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Biomedical subjects

C Zwerling

Publications and source records attributed to C Zwerling.

At least 55 records · Page 3Linked to original sources
PubMed1996

Injuries among construction workers in rural Iowa: emergency department surveillance.

Surveillance of all emergency department admissions for nine rural hospitals identified visits for injuries by 189 employed patients with construction occupations out of a total of 1843 injury visits of all employed patients with known occupations. The injury rate for construction workers was 20.28 injuries per 100 workers per year-more than 2.5 times that of all other employed people. The work-related injury rate was 7.63 per 100 construction workers, more than four times that of all other employed people. The injuries of construction workers seen in the emergency department were primarily open wounds, fractures and dislocations, and contusions, injuries similar to those of other workers. The percentage of work-related burns was higher in construction workers than for other workers, particularly because of burns to roofers and laborers from tar or hot fluids and flash burns from welding.

Adult↗
PubMed1996

Cigarette smoking at hire as a predictor of employment outcome.

We have reported that cigarette smoking at the time of hire is associated with elevated rates of accidents, injuries, absence, discipline, and firing among US postal workers. We followed this cohort of 2537 for a second year to assess whether these associations would change with time in a workplace with active smoking cessation programs. Smokers' elevated risks for accidents, injuries, and discipline decreased after the first year. Risk for involuntary turnover was slightly higher in the 2-year analysis. The elevation in the rate of absence for smokers remained comparable in both periods. Although it is possible that the decline in the relative risk of accidents, injuries, and discipline may reflect changes in smoking status, we were unable to obtain follow-up data on smoking status to test this hypothesis.

Absenteeism↗
PubMed1996

Risk factors for occupational injuries among older workers: an analysis of the health and retirement study.

OBJECTIVES: This study examined risk factors for occupational injury among older workers. METHODS: We analyzed data on 6854 employed nonfarmers from the Health and Retirement Study (HRS), a population-based sample of Americans 51 through 61 years old. RESULTS: Occupational injuries were associated with the following: the occupations of mechanics and repairers (odds ratio [OR] = 2.27), service personnel (OR = 1.68), and laborers (OR = 2.18); jobs requiring heavy lifting (OR = 2.75); workers' impaired hearing (OR = 1.60) and impaired vision (OR = 1.53); and jobs requiring good vision (OR = 1.43). Self-employment was associated with fewer injuries (OR = 0.47). CONCLUSIONS: These results emphasize the importance of a good match between job demands and worker capabilities.

Accidents, Occupational↗
PubMed1995

Injury mortality among Iowa farmers, 1980-1988: comparison of PMR and SMR approaches.

State and provincial proportional mortality studies in the United States and Canada have found increased ratios of overall injury mortality among farmers, including occupational injuries and other unintentional injuries, such as those from motor vehicle crashes and fires, as well as suicides. In contrast, Scandinavian standardized mortality (morbidity) studies have found no increase in the injury fatality or morbidity ratios of farmers in comparison with the rest of the population. This study reviews the injury mortality of Iowa farmers for the years 1980-1988. Among white male farmers, we found an increased proportional mortality ratio for all injuries of 1.26 (95% confidence interval (CI) 1.21-1.31). In part, this was a result of the increased proportional mortality ratio for at-work injuries of 3.77 (95% CI 3.35-4.24), but there were also elevated proportional mortality ratios for such nonoccupational injuries as suicides, 1.20 (95% CI 1.09-1.32), motor vehicle crashes, 1.23 (95% CI 1.12-1.34), and electrocutions, 1.78 (95% CI 1.08-2.95). For younger farmers aged 20-64 years, we calculated standardized mortality ratios as well. The standardized mortality ratios were generally within 10% of the proportional mortality ratios, which suggests that the differences between North America and Scandinavia are not the result of methodological differences, but are more likely related to differences in environmental exposures and safety practices.

Accidents, Occupational↗
PubMed1995

Effect of recall period on the reporting of occupational injuries among older workers in the Health and Retirement Study.

Studies of injury morbidity often rely on self-reported survey data. In designing these surveys, researchers must chose between a shorter recall period to minimize recall bias and a longer period to maximize the precision of rate estimates. Using data from the Health and Retirement Study, which employed a recall period of 1 year, we examined the effect of the recall period on rates of occupational injuries among older workers as well as upon rate ratios of these injuries for nine risk factors. We fit a stochastic model to the occupational injury rates as a function of time before the interview and used this model to estimate what the injury rates would have been had we used a 4-week recall period. The adjusted occupational injury rate of 5.9 injuries per 100 workers per year was 36% higher than the rate based on a 1-year recall period. Adjustment for recall period had much less effect on rate ratios, which typically varied by < 10%. Our work suggests that self-reported surveys with longer recall periods may be used to estimate occupational injury rates and also may be useful in studying the associations between occupational injuries and a variety of risk factors.

Accidents, Occupational↗
PubMed1994

Medical examiner data in injury surveillance: a comparison with death certificates.

Increasingly, researchers use medical examiner reports to study the epidemiology of fatal injuries, often assuming that reports of all fatal injuries are included in medical examiner databases. This study evaluated that assumption by comparing the medical examiner database with the death certificates of persons who died of fatal injuries in Iowa during 1990-1991. The authors also examined the association between demographic variables and the presence of a medical examiner report. Overall, medical examiners reported 68.7% of fatal injuries. Among broad categories of injury deaths, the percentages of medical examiner reports varied: 36.9% of fatalities from unintentional falls, 79.2% of transportation fatalities, 82.6% of intentional fatalities, and 57.3% of other external causes of death. Age and sex were also associated with the presence of a medical examiner report. Women's deaths were half as likely as men's to be reported by the medical examiner. Deaths among the elderly were underreported as well. Among the elderly, fatalities from unintentional falls and, to a lesser extent, transportation fatalities were less likely to be investigated by a medical examiner, but intentional fatalities were more likely to be. Although medical examiner reports may contain detailed information, they underreport the actual number of injury deaths. This underreporting is of special concern for injury research, since certain demographic groups were found to be underrepresented in medical examiner reports.

Accidental Falls↗
PubMed1994

Epidemiology of back injury in university hospital nurses from review of workers' compensation records and a case-control survey.

Reviewing Workers' Compensation records for back injury from a large university hospital for a 2-year period, we found a yearly incidence of lost work time back injury among nurses of 2.0% per year, exceeded only by physical plant staff, who had a rate of 3.5%. Nurses' aides had an injury rate 3.3-fold higher than registered nurses and licensed practical nurses and higher than any other occupational group. We compared 100 cases of nurses with back injury in the previous 2 years with 197 noninjured control subjects using a mailed 40-item questionnaire. Multivariate logistic modelling showed that prior nonback injury and performing combined lifting activities were statistically significant risk factors for back injury, and being overweight approached significance, after adjusting for the effects of age, gender, and each of the evaluated risk factors.

Accidents, Occupational↗
PubMed1993

Occupational injuries: comparing the rates of male and female postal workers.

To compare the injury rates of male and female postal workers, the authors reanalyzed data on a cohort of 2,337 new postal employees in Boston, Massachusetts, hired between 1986 and 1989. The analysis controlled for potential confounding by age, race, smoking status, and drug use. Using Cox proportional hazards models with time-dependent variables, the authors found that, compared with men, women had an increased relative risk for occupational injuries in each of the three largest job classifications: letter carrier, letter-sorting machine clerk, and mail handler. The relative risks were not constant over time. For letter carriers and letter-sorting machine clerks, the increased risks for women were noted only during the first year of employment (relative risk (RR) = 1.93, 95% confidence interval (CI) 1.40-2.67) and RR = 2.60, 95% CI 1.31-5.15, respectively). For mail handlers, the increased risks for women were noted only after the first year of employment (RR = 2.13, 95% CI 1.09-4.15). As the percentage of women in the work force increases, these results suggest the need for further research to define sex-specific injury risks and to devise prevention strategies.

Accidents, Occupational↗
PubMed1993

A case-control study of risk factors for industrial low back injury. The utility of preplacement screening in defining high-risk groups.

Using a cohort of 8183 postal workers, this study assesses the efficacy of preplacement medical examinations in defining the risk of occupational low back injuries. From this cohort, 154 subjects with occupational low back injuries between 1983 and 1988 and 942 control subjects who did not have low back injuries were identified. A multivariate logistic regression shows that a history of prior disability, odds ratio 2.90 (95% confidence interval 1.88-4.48), and a heavy lifting job, odds ratio 1.91 (1.32-276) are associated with occupational low back injuries. However, a history of previous back injury on screening examination is not associated with subsequent occupational injury. The association between a history of disability and occupational low back injury has not been previously noted and warrants further research.

Adult↗
PubMed1993

Teaching and social support: effects on knowledge, attitudes, and behaviors to prevent low back injuries in industry.

An educational program designed to reduce low back injuries was modeled after several well-known back schools and taught to postal workers in a randomized trial of about 4,000 workers. Physical therapists taught 3 hours of class sessions, including knowledge, skills, and individual work station assessment, to small groups of workers and supervisors, with reinforcement every 6 months afterward. At 2 1/2 years, a random sample of 209 workers was surveyed for program impact on intermediate outcomes. We observed increased knowledge among experimental unit workers, but no significant improvements in behaviors associated with back health or in proportion of workers with tired backs. Experimental unit workers who had received training by the time of the survey were less likely to report helping/reinforcement for healthy behaviors than controls or untrained experimental unit workers. The program might have led trained workers to perceive a lack of support and reinforcement for back safety among coworkers and supervisors by sensitizing them to what is possible and raising expectations. There appeared to be group social effects in the dissemination of knowledge and perhaps of helpful behaviors; however, it is apparent that worker social support for change in health behaviors is a complex phenomenon that cannot always be relied upon to enhance program goals.

Back↗
PubMed1993

Safety behavior among Iowa junior high and high school students.

The goal of this study was to determine demographic factors associated with reported safety behavior by studying 2250 Iowa junior high and high school students via a self-administered questionnaire. Students attending rural schools used front seat belts and helmets less frequently than urban students. Seat belt and helmet use and swim safety decreased dramatically with age. Occurrences of driving or riding while drunk or high increased with age. Boys were less likely than girls to wear back seat belts and moped helmets and to check water depth before diving. Possession of a driver's license was not independently associated with any of the safety behaviors.

Adolescent↗
PubMed1993

The choice of weapons in firearm suicides in Iowa.

This study reports the types of firearms used in firearm suicides in Iowa and tests the hypothesis that the use of handguns, rifles, and shotguns in such suicides reflects the availability of these weapons. The percentage of firearm suicides involving handguns increased from 36.6% in 1980 through 1984 to 43.3% during 1990 and 1991. In both time periods, the use of handguns was more likely than would be expected from their household prevalence. Our data suggest that handguns are disproportionately represented among firearm suicides and that this overrepresentation has increased during the last decade.

Cause of Death↗
PubMed1993

Current practice and experience in drug and alcohol testing in the workplace.

The present paper presents a review of the current practice and experience in drug and alcohol testing in the workplace, focusing primarily on the United States of America. After reviewing the history of workplace drug screening, the author describes the growth and impact of the drug-testing industry. He outlines the four most common rationales for workplace drug testing: safety, productivity, decreasing drug use and legislative/regulatory requirements. He summarizes the best studies on the prevalence of workplace drug testing in the United States and describes employer attitudes in that country. The author reviews in some detail the association between drugs, alcohol, occupational injuries and other adverse employment outcomes. He then reviews the literature on cost-benefit analysis of workplace drug testing. The author concludes that relatively little is known about the role of alcohol and drugs in the workplace. The important association between substance abuse and occupational injury has not been established. If there is such an association, it is much weaker than previously believed. The contradictory findings in different studies suggest that substance abuse may well play different roles in different occupational and cultural settings. Thus, caution should be exercised in transposing results from one setting to another. Finally, the review of cost-benefit analyses suggests that any economic analysis of workplace drug screening is likely to be greatly influenced by the prevalence of drugs in the population screened.

Accidents, Occupational↗
PubMed1992

Costs and benefits of preemployment drug screening.

OBJECTIVE: This study provides a cost-benefit analysis of preemployment drug screening and evaluates the sensitivity of this analysis to variation in its underlying assumptions. DESIGN: Cost-benefit analysis, based on a cohort analytic study previously reported. SETTING: Employees of the US Postal Service in Boston, Mass. PARTICIPANTS: Estimates of costs and benefit are based on a cohort of 2533 postal workers in Boston and on average costs for the Postal Service in Boston and nationwide. RESULTS: Drug screening would have saved the Postal Service $162 per applicant hired. However, these results were sensitive to the assumptions in the model. If the prevalence of drug use in the population screened were 1% rather than 12%, the program would lose money. Similarly, if the cost per urine sample screened were $95 rather than the $49 assumed, then the program would lose money, even if the prevalence of drug positives was as high as 9%. CONCLUSIONS: Because of the sensitivity of this analysis to changes in its underlying assumptions, any company considering preemployment drug screening should carefully weigh the costs and benefits in its own industry.

Adult↗
PubMed1992

The effectiveness of preemployment drug screening in the prediction of employment outcome.

Studies of adverse employment outcomes associated with positive preemployment drug screens have tracked employees for only about 1 year. Changes in drug use after hire may invalidate the predictions of employment outcome in later years which are essential for cost-benefit analyses. This blinded, prospective cohort study tracks absence, industrial accidents, occupational injuries, discipline, and turnover in 2537 screened employees through an average of 2 years. Marijuana-positive urines predicted increased turnover, accidents, injuries, discipline, and absence, but these risks appeared lower in the second year than the first. Cocaine-positive urines predicted increased turnover, accidents, injuries, discipline, and absence at levels not consistently different than the first year. Cost-benefit analyses of drug screening project employment risks throughout employees' careers. This study raises the possibility that elevated risks may decrease after the first year.

Boston↗
PubMed1992

Occupational risks associated with cigarette smoking: a prospective study.

BACKGROUND: Studies have indicated that cigarette smokers have more occupational accidents and injuries and use more sick time and health benefits than nonsmokers, thereby producing sizeable costs for employers. However, they usually have not controlled for other possible sources of these costs. We analyzed occupational costs associated with smoking while adjusting for a number of potential confounders. METHODS: We conducted a prospective, controlled study of the association between smoking and employment outcomes in 2537 postal employees, adjusting for age, gender, race, drug use, job category, and exercise habits. RESULTS: For smokers, the relative risk for turnover was 1.01 (95% confidence interval [CI], 0.83-1.21); for accidents 1.29 (CI, 1.07-1.55); for injuries 1.40 (CI, 1.11-1.77); for discipline 1.55 (CI, 1.19-2.02). Their mean absence rate was 5.43% compared with 4.06% for nonsmokers. CONCLUSIONS: Our study shows that cigarette smoking is associated with adverse employment outcomes after controlling for a number of possible confounders. This finding has implications for companies formulating smoking policies and considering the establishment of smoking cessation programs.

Absenteeism↗