Biomedical subjects

T K Courtney

Publications and source records attributed to T K Courtney.

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↗

PubMed2001

The measurement of slipperiness--an international scientific symposium.

Occupational slips, trips, and falls (STF) present a tremendous burden on the working people of the world. The precise contribution of slipping to this burden is not completely understood and significant questions exist regarding the definition and measurement of slipperiness. In an attempt to advance slipperiness measurement, a workshop symposium of tribologists, biomechanists, clinicians, engineers, epidemiologists and related scientists was held in order to summarize the state of the science in slipperiness measurement. Organized into issue-focused working groups, participants collaborated on manuscripts addressing conceptual and definitional issues, the contribution of slipperiness to STF injury, and biomechanical, human-centred, and tribological approaches to slipperiness measurement. The conference design, contributions of working groups and outcomes are summarized.

Accidental Falls↗

PubMed2001

Measurement of slipperiness: fundamental concepts and definitions.

The main objective of this paper is to give an overview of basic concepts and definitions of terms related to the 'measurement of slipperiness' from the onset of a foot slide to a gradual loss of balance and a fall. Other unforeseen events prior to falls (e.g. tripping) are sparingly dealt with. The measurement of slipperiness may simply comprise an estimation of slipping hazard exposures that initiate the chain of events ultimately causing an injury. However, there is also a need to consider the human capacity to anticipate slipperiness and adapt to unsafe environments for avoiding a loss of balance and an injury. Biomechanical and human-centred measurements may be utilized for such an approach, including an evaluation of relevant safety criteria for slip/fall avoidance and procedures for validation of slip test devices. Mechanical slip testing approaches have been readily utilized to measure slipperiness in terms of friction or slip resistance but with conflicting outcomes. An improved understanding of the measurement of slipperiness paradigm seems to involve an integration of the methodologies used in several disciplines, among others, injury epidemiology, psychophysics, biomechanics, motor control, materials science and tribology.

Accidental Falls↗

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

The role of friction in the measurement of slipperiness, Part 2: survey of friction measurement devices.

This paper seeks to address questions related to friction measurement such as how friction is related to human-centred assessment and actual slipping, and how repeatable friction measurements are. Commonly used devices for slipperiness measurement are surveyed and their characteristics compared with suggested test conditions from biomechanical observations summarized in Part 1. The issues of device validity, repeatability, reproducibility and usability are examined from the published literature. Friction assessment using the mechanical measurement devices described appears generally valid and reliable. However, the validity of most devices could be improved by bringing them within the range of human slipping conditions observed in biomechanical studies. Future studies should clearly describe the performance limitations of any device and its results and should consider whether the device conditions reflect these actual human slipping conditions. There is also a need for validation studies of more devices by walking experiments.

Accidental Falls↗

PubMed2000

Low back pain disability: relative costs by antecedent and industry group.

BACKGROUND: Previous studies of workers' compensation claims for low back pain (LBP) have revealed that the preponderance of disability is borne by a fraction of cases. However, less is known regarding the influence of occupational factors on these extreme conditions. METHODS: Workers' compensation claims (n=107,867) for LBP reported to a large, national insurer in 1992 were examined by antecedent event and industry class. In addition to summaries of the frequency and cost distribution, each factor was examined at two points on its cost distribution: one more representative of the typical case and one more representative of the case with long disability. These alternative disability indicators were introduced to explore a different perspective of LBP disability. RESULTS: The information provided by the alternative indicators was distinct from the information provided by the traditional aggregate indicators (claim frequency and claim cost frequency). In particular, this method identified increased severity for claims in the construction and services sectors, as well as for claims arising from falls and motor vehicle crashes. CONCLUSIONS: The results suggest that the construction and service sectors confront unique challenges to prevention and management of LBP disability. LBP related to discrete antecedents such as falls and motor vehicle crashes merits consideration on the basis of exceptionally severe disability.

Accidental Falls↗

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↗

PubMed2000

Clinical management and the duration of disability for work-related low back pain.

Clinical practice guidelines recommend a conservative approach to management of acute low back pain (LBP). The present study sought to determine whether health care utilization and the physician's initial management of work-related LBP were associated with disability duration. Clinical management information was obtained for 98 randomly selected, workers' compensation claimants with acute, uncomplicated, disabling work-related LBP. Length of disability was based on indemnity (wage replacement) payments. Disability was significantly associated with increased utilization of specialty referrals (P = 0.013) and provider visits (P < 0.001), use of magnetic resonance imaging (P = 0.003), and use of opioids for more than 7 days (P = 0.013). Effects of early diagnostic imaging (first 30 days of care) on length of disability were observed (P = 0.001). Patients whose treatment course did not involve extended opioid use and early diagnostic testing were 3.78 times more likely (95% confidence interval, 1.6 to 8.9) to have gone off disability status by the end of the study. The nature of the association between these initial clinical management aspects and LBP disability duration merits further exploration.

Absenteeism↗

PubMed1999

Disabling occupational morbidity in the United States. An alternative way of seeing the Bureau of Labor Statistics' data.

The United States Bureau of Labor Statistics' (BLS) annual survey of occupational injuries and illnesses (ASOII) is one of the most frequently utilized sources of data on national occupational morbidity. In 1992 the BLS introduced a new and expanded survey method that collects more detailed data on cases with days-away-from-work (DAW). However, to date, the BLS has not released any official publication that contains a comprehensive set of crosstabulated part-of-body (BP) and nature-of-injury (NOI) data. To improve the understanding of national DAW case morbidity estimates, the study presented here utilized a special data-call and data-reduction strategy to identify the leading ASOII BP-NOI combinations for DAW cases by frequency, incidence rate, and severity (median DAW) for 1994. The results indicated the significance of disability associated with discrete trauma (ie, resulting from instantaneous or sudden events) in the US workplace. While morbidity associated with back pain clearly continued as the most frequent type of disabling case, fractures at critical anatomical sites (eg, pelvic region, leg, shoulder) were responsible for the most lengthy disability absences from work in 1994. In some instances these findings were contrary to conclusions typically inferred from BLS publications.

Back Pain↗

PubMed1998

A descriptive study of U.S. OSHA penalties and inspection frequency for musculoskeletal disorders in the workplace.

Information on the frequency and cost of OSHA enforcement penalties for musculoskeletal disorders (MSD) in the literature is limited. Such information would be of value to organizations in estimating the likelihood and financial impact of enforcement activity in their operations. This descriptive study utilized data from federal Occupational Safety and Health Administration (OSHA) inspections to examine the distribution of penalty costs arising from inspections with MSD-related citations from January 1985 to June 1994 and to estimate the probability of OSHA inspection in general and OSHA citation for MSD hazards from October 1985 to September 1993. The mean and median values of proposed penalties were $47,707 and $3600 respectively. A substantial influence of 1991 changes to the penalty structure was noted with decreasing mean and increasing median penalty values. Penalty values increased with establishment size and were higher for unplanned than for planned inspections. The probability of a federal OSHA inspection for any establishment ranged from 1:50 in 1986 to 1:100 in 1993 whereas the estimated probability of an inspection with MSD-related citations ranged from 1:167,000 in 1996 to as much as 1:38,000 during the peak of enforcement activity in 1990. The probability of an inspection with MSD citations for the largest establishments during the period was more than 1000 times greater than that for the smallest. The results of this study may be utilized by organizations seeking to demonstrate the advantages of reducing musculoskeletal morbidity in the workplace.

Guideline Adherence↗

PubMed1998

Length of disability and cost of work-related musculoskeletal disorders of the upper extremity.

There is little information on the length of disability (LOD) reported for work-related musculoskeletal disorders of the upper extremity (WMSDUE). For this study, LOD, cost, and the relationship between LOD and cost were derived from a large workers' compensation company's claims data for 1994 WMSDUE (n = 21,338). The average LOD was 87 days, with a median of zero days. For those claims with at least one day of compensable disability (25.2%), the average and median LOD were 294 and 99 days, respectively. The distribution of cost was skewed, with the average cost of a claim being 13 times higher than its median. Approximately 60% of the claims cost $1000 or less. Additionally, the 6.8% of the claims with an LOD greater than one year accounted for 59.9% of the cost and 75% of the total disability days. The majority of WMSDUE claimants did not lose sufficient time to qualify for indemnity. For those who did receive lost time wages, a disability duration of more than three months was typical.

Adult↗

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

Conceptual and definitional issues in occupational injury epidemiology.

This paper presents several models that further define the concept of occupational injury. While traditional models have proved successful in isolating specific research questions and health phenomena, the conceptual model presented permits a broader view of all injury morbidity. This model is based on both the level and frequency of energy transfers. A process model of occupational injury is also presented to describe the basic pathophysiological relationships associated with tissue effects/damage and recovery/repair. Numerous tradeoffs exist in variable selection, and a third model explores some of these tradeoffs. Differences in terminology and fundamental principles can limit the progress of occupational injury research. Accordingly, an argument is made for consolidation and consensus of terms. Finally, considerations for research are suggested, with an emphasis on the severity of the injury, the risk ratio, and the population at risk.

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↗

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

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↗