Agreement between fixed-ratio and lower limit of normal spirometry interpretation protocols decreases with age: is there a need for a new GOLD standard?

OBJECTIVES: To assess concordance between the fixed 70% ratio cutoff point with the fixed percent predicted values (Fixed-ratio) and the lower limit of normal (LLN) algorithms in interpreting spirometry results in an older population. METHODS: Spirometries were interpreted using Third National Health and Nutrition Examination Survey reference equations for 2319 workers. RESULTS: The Fixed-ratio algorithm characterized 34.5% (n = 801) results as abnormal, compared with 29.7% (n = 689) by the LLN. There were almost twice as many obstructive and mixed airways spirometries identified under the Fixed-ratio compared to LLN. Rates of restrictive pattern physiology were virtually the same under each algorithm. Overall agreement between the algorithms decreased with age from "almost perfect" for those younger than 60 years to "substantial" for those older than 80 years. CONCLUSIONS: This study found age-related discordance between two algorithms possibly related to the lack of reference equations and standards for individuals older than 80 years.

Risk and significance of chest radiograph and pulmonary function abnormalities in an elderly cohort of former nuclear weapons workers.

OBJECTIVE: To estimate prevalence and risk factors for International Labour Organization radiographic abnormalities, and assess relationship of these abnormalities with spirometry results in former Department of Energy nuclear weapons workers. METHODS: Participants were offered chest x-ray (CXR) and lung function testing. Three occupational medicine physicians read CXRs. RESULTS: Forty-five (5.9%) of 757 screened workers were found to have isolated parenchymal abnormalities on CXR and this rate is higher than that in many Department of Energy studies. Parenchymal and pleural and isolated pleural abnormalities were found in 19 (2.5%) and 37 (4.9%) workers, respectively, and these rates are lower than those in other Department of Energy studies to date. Lung function impairment was associated with radiographic abnormalities. CONCLUSIONS: This study found an elevated rate of parenchymal abnormalities compared to other DoE populations but the effect of age or other causes could not be ruled out.

Risk of beryllium sensitization in a low-exposed former nuclear weapons cohort from the Cold War era.

BACKGROUND: The nuclear weapons industry has long been known as a source of beryllium exposure. METHODS: A total of 1,004 former workers from a nuclear weapons assembly site in the Midwest were screened for sensitization to beryllium (BeS). The screenings were part of the Department of Energy (DOE) Former Worker Program established in 1996. RESULTS: Twenty-three (2.3%) workers were found sensitized to beryllium and this prevalence was comparable to other DOE sites. Occasional, direct exposure to beryllium through machining and grinding of copper-beryllium (Cu-Be) 2% alloy tools was found to increase the risk of sensitization compared to background exposure (OR = 3.83; 95% CI: 1.04-14.03) with a statistically significant trend (P = 0.03) revealing that particular jobs are associated with sensitization. Exposure potential in this study was estimated based on job titles and not personal exposure information. CONCLUSIONS: These results confirm the need to screen workers using beryllium alloy tools in other industries and for consideration of altering work practices.

Prevalence of beryllium sensitization among Department of Defense conventional munitions workers at low risk for exposure.

OBJECTIVE: To estimate the prevalence of beryllium sensitization among former and current Department of Defense workers from a conventional munitions facility. METHODS: Participants were screened by using Beryllium Lymphocyte Proliferation Test. Those sensitized were offered clinical evaluation for chronic beryllium disease. RESULTS: Eight (1.5%) of 524 screened workers were found sensitized to beryllium. Although the confidence interval was wide, the results suggested a possibly higher risk of sensitization among workers exposed to beryllium by occasional resurfacing of copper-2% beryllium alloy tools compared with workers with the lowest potential exposure (odds ratio = 2.6; 95% confidence interval, 0.23-29.9). CONCLUSIONS: The findings from this study suggest that Department of Defense workers with low overall exposure to beryllium had a low prevalence of beryllium sensitization. Sensitization rates might be higher where higher beryllium exposures presumably occurred, although this study lacked sufficient power to confirm this.

Farm activities associated with eye injuries in the Agricultural Health Study.

Farmers are at risk for work-related eye injuries, some of which can be very serious. This study describes the farm activities that were related to eye injury in a group of 36 Iowa farmers in the Agricultural Health Study who sustained 40 farmwork-related eye injuries requiring medical advice or treatment. Farm activities of grinding or cutting metal accounted for 11 (27.5%) of the eye injuries, welding for 3 (7.5%), and drilling for 2 (5%). The other 24 eye injuries were related to diverse farm activities. One injury was caused by an animal. Only one injury was caused by a chemical exposure. Foreign body in the eye was the most frequent type of eye injury overall, accounting for 32 (80%) of the eye injuries. Of those, 20 were metallic foreign bodies. Although none of the injuries required hospitalization, 10 eye injuries (25%) resulted in the farmer missing 1 to 5 days of work. At least three injuries occurred while farmers were wearing safety glasses/goggles. These results suggest that farmers are at risk for eye injury from activities such as grinding and cutting metal, welding, and drilling and from other diverse activities on the farm for which eye hazards may not have been anticipated. In addition, these findings have implications for use of appropriate eye protection during all farm activities.

Occupational injuries among workers with diabetes: the National Health Interview Survey, 1997-2005.

OBJECTIVE: To assess associations between diabetes and occupational injury. METHODS: Data from the 1997 to 2005 National Health Interview Survey comprised a sample of 195,284 adult workers. Multivariate logistic regression analysis assessed associations between diabetes and occupational injuries, adjusting for age, sex, race, and education. Additional logistic regression analysis examined the effect of medical therapy and duration of diabetes with occupational injury. RESULTS: There was no significant association between diabetes and occupational injury (adjusted OR = 1.18; 95% CI = 0.86 to 1.61). Subgroups of diabetics who reported no current diabetes therapy (OR = 1.87; 95% CI = 1.01 to 3.47) or duration of diabetes longer than 12 years (OR = 1.83; 95% CI = 1.05 to 3.18) were at increased risk for occupational injury. CONCLUSION: The finding of no overall increased risk for occupational injury among workers with diabetes provides nationally representative results that may be useful to policymakers. Increased risk for occupational injury among untreated diabetics or those with long duration of disease may lead to focused efforts to prevent occupational injuries.

Occupational and non-occupational injuries in the United States Army: focus on gender.

BACKGROUND: The differences in occupational and non-occupational injuries between military men and women have not been documented. This study compares occupational and non-occupational injuries between male and female United States Army soldiers by examining injury hospitalization rates and characteristics. METHODS: The U.S. Army's Total Army Injury and Health Outcomes Database was searched for hospitalizations with ICD-9-CM codes for injury (800-959.9) between 1992 and 2002. Injury rates were calculated using yearly U.S. Army population data and compared using rate ratios. Injury characteristics were compared among categories of the Trauma Code (on duty; off duty; scheduled training, schemes, and exercises), stratified by gender. RESULTS: Included in this analysis were 792 women for an injury hospitalization rate of 11.0 per 1000 individuals (95% confidence interval [CI]=8.5-13.5) and 4879 men for a rate of 15.5 per 1000 individuals (95% CI=14.0-16.9). While women had significantly more injuries during scheduled training, schemes, and exercises than men (p<0.0001), there were few differences in the cause of those injuries. Women had longer average hospital stays compared to men due to these injuries (9.3 days vs 7.4 days, p=0.002), although these injuries were not more severe (average Injury Severity Score=3.5 for men vs average ISS for women=3.5, p=0.79). There was no difference between the genders in the percent of injuries that occurred off duty; however, men were more likely to get injured due to sports and athletics (p=0.001) and due to fighting (p=0.017) while off duty compared to women. CONCLUSIONS: Injury prevention messages for military personnel should focus on reducing risk factors for both on- and off-duty injuries.

Characteristics of crashes with farm equipment that increase potential for injury.

CONTEXT: Crash fatality and injury rates are higher on rural roadways than other roadway types. Although slow-moving farm vehicles and equipment are risk factors on rural roads, little is known about the characteristics of crashes with farm vehicles/equipment. PURPOSE: To describe crashes and injuries for the drivers of farm vehicles/equipment and non-farm vehicles involved in an injury crash. Passengers are not included in this analysis. METHODS: Injury crashes were included that involved a farm vehicle/equipment and at least one non-farm vehicle reported in Iowa Department of Transportation crash data from 1995 to 2004. Odds ratios were calculated through logistic regression to identify increased odds for injury among drivers of non-farm vehicles and farm vehicles/equipment. We examined frequently occurring crash characteristics to identify crash scenarios leading to the highest odds for injury. FINDINGS: Non-farm vehicle drivers were 5.23 times more likely to be injured than farm vehicle/equipment drivers (95% CI = 4.12-6.46). The absence of restraint use was a significant predictor of injury for both farm vehicle/equipment drivers (OR = 2.85; 95% CI = 1.14-7.13) and non-farm vehicle drivers (OR = 2.53; 95% CI = 1.54-4.15). Crash characteristics increasing the odds of injury for non-farm vehicle drivers included speeding, passing the farm vehicle/equipment, driving on a county road, having a frontal impact collision, and crashing in darkness. Ejection was the strongest predictor of injury for the farm vehicle/equipment driver. CONCLUSION: Non-farm vehicle drivers were much more likely to be injured than farm vehicle/equipment drivers, suggesting that farm vehicle/equipment crash prevention should be a priority for all rural road users. Prevention strategies that reduce motor vehicle speed, assist in safe passing, increase seat belt use, and increase conspicuousness of the farm vehicle/equipment are suggested.

Sleep quantity and quality as a predictor of injuries in a rural population.

This study aimed to assess the association of sleep disturbance and injuries in a rural population of Iowa. Study participants were 1345 adults who were enrolled in the KCRHS. Sleep problems were assessed based on self-reports at the beginning of the study. Injury information was collected by telephone interviews an average of every 6 months from August 1999 to June 2004. Sleeping for less than 7.5 hours increased the risk for injuries by 61% (rate ratio, 1.61; 95% confidence interval, 1.21-2.15) compared with sleeping for 7.5 to 8.5 hours (reference). Snoring frequency/severity and daytime fatigue/sleepiness were not significant in predicting the risk for injuries. Alcohol consumption of 1 to 2 or more drinks per day increased the risk for injuries among those who had sleep problems. Having adequate hours of sleep is important in preventing injuries. Avoiding alcohol consumption would be especially helpful in reducing injuries among people with sleep disturbance.

Hearing loss as a risk factor for agricultural injuries.

BACKGROUND: Previous studies suggested that hearing impairment based on self-report might increase the risk of agricultural injuries. However, self-reported hearing measures may be subject to inaccuracy and subjective perception. We assessed the association of agricultural injuries with hearing loss and other hearing characteristics using measured hearing. METHODS: Study subjects were 150 farmers who participated in the Iowa Certified Safe Farm study. Injury information was collected by telephone interviews at 2-5 month intervals from September 1999 to October 2002. Hearing levels were measured annually using the pure tone audiometry from 1998 to 2002. Adjusted rate ratios of injuries were calculated using the multivariate Poisson regression model. RESULTS: Hearing loss in the better ear (RR = 1.62), hearing asymmetry (RR = 1.67), and fair/poor self-reported hearing (RR = 1.96) were significantly associated with the risk of agricultural injuries. It is notable that self-reported hearing might be a stronger predictor of injuries than pure tone audiometry (PTA). Exposure to noise elevated the risk of injuries in those farmers with hearing loss or hearing asymmetry. The occasional use of hearing protection was significantly associated with agricultural injuries. CONCLUSIONS: This study adds substantial evidence that hearing loss acts as a risk for agricultural injuries. Prevention of hearing loss and noise exposure may be important in reducing the burden of agricultural injuries.

Effects of premium discount on workers' compensation claims in agriculture in Finland.

BACKGROUND: The objective of this study was to measure changes in injury claim rates after a premium discount program was implemented in the Finnish farmers' workers' compensation insurance. We focused on measures that could indicate whether the changes occurred in the true underlying injury rate, or only in claims reporting. METHODS: Monthly injury claim rates were constructed at seven disability duration levels from January 1990 to December 2003. We conducted interrupted time series analyses to measure changes in the injury claim rates after the premium discount was implemented on July 1, 1997. Three additional policy change indicators were included in the analyses. RESULTS: The overall injury claim rate decreased 10.2%. Decreases occurred at four severity levels (measured by compensated disability days): 0 days (16.3%), 1-6 days (14.1%), 7-13 days (19.5%), and 14-29 days (8.4%). No changes were observed at higher severity levels. Minor injuries had a seasonal pattern with higher rates in summer months while severe injuries did not have a seasonal pattern. CONCLUSIONS: The premium discount decreased the overall claim rate. Decreases were observed in all categories up to 29 disability days. This pattern suggests that under-reporting contributes to the decrease but may not be the only factor. The value of the premium discount is lower than the value of a lost-time claim, so there was no financial reason to under-report lost-time injuries. Under-reporting would be expected to be greatest in the 0 day category, but that was not the case. These observations suggest that in addition to under-reporting, the premium discount may also have some preventive effect.

Comparison of farmers in the agricultural health study to the 1992 and the 1997 censuses of agriculture.

CONTEXT: The Agricultural Health Study (AHS) is a large, prospective cohort study in the states of Iowa and North Carolina that has been developed to better understand how pesticides and other agricultural exposures relate to the occurrence of cancer and other diseases. PURPOSE: This report compares the characteristics of AHS farmers to the Census of Agriculture to evaluate the generalizability of AHS findings. METHODS: We restricted the AHS to private pesticide applicators who enrolled in Iowa (n = 31,065) and in North Carolina (n = 17,239) between 1993 and 1997, and who identified themselves as living or working on a farm. We compared their self-reported data with data from the 1992 and 1997 Censuses of Agriculture. FINDINGS: AHS farmers in Iowa are younger; live or work on larger farms; more frequently apply herbicides, insecticides, and fungicides; and are more likely to raise beef cattle and swine, and grow corn, soybeans, hay, and oats. AHS farmers in North Carolina are also younger, live or work on larger farms, more frequently reported growing crops commonly seen in the state, and are more frequent pesticide users. However, animals raised are similar to those in the North Carolina Census of Agriculture. CONCLUSIONS: AHS farmers likely represent the higher end of pesticide usage in both states in part because AHS farmers have larger farms. Since the health effects of pesticides are best ascertained among pesticide users with the greatest exposure, the AHS cohort should prove to be a valuable resource for health effects research.

Cost of compensated injuries and occupational diseases in agriculture in Finland.

Although agriculture is one of the most hazardous industries, the costs of agricultural injuries and illnesses are not well known. This study aimed to determine the cost burden from compensated injuries and occupational diseases in Finnish agriculture using workers compensation records. The incidence rates in 1996 were 7.4/100 for injuries and 0.61/100 for occupational diseases. Men had a higher risk of injury (RR = 1.89; 95% CI: 1.81-1.97), but a lower risk of an occupational disease (RR = 0.68; 95% CI: 0.60-0.78), compared to women. The total cost burden was 75 (Euros) per person in 1983, increasing to 215 in 1999. The total insurance cost in 1996 was 23.5 million consisting of medical care (16%), per diem (lost time compensation within one year from the incident) (37%), pension (lost time compensation after one year from the incident) (23%), survivors pension (3%), impairment allowance (7%), rehabilitation (6%), and other costs (9%). The total cost was 0.7% of the national gross farm income and 2.2% of the net farm income. The mean cost of 1996 cases was 1340 for injuries and 6636 for occupational diseases. Injuries represented 92% of the claims and 71% of the total costs. Occupational diseases represented 8% of the claims and 29% of the costs. Twenty percent of the most severe claims represented 79.5% of the total insurance costs. Injuries and occupational diseases result in significant costs in agriculture. Lost time was the largest cost item. Overall, injuries were more costly than occupational diseases. This study indicates that the 20%-80% rule applies to agricultural injury and illness costs, and from the cost standpoint, it is important to focus prevention efforts on the most severe incidents.

A comparison of self-reported hearing and pure tone threshold average in the Iowa Farm Family Health and Hazard Survey.

BACKGROUND: Self-reported hearing measures are useful for surveying hearing loss in a population because they are short, and easy to administer by either questionnaire or telephone. This study aims to assess the performance of several self-reported hearing measures to identify hearing loss in a group of Iowa farmers. METHODS: The study subjects were 98 male farmers who participated in the Iowa Farm Family Health and Hazard Survey. We tested three self-reported hearing measures; the hearing screening questions, the Rating Scale for Each Ear (RSEE), and the Health, Education and Welfare-Expanded Hearing Ability Scale (HEW-EHAS), which were originally developed and implemented in the National Health Interview Survey. The sensitivity and specificity of the self-reported hearing measures were assessed by comparing them with pure tone threshold averages. These sensitivity and specificity measures were compared between younger and older age groups. RESULTS: The sensitivities of the screening questions, RSEE, and HEW-EHAS were 73.0%, 66.7%, and 53.3%, respectively. The specificities of the self-reported hearing measures were similar, which ranged from 81.4% to 84.8%. The sensitivities of the self-reported hearing measures were higher in the younger age group while the specificities were higher in the older age group. CONCLUSIONS: The results of this study support the use of simple screening questions in identifying hearing loss among farmers.

Risk factors for falls among Iowa farmers: a case-control study nested in the Agricultural Health Study.

BACKGROUND: Farmers are at increased risk for fall-related injury compared with other occupations. Little is known about risk factors for non-fatal falls on the farm. This case-control study, nested within the Agricultural Health Study, aimed to assess risk factors for work-related falls among Iowa farmers. METHODS: A screener questionnaire sent to 6,999 farmers in 1998 identified 79 farmers who reported a fall-related farm injury that required medical advice or treatment in the previous year. Multivariable logistic regression analysis was used to assess several possible risk factors for injury among these farmers compared with 473 farmers with no injury in the previous year. RESULTS: There were significant associations between fall-related farm injury and age between 40 and 64 years (OR = 2.21; 95% CI = 1.20-4.07), doctor-diagnosed arthritis/rheumatism (OR = 2.05; 95% CI = 1.11-3.79), difficulty hearing normal conversation (even with a hearing aid, in the case of those who used one) (OR = 1.82; 95% CI = 1.07-3.08), and taking medications regularly (OR = 1.80; 95% CI = 1.02-3.18). CONCLUSIONS: Aging and health impairments, such as arthritis and hearing difficulties, are risk factors for which accommodations and preventive strategies can be devised to prevent fall-related injuries on the farm.

Workplace accommodations for people with disabilities: National Health Interview Survey Disability Supplement, 1994-1995.

As American workers age, workers with impairments and functional limitations make up a larger percentage of our workforce. This investigation presents data from the National Health Interview Survey Disability Supplement 1994-1995 (NHIS-D) describing the nature of workplace accommodations in the American workforce and factors associated with the provision of such accommodations. Of a nationally representative sample of workers aged 18 to 69 years with a wide range of impairments, 12% reported receiving workplace accommodations. Males (odds ratio (OR) 0.64: 95% confidence interval (CI) 0.53-0.78) and Southerners (OR 0.57; 95% CI = 0.47-0.70) were less likely than others to receive workplace accommodations. Those with mental health conditions were less likely than others to receive accommodations (OR 0.56; 95% CI = 0.44-0.70). College graduates (OR 1.53; 95% CI = 1.22-1.91), older workers, full time workers (OR 3.99; 95% CI = 2.63-3.87), and the self-employed (OR 1.76; 95% CI = 1.28-2.41) were more likely than others to receive accommodations.

Risk factors for animal-related injury among Iowa large-livestock farmers: a case-control study nested in the Agricultural Health Study.

CONTEXT: Although farmers are at risk for injuries from contact with large livestock, few previous studies have examined risk factors for animal-related injuries. PURPOSE: This case-control study, nested in the Agricultural Health Study, aimed to assess risk factors for animal-related injury among Iowa large-livestock farmers. METHODS: A screener questionnaire sent to 6999 farmers identified 116 farmers with large livestock who had an animal-related injury requiring medical advice/treatment in the previous year. Several possible risk factors for injury were assessed by comparing these farmers with 342 farmers who had livestock but were not injured in the previous year. FINDINGS: A multiple logistic regression analysis showed significant associations between animal-related injury and the use of a hearing aid (odds ratio [OR] = 5.4 [95% CI, 1.6 to 18.0]), doctor-diagnosed arthritis or rheumatism (OR = 3.0 [95% CI, 1.7 to 5.2]), education beyond high school (OR = 1.8 [95% CI, 1.1 to 2.8]), and a younger age. Farmers engaged in off-farm work were less likely to sustain animal-related injuries (OR = 0.4 [95% CI, 0.2 to 0.8]). CONCLUSIONS: This is the first study to show associations between animal-related injury and a younger age, hearing difficulties, and doctor-diagnosed arthritis. Hearing loss and arthritis, which are more common among farmers than among other workers, may be particularly important risk factors to address in future preventive studies.

Risk factors for machinery-related injury among Iowa farmers: a case-control study nested in the Agricultural Health Study.

Farm machinery is a major cause of injury morbidity and mortality among farmers. This case-control study assessed risk factors for machinery-related injuries among Iowa farmers. A screener questionnaire sent to 6,999 farmers in 1998 identified 205 farmers who had machinery-related injuries requiring medical advice/treatment in the previous year. Possible risk factors for injury were assessed among these farmers compared with 473 farmers with no injury in the previous year. A multiple logistic regression analysis showed significant associations between machinery-related injury and hours per week spent on farmwork (OR = 2.02; 95% CI 1.38-2.94), fewer years of farming experience (OR = 1.79; 95% CI 1.14-2.79), wearing a hearing aid (OR = 4.37; 95% CI 1.55-12.25), and a high CAGE score suggesting problem drinking (OR = 2.49; 95% CI 1.00-6.19). This is the first study to show associations between machinery-related injury and hearing impairment, problem drinking, and fewer years of farming experience. These findings may be useful for future interventions to decrease injuries related to farm machinery.

Health risk factors among Iowa farmers.

This study compares the prevalence of the health risk factors for chronic disease and injury among farmers with their prevalence among other workers, using data from the Iowa Behavioral Risk Factor Surveillance System. From January 1999 to December 1999, there were 3,620 adults who participated in the survey. This report focuses on the 2,140 subjects who reported they were working. We calculated the percentage with each health risk factor, the adjusted odds ratio (OR) and the associated 95% confidence interval (CI), comparing the prevalence of health risks among farmers and other workers. Most health conditions and risk factors were similar among farmers and other workers. However, we found that farmers had some protective behaviors. They had better oral health (OR = 0.34, 95% CI 0.20-0.57) and were less likely to smoke (OR = 0.14, 95% CI 0.06-0.29) than other workers. In contrast, we found that farmers reported some high-risk behaviors compared to other workers. They were less likely to have smoke detectors at home (OR = 0.39, 95% CI 0.18-0.82), or to have had stool blood screening for colorectal cancer (OR = 0.41, 95% CI 0.1 7-1.00). These results suggest areas for future research to define targeted preventive interventions in farm communities.