Biomedical subjects

J Bondy

Publications and source records attributed to J Bondy.

8 recordsLinked to original sources

PubMed1999

Contractor safety practices and injury rates in construction of the Denver International Airport.

BACKGROUND: We sought to explain the variation in injury rates found for categories of companies and contracts involved in the construction of the Denver International Airport (DIA) by surveying contractors about company and contract-level safety practices. METHODS: We conducted 213 telephone interviews (83% response) with representatives of contracts with payrolls of more than $250,000. We investigated the bivariate relationship between safety actions reported in the survey and injury occurrence by calculating the aggregate injury rates (lost work-time (LWT) rates and non-LWT rates) for the group of respondent contracts reporting always taking the action and for the group not always taking the action. Using Poisson regression, we examined the association between contract injury rates and contract safety practices while controlling for variables previously shown to affect contract-level injury rates. RESULTS: In Poisson regression, two actions, 1) disciplinary action always resulting when safety rules were violated and 2) always considering experience modification ratings when selecting subcontractors, were associated with lower LWT injury rates. Three actions or contract characteristics resulted in lower non-LWT rates: management always establishing goals for safety for supervisors, conducting drug testing at times other than badging or after an accident, and completing the DIA contract on budget, rather than over budget. Reportedly consistent use of a number of accepted safety practices was associated with significantly higher injury rates in bivariate and multivariate analyses. CONCLUSIONS: The pattern of counterintuitive results found in this study suggests that questions reflecting agreed-upon safety practices, when asked of the person responsible for all on-site construction activities, are likely to elicit normative responses. Objective validation of reported safety practices is critical to evaluating their efficacy in reducing injury rates, along with measures of both time at risk and outcome and control for prevailing risk of the work performed.

Absenteeism↗

PubMed1998

Construction injury rates may exceed national estimates: evidence from the construction of Denver International Airport.

BACKGROUND: Construction of Denver International Airport (DIA) provided a unique opportunity to describe the magnitude of injury on a major construction project for which complete data on injury and hours at risk were available for over 32,000 employees working 31 million hours. METHODS: Comprehensive payroll data for all workers, who were paid standard Davis-Bacon wages, allowed calculation of person-hours at risk by job classification. Complete reporting, facilitated by a single workers' compensation plan covering all contracts and by an on-site medical clinic and designated provider system, allowed us to determine both total and lost-work-time (LWT) injury rate per 200,000 hours at risk by industrial sector, company size, and year of construction. Workers' compensation payment rates were calculated and compared with expected loss rates, derived by the National Council on Compensation Insurance, by sector, company size, and year. RESULTS: DIA's overall total injury rates were over twice those published by the Bureau of Labor Statistics (BLS) for the construction industry for each year of DIA construction. Differences in LWT injury rates were more modest. Total injury rates were also at least twice BLS's rates for all contractor sizes. The injury rate pattern by company size at DIA differed from BLS's in that small firms had injury rates that were lower than or comparable to most other size categories; BLS's rates for small firms were lower than those for all but the very largest (250 or more employees) contractors. DIA's total workers' compensation (WC) payment rate of $7.06 per $100 payroll was only 11% higher than Colorado-specific expected loss rates reported by the National Council on Compensation Insurance. DISCUSSION: Complete reporting, facilitated by the existence of a single WC plan, an on-sites medical clinic, and designated medical providers, yielded injury rates significantly higher than previously reported. The relatively small difference between DIA payment rates significantly higher than previously that the discrepancy between DIA's injury rates and national estimates is due to underreporting of non-LWT injuries of the BLS. The burden of on-site work-related construction injury may be higher and more costly than has been evident from national data.

Accidents, Occupational↗

PubMed1998

Risk factors for injury among construction workers at Denver International Airport.

BACKGROUND: The Denver International Airport construction project provided a rare opportunity to identify risk factors for injury on a large construction project for which 769 contractors were hired to complete 2,843 construction contracts. Workers' compensation claims and payroll data for individual contracts were recorded in an administrative database developed by the project's Owner-Controlled Insurance Program. METHODS: From claims andy payroll data linked with employee demographic information, we calculated injury rates per 200,000 person-hours by contract and over contract characteristics of interest. We used Poisson regression models to examine contract-specific risk factors in relation to total injuries, lost-work-time (LWT), and non-LWT injuries. We included contract-specific expected loss rates (ELRs) in the model to control for prevailing risk of work and used logistic regression methods to determine the association between LWT and non-LWT injuries on contracts. RESULTS: Injury rates were highest during the first year of construction, at the beginning of contracts, and among older workers. Risk for total and non-LWT injuries was elevated for building construction contracts, contract for special trades companies (SIC 17), contracts with payrolls over $1 million, and those with overtime payrolls greater than 20%. Risk for LWT injuries only was increased for site development contracts and contract starting in the first year of construction. Contracts experiencing one or more minor injuries were four times as likely to have at least one major injury (OR = 4.0, 95% CI (2.9, 5.5)). CONCLUSIONS: Enhancement of DIA's safety infrastructure during the second year of construction appears to have been effective in reducing serious (LWT) injures. The absence of correlation between injury rates among contracts belonging to the same company suggest that targeting of safety resources at the level of the contract may be an effective approach to injury prevention. Interventions focused on high-risk contracts, including those with considerable overtime work, contracts held by special trades contractors (SIC 17), and contracts belonging to small and mid-sized companies, and on high-risk workers, such as those new to a construction site or new to a contract may reduce injury burden on large construction sites. The join occurrence of minor and major injuries on a contract level suggests that surveillance of minor injuries may be useful in identifying opportunities for prevention of major injures.

Accidents, Occupational↗

PubMed1997

Utilization of services for otitis media by children enrolled in Medicaid.

OBJECTIVE: To provide population-based information about the utilization of ambulatory visits, antibiotic prescriptions, and surgical procedures related to the diagnosis and management of otitis media. DESIGN: A descriptive study in which utilization rates per child and per child-year were calculated. Child-year rates stratified by age were calculated only for children having at least 1 ambulatory visit with a diagnosis of otitis media. SETTING: Administrative data from Colorado Medicaid for the 1991 and 1992 calendar years. PATIENTS: All children enrolled in Medicaid who are younger than 13 years and not participating in a prepaid health care plan during the study years (n = 131,169 and n = 157,065) were included in the analysis. RESULTS: Approximately 22% of children made at least 1 ambulatory visit with a diagnosis of otitis media, with the peak prevalence (46.8%) occurring between ages 1 and 2 years. Among all children younger than 13 years enrolled in Medicaid, there were 0.5 ambulatory visits for otitis media per child (0.7 ambulatory visits per child-year), with 70% occurring in a physician office setting, 14.8% in a hospital clinic or community health center, and 15.2% in a hospital emergency department. For all children enrolled in Medicaid, the rate of antibiotic courses for otitis media was 0.34 per child (0.48/child-year). Each child with otitis media had an annual average of 1.55 antibiotic courses (1.82 antibiotic courses per child-year). The average ratio of antibiotic courses to ambulatory visits related to otitis media was 65%. There was an annual rate of 12 surgical procedures related to otitis media per 1000 children (16.6/1000 child-years). The peak rate of ventilating tube insertion occurred in children ages 1 to 2 years and for adenoidectomy in children 3 to 6 years. Mastoidectomy rates were low, 92% occurring in children older than 2 years. CONCLUSIONS: This study represents preliminary techniques to profile the care of children with otitis media. Our findings support the need to measure volatility of enrollment in an insured population before calculating rates of utilization. Additional research is needed to measure the effects of discontinuous eligibility, access to a regular source of primary care, site of treatment, and physician preferences on the quantity and quality of treatments for otitis media.

Adenoidectomy↗

PubMed1997

Otitis media-related antibiotic prescribing patterns, outcomes, and expenditures in a pediatric medicaid population.

BACKGROUND: Treatment of otitis media is the most frequent reason for administering antibiotics to children in the United States. However, only limited data are available on medical effectiveness of antibiotic prescribing patterns for otitis media and their associated expenditures or the factors that influence antibiotic prescribing. METHODS: The study population consisted of 131 169 children during 1991 and 157 065 children during 1992 who were </=13 years of age and enrolled in Colorado's fee-for-service Medicaid program. Among these children, 5127 (1991) and 7254 (1992) were enrolled in the cohort treated for a "new" episode of acute otitis media. An analysis using this cohort was performed to document the antibiotics used to treat a new episode of acute otitis media, factors influencing antibiotic selection, and the short-term outcomes of therapy. An analysis using the entire Medicaid population was performed to document the annual use of antibiotics for otitis, the associated antibiotic expenditures, and factors influencing antibiotic selection. RESULTS: In the cohort analysis, office-based physicians prescribed second- and third-generation cephalosporins more often than did physicians in other settings (17% vs 9.7% and 11.8%), whereas hospital clinics prescribed trimethoprim plus sulfamethoxazole more frequently than did office-based physicians (19.2% vs 7.1% and 10.9%). Family physicians prescribed second- and third-generation cephalosporins more often than did pediatricians (16.6% vs 12.3%) but trimethoprim plus sulfamethoxazole and erythromycin plus sulfisoxazole less often than did pediatricians (10.5% vs 17%). The average rate of prescribing a second course of antibiotics within 24 days after initial antibiotic treatment of a new acute otitis media episode was 11.6% when less expensive antibiotics (amoxicillin, trimethoprim plus sulfamethoxazole, or erythromycin plus sulfisoxazole) were prescribed, and 13.2% when more expensive antibiotics (cefaclor, amoxicillin plus clavulanate, or cefixime) were prescribed. The average adverse drug reaction rate was 5.9% when less expensive antibiotics were prescribed, compared with 6.1% when more expensive antibiotics were prescribed. In each of the two study years, amoxicillin accounted for almost half of the total antibiotic fills but only 9% to 10% of the expenditures. Low-cost antibiotics (amoxicillin, trimethoprim plus sulfamethoxazole, and erythromycin plus sulfisoxazole) were prescribed for 66% to 67% of the total fills and accounted for 21% of the total projected expenditures. More expensive antibiotics (cefaclor, cefixime, amoxicillin plus clavulanate) prescribed for 30% of the fills generated 76% to 77% of expenditures. Cefaclor, prescribed for 17% to 18% of the total fills, generated 43% to 45% of total antibiotic expenses. CONCLUSIONS: The findings of this study document a preference for amoxicillin as the initial antibiotic for a new episode of acute otitis media. Although there was a wide variation in the selection of antibiotics to treat otitis, the more expensive antibiotics were not associated with better outcomes. This wide variation has important financial implications because of differences in antibiotic costs. Changes in prescribing patterns among initially uncomplicated children that reduce the use of high-cost antibiotics could reduce expenditures substantially without compromising short-term outcomes.

Acute Disease↗

PubMed1994

Finding temporal patterns--a set-based approach.

We created an inference engine and query language for expressing temporal patterns in data. The patterns are represented by using temporally-ordered sets of data objects. Patterns are elaborated by reference to new objects inferred from original data, and by interlocking temporal and other relationships among sets of these objects. We found the tools well-suited to define scenarios of events that are evidence of inappropriate use of prescription drugs, using Medicaid administrative data that describe medical events. The tools' usefulness in research might be considerably more general.

Artificial Intelligence↗

PubMed1988

Using smoothing splines to make inferences about the shape of gas-exchange curves.

Respiratory gas-exchange data from progressive exercise tests are typically interpreted by visual inspection. Attempts to objectify such interpretation have applied particular parametric models which limit the measures which can be studied and the inferences which can be made. We use a known spline-smoothing procedure which fits a continuous curve to such data, yielding confidence intervals for the curve and for its first and second derivatives. Rules can be made which use the derivatives to infer features of a curve's shape and to relate features from different curves in the same data set. In this way complex interpretations can be made objective, so that they may be adequately tested.

Algorithms↗

PubMed1984

Survey of reproductive hazards among oil, chemical, and atomic workers exposed to halogenated hydrocarbons.

Several halogenated hydrocarbons are suspected of causing adverse reproductive effects. Because of such concerns, the Oil, Chemical, and Atomic Workers International Union surveyed the reproductive histories of two groups of workers. One group worked at plants engaged in the production or use of halogenated hydrocarbons (exposed) whereas the others had no such opportunity for exposure (nonexposed). Although a low response rate precludes firm conclusions, the 1,280 completed questionnaires provide useful data for generating hypotheses in this developing field of interest. A history of diagnosed cancer was reported more frequently among exposed workers. The infant mortality rate was also significantly elevated among the offspring of exposed workers. No risk gradient was observed for episodes of infertility, fetal loss, congenital defects, or low-birthweight offspring. Concerns with nonresponse, exposure characterization, possible confounding factors, and limited statistical power are addressed. The results provide further suggestions which help to direct studies of occupational reproductive risks.

Abnormalities, Drug-Induced↗