Biomedical subjects

David A Lombardi

Publications and source records attributed to David A Lombardi.

10 recordsLinked to original sources

PubMed2006

Work-related ladder fall fractures: identification and diagnosis validation using narrative text.

OBJECTIVE: To identify ladder-related fracture injuries and determine how ladder fall fractures differ from other ladder-related injuries. METHODS: Ladder-related fracture cases were identified using narrative text and coded data from workers' compensation claims. Potential cases were identified by text searches and verified with claim records. Injury characteristics were compared using proportionate injury ratios. RESULTS: Of 9826 ladder-related injuries, 7% resulted in fracture cases. Falls caused 89% of fractures and resulted in more medical costs and disability days than other injuries. Frequent mechanisms were ladder instability (22%) and lost footing (22%). Narrative text searches identified 17% more fractures than injury codes alone. Males were more likely to sustain a fall fracture than other injuries; construction workers were most likely, and retail workers were the least likely to sustain fractures. CONCLUSIONS: Fractures are an important injury from ladder falls, resulting more serious consequences than other ladder-related injuries. Text analysis can improve the quality and utility of workers compensation data by identifying and understanding injury causes. Proportionate injury ratios are also useful for making cross-group comparisons of injury experience when denominator data are not available. Greater attention to risk factors for ladder falls is needed for targeting interventions.

Accidental Falls↗

PubMed2006

Modeling the impact of the components of long work hours on injuries and "accidents".

BACKGROUND: Many of the industrial disasters of the last few decades, including Three Mile island, Chernobyl, Bhopal, Exxon Valdez, and the Estonia ferry, have occurred in the early hours of the morning. Follow-up investigations concluded that they were at least partially attributable to human fatigue and/or error. The potential impact of long work hours on health and safety is a major concern that has resulted in various work hour regulations. METHODS: The risk of injuries and "accidents" (incidents) associated with features of work schedules from published epidemiological studies are pooled using an additive model to form a "Risk Index." The estimated risks of an incident for various standard work schedules are presented using the proposed model. RESULTS: The estimated risk of an injury or accident associated with any given number of weekly work hours varies substantially depending on how work hours are comprised. The risk depends on the length and type of shift, as well as the frequency of rest breaks. CONCLUSIONS: We conclude that placing a limit on the risk associated with a particular work schedule is likely more effective than setting daily, weekly or monthly work hour regulations in keeping workplace safety within acceptable limits.

Accidents, Occupational↗

PubMed2006

Estimating the circadian rhythm in the risk of occupational injuries and accidents.

The authors recently published a prototypic Risk Index (RI) to estimate the risk of critical errors associated with shift systems. This RI was based on published trends in the relative risk of injuries and accidents, and a simple additive model was proposed to estimate the risk for a given shift system. However, extending the RI to irregular work schedules requires an estimation of the phase and amplitude of the circadian rhythm in risk. This paper integrates the published evidence on three independent sources of data that allow such estimations to be made: the trend in risk over a 24 h day, over the course of the night shift, and across the three different (8 h) shifts. Despite potential confounders, maximum risk (i.e., acrophase = peak time) estimates across these three trends showed a remarkable consistency, with all three estimates occurring at about midnight, although the amplitude estimates varied considerably. The best estimate of the amplitude of the circadian rhythm in risk would appear to be that based on trend over the three (8 h) shifts, as this trend is the least confounded. The estimated acrophase (peak time) in risk appeared earlier than would be predicted from consideration of the circadian rhythm in alertness, fatigue, or performance on simple interpolated tasks, such as reaction time or performance on the Psychomotor Vigilance Test.

Accident Prevention↗

PubMed2005

Does occupation explain gender and other differences in work-related eye injury hospitalization rates?

OBJECTIVE: We sought to determine whether demographic differences in eye injury rates persist after adjusting for occupational exposure. METHODS: On-duty eye injury hospitalizations were linked to occupation among active-duty US Army personnel. RESULTS: Eye injury rates were higher for white soldiers, men, and for younger soldiers, even after adjusting for occupational group and specific job titles using multivariate models. CONCLUSIONS: This finding contrasts with studies of other injuries, suggesting that occupation does not fully account for variations in eye injury risk. Because protective eye-wear can prevent most serious eye injuries, we hypothesize that differences in protective eye-wear use between men and women may contribute to differences in eye injury rates, although follow-up studies are needed to confirm this. Prevention efforts should consider targeting high-risk demographic groups in addition to high-risk occupations.

Adolescent↗

PubMed2005

Shiftwork: safety, sleepiness and sleep.

This brief paper reviews the available published literature on shiftwork and safety that allows the relative risk of "accidents" or injuries associated with specific features of shift systems to be estimated. Three main trends in risk are discussed, namely that (i) risk is higher on the night shift, and to a lesser extent the afternoon shift, than on the morning shift, (ii) risk increases over a span of shifts, especially so if they are night shifts, and (iii) risk increases with increasing shift length over eight hours. We discuss that some of these trends are not entirely consistent with predictions derived from considerations of the circadian variations in sleep propensity or rated sleepiness, and consider factors relating to sleep that may underlie the observed trends in risk. Finally, the practical implications of the trends in risk for the design of safer shift systems are discussed.

Accidents, Occupational↗

PubMed2004

Glove use and the relative risk of acute hand injury: a case-crossover study.

The purpose of this study was to investigate the relationship between glove use and acute traumatic occupational hand injury. We used a case-crossover, within-subject study design to control for differences between individuals such as occupation, injury history, age, gender, risk-taking behavior, manual dexterity, and muscle strength. A total of 1166 hand-injured workers were interviewed regarding the use of gloves at the time of the injury. The self-reported average duration of glove use in the previous work month was the measure of expected exposure to wearing gloves. Nineteen percent of subjects reported wearing gloves at the time of the injury. The expected exposure to glove use in the past work month was 27.9%. Glove use was associated with a lower risk of lacerations and punctures but not crush, fractures, avulsions, amputations, dislocations; the risk of the former two injury types was estimated to be 60-70% lower while wearing gloves. Glove use is only one component of a comprehensive hand injury prevention approach that might include the identification and elimination of sharp hazards, engineering controls, safety warnings, training in high-risk situation awareness, and proper selection and timing of glove use.

Acute Disease↗

PubMed2004

Toward a "Risk Index" to assess work schedules.

This article describes our preliminary attempt to develop a Risk Index to estimate the risk of human error on different work schedules based on trends in the relative risk of accidents and injuries, rather than on hypothetical intervening variables such as alertness, fatigue, or performance on interpolated tasks. We briefly review trends in risk from the published epidemiological studies that have ensured that the a priori risk was constant. A simple Risk Index based on an additive model is developed on the basis of these trends, and we illustrate how it may be used to assess work schedules. Finally, we compare the results from this Risk Index with those from the UK HSE's Fatigue Index and point out the discrepancies that emerge. We conclude that our risk-based modeling approach may assist in developing safer work schedules and also increase our understanding of this complex, multifaceted area.

Accidents, Occupational↗

PubMed2003

Temporal factors and the prevalence of transient exposures at the time of an occupational traumatic hand injury.

Temporal factors and the prevalence of exposure to transient risk factors for occupational traumatic hand injury were analyzed among 1166 subjects participating in a case-crossover study. Temporal factors included time of injury and elapsed time to injury since the start of the work shift. Transient exposures included work equipment, work practice, and worker-related factors. The highest frequency of injury was observed from 08:00 am to 12:00 pm (54.6%), with a peak from 10:00 to 11:00 am (14.9%). The median time into the work shift for injury was 3.5 hours. Subjects injured 2 to 3 hours into their work shift most often reported using a machine, tool, or work material that performed differently than usual (23.9%). These results suggest that acute hand injuries occur earlier in the workday and safety programs should place increased vigilance on these times.

Accidents, Occupational↗

PubMed2002

A reliability study of potential risk factors for acute traumatic occupational hand injuries.

BACKGROUND: A reliability study of transient workplace exposures was conducted within a case-crossover study of acute traumatic occupational hand injuries. Exposures examined included features of work equipment (unusual performance of equipment or materials, glove use), work practices (performing an uncommon work task, using an unusual work method), and worker-related factors (being rushed, distracted, ill, or working overtime). METHODS: Interviewers administered a follow-up questionnaire about exposure up to 4 days after the initial interview. The reliability of the usual frequency of exposure in the past month, exposure reported at the time of the injury, and the degree to which subjects had confidence in the accuracy of their memory for exposure was assessed. RESULTS: The test-retest reliability for the estimated number of hours of exposure during the past month was high for six of the eight potential risk factors (intraclass correlation coefficients (ICC) ranging from 0.84-0.99). ICC for the frequency per month and minutes per exposure, used to calculate the estimated number of hours per month, ranged from 0.12-0.99 and 0.49-0.99, respectively. Agreement of reported exposure at the time of the injury, evaluated using the kappa statistic, ranged from substantial agreement to perfect agreement (0.65-1.0). However, for some factors, there was little or no reported exposure. Most subjects (74-100%) reported being "very confident" or "certain" in their memory for each exposure. CONCLUSIONS: These findings suggest that the frequency and duration of unusual transient workplace exposures can be reliably recalled by subjects interviewed by telephone within 4 days of an injury.

Accidents, Occupational↗

PubMed2002

Acute traumatic occupational hand injuries: type, location, and severity.

The National Electronic Injury Surveillance System reports that the fingers and hand are the most frequent body parts injured at work and treated in hospital emergency departments. In this study, we describe the type, location, and severity of occupational hand injuries among 1166 patients recruited from 23 occupational health clinics in five New England states. Subjects ranged in age from 18 to 77 years, with a mean of 37.2 years (SD, 11.4), and approximately 75% were men. In decreasing order of frequency, subjects were employed in machine trades, service work, structural work, and less frequently, in benchwork, professional, technical managerial and clerical, and sales work. The majority of subjects (83.4%) had a single type of injury: 62.6% were lacerations, 13.1% were crush injuries, 8.0% were avulsions, and 6.1% were punctures. Metal items, such as nails, metal stock, and burrs accounted for 38.4% of the injuries, followed by hand tools with blades and powered machinery (24.4% and 12.3%, respectively). Hand tools with blades were least likely to result in multiple types of injuries, whereas powered machines or nonpowered hand tools were more likely to result in multiple types of injuries than other injury sources. The generalizability of these results should be limited to clinic-based patients employed in similar occupations. The results of this study may suggest possible prevention strategies for acute traumatic hand injuries.

Adolescent↗