Biomedical subjects

C Zwerling

Publications and source records attributed to C Zwerling.

63 records · Page 4Linked to original sources

PubMed1992

Preemployment drug screening. The epidemiologic issues.

Deciding to test applicants for employment for drugs raises complex, legal, moral, economic, and technical issues. However, we focus here on three epidemiologic issues germane to this decision. In one industry, the United States Postal Service, two recent studies suggest associations between positive preemployment drug screens and turnover, absenteeism, accidents, injuries, and discipline, but these associations are weaker than had been assumed. Cost-benefit analyses show that whether drug screening saves money depends both on the costs associated with adverse outcomes such as accidents and on the prevalence of drug use in the population screened. Finally, the predictive value of a positive drug screen also depends crucially on the prevalence of drug use. In populations with low prevalence of drug use, a large proportion of the positives may be false positives.

Absenteeism↗

PubMed1991

Workers' compensation cost shifting: an empirical study.

It has been suggested that health maintenance organizations (HMOs) overdiagnose work-related injuries and illnesses to increase their income. This study compared the Workers' Compensation experience of 2,176 Boston postal employees enrolled in a large HMO with that of 3,473 employees enrolled in a large fee-for-service health insurance plan. It controlled for the potential confounders of age, gender, job classification, type of injury, and duration of employment. It found no difference in the incidence of injuries: 5.93% for HMO enrollees and 6.25% for fee-for-service plan enrollees. Medical costs averaged $475 for HMO enrollees and $838 for fee-for-service plan enrollees (p = 0.018). Total costs averaged (09 for HMO enrollees and $1388 for fee-for-service plan enrollees (p = 0.063). In our cohort, there was no evidence of cost shifting. It appeared that the HMO provided less expensive medical care for injured postal workers.

Boston↗

PubMed1991

Risk and severity of non-back occupational injuries after lumbar laminectomy for degenerative disc disease.

An increased risk, after lumbar laminectomy, for lost work time occupational back injury (odds ratio, 5.9; 95% confidence interval, 1.9-18.8) and disability (mean 292.8 days vs. 24.8 for controls) was previously demonstrated. Such differences could be due to physical sequelae of back surgery or to psychosocial factors. Extensive literature addresses the impact of psychosocial factors on the incidence of occupational injury and severity of disability. This study assumes that psychosocial factors would affect both back and non-back injuries, while surgery-related physical factors would not. The odds ratio for non-back lost work time injury for subjects in the same cohort studied previously was 1.5 (0.5-4.5), with no significant increase in duration of disability (mean 27.0 days vs. 24.8 for controls). The increased risk for back injury in the absence of an increased risk for other injuries suggests that physiologic rather than psychosocial factors provide the more likely explanation for the differences in back injuries.

Adult↗

PubMed1991

A case-control study of risk factors for industrial low back injury: implications for primary and secondary prevention programs.

Data were collected on 228 consecutive back injuries in Boston's General Mail Facility and 228 non-injured controls drawn randomly from each case's work unit, matching on craft (clerk, mailhandler, maintenance), shift, and general supervisor. Data were collected on age, gender, duration of employment, 3 year history of injury claims, overtime work in the past 2 weeks, job change in the past 60 days, and machine vs. manual job. Risk factors for back injury were examined simultaneously in a conditional logistic regression for matched pairs. Risk factors included history of back injury claim (OR = 16.5, p less than 0.0001), younger age (OR = 3.0, p = 0.0001), shorter duration of employment (OR = 2.6, p = 0.0007), recent job change (OR = 2.5, p = 0.06), and history of non-back injury claim (OR = 2.0, p = 0.08). Among heavy lifters (vs. clerks) overtime and being female increased the risk of injury. In this setting, higher risk workers who may benefit from preventive education programs can be identified.

Accidents, Occupational↗

PubMed1990

The efficacy of preemployment drug screening for marijuana and cocaine in predicting employment outcome.

We present a prospective, controlled study of the association between preemployment drug screening results and employment outcomes in 2537 postal employees. For identified marijuana users, relative risk for turnover was 1.56 (95% confidence interval [Cl], 1.17 to 2.08); accidents, 1.55 (95% Cl, 1.16 to 2.08); injuries, 1.85 (95% Cl, 1.30 to 2.64); and discipline, 1.55 (95% Cl, 1.03 to 2.32). Their mean absence rate was 7.1% compared with 4.0% for nonusers. For identified cocaine users, relative risk for turnover was 1.15 (95% Cl, 0.65 to 2.05); accidents, 1.59 (95% Cl, 0.95 to 2.67); injuries, 1.85 (95% Cl, 1.01 to 3.39); and discipline, 1.40 (95% Cl, 0.62 to 3.17). Their mean absence rate was 9.8%. Our study shows that a preemployment drug screen positive for marijuana or cocaine is associated with adverse employment outcomes. The level of risk, however, is much less than previously estimated. This finding has important implications for the social, legal, and economic arguments for and against drug testing.

Absenteeism↗

PubMed1990

Risk for occupational low-back injury after lumbar laminectomy for degenerative disc disease.

Thirty-two Postal Service applicants who had undergone laminectomies were classified as low risk for back injury after preplacement examinations and were subsequently hired for employment. Each was compared with six control subjects, who were matched by age, gender, date of hire, and job classification. The odds ratios for occupational back injury with 95% confidence intervals were 5.9 (1.9-18.8) overall and 9.1 (1.5-73.8) for letter carriers. Of subjects, 25% were injured, compared with 6% of controls. The median elapsed time between surgery and hire was 5.9 years for injured subjects and 6.8 years for uninjured subjects. A rank sum test comparing the elapsed times of the two groups was not significant (P = 0.30). Postal workers are at increased risk for back injury after laminectomy. The risk does not appear to decrease with increased time since surgery.

Adult↗

PubMed1990

Severity of disability due to occupational low back injury after lumbar laminectomy for degenerative disc disease.

Thirty-two postal workers were rated low risk in preplacement examinations after lumbar laminectomies for degenerative disc disease. They demonstrated an odds ratio for occupational back injury of 5.9 when compared with 192 control subjects matched by age, gender, employment date, and job classification. Each injured employee was subsequently observed for 2 years after injury. Data were collected on time lost from work due to the injury and incidence of surgical treatment. Injured subjects lost a median of 66 and a mean of 292.8 days from work, whereas injured control subjects lost a median of 8.5 and a mean of 24.8 days. Mean time lost per person hired was 73.2 days for subjects compared with 1.6 days for control subjects. Three of eight injured subjects required repeat surgery and three remain totally disabled. No injured control subjects required surgery and all resumed work.

Adult↗

PubMedDate not supplied

Self-reported postwar injuries among Gulf War veterans.

OBJECTIVE: From September 1995 to May 1996, the authors conducted a telephone survey of Iowa military personnel who had served in the regular military or activated National Guard or Reserve during the Gulf War period. To assess the association between military service in a combat zone and subsequent traumatic injury requiring medical consultation, the authors analyzed veterans' interview responses. METHODS: Using data from the larger survey, the authors compared rates of self-reported postwar injuries requiring medical consultation in a sample of Iowa Gulf War veterans to the rates in a sample of Iowa military personnel who served at the same time, but not in the Persian Gulf. RESULTS: Of 3695 veterans, 605 (16%) reported a traumatic injury in the previous three months requiring medical consultation. Self-reported injuries were associated with service in the Persian Gulf (odds ratio 1.26; 95% confidence interval 1.02, 1.55). CONCLUSION: This finding is consistent with the results of earlier studies of traumatic injury mortality rates among war veterans.

Adult↗

PubMedDate not supplied

Occupational injuries among workers with disabilities: the National Health Interview Survey, 1985-1994.

CONTEXT: As the baby boom generation ages, more people will be working with disabilities, but we have little information regarding how disabilities affect risk for occupational injury. OBJECTIVE: To test the hypothesis that work-limiting disabilities in general and hearing and visual impairments in particular are risk factors for occupational injuries. DESIGN: Retrospective cohort study. SETTING: The National Health Interview Survey (NHIS), 1985 to 1994. PARTICIPANTS: The 459827 participants in the NHIS from 1985 to 1994 who listed "working" as their primary activity, who were not farmers, and who were between 18 and 65 years of age. MAIN OUTCOME MEASURE: Occupational injuries in the year preceding the interview causing a residual impairment at the time of interview. RESULTS: After adjusting for occupation, self-employment, and age, occupational injury was associated with preceding work disability (odds ratio [OR], 1.36; 95% confidence interval [CI], 1.19-1.56); blindness (OR, 3.21; 95% CI, 1.32-7.85); deafness (OR, 2.19; 95% CI, 1.17-4.12); hearing impairment (OR,1.55; 95% CI, 1.29-1.87); upper extremity impairment (OR, 1.46; 95% CI, 1.05-2.05); and arthritis (OR, 1.34; 95% CI, 1.07-1.68). Visual impairment was not associated with a significantly increased risk (OR, 1.37; 95% CI, 0.87-2.17). CONCLUSIONS: Workers with disabilities, especially sensory impairments, appear to have an elevated risk for occupational injury. Further research in the design and evaluation of improved workplace accommodations for workers with these disabilities is needed.

Accidents, Occupational↗