PubMed Health⌕ Search

Biomedical subjects

J M Dement

Publications and source records attributed to J M Dement.

At least 19 recordsLinked to original sources
PubMed2003

Nail gun injuries in residential carpentry: lessons from active injury surveillance.

OBJECTIVE: To describe circumstances surrounding injuries involving nail guns among carpenters, calculate injury rates, identify high risk groups and preventive measures. METHODS: and setting: Active injury surveillance was used to identify causes of injury among a large cohort of union residential and drywall carpenters. Injured carpenters were interviewed by experienced journeymen; enumeration of workers and hourworked were provided by the union. The combined data allowed definition of a cohort of carpenters, their hours worked, detailed information on the circumstances surrounding injuries, and identification of preventive measures from the perspectives of the injured worker and an experienced investigator. RESULTS: Nail guns were involved in 14% of injuries investigated. Ninety percent of these injuries were the result of the carpenter being struck, most commonly by a nail puncturing a hand or fingers. The injury rate among apprentices was 3.7 per 200 000 hours worked (95% confidence interval (CI) 2.7 to 4.9) compared with a rate of 1.2 among journeymen (95% CI 0.80 to 1.7). While not always the sole contributing factor, a sequential trigger would have likely prevented 65% of the injuries from tools with contact trip triggers. CONCLUSIONS: Training, engineering, and policy changes in the workplace and manufacturing arena are all appropriate targets for prevention of these injuries. Use of sequential triggers would likely decrease acute injury rates markedly. Over 70% of injuries among residential carpenters were associated with through nailing tasks (such as nailing studs or blocks, trusses or joists) or toe nailing (angled, corner nailing) as opposed to flat nailing used for sheathing activities; this provides some indication that contact trip tools could be used solely for flat nailing.

Accidents, Occupational↗
PubMed2000

Deaths from external causes of injury among construction workers in North Carolina, 1988-1994.

Records from the Office of the North Carolina Chief Medical Examiner were used to describe 3955 deaths, both on and off the job, between 1988 and 1994 from external causes of injury (E-codes) among individuals whose usual occupation was in the construction trades. For the calculation of rates, population sizes were estimated using 1980 and 1990 census data. Deaths from injuries occurred at an average rate of 226 per 100,000 population; 213 per 100,000 for non-work-related fatalities and 13 per 100,000 for work-related fatalities. Overall, deaths were most often from guns or motor vehicle accidents. Work-related deaths were most often caused by motor vehicles (21%); falls (20%), most commonly from roofs or scaffolds; and machinery (15%), electrocutions (14%), and falling objects (10%). Three major causes of work-related motor vehicle accidents were identified including injuries to pedestrians in highway work zones and in backovers on construction sites, and injuries to drivers caused by shifting loads while transporting construction materials. The circumstances surrounding deaths involving scaffolding document the need for training and safety procedures for erecting, moving, and disassembling scaffolds, but also for safe work practices on scaffolds. Training and safety procedures to avoid electrocutions must involve workers who are not in the electrical trades, as these deaths often occurred among individuals who were not electricians or linemen. Significant differences were observed in the proportion of victims having elevated blood-alcohol levels depending on whether the injury was work-related; 57 percent of victims were impaired at the time of fatal non-work-related injuries compared to 5 percent of work-related injuries. Interventions to treat and prevent alcohol abuse among construction workers could have a significant public health impact in the prevention of premature death from injury, particularly outside the workplace.

Accidental Falls↗
PubMed2000

Work-related injuries in drywall installation.

Administrative data sources were used to describe the work-related injuries of drywall carpenters, to calculate rates of occurrence, and to explore high risk sub-groups. Health insurance eligibility files were used to identify a cohort of active union carpenters affiliated with a union local whose predominant work involved drywall installation in the state of Washington. These files contained the hours worked by each individual for each month between January 1989 and December 1995, providing person-hours at risk as a union carpenter. The Washington Department of Labor and Industries (L&I) provided records of workers' compensation claims filed by these individuals. Over seven years 1773 drywall carpenters filed 2567 workers' compensation claims representing an overall rate of 53.3 per 200,000 hours worked. These claims were filed by 1046 different individuals, or 59.0 percent of the cohort. Claims resulting in paid lost time from work were filed at a rate of 12.5 per 200,000 hours worked (n = 609) by 445 (25.1%) different individuals. The most common mechanisms of injury involved being struck (38.3%), overexertion (28.1%), and falls (13.2%). Struck by injuries most commonly involved cuts to the upper extremity. Overexertion injuries were most commonly described as sprains or strains involving the back. Sheetrock was associated with over 40 percent of these injuries. Falls most commonly involved injuries to the knee followed by the back and multiple injuries. Struck by injuries decreased steadily with increasing age and increasing time in the union. There was a steady increase in the rate of falls with increasing age. Overexertion injuries were responsible for the greatest proportion of costs for medical care, permanent impairment, and paid lost days. The high rates of overexertion injuries among these workers is consistent with known ergonomic stresses on drywall jobs. However, these workers are also at high risk of acute traumatic injuries.

Adolescent↗
PubMed1999

Work-related eye injuries among union carpenters.

Union administrative records were combined with workers' compensation data to identify a cohort of 12,958 active union carpenters, their person-time at risk, and their documented work-related eye injuries between 1989 and 1995 in the state of Washington. The injuries were described using ANSI codes for injury nature, type (mechanism), and source or object associated with the event. Injuries which resulted in paid lost time from work were also described based on the ICD-9 codes attached to claims for their medical treatment. Overall rates of filing compensation claims for eye injuries as well as age, gender, and union local specific rates were calculated. To identify high risk subgroups and explore incident and recurrent events, the person-time and events were stratified by age, gender, time in the union, claim status, and predominant type of work of the union local with which each carpenter was affiliated for multivariate analyses with Poisson regression. Eye injuries were responsible for 12 percent (n = 1730) of workers' compensation claims during this time period, exceeded only by back and finger injuries. Thirty-one claims resulted in paid lost time from work and these cases accounted for one-third of all costs for medical care for eye injuries. At least 10 percent of all medical costs for eye injuries and 35.5 percent of medical costs for eye injuries which resulted in paid lost time were associated with injuries sustained while hammering--a very common carpenter exposure. Claims were filed at an estimated rate of 6.1 per 200,000 hours worked. Individuals with previous compensation claims for eye injuries had rates of injury 1.6 times higher than individuals without previous eye injuries. Rates decreased significantly with age and time in the union. Eye injuries among these union carpenters were very common, but the rate of injuries severe enough to require paid time off work was quite low. These findings raise questions about factors which might influence the failure to use appropriate protection including availability and acceptability of eye protection, use by peers, and perception of risk.

Adult↗
PubMed1999

Workers' compensation experience of North Carolina residential construction workers, 1986-1994.

A total of 31,113 workers' compensation claims among 7,400 North Carolina Homebuilders Association (NCHA) members and their subcontractors for the period 1986-1994 were analyzed to calculate workers' compensation claim incidence density rates. For the 7 years studied, the average rate (cases/200,000 work hours) for all claims was 16.40 and the rate for medical or lost time cases was 10.78. Highest rates for cases involving medical costs or paid lost time by mechanism of injury were observed for being struck by an object (3.1), lifting/movement (1.97), falls from a different level (1.13), striking against an object (0.87), and falls on the same level (0.46). Rates by mechanism of injury were highest for muscle strains (2.34), wounds/punctures (2.33), bruises/contusions (1.24), fractures/dislocations (0.98), and injuries to the eyes (0.81). Among medical cost or lost work time cases, body parts with highest injury rates were back/shoulders (1.99), fingers (1.31), leg/knee (1.00), hand/wrist (1.00), foot/ankle (0.86), and eyes (0.82). Injury rates were found to vary substantially among the residential construction trades. For more serious injuries involving medical costs greater than $2,000 or any lost work time, rates were highest for welders and cutters (28.1), insulators (24.3), roofers (19.4), and carpenters (15.3). The same general trends by trade were observed for cases involving paid lost time except that roofers were highest, with a rate of 9.1, followed by insulators (8.5), welders and cutters (5.8), and carpenters (5.8). Rates of falls from a different level resulting in medical costs or lost work time were highest for roofers (5.54), insulators (3.53), carpenters (2.05), and drywall installers (1.99). Descriptive information for falls from a different level resulting in paid lost time during 1993-1994 (n = 219) were reviewed to better determine the causes and circumstances of injuries. Falls from a roof accounted for 25.4 percent of the cases followed by falls involving scaffolds (23.9%) and ladders (20.6%), and falls from ceiling joists, floor joists, or framing (14.8%). Twenty-six work-related deaths occurred with vehicle accidents (n = 6) being the major known cause of death, followed by falls (n = 3), being struck by an object (n = 3), electric shock (n = 2), and contact with energy or chemicals (n = 2). Consistent with other analyses of workers' compensation data, chronic occupational diseases are not well captured in the workers' compensation claims among home builders; therefore, a companion study has examined mortality patterns among North Carolina construction workers.

Humans↗
PubMed1999

Mortality among North Carolina construction workers, 1988-1994.

This study evaluated proportionate mortality patterns among all male construction workers in North Carolina who resided and died in North Carolina during the period 1988-1994. Proportionate Mortality Ratios (PMRs) and Proportionate Cancer Mortality Ratios (PCMRs) compared the number of deaths among male construction workers with the number of deaths expected based on the gender, race, and cause-specific mortality experience of the entire North Carolina population by five-year age groups for the same years of study. PMRs based on United States death rates also were calculated. Among all male construction workers, significantly elevated mortality was observed for several causes possibly related to work including malignant neoplasms of buccal cavity (PMR = 143), pharynx (PMR = 134), and lung (PMR = 113), pneumoconiosis (PMR = 111), transportation accidents (PMR = 106), and accidental falls (PMR = 132). Elevated mortality also was observed for causes more related to lifestyle and non-occupational factors including alcoholism (PMR = 145), cirrhosis of the liver (PMR = 129), accidental poisoning (PMR = 136), and homicide (PMR = 141). Patterns of elevated mortality for Whites and Black men were similar and PCMR mortality patterns for Blacks and Whites combined were similar to PMRs. Construction workers were at significantly increased risk for deaths resulting from falls from ladders or scaffolds, falls from or out of buildings or structures, and electrocutions. Construction trades found to have statistically elevated cancer risks include laborers and roofers (buccal cavity), painters (pharynx), laborers (peritoneum), and carpenters, painters, brick masons, and operating engineers (lung). These data are consistent with other reports demonstrating excess mortality from asbestos-related diseases (pneumoconiosis, lung cancer, and mesothelioma) among construction workers. Dry-wall workers and laborers were found to have a statistically elevated risk of death as a result of respiratory tuberculosis.

Adolescent↗
PubMed1998

Respiratory diseases among union carpenters: cohort and case-control analyses.

Lung diseases, defined by ICD-9 diagnoses on medical insurance claims, were studied through the combined use of administrative records, private health insurance, and workers' compensation claims for a cohort of 10,938 active union carpenters between 1989 and 1992. The cohort defined the study base for a nested case-control study, in which cases (n = 220) were initially identified by an ICD-9 code for asthma in private health insurance or workers' compensation files. A questionnaire was used to collect information on respiratory history and potential home and workplace exposures. Questions used by Burney et al. to define a discriminant function predictor (DFP) of a bronchial response to histamine were used to reclassify cases and controls for further exploratory analyses. Bronchitis accounted for over 50% of the lung disease cases among this cohort followed by asthma, chronic obstructive airway disease, and chronic bronchitis. Incidence density rates of asthma, chronic bronchitis, and chronic obstructive airway disease adjusted for age, sex, and time in the union increased with increasing age. Using Surveillance, Epidemiology, and End Results (SEER) Program data to estimate expected lung cancer cases in our cohort, an elevated standardized incidence rate (SIR) was seen among male carpenters between the ages of 45-54. Smoking history was not available for the entire cohort. Using the ICD-9 or Burney case definition of asthma, odds ratios were significantly elevated for exposure to hay, epoxy paints, enzymes, animals, and molds. Additional exposures associated with asthma using Burney's definition, are ones to which a majority of these carpenters were exposed including cement, drywall, and demolition dusts.

Adolescent↗
PubMed1998

Proportionate mortality among union members employed at three Texas refineries.

The cause-specific mortality (1940-1993) of 2,985 male workers employed in three oil refineries was examined using a proportionate mortality study design. Separate analyses were undertaken by race, refinery, employment status (active and retired), and time since entry into the Oil, Chemical, and Atomic Workers (OCAW) union. Proportionate cancer mortality ratio (PCMR) analyses also were conducted. Proportionate mortality ratios (PMR) were significantly increased (P < 0.05) for cancers of the lip (PMR = 384), stomach (PMR = 142), unspecified sites of the liver (PMR = 238), pancreas (PMR = 151), connective tissues (PMR = 243), prostate (PMR = 135), eye (PMR = 407), brain (PMR = 181), benign and unspecified neoplasms (PMR = 289), and leukemia (PMR = 175) for the entire cohort. Significantly decreased mortality was observed for respiratory tuberculosis (PMR = 29), esophageal cancer (PMR = 45), rectal cancer (PMR = 49), and cancers of the bladder and other urinary organs (PMR = 40). Skin cancer was observed to be significantly increased (PMR = 242) for workers with less than 20 years since union initiation. Significantly increased PCMRs were seen for cancers of unspecified sites of the liver (PCMR = 205), brain (PCMR = 147), benign and unspecified neoplasms (PCMR = 243), and leukemia (PCMR = 146). Among nonwhites, an increased risk of bone cancer was observed in the PCMR analysis (PCMR = 704), although based on only two deaths. Analyses of mortality patterns for white males by refinery revealed similar patterns in each refinery as was seen in the overall cohort of refinery workers. Mortality patterns for whites and nonwhites also were similar. Additional analyses of deaths between 1960 and 1993 demonstrated increased mortality due to asbestosis (PMR = 683) and multiple myeloma (PMR = 124), although the multiple myeloma excess was not statistically significant. Ten deaths due to mesotheliomas were observed among these refinery workers.

Adult↗
PubMed1997

Surveillance of work-related musculoskeletal injuries among union carpenters.

Combined data sources, including union administrative records and workers' compensation claims, were used to construct event histories for a dynamic cohort of union carpenters from Washington State during the period 1989-1992. Person-time at risk and the events of interest were stratified by age, sex, time in the union, and predominant type of carpentry work. Poisson regression techniques were used to identify subgroups at greatest risk of filing claims for a variety of musculoskeletal disorders defined by ANSI codes for body part injured and injury nature. Distinguishing different kinds of musculoskeletal disorders, even crudely with ANSI codes, led to different conclusions about the effects of the explanatory variables. Among older workers, the rates of fractures of the foot were higher, while rates of contusions of the hand and foot were lower. Women had higher rates of sprain/strains and nerve conditions of the wrist/forearm. Higher rates of injuries to the axial skeleton were seen among carpenters who did predominantly light commercial and drywall work, while piledrivers had lower rates of these injuries. Drywall workers had higher rates of sprains to the ankle/lower leg. Workers who were members of the union as long as four years had lower risks for the vast majority of musculoskeletal disorders studied. Similar patterns were seen for more serious claims that resulted in paid lost time from work.

Adolescent↗
PubMed1994

Follow-up study of chrysotile asbestos textile workers: cohort mortality and case-control analyses.

Previous studies of mortality among white males employed in a Charleston, South Carolina asbestos textile plant using chrysotile demonstrated significant excess mortality due to asbestos-related disease and a steep exposure-response relationship for lung cancer. This cohort was further studied by adding 15 years of follow-up and including mortality among white female and black male workers. Nested case-control analyses were undertaken to further explore possible differences in lung cancer risk by textile operation as well as possible confounding by mineral oil exposures. Preliminary data for white males have been previously published. White males experienced statistically significant excess mortality due to lung cancer (standardized mortality ratio [SMR] = 2.30; confidence interval [CI] = 1.88-2.79), all causes (SMR = 1.48; CI = 1.38-158), all cancers (SMR = 1.50; CI = 1.29-1.72), diabetes mellitus (SMR = 2.05; CI = 1.18-3.33), heart disease (SMR = 1.41; CI = 1.26-1.58), cerebrovascular disease (SMR = 1.50; CI = 1.08-2.02), pneumoconiosis and other respiratory diseases (SMR = 4.10; CI = 3.10-5.31), and accidents (SMR = 1.49; CI = 1.15-1.91). Among white females, statistically significant excesses occurred for lung cancer (SMR = 2.75; CI = 2.06-3.61), all causes (SMR = 1.21; CI = 1.11-1.32), pneumoconiosis and other respiratory diseases (SMR = 2.40; CI = 1.53-3.60), and other respiratory cancers (SMR = 14.98; CI = 4.08-38.7). Among the total cohort of black males, the only statistically significant excess observed was for pneumoconiosis (SMR = 2.19; CI = 1.23-3.62). Based on historical exposure measurements at the plant, there was a positive exposure-response relationship for both lung cancer and pneumoconiosis. Data for the entire cohort demonstrate an increase in the lung cancer relative risk of 2-3% for each fiber/cc-year of cumulative chrysotile exposure. This relationship was more consistent for the white male workers. The excess risk for lung cancer among white males and females appeared to occur at cumulative exposures lower than those for black males. Possible reasons for the lesser lung cancer risk among black males include less smoking and differences in airborne fiber characteristics experienced by black males as a result of plant job placement patterns. The case-control analysis found employment in preparation and carding operations (where most of the black males worked) to be associated with a slightly reduced lung cancer risk, although not statistically significant, whereas spinning and twisting employment was associated with a statistically significant increased lung cancer risk compared to other plant operations.(ABSTRACT TRUNCATED AT 400 WORDS)

Black or African American↗
PubMed1994

Lung cancer mortality among asbestos textile workers: a review and update.

In an update of the mortality of the cohort of 1200 South Carolina textile workers, of whom almost half died, there were 185 excess deaths (SMR = 1.44), which included 71 cardiovascular diseases (SMR = 1.37), 43 non-malignant respiratory diseases (SMR = 2.25) and 41 lung cancers (SMR = 2.25). Only two definite mesotheliomas were observed. Other possible cases may have occurred but no confirmatory pathology was available. Strong exposure-response relationships have been found for lung cancer and for non-malignant respiratory diseases. The data suggest a doubling of the lung cancer risk at an exposure of approximately 30 fibre years. Mortality from pneumoconiosis and other respiratory diseases was elevated at even the lowest cumulative exposure category (< 2 f ml-1 years). A nested case-control analysis failed to demonstrate a significant role for mineral oil exposure in the etiology of lung cancer. Differences in airborne fibre sizes may be important in explaining different lung cancer and pneumoconiosis risks in various industries. In particular, the data on airborne fibres in textile manufacturing industries suggested 11-27% were longer than 5 microns compared to 2-5% for mining and milling.

Asbestos, Serpentine↗
PubMed1994

Mortality patterns among female and male chrysotile asbestos textile workers.

This study updates a retrospective cohort mortality analysis of workers from a South Carolina textile plant where chrysotile asbestos was the primary exposure. The update adds 15 years of observation to the original study, adds analyses of white women and black men, and allows comparison of mortality risks between race/gender groups. The total cohort includes 3,022 workers: 1,229 white women (363 deaths), 1,247 white men (607 deaths), and 546 black men (289 deaths). Statistically significant risks for lung cancer were observed among white women (standardized mortality ratio [SMR] = 2.07; 90% confidence interval [CI] = 1.55-2.71) and white men (SMR = 2.24; 90% CI = 1.83-2.72); both of these groups exhibited positive exposure-response trends. Although the lung cancer risk among black men was lower than expected (SMR = 0.70; 90% CI = 0.42-1.08), a statistically significant increase was observed at high levels of exposure. Statistically significant excess risk for pneumoconiosis and other respiratory diseases were observed for all race/gender groups. Despite the relatively high percentage of white women lost to follow-up and missing death certificates, both of which allow underestimation of the true relative risk, statistically significant excess risks were observed for lung cancer and pneumoconiosis among this group.

Asbestos, Serpentine↗
PubMed1994

Exposure assessment and gender differences.

Exposure assessments for occupational epidemiological studies are typically conducted to (1) establish risk gradients with exposure, evaluating a potential causal relationship, or (2) estimate exposure-response dosimetry for quantitative risk calculations. Unavailable quantitative exposure data require use of surrogate or qualitative measures. Differences in women's employment patterns may make surrogate measures less reliable, resulting in systematic errors. Exposures associated with traditionally female careers have not been fully evaluated. Occupational cohorts are often defined to include workers with a minimum employment duration or employment for some minimum time in exposure-related jobs, thereby excluding many women workers. Even when included among studied and exposed worker cohorts, women's domestic exposures may confound risk evaluation. Male/female differences in xenobiotic uptake, distribution, kinetics, and metabolism may affect the relationship between external exposure and resulting biologically effective dose. Clinical factors alter the recognition of disease among women workers, confounding risk determination. Recognizing these problems during design and analysis of occupational cancer epidemiology research is essential to develop valid preventive strategies.

Adult↗
PubMed1993

Carcinogenic effects of wood dust: review and discussion.

Occupational exposure to wood dust (alone or chemically treated) is associated with an increased risk of developing adenocarcinoma of the nasal cavity. The specific causative agents, i.e., wood dust alone (natural products), wood dust with additives used in the processing or manufacturing of wood products, and/or physical determinants of wood dust and the associated risk factors, are not known or understood. The strongest association of exposure to wood dust and development of nasal cancer is observed in those occupations where workers are exposed to hard wood dust and chemical additives are not used. The time between first occupational exposure to wood dust and the development of adenocarcinoma of the nasal cavity averages 40 years (range 7-70 years). The epidemiological data available are not sufficient to make a definitive assessment between wood dust exposure and increased risk for cancer other than nasal cancer. The toxicity, mutagenicity, and carcinogenicity of wood dust to laboratory animals or in vitro with animal or microbial cells have not been thoroughly studied. Thus there is no direct experimental evidence on the potential hazards of wood dust. Data are insufficient or lacking on 1) wood dust exposure levels in ambient air and worker's breathing zone, and the deposition in the nasal cavity; 2) hard vs. soft wood dusts; 3) particle size and shape; 4) chemical composition of wood dust and the extent of contamination with chemical additives; and 5) interaction between inhaled wood dust, chronic irritation, and tobacco smoking. These data are required so that one can understand the association between wood dust exposure and nasal cavity tumors, along with demographic differences in cancer rates, and to develop strategies for intervention and reduction of disease causing agents in order to reduce risk to wood industry workers.

Animals↗
PubMed1991

Carcinogenicity of chrysotile asbestos: a case control study of textile workers.

Chrysotile is the predominant type of asbestos used in the United States and thus represents the most important source of exposure to asbestos already in place. While the steepest exposure-response observed for lung cancer has been in workers exposed to chrysotile in textile operations, some argue that chrysotile is less carcinogenic than amphibole asbestos types. Mineral oil exposures have been hypothesized to be responsible for the highly elevated lung cancer risk seen in textile workers. A lung cancer case-control analysis among a cohort of South Carolina chrysotile asbestos textile workers was conducted. Only a modest reduction in the slope of the lung cancer exposure-response relationship was observed after controlling for mineral oil exposures. These data do not support mineral oil exposure as a plausible explanation for the elevated lung cancer risk seen in chrysotile asbestos textile workers. The possible role of longer, thinner, more carcinogenic fibers in textiles is one plausible hypothesis needing further investigation.

Asbestos↗