulties of ecologic studies, the six studies reviewed represent accumulating evidence in support of the effectiveness of these laws. The sum of the evidence is strengthened because similar results were found in different countries (Australia and the United States), using different laws (some aimed at younger drivers and others aimed at inexperienced drivers), using different outcome variables (fatalities, injuries, and crashes), and using different research methodologies (interrupted time series and pre- and post-studies). In addition, the largest U.S. study found that laws with lower BAC limits resulted in greater casualty reductions, analogous to a dose response effect.

Accidents, Traffic↗
PubMed1999

Application of a subjective health and safety rating system to Iowa farm operations.

A rapid, subjective health and safety assessment tool was developed and applied to 121 farm operations visited during a cross-sectional, on-farm industrial hygiene (IH) study of the Iowa Farm Family Health and Hazard Surveillance Project (IFFHHSP). The study utilized a single field investigator who conducted visits of farm operations from August 1995 to July 1996. The farm operations visited were randomly selected from a stratified, two-stage cluster sample of Iowa farm operations. The tool developed and applied to each farm operation--the Site Rank System--was based on the average of scores assigned to four different farm characteristics, which we believed would predict the health and safety status of the farm operations. Two of these characteristics were based on an assessment of each farm's operator (operator attitude and operator practices) and the other two were based on weighted scores assigned to physical components of the farm operation (status of facilities and status of equipment). The Site Rank System was found to have been assigned consistently, but an analysis comparing the Site Rank System scores to initial in-depth medical and environmental data gathered from the visited farm operations via self-reported questionnaires showed little correlation with outcomes. However, self-reported injuries (11 total) which occurred to the principal farm operators of the farm operations visited during the on-farm IH study phase (August 1995 to July 1996) correlated with low Site Rank System scores.

Agriculture↗
PubMed1998

Factors associated with fatalities and injuries from hot-air balloon crashes.

CONTEXT: Despite the increased popularity of hot-air balloon flight, data on injuries and fatalities associated with hot-air balloon crashes are limited. OBJECTIVE: To determine factors associated with injury and death in hot-air balloon crashes. DESIGN: Retrospective review of data collected from reports and investigations by the Civil Aeronautics Board and the National Transportation Safety Board. STUDY SUBJECTS: Individuals involved in US hot-air balloon crashes from 1964 to 1995. MAIN OUTCOME MEASURES: Total number of crashes and factors associated with fatality or serious injury. RESULTS: From 1964 to 1995, a total of 495 hot-air balloon crashes involving 1533 persons were reported and included 92 fatalities and 384 serious injuries. Pilot error or incapacitation was determined subjectively by crash investigators to contribute to 85.1% of the crashes. In univariate analysis, collision with the ground was the most significant predictor of a fatality or serious injury (P<.001), and power-line contact was the most significant predictor of fatality (P<.001). In multiple logistic regression, only the type of object struck by a balloon predicted a fatal crash or a fatality or serious injury. CONCLUSIONS: Although a number of factors likely contribute to increased severity of hot-air balloon crashes, the object struck during a crash is most predictive of fatality or serious injury. Preventive efforts are needed to decrease future injuries.

Accidents, Aviation↗
PubMed1998

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.

Accidents, Occupational↗
PubMed1998

Comparison of health outcomes among older construction and blue-collar employees in the United States.

Using the Health and Retirement Study, we compare the health outcomes of older male construction workers with their counterparts in other occupations. We find that construction workers are more susceptible to musculoskeletal problems, chronic lung disease, and emotional/psychiatric disorders. Older construction workers were 1.4 times more likely to have a back problem and 1.3 times more likely to have a foot or leg problem than were other blue-collar workers. Nonsmoking older construction workers were 3.2 times more likely to have chronic lung disease than their nonsmoking blue-collar counterparts. When accounting for alcohol consumption, older construction workers were 1.7 times more likely to have been diagnosed with an emotional problem than other older blue-collar workers. The high rate of chronic lung disease is most likely related to on-the-job dust exposure, while the increased risk of emotional disorders might be due to the dynamics of the construction labor market.

Alcohol Drinking↗
PubMed1998

Injury-control education in six U.S. medical schools.

PURPOSE: To assess knowledge, attitudes, and formal instruction related to injury control among fourth-year medical students. Injury is the leading cause of death among Americans aged 1 to 44 years. METHOD: The authors conducted a cross-sectional survey of fourth-year students at six U.S. medical schools, four of which maintain federally funded injury prevention research centers. Main outcome measures included injury-related knowledge scores, three attitude measures, and self-reported exposures to injury prevention education. RESULTS: Six hundred and thirty-five fourth-year medical students (73% of those eligible) participated. The responding students were, on average, unable to correctly answer half of the questions testing injury-related knowledge. They rated medical problems more important and more preventable than injury problems, and they felt more comfortable asking their patients about risk factors for medical problems. These findings may be explained, in part, by the students' reported minimal exposure to injury control education in medical school. The students encountered the topic more frequently on rotations in pediatrics (84%), family medicine (73%), and preventive medicine (66%) than on rotations in emergency medicine (47%), internal medicine (41%), or obstetrics and gynecology (34%). Injury control was encountered least often on rotations in psychiatry (23%) and surgery (14%). CONCLUSIONS: These findings suggest that injury control is given limited coverage in the curricula of U.S. medical schools. As a result, students have little understanding of the principles and benefits of injury control.

Cross-Sectional Studies↗
PubMed1998

Occupational injuries among older workers with visual, auditory, and other impairments. A validation study.

This study aims to validate a previously defined model of the risk of occupational injuries among older workers with visual, auditory, or other impairments. That model was based upon the Health and Retirement Study (HRS). The previous logistic regression model was recalculated using data from the 1994 National Health Interview Survey (NHIS). The parameter estimates for impaired hearing (.181 in NHIS, 1.55 in HRS), impaired vision (2.42 in NHIS, 1.48 in HRS), and self-employment (0.22 in NHIS, 0.49 in HRS) were in same direction and of roughly the same magnitude. The previously defined model was confirmed using NHIS data. The data suggest that as the workforce ages, more attention must be paid to the accommodation of disabilities in the workplace, especially sensory impairments-poor vision and hearing.

Accidents, Occupational↗
PubMed1998

Occupational injuries among older workers with disabilities: a prospective cohort study of the Health and Retirement Survey, 1992 to 1994.

OBJECTIVES: We tested the hypothesis that among older workers, disabilities in general, and hearing and visual impairments in particular, are risk factors for occupational injuries. METHODS: Using the first 2 interviews of the Health and Retirement Study, a nationally representative survey of Americans aged 51 to 61 years, we conducted a prospective cohort study of 5600 employed nonfarmers. RESULTS: Testing a logistic regression model developed in a previous cross-sectional study, we found that the following occupations and risk factors were associated with occupational injury as estimated by odds ratios: service personnel, odds ratio = 1.71 (95% confidence interval = 1.13, 2.57); mechanics and repairers, 3.47 (1.98, 6.10); operators and assemblers, 2.33 (1.51, 3.61); laborers, 3.16 (1.67, 5.98); jobs requiring heavy lifting, 2.05 (1.55, 2.70); self-employment, 0.50 (0.34, 0.73); and self-reported disability, 1.58 (1.14, 2.19). Replacing the general disability variable with specific hearing and visual impairment variables, we found that poor hearing (1.35 [0.95, 1.93]) and poor sight (1.45 [0.94, 2.22]) both had elevated odds ratios. CONCLUSIONS: Poor sight and poor hearing, as well as work disabilities in general, are associated with occupational injuries among older workers.

Accidents, Occupational↗
PubMed1997

A controlled trial of an educational program to prevent low back injuries.

BACKGROUND: Low back injuries are common and costly, accounting for 15 to 25 percent of injuries covered by workers' compensation and 30 to 40 percent of the payments made under that program. The high costs of injury, the lack of effective treatment. and the evidence that there are behavioral risk factors have led to widespread use of employee education programs that teach safe lifting and handling. The effectiveness of those programs, however, has received little rigorous evaluation. METHODS: We evaluated an educational program designed to prevent low back injury in a randomized, controlled trial involving about 4000 postal workers. The program, similar to that in wide use in so-called back schools, was taught by experienced physical therapists. Work units of workers and supervisors were trained in a two-session back school (three hours of training), followed by three to four reinforcement sessions over the succeeding few years. Injured subjects (from both the intervention and the control groups) were randomized a second time to receive either training or no training after their return to work. RESULTS: Physical therapists trained 2534 postal workers and 134 supervisors. Over 5.5 years of follow-up, 360 workers reported low back injuries, for a rate of 21.2 injuries per 1000 worker-years of risk. The median time off from work per injury was 14 days (range, 0 to 1717); the median cost was $204 (range, zero to $190,380). After their return to work, 75 workers were injured again. Our comparison of the intervention and control groups found that the education program did not reduce the rate of low back injury, the median cost per injury, the time off from work per injury, the rate of related musculoskeletal injuries, or the rate of repeated injury after return to work; only the subjects' knowledge of safe behavior was increased by the training. CONCLUSIONS: A large-scale, randomized, controlled trial of an educational program to prevent work-associated low back injury found no long-term benefits associated with training.

Adolescent↗
PubMed1997

Respiratory symptoms and lung function abnormalities among machine operators in automobile production.

This cross-sectional study was designed to assess differences in prevalence of respiratory symptoms and lung function between machine operators exposed to semisynthetic or soluble metal-working fluids (MWFs) and unexposed assemblers and to assess exposure-response relationships with MWF type, total aerosol, endotoxin, culturable bacteria and fungi. We evaluated 183 machine operators and 66 assemblers from one large automobile transmission plant using questionnaires, spirometry data, and cross-shift assessment of both lung function and respiratory symptoms. We found that airborne exposures to total aerosol, endotoxin, culturable bacteria and fungi were higher in machine operations than in the assembly area. There was a correlation between bulk and airborne culturable bacteria, but not between bulk and airborne culturable fungi. Machine operators had significantly more usual cough, usual phlegm, work-related chest tightness and post-shift symptoms of chest tightness, throat irritation, and cough compared with assemblers. We found exposure-response relationships between respiratory symptoms and total aerosol, as well as culturable fungi and bacteria. Associations with endotoxin were not strong or consistent, possibly because airborne levels were generally low. Cross-shift lung function decrements did not differ between machine operators and assemblers and there were no associations with MWF or specific exposures. The finding of respiratory symptoms at low levels of exposure in this study suggests the need to re-assess total aerosol thresholds. Associations between airborne fungal exposures and respiratory symptoms need further study to characterize sources of exposure other than MWF in machining operations.

Adult↗
PubMed1997

Design and conduct of occupational injury intervention studies: a review of evaluation strategies.

Occupational injuries continue to exact a great toll on American workers and their employers--the physical and financial costs are enormous. However, in the current political climate, few employers or regulatory agencies will implement injury prevention interventions without specific evidence of their effectiveness. This paper reviews the literature on the design, conduct, and evaluation of occupational injury interventions. Our review suggests that randomized controlled trials are rare and also notes that the quasi-experimental studies in the literature often use the weakest designs. We recommend a hierarchical approach to evaluating occupational injury interventions--beginning with qualitative studies, following up with simple quasi-experimental designs using historical controls, continuing with more elaborate quasi-experimental designs comparing different firms' experience, and, when necessary, implementing randomized controlled trials.

Accidents, Occupational↗
PubMed1996

Dermatitis among automobile production machine operators exposed to metal-working fluids.

This cross-sectional study was designed to assess differences in prevalence of contact dermatitis between machine operators exposed to metal-working fluids (MWFs) and unexposed assemblers, and to assess potential risk factors for contact dermatitis among these machine operators. In their work, machine operators were exposed to either semisynthetic or soluble oil MWFs. We evaluated 158 machine operators and 51 assemblers from one large automobile transmission plant using questionnaires, dermatologist examination of the skin, and dermal dosimetry to measure wetness and metal exposures. We found that machine operators had more combined (definite plus possible) dermatitis (27.2% vs. 13.7%, chi(2) = 3.9, p = 0.05, 1 df) compared with assemblers. Among machine operators, risk factors significantly associated with (combined) dermatitis were subjective assessment of wetness of the work, exposure to semisynthetic as opposed to soluble oil MWF, current cigarette smoking, and increasing worker age. These risk factors suggested preventive and control measures including control of wet work, surveillance program including early self-report of dermatitis, consideration of replacement of semisynthetic with soluble oil MWFs, and strictly limiting smoking among machine operators exposed to MWFs.

Adult↗
PubMed1996

Method to electronically collect emergency department data.

STUDY OBJECTIVE: To describe the development and completeness of an electronic injury-surveillance system, the Rural Injury Surveillance System (RISS). METHODS: The emergency departments of nine rural Iowa hospitals submitted information on all patients treated from May 1993 through June 1994. RESULTS: The EDs submitted information on 23,594 patients with 32,445 different injury, disease, or follow-up visits. On the basis of comparison with the handwritten ED logbook, 90% of visits were also available in the RISS. Of the visits recorded in the RISS, 99% were also recorded in the logbook. The proportion of missing diagnostic codes decreased from a high of 22.6% in May 1993 to 8.1% in June 1994. The proportion of missing external cause codes was about 25% at the end of the study period. The proportion of missing industry and occupational codes was less than 5% at the end of the study period. CONCLUSION: Our findings show that complete, computerized, ED-based injury surveillance in rural EDs is possible and should be developed further.

Data Collection↗