Biomedical subjects

G S Sorock

Publications and source records attributed to G S Sorock.

At least 19 recordsLinked to original sources

PubMed2006

Blurring the distinctions between on and off the job injuries: similarities and differences in circumstances.

OBJECTIVES: To compare the causes of non-fatal work and non-work injuries and the places or environments where they occur. It has been suggested that many injuries may have similar etiologies on and off the job and thus involve some common prevention strategies. However lack of comparable data on work relatedness has prevented testing this proposition. METHODS: The National Health Interview Survey (NHIS) now collects information on the cause, location, and work relatedness of all medically attended injuries. National US estimates of non-fatal work and non-work injuries were compared by cause and place/location for working age adults (18-64 years). RESULTS: Overall 28.6% of injuries to working age adults were work related (37.5% among employed people). The causes and locations of many work and non-work injuries were similar. Falls, overexertion, and struck/caught by were leading causes for work and non-work injuries. Motor vehicle injuries were less likely to be work related (3.4% at work v 19.5% non-work) and overexertion injuries more likely to be work related (27.1% v 13.8%). Assaults were less than 1% of work injuries and 1.8% of non-work injuries. Both work and non-work injuries occurred in every location examined-including the home where 3.5% of injuries were work related. CONCLUSIONS: Work and non-work injuries share many similarities suggesting opportunities to broaden injury prevention programs commonly restricted to one setting or the other. Comprehensive efforts to prevent both non-work and work injuries may result in considerable cost savings not only to society but also directly to employers, who incur much of the associated costs.

Accidental Falls↗

PubMed2005

Welding related occupational eye injuries: a narrative analysis.

OBJECTIVE: To determine the activities and circumstances proximal to a welding related occupational eye injury, a hybrid narrative coding approach derived from two well developed classification systems was developed to categorize and describe the activity, initiating process, mechanism of injury, object and/or substance, and the use of protective eyewear from the narrative text data reported for each injury. METHODS: Routinely collected workers' compensation claims over a one year period (2000) were analyzed from a large US insurance provider. An index term search algorithm of occupation, incident, and injury description fields identified 2209 potential welding related eye injury claims. After detailed review of these claims, 1353 welders and 822 non-welders were analyzed. RESULTS: During 2000, eye(s) as the primary injured body part accounted for 5% (n = 26 413) of all compensation claims. Eye injuries accounted for 25% of all claims for welders. Subjects were mainly male (97.1%) and from manufacturing (70.4%), service (11.8%), or construction (8.4%) related industries. Most injuries were foreign body (71.7%) or burn (22.2%) and 17.6% were bilateral. Common activities include welding (31.9%) and/or grinding (22.5%). Being struck by an airborne object occurred in 56.3% of cases. Non-welders showed similar patterns except that burns (43.8%) were more frequent and more often initiated by another worker (13.9%). CONCLUSIONS: Narrative injury text provides valuable data to supplement traditional epidemiologic analyses. Workers performing welding tasks or working nearby welders should be trained to recognize potential hazards and the effective use of proper safety equipment to prevent ocular injury.

Accidents, Occupational↗

PubMed2004

Using narrative text and coded data to develop hazard scenarios for occupational injury interventions.

OBJECTIVE: To determine whether narrative text in safety reports contains sufficient information regarding contributing factors and precipitating mechanisms to prioritize occupational back injury prevention strategies.Design, setting, subjects, and MAIN OUTCOME MEASURES: Nine essential data elements were identified in narratives and coded sections of safety reports for each of 94 cases of back injuries to United States Army truck drivers reported to the United States Army Safety Center between 1987 and 1997. The essential elements of each case were used to reconstruct standardized event sequences. A taxonomy of the event sequences was then developed to identify common hazard scenarios and opportunities for primary interventions. RESULTS: Coded data typically only identified five data elements (broad activity, task, event/exposure, nature of injury, and outcomes) while narratives provided additional elements (contributing factor, precipitating mechanism, primary source) essential for developing our taxonomy. Three hazard scenarios were associated with back injuries among Army truck drivers accounting for 83% of cases: struck by/against events during motor vehicle crashes; falls resulting from slips/trips or loss of balance; and overexertion from lifting activities. CONCLUSIONS: Coded data from safety investigations lacked sufficient information to thoroughly characterize the injury event. However, the combination of existing narrative text (similar to that collected by many injury surveillance systems) and coded data enabled us to develop a more complete taxonomy of injury event characteristics and identify common hazard scenarios. This study demonstrates that narrative text can provide the additional information on contributing factors and precipitating mechanisms needed to target prevention strategies.

Accidental Falls↗

PubMed2004

A case-crossover study of transient risk factors for occupational acute hand injury.

BACKGROUND: Workers with acute hand injuries account for over 1 000 000 emergency department visits annually in the United States. AIMS: To determine potential transient risk factors for occupational acute hand injury. METHODS: Subjects were recruited from 23 occupational health clinics in five northeastern states in the USA. In a telephone interview, subjects were asked to report the occurrence of seven potential risk factors within a 90-minute time period before an acute hand injury. Each case also provided control information on exposures during the month before the injury. The self-matched feature of the study design controlled for stable between-person confounders. RESULTS: A total of 1166 subjects were interviewed (891 men, 275 women), with a mean age (SD) of 37.2 years (11.4). The median time interval between injury and interview was 1.3 days. Sixty three per cent of subjects had a laceration. The relative risk of a hand injury was increased when working with equipment, tools, or work pieces not performing as expected (11.0, 95% CI 9.4 to 12.8), or when using a different work method to do a task (10.5, 95% CI 8.7 to 12.7). Other transient factors in decreasing order of relative risk were doing an unusual task, being distracted, and being rushed. Wearing gloves reduced the relative risk by 60% (0.4, 95% CI 0.3 to 0.5). Occupational category, job experience, and safety training were found to alter several of these effects. CONCLUSION: The results suggest the importance of these transient, potentially modifiable factors in the aetiology of acute hand injury at work. Attempts to modify these exposures by various strategies may reduce the incidence of acute hand injury at work.

Accidents, Occupational↗

PubMed2001

Occupational slip, trip, and fall-related injuries--can the contribution of slipperiness be isolated?

To determine if the contribution of slipperiness to occupational slip, trip and fall (STF)-related injuries could be isolated from injury surveillance systems in the USA, the UK and Sweden, six governmental systems and one industrial system were consulted. The systems varied in their capture approaches and the degree of documentation of exposure to slipping. The burden of STF-related occupational injury ranged from 20 to 40% of disabling occupational injuries in the developed countries studied. The annual direct cost of fall-related occupational injuries in the USA alone was estimated to be approximately US$6 billion. Slipperiness or slipping were found to contribute to between 40 and 50% of fall-related injuries. Slipperiness was more often a factor in same level falls than in falls to lower levels. The evaluation of the burden of slipperiness was hampered by design limitations in many of the data systems utilized. The resolution of large-scale injury registries should be improved by collecting more detailed incident sequence information to better define the full scope and contribution of slipperiness to occupational STF-related injuries. Such improvements would facilitate the allocation of prevention resources towards reduction of first-event risk factors such as slipping.

Accidental Falls↗

PubMed2001

A case-crossover study of occupational traumatic hand injury: methods and initial findings.

BACKGROUND: Acute hand injury is the leading cause of occupational injury treated in United States' hospital emergency departments (e.g., laceration, crush or fracture). To identify risk factors for traumatic hand injuries, we conducted a case-crossover study of transient exposures (e.g., being rushed) for acute occupational traumatic hand injury. METHODS: The case-crossover method, which uses subjects as their own controls, was used to identify risk factors for occupational hand injury. Two hundred and thirty-two subjects were recruited from 17 occupational health clinics in New England and interviewed by telephone a median of 1.2 days after their injury. The a priori hazard period was defined as 10 min before the injury. Two control periods were used: one was 60-70 min prior to the injury (matched-pair interval analysis); the other was the total work-time exposed, on average, in the previous month (usual frequency analysis). RESULTS: In the usual frequency analysis, the relative risk for using malfunctioning or different-from-usual equipment or tools in the hazard period was 25.5 (95% confidence interval = 18.4-35.2). Relative risks were also significantly elevated for performing a task using an unusual work method, doing an unusual task, being distracted, or being rushed. Wearing gloves appeared to be protective (relative risk = 0.8, 95% CI = 0.5-1.2). Matched-pair interval analysis, where appropriate, provided similar findings but had much wider confidence intervals. CONCLUSIONS: This study demonstrates that the case-crossover design is a feasible and efficient method for studying transient risk factors for sudden-onset traumatic occupational hand injury. The usual frequency analysis proved more useful than the match-pair approach to control period selection.

Accidents, Occupational↗

PubMed2001

Influence of measurement accuracy on the application of the 1991 NIOSH equation.

A relatively neglected topic in manual materials handling (MMH) research is the impact of the accuracy of task parameter measurements on the application of various assessment methods. A laboratory experiment was conducted to investigate the accuracy of NIOSH equation parameter measurements made by eight subjects following a 4-h training session. Five individual tasks were measured; two were single tasks and three were part of a multiple-component simulated palletizing operation. Significant differences between reference parameter measurements and average measurements made by subjects were found. The sensitivity analysis showed that frequency and horizontal location are the most important parameters. These parameters also tended to have the highest measurement errors. Recommendations for increasing the effectiveness of training programs for NIOSH equation users based on the results of the study are presented.

Ergonomics↗

PubMed2001

Case-crossover studies of occupational trauma: methodological caveats.

OBJECTIVES: The case-crossover study design was developed to examine triggers for the onset of myocardial infarction. This paper seeks to examine selected methodological issues when applying the case-crossover method to the study of traumatic injuries in the work environment. METHODS: Researchers known to be working on occupational case-crossover studies were invited to present at a workshop held at the National Occupational Injury Research Symposium in October 2000. Data from ongoing studies were used to illustrate various methodological issues involved in case-crossover studies of occupational injury. KEY FINDINGS AND ISSUES IDENTIFIED: To utilize the case-crossover design, investigators must clearly define the time during which a worker is at risk of injury, the period of time during which a particular transient exposure could cause an injury and carefully select control time periods that estimate the expected frequency of exposure. Other issues of concern are changing work tasks over time, correlated exposures over time and information bias. CONCLUSIONS AND FUTURE RESEARCH NEEDS: More case-crossover studies of occupational injury are needed to compare results from multiple studies. The validation of the timing of transient exposures relative to injury onset, whether done in a laboratory or field setting, should be conducted. Nested case-crossover designs in other epidemiological studies (case-control or cohort) can examine both transient and fixed risk factors for occupational injury, and should be attempted.

Accident Prevention↗

PubMed2000

Fatal occupational injuries in a new development area in the People's Republic of China.

Fatal occupational injuries in a new development region in Shanghai in east China are described. All occupational deaths in the East Pujiang New Area during the period 1991 through 1997 were abstracted from multiple, overlapping source documents. There were 426 deaths and a crude mortality rate of 9.1 per 100,000 workers. The death rate was highest in 1995 (14.6%), when expansion in the area was most rapid. The construction sector accounted for 55% of the deaths, followed by manufacturing (23%) and transport, storage, and telecommunications (11%). Falls, collisions, struck by/against incidents, and electrocutions accounted for 80% of all deaths. Falls led all other causes of deaths (33%) and were particularly prevalent in the construction industry (46% of all deaths in construction). The development of ongoing, comprehensive injury surveillance systems in the People's Republic of China will be essential to target and evaluate injury prevention activities in the future.

Accidents, Occupational↗

PubMed1997

Methodological challenges to the study of occupational injury--an international epidemiology workshop.

Occupational and work-related injuries comprise the majority of reported workplace morbidity in the employed population in the United States. Despite intervention attempts, the overall trend for these injuries has been relatively stable over the past several decades. Three significant problems are raised as potentially contributing to this stability. Minimal progress in reduction may be due to: lack of etiologic understanding, lack of appropriate intervention selection, or lack of appropriate intervention implementation. Focusing on the first of these problems, a workshop symposium of injury epidemiologists and related scientists was held that developed a series of collaborative manuscripts on issues in injury epidemiology and recommendations for future research. The contributions of each are briefly summarized.

Accidents, Occupational↗

PubMed1997

Three perspectives on work-related injury surveillance systems.

This paper reviews surveillance approaches for occupational injuries and evaluates three emerging methodologies for the enhancement of work-related injury surveillance: (1) narrative data analysis, (2) data set linkage, and (3) comprehensive company-wide surveillance systems. All three methods are the result of new applications of computer hardware and software that have apparent strengths and limitations. A major strength is the improved description of work exposures and related injuries leading to better understanding of injury etiology. This understanding, however, is limited by the data quality and completeness entered on records at the time of the injury. We recommend (1) more widespread inclusion of narrative text in databases, analyses of which can be a valuable supplement to injury coded data; (2) the increased use of data set linkage studies to combine injury and work-history data; and (3) the development of comprehensive company-wide surveillance systems to expedite the use of epidemiologic data for occupational injury prevention activities. Further development of these methods and others is encouraged, especially in light of technological advancements in data capture, analysis and presentation. Only through such efforts can we best apply epidemiologic principles to preventing injuries in the workplace.

Accidents, Occupational↗

PubMed1997

Alternative approaches to analytical designs in occupational injury epidemiology.

In this paper, we discuss the theoretical framework upon which observational studies of occupational injuries are based. Following a general description of how causal effects are estimated, the challenges faced by researchers working in this area are outlined, with an emphasis on case-control studies. These challenges include defining the at-risk period for workers whose tasks change over time and whose hazard period may be very brief, evaluating the underreporting of both exposures and injuries, and considering the effects of multiple injuries per individual on study design and data analysis. We review both the theoretical and practical considerations in the design and conduct of traditional case-control studies, based on the collection of individual level data, as well as other approaches, such as using information culled from administrative and descriptive databases, and case-control studies in which the plant or work site is the unit of analysis. The case-crossover design is also reviewed and its utility for reducing confounding due to differences between individuals by self-matching is highlighted. While this design has not yet been applied to the work setting, its potential for increasing our understanding of the causes of acute-onset occupational injuries seems promising. Finally, a variety of hybrid designs are discussed, including combinations of case-control, case-crossover, and cohort designs.

Accidents, Occupational↗

PubMed1997

Advancing epidemiologic studies of occupational injury--approaches and future directions.

Despite increased attention to the epidemiology of occupational injuries and work-related musculoskeletal disorders, little is known about the relative contribution of risk factors for specific injuries and diseases and effective ways to prevent them. Building on the knowledge and ideas presented in the previous papers in this special issue, this paper describes the salient issues regarding the needs and the opportunities in design, conduct, and analysis of epidemiologic research on occupational injury. There is a clear need for standardization of definitions on exposure variables and health outcomes, since basic terminology is not used consistently across studies. Improved surveillance systems with linkage to other databases offer excellent opportunities to evaluate trends in risk factors and occupational injuries. New opportunities for etiologic studies include the case-crossover design, which focuses on relations between intermittent exposures and injuries, as well as several hybrid designs that combine advantages and strength of the traditional case-control and cohort study designs. Various suggestions are presented to capture the dynamics of exposure, including both intermittent and continuous factors in the assessment strategy. The importance of cohort studies is emphasized to clarify the temporal relations between causes and effects in work-related injury research. Finally, intervention studies are much needed and a hierarchical approach is suggested, starting with observational surveys, continuing with quasi-experimental studies and concluding with randomized controlled experiments of those interventions that hold the largest promise.

Accidents, Occupational↗

PubMed1997

A descriptive study of recurrent low back pain claims.

This is the first large-scale study of US workers that describes the demographic and cost differences between recurrent and nonrecurrent low back pain (LBP) disability claimants, using data from a large workers' compensation insurer. Persons with at least one LBP claim in 1990 and one or more additional claims in 1990 to 1996 were defined as recurrent. Persons with at least one LBP claim in 1990 but no subsequent claims were defined as nonrecurrent. Fourteen percent of claimants were recurrent. The percentage of recurrent claimants who were male (77.2%) was higher than the percentage that were female (22.8%). This difference was more pronounced in the younger age groups. The median total cost for recurrent LBP claims in 1990 was 4% greater than for nonrecurrent 1990 LBP claims, whereas the mean cost was 48% less. Most studies of LBP recurrence among US workers have followed single-corporation employees. Our rate of recurrence was lower than these previously reported rates. However, analysis of independent workers' compensation insurance company data may provide a more accurate assessment of LBP claim recurrence among US workers.

Adult↗

PubMed1996

Injury and illness in the American workplace: a comparison of data sources.

Setting priorities for workplace health and safety research depends upon accurate and reliable injury and illness data. All occupational health databases have limitations when used to summarize the national scope of workplace hazards. The comparison of data from multiple sources may produce more credible estimates of the leading occupational injuries and illnesses. The purpose of this paper is to describe the strengths and weaknesses of six data collection systems that record occupational injuries and illnesses on a national level and to compare the leading estimates from these systems for 1990. The six systems are: 1) National Traumatic Occupational Fatalities database, 2) the Bureau of Labor Statistics Census of Fatal Occupational Injuries, 3) The Bureau of Labor Statistics Annual Survey data, 4) a large workers' compensation database, 5) the National Council on Compensation Insurance data, and 6) The National Electronic Injury Surveillance System. Occupational injuries, as defined herein, predominate over illnesses in terms of the number of cases and the overall costs. Databases that provide information on the antecedents of injuries suggest how these injuries may be prevented and warrant more attention and refinement.

Accidents, Occupational↗

PubMed1996

Motor vehicle crashes in roadway construction workzones: an analysis using narrative text from insurance claims.

Motor vehicle travel through roadway construction workzones has been shown to increase the risk of a crash. The number of workzones has increased due to recent congressional funding in 1991 for expanded roadway maintenance and repair. In this paper, we describe the characteristics and costs of motor vehicle crashes in roadway construction workzones. As opposed to using standard accident codes to identify accident types, automobile insurance claims files from 1990-93 were searched to identify records with the keyword "construction" in the accident narrative field. A total of 3,686 claims were used for the analysis of crashes. Keywords from the accident narrative field were used to identify five pre-crash vehicle activities and five crash types. We evaluated misclassification error by reading 560 randomly selected claims and found it to be only 5%. For each of four years, 1990-93, there was a total of 648,996,977 and 1,065 crashes, respectively. There was a 70% increase in the crash rate per 10,000 personal insured vehicles from 1990-93 (2.1-3.6). Most crashes (26%) involved a stopped or slowing vehicle in the workzone. The most common crash (31%) was a rear-end collision. The most costly pre-crash activity was a major judgment error on the part of a driver (n = 120, median cost = $2,628). An overturned vehicle was the most costly crash type (n = 16, median cost = $4,745). In summary, keyword text analysis of accident narrative data used in this study demonstrated its utility and potential for enhancing injury epidemiology. The results suggest interventions are needed to respond to growing traffic hazards in construction workzones.

Accidents, Traffic↗

PubMed1996

Epidemiologic concerns for ergonomists: illustrations from the musculoskeletal disorder literature.

Ergonomics and epidemiology are unique fields that share some common interests. Epidemiologic methods are increasingly being utilized in ergonomic studies of the work-related risk factors of musculoskeletal disorders. This multidisciplinary approach requires a shared knowledge base and understanding of the methodology of both disciplines. In this paper, basic epidemiologic concepts are introduced. Examples from the upper extremity musculoskeletal disorder literature are used to illustrate study design issues and to suggest improved study methods. Epidemiologic design problems including selection bias (healthy worker survivor effect), misclassification, and confounding are discussed. Prospective research designs are described as a feasible approach for the study of these disorders. Increased collaboration between ergonomists and epidemiologists is encouraged to improve progress towards the reduction of workplace injuries and illnesses.

Epidemiology↗

PubMed1996

Recent trends in work-related cumulative trauma disorders of the upper extremities in the United States: an evaluation of possible reasons.

The increasing trends of cumulative trauma disorders of the upper extremities (CTDUEs) in US industry is well established; however, systematic examination of potential reasons for these trends has been lacking. Data from the United States Bureau of Labor Statistics and from Liberty Mutual Group workers' compensation claims were used to count CTDUEs. The proportions of all Bureau of Labor Statistics' cases and Liberty Mutual Group workers' compensation claims that resulted from CTDUEs were estimated for the years 1986 to 1993. The proportions by occupation (job classification code), gender, potential video display unit use, and in the meat-packing industry are described. Both data systems show a steady increase in cases and claims from less than 1% in 1986 to about 4% in 1993. Women and specific occupational categories are over-represented with respect to CTDUEs. A shift to service industry work and video display unit use do not appear to be strongly related to the increased reporting of CTDUEs, whereas increased productivity, an increased number of women in the work force and general awareness of CTDUEs in the media and health care system may be related. Coding and definition problems still limit these conclusions, however.

Arm Injuries↗