[Current status of abdominal pancreatic ultrasound. A retrospective analysis of 585 pancreatic ultrasound examinations]. / Aktueller Stellenwert der abdominellen Pankreassonographie. Eine retrospektive Analyse von 585 sonographischen Pankreasuntersuchungen.

BACKGROUND: In the recent years several investigations focused on the diagnostic value of abdominal ultrasonography in pancreatic disorders. However, the diagnostic accuracy in these studies ranged between 40 and 90% probably related to variations in study design and other methodologic criteria. PATIENTS: We examined retrospectively 585 patients subdivided into six subgroups. 385 patients had a clinical question aimed at the pancreas and the remaining 200 functioned as screening patients. RESULTS: Using laboratory tests, CT, ERCP, surgery and autopsy as reference methods the positive predictive value for all pancreatic disorders was 85% with the best results for chronic pancreatitis (86% versus 77.5% for acute pancreatitis and 79.5% for malignant tumors). The prevalence of pancreatic disease in symptomatic patients was 28.6% versus only 2.5% in the screening groups. Therefore no significant differences could be detected in groups where the pancreas was not clearly visualized and groups with negative sonographic findings (4% false negative findings versus 1%, respectively). In groups with suspected pancreatic disease the negative predictive value was 86% which was independent of the visualization of the pancreas. CONCLUSION: In summary positive sonographic findings have a high predictive value for pancreatic disorders and negative results are not more reliable than missing visualization of the pancreas. The positive predictive value is independent from the kind of pancreatic disease and in screening examinations negative findings and findings without clearly visualization of the pancreas have both high negative predictive values.

Denominator choice in the calculation of workplace fatality rates.

The U.S. government currently publishes workplace fatality rates, using employment as the denominator. However, employment may not be a good proxy for worker exposure to risk if groups of workers differ in their hours worked. Using micro data from the Census of Fatal Occupational Injuries and Current Population Survey, this paper presents alternative fatality rates calculated using employment and hours worked. Rates are compared for worker groups defined by gender, age, occupation, and industry. In general, both measures identify the same groups of workers as facing especially high and low fatality risks. The rank correlation of the employment- and hours-based fatality rates for 222 detailed occupations is very high, with a value of 0.99. However, for a few groups, the hours- and employment-based rates may differ more than 10%. Most notably, workers below age 20 and above age 64 have rates that are 60% and 37% higher, respectively, when hours is used in the denominator. This suggests that hours--the conceptually preferable denominator--should be used when possible to calculate workplace fatality rates.

Male and female rate differences in carpal tunnel syndrome injuries: personal attributes or job tasks?

Carpal tunnel syndrome (CTS) exacts a significant toll on the health and productivity of American workers. In 1996, 29,937 workers lost time from work due to CTS. Half of these were out for more than 25 days, compared to a median of 5 days for all injuries/illnesses. There are striking gender disparities in CTS rates. Overall, three times more women suffer from CTS than men. While some authors have emphasized the role of gender attributes in this risk disparity, the multifactoral causes of CTS, and the sex segregation of women into jobs with high-risk tasks, may be obscuring the work-related contributions to CTS risk. We argue here that men and women doing the same work tasks will have similar rates of CTS. To examine this premise, we used Bureau of Labor Statistics injury counts (numerator) and census data from the Current Population Survey (denominator) to determine injury rates of CTS for both men and women in six high-risk occupations: (1) assembler, (2) laborer-nonconstruction, (3) packaging and filling machine operators, (4) janitors and cleaners, (5) butchers and meat cutters, and (6) data entry keyers. Variable job tasks exist within five of the six high-risk occupational titles. Among those five, the male to female (M:F) risk rate ratio ranged from 0.29 to 0.50. However, the sixth occupational title, data entry keyers, which requires a single physical task, had a risk rate ratio of 1.06. This suggests that an equal risk between genders exists when the occupational tasks (exposure) are truly similar. Job task analysis unmasks potential biases that may wrongly attribute disproportionate CTS rates to gender attributes. This focus on gender attributes fails all workers because preventive interventions in the workplace are deferred. It fails women disproportionately because they are overrepresented in jobs at high risk for CTS.