Carpal tunnel syndrome among Manitoba workers: Results from the Manitoba Occupational Disease Surveillance System.

BACKGROUND: Carpal tunnel syndrome (CTS) is associated with occupational high-force repetitive tasks and vibration. This project examines the relationship between CTS and work to: (1) identify jobs and industries with increased CTS risk; (2) explore whether there is a sex difference in the risk of CTS after controlling for occupation; and (3) determine whether any observed relationships persist after excluding Workers Compensation Board (WCB) accepted time-loss CTS claims. METHODS: We linked 95.5% of time-loss WCB claims from 2006 to 2019 to provincial administrative health data. The cohort included 143,001 unique person-occupation combinations. CTS cases were defined as at least two medical claims for (ICD-9 354) within a 12-month period or a surgical claim for CTS from 2 years before the WCB claim to 3 years after. WCB accepted CTS time-loss claims not identified by the medical claims were also included. RESULTS: A total of 4302 individuals (3.0%) met the CTS definition. Analysis revealed that the hazard ratios (HRs) of CTS vary considerably with occupation. Sex-based differences in CTS risks were observed, both in low- and high-risk occupations. In many occupations with increased HR, the HR remained elevated after excluding accepted time-loss WCB cases. CONCLUSIONS: The risk of developing CTS varied with occupation. Job titles with ergonomic risk factors had higher risks than those with lower exposures. This finding remained after eliminating time-loss compensated WCB cases, suggesting that all cases of CTS in high risk jobs are not identified in WCB statistics. Female workers in some job titles had excess CTS cases compared to male workers within the same job title.

Acute myocardial infarctions identified in the Manitoba Occupational Disease Surveillance System: A linkage of worker's compensation and provincial health data.

INTRODUCTION: The purpose of this study was to identify jobs and industries that may be associated with increased or decreased risk of myocardial infarction. METHODS: We linked provincial health care data with Workers Compensation Board (WCB) of Manitoba claims data to create the Manitoba Occupational Disease Surveillance System (MODSS). Workers were eligible for inclusion in this study if their WCB claim listed an occupation, their claim could be linked to health data, they had an accepted non-acute myocardial infarction (AMI) compensation time loss claim and were free of a recent (<1 year) AMI diagnosis at the start of disease follow-up. AMI cases were identified as the most-responsible diagnosis in the hospitalization file (ICD-9 410 or ICD-10 I20). Cases were included if they occurred after the WCB record injury date until end of coverage, either through moving out of province, reaching age 65, death, or the end of the study period (March 1, 2020). RESULTS: We identified 1880 incident AMIs amongst 150,022 claims recorded in the MODSS (1.25%). A number of industries and occupations were found to have higher and lower AMI rates. Care providers and educational, legal, and public protection support occupations had a lower hazard ratio (HR; 0.64; 95% confidence interval [CI]: 0.44-0.92) compared to the overall cohort. Female chefs and cooks, and male butchers and bakers had elevated AMI HRs. Both male and female transport and heavy equipment operators and related maintenance occupations had increased HRs (1.48; 95% CI: 1.30-1.67). Often male and female workers employed in the same occupations had congruent AMI risks, but this was not always the case. CONCLUSIONS: The linkage of a WCB data set with provincial health claims data led to the identification of a number of occupations with elevated risks of AMI in Manitoba. This was most notable in the transportation industry. Identifying work areas with increased risk of AMIs could lead to targeted educational efforts and potential workplace modifications to lower this risk.

Determining the influence of the Workers Compensation Board of Manitoba's opioid policy on prescription opioid use amongst WCB recipients.

BACKGROUND: Opioid medications are commonly used by Workers Compensation Board (WCB) claimants following workplace injuries. The purpose of this study is to describe the impact of an opioid management policy on opioid prescriptions amongst a WCB-covered population compared to changes in the use of these medications in the general population of a Canadian province. METHODS: We linked WCB claims data from 2006 to 2016 (13,155 claims, 11,905 individuals) to Manitoba provincial health records and compared opioid use amongst this group to 478,606 individuals aged 18-65. Linear regression was performed to examine the change over time in number of individuals being prescribed opioids for various durations and dosages of 50 or more, and 120 or more morphine equivalents (ME)/day for both the WCB and Manitoba population. RESULTS: WCB claimants totaled 2.5% of Manitoba residents aged 18-65 who were prescribed opioids for non-cancer pain. After the introduction of the opioid use policy for the WCB population in November 2011, the number of people prescribed opioids declined 49.4% in the WCB group, while increasing 10.8% in the province as a whole. The number of individuals using 50 ME/day or more declined 43.1% in the WCB group and increased 5.8% in the province. CONCLUSIONS: Opioid management programs organized by a compensation board can lead to a substantial reduction in the prescription of opioid medications to a WCB client population, including individuals who were prescribed higher doses of these medications when compared with general trends in the community.

Do Differences in Work Disability Duration Between Men and Women Vary by Province in Canada?

Purpose Research has shown that there are important sex and gender-based differences in the work disability duration of men and women. This research is often limited to single jurisdictions, using different outcome measures, and therefore has limited generalisability of findings. This study examined if differences between work disability of men and women differed by province and by duration of work disability. Methods Cohorts of injured workers in the Canadian provinces of British Columbia (BC), Manitoba (MB) and Ontario (ON) were analysed using workers' compensation data for work-related injuries occurring between 2007 and 2011. Work disability duration was measured using cumulative days in receipt of disability benefits paid during one-year post-injury. Poisson models with restricted cubic splines tested whether differences between men and women in the likelihood of transitioning off disability benefits varied by duration of work disability in each province, adjusting for confounders. Results Men transitioned off disability benefits faster than women for claim durations of up to two to four months, after which women transitioned off disability benefits faster until ten months. Differences between men and women were consistent across all jurisdictions. For claims longer than ten months, men transitioned off work disability benefits faster than women in BC and ON, but there were no significant differences between men and women in MB. Conclusions Differences in the work disability duration between men and women vary by province and duration of work disability. Claims management processes need to be sensitive to differences that men and women face and the timing of interventions.

A comparison of opioid use between WCB recipients and other Manitobans for knee, shoulder, back and carpal tunnel release procedures.

BACKGROUND: This study's objectives were to evaluate whether WCB claimants with conditions requiring certain surgical procedures are more likely to be prescribed outpatient opioids than other Manitobans and whether those prescribed opioids are more likely to still be on opioid medications 6 months post procedure. METHODS: We compared 7,246 WCB claims for a number of surgical procedures to 65,032 similar procedures performed in other Manitobans. Logistic regression was used to explore the association between being a WCB claimant and being prescribed opioids, while controlling for type of surgical procedure and other potential confounders. RESULTS: WCB claimants were more likely than other Manitobans to be prescribed opioids (adjusted OR 1.38; 95%CI 1.30-1.47). Amongst those prescribed opioids, the odds of being still on opioids 6 months post-procedure were not significantly elevated for WCB claimants (adjusted OR 1.09 95%CI 0.97-1.23). CONCLUSIONS: WCB claimants are prescribed opioids more often than non-claimants for similar procedures.

The impact of opioid prescription dose and duration during a workers compensation claim, on post-claim continued opioid use: A retrospective population-based study.

BACKGROUND: Workers Compensation Board (WCB) recipients are a group commonly prescribed opioids. METHODS: We explored factors influencing post-claim opioid dose and duration by linking data from 22,451 claims with the Manitoba Center for Population Health registry. RESULTS: On average, the WCB paid for 94.55% of opioids prescribed during a claim. The amount paid for by the WCB varied significantly by total opioids prescribed. The main predictors of high opioid dosage (120 + morphine equivalents (ME)/day) during the first year post-claim (logistic regression), and of longer post-claim opioid usage (survival analysis), included opioid dosage during the final month of the claim both paid for and not paid for by the WCB. CONCLUSIONS: Amongst low dose opioid claims, the WCB covers most opioids prescribed. Higher opioid dose WCB recipients are often prescribed opioids not covered by the WCB. Both opioids paid for and not paid for by the WCB are associated with post-claim opioid use.

Proportion of opioid use due to compensated workers' compensation claims in Manitoba, Canada.

BACKGROUND: This study identifies the percentage of opioids prescribed for compensated workplace conditions in Manitoba, Canada and whether Workers Compensation Board (WCB) status is associated with higher prescription opioid doses. METHODS: Opioid prescriptions for WCB recipients were linked with databases housed at the Manitoba Center for Health Policy. Duration of continuous opioid prescription and morphine equivalents (ME) per day (ME/D) were calculated for individuals age 18-65. RESULTS: Over the period from 1998 to 2010, 3.8% of the total opioid dosage of medication prescribed in the study population were prescribed to WCB recipients. WCB recipients accounted for 2.1% of the individuals prescribed opioids. In adjusted analyses WCB recipients were more likely to be prescribed over 120 ME/D (OR 2.06 95% CI, 1.58-2.69). CONCLUSIONS: WCB recipients account for a small, but significant amount of the total opioid prescribed in Manitoba. Manitoba's WCB population is a group at increased risk of being prescribed over 120 ME/day.

Rates of readmission and death associated with leaving hospital against medical advice: a population-based study.

BACKGROUND: Leaving hospital against medical advice may have adverse consequences. Previous studies have been limited by evaluating specific types of patients, small sample sizes and incomplete determination of outcomes. We hypothesized that leaving hospital against medical advice would be associated with increases in subsequent readmission and death. METHODS: In a population-based analysis involving all adults admitted to hospital and discharged alive in Manitoba from Apr. 1, 1990, to Feb. 28, 2009, we evaluated all-cause 90-day mortality and 30-day hospital readmission. We used multivariable regression, adjusted for age, sex, socioeconomic status, year of hospital admission, patient comorbidities, hospital diagnosis, past frequency of admission to hospital, having previously left hospital against medical advice and data clustering (patients with multiple admissions). For readmission, we assessed both between-person and within-person effects of leaving hospital against medical advice. RESULTS: Leaving against medical advice occurred in 21 417 of 1 916 104 index hospital admissions (1.1%), and was associated with higher adjusted rates of 90-day mortality (odds ratio [OR] 2.51, 95% confidence interval [CI] 2.18-2.89), and 30-day hospital readmission (within-person OR 2.10, CI 1.99-2.21; between-person OR 3.04, CI 2.79-3.30). In our additional analyses, elevated rates of readmission and death associated with leaving against medical advice were manifest within 1 week and persisted for at least 180 days after discharge. INTERPRETATION: Adults who left the hospital against medical advice had higher rates of hospital readmission and death. The persistence of these effects suggests that they are not solely a result of incomplete treatment of acute illness. Interventions aimed at reducing these effects may need to include longitudinal interventions extending beyond admission to hospital.

A population-based analysis of leaving the hospital against medical advice: incidence and associated variables.

BACKGROUND: Prior studies of patients leaving hospital against medical advice (AMA) have been limited by not being population-based or assessing only one type of patient. METHODS: We used administrative data at the Manitoba Centre for Health Policy to evaluate all adult residents of Manitoba, Canada discharged alive from acute care hospitals between April 1, 1990 and February 28, 2009. We identified the rate of leaving AMA, and used multivariable logistic regression to identify socio-demographic and diagnostic variables associated with leaving AMA. RESULTS: Of 1,916,104 live hospital discharges, 21,417 (1.11%) ended with the patient leaving AMA. The cohort contained 610,187 individuals, of whom 12,588 (2.06%) left AMA once and another 2986 (0.49%) left AMA more than once. The proportion of AMA discharges did not change over time. Alcohol and drug abuse was the diagnostic group with the highest proportion of AMA discharges, at 11.71%. Having left AMA previously had the strongest association with leaving AMA (odds ratio 170, 95% confidence interval 156-185). Leaving AMA was more common among men, those with lower average household incomes, histories of alcohol or drug abuse or HIV/AIDS. Major surgical procedures were associated with a much lower chance of leaving the hospital AMA. CONCLUSIONS: The rate of leaving hospital AMA did not systematically change over time, but did vary based on patient and illness characteristics. Having left AMA in the past was highly predictive of subsequent AMA events.

Hospitalization in Winnipeg, Canada due to occupational disease: a pilot study.

BACKGROUND: The objectives of this study were to identify the extent of occupational exposures to hazardous substances amongst male medical inpatients and to determine the extent to which these exposures may have contributed to the development of medical conditions. METHODS: A random sample of 297 male who were admitted from outside the hospital to the medical wards to a large tertiary care hospital, were between age 18-75 and could communicate in English completed an occupational history questionnaire. This information was merged with an inpatient database which contained patient demographics, admission diagnoses, and co-morbidity data. A specialist in occupational medicine and internal medicine determined whether the medical conditions the participants had were related to their exposures. RESULTS: One individual had a condition causing admission that was related to his work and 12 others (4%) had a condition that was possibly related to their work which had caused symptoms. One additional individual was found to have asymptomatic asbestos related pleural fibrosis. Fourteen of 37 possible harmful occupational exposures were reported by more than 10% of the study participants. On average each participant reported 5.5 exposures. CONCLUSIONS: Occupational exposures to male medical inpatients are common. For 4.4% (13/297) of male admissions to the general medical wards from the emergency room occupational factors may have played a role in the development of medical conditions which led to admission or to major co-morbidities. Detailed occupational histories will likely lead to more suspected cases of work related medical admissions.

Practice patterns of occupational medicine physicians in Canada.

The objectives of this survey were to identify the practice patterns of Canadian physicians working in the field of occupational medicine and to determine whether the type of certification influences the nature of the work they perform in the field. An Internet-based survey was conducted in September 2015 of members of the Occupational and Environmental Medicine Association of Canada. Eighty-six Canadian-based occupational medicine physicians completed the survey (response rate 36%). These physicians performed a wide variety of tasks (12 ± 6), with few spending most of their time doing a single task. The most frequently performed tasks were fitness-to-work (78%) and return-to-work evaluations (78%). Specialty-trained physicians were more likely to be involved in teaching and research and less likely to be involved in a variety of ability-to-work evaluations.

The ALERT scale: an observational study of early prediction of adverse hospital outcome for medical patients.

OBJECTIVES: Some medical patients are at greater risk of adverse outcomes than others and may benefit from higher observation hospital units. We constructed and validated a model predicting adverse hospital outcome for patients. Study results may be used to admit patients into planned tiered care units. Adverse outcome comprised death or cardiac arrest during the first 30 days of hospitalisation, or transfer to intensive care within the first 48 h of admission. SETTING: The study took place at two tertiary teaching hospitals and two community hospitals in Winnipeg, Manitoba, Canada. PARTICIPANTS: We analysed data from 4883 consecutive admissions at a tertiary teaching hospital to construct the Early Prediction of Adverse Hospital Outcome for Medical Patients (ALERT) model using logistic regression. Robustness of the model was assessed through validation performed across four hospitals over two time periods, including 65,640 consecutive admissions. OUTCOME: Receiver-operating characteristic curves (ROC) and sensitivity and specificity analyses were used to assess the usefulness of the model. RESULTS: 9.3% of admitted patients experienced adverse outcomes. The final model included gender, age, Charlson Comorbidity Index, Activities of Daily Living Score, Glasgow Coma Score, systolic blood pressure, respiratory rate, heart rate and white cell count. The model was discriminative (ROC=0.83) in predicting adverse outcome. ALERT accurately predicted 75% of the adverse outcomes (sensitivity) and 75% of the non-adverse outcomes (specificity). Applying the same model to each validation hospital and time period produced similar accuracy and discrimination to that in the development hospital. CONCLUSIONS: Used during initial assessment of patients admitted to general medical wards, the ALERT scale may complement other assessment measures to better screen patients. Those considered as higher risk by the ALERT scale may then be provided more effective care from action such as planned tiered care units.

Predictors of positive tuberculin skin test (TST) results after 2-step TST among health care workers in Manitoba, Canada.

BACKGROUND: Baseline 2-step tuberculin skin testing (TST) is recommended for health care workers (HCWs) to identify cases of the "boosting phenomenon" (i.e., a negative initial TST result followed by a positive result) and to track the risk of acquiring occupational tuberculosis. However, the 2-step TST has been shown to be insufficient to identify all cases of the booster phenomenon in older adults and refugees. The objective of this study was to identify whether a history of bacille Calmette-Guérin (BCG) vaccination and foreign birth--variables that are known to be associated with the booster phenomenon--remain predictors of a positive TST result in a group of HCWs documented to have negative 2-step TST results (i.e., 2 TSTs done 7-28 days apart with indurations <10 mm in diameter). METHODS: We performed a retrospective analysis of an employee database in a tertiary care hospital in Winnipeg, Canada. The study population was comprised of 698 HCWs with negative 2-step TST results who underwent a TST 0-2 years after completion of the 2-step procedure. RESULTS: Forty-six HCWs (6.6%) had a positive TST result 0-2 years after the 2-step test. In a multiple logistic regression analysis controlling for age, BCG vaccination, foreign birth, sex, and work setting, only history of BCG vaccination (odds ratio [OR], 8.38; 95% confidence interval [CI], 4.04-17.4), foreign birth (OR, 3.19; 95% CI, 1.53-6.62), and high-risk work setting (OR, 2.93; 95% CI, 1.44-5.95) were associated with a positive TST result. CONCLUSIONS: Even for HCWs with negative results of 2-step TST, foreign birth and history of BCG vaccination are associated with a positive result of a future TST. Some positive TST results in such HCWs are related to nonoccupational factors, including delayed boosting, rather than to conversion due to recent tuberculosis contact.

Association of self-reported religiosity and mortality in industrial employees: the CORDIS study.

This study examined the association between self-reported religiosity and mortality in industrial employees, while controlling for workplace and socioeconomic factors. Subjects were 3638 Jewish Israeli males who participated in a 12-year follow-up study. During this period 253 deaths were recorded. The prevalence of negative workplace and sociodemographic factors: lower education, non-European origin, heavy physical work, blue-collar jobs and adverse job and environmental conditions, was highest among religious employees, and lower in traditional and nonreligious employees in descending order. Using Cox's proportionate hazard model an age by religiosity interaction on mortality was uncovered. In younger employees (age <55 years) religiosity was associated with lower adjusted mortality, after controlling for negative workplace and sociodemographic factors. Compared with nonreligious employees, the hazard ratios for the religious and traditional employees were: 0.64 (p=0.016) and 0.39 (p=0.118), respectively. In older employees (age >/=55 years), religiosity was associated with higher adjusted mortality. The corresponding hazards ratios were 1.69 (p=0.011) and 1.08 (p=0.004), even after controlling for the above possible confounding variables. It was concluded that religiosity had a protective effect on mortality in younger employees, but the reverse was true for older employees. This opposite trend could not be explained by negative sociodemographic and workplace conditions. The possibility of involvement of yet another potent factor of social isolation was discussed.

Effect of school age sports on leisure time physical activity in adults: The CORDIS Study.

PURPOSE: Data evaluating the impact of various types of childhood physical activity on adult leisure time physical activity (LTPA) are inconsistent. The purpose of this study was to evaluate the influence of organized childhood sporting activities on LTPA as an adult in a cohort of industrial workers. METHODS: The frequency of current LTPA, defined as a half hour or more of activity at least once per week, of 3687 industrial workers in the Cardiovascular Occupational Risk Factors in Israel Study (CORDIS) cohort was the outcome variable. We analyzed the association of organized school age sports with adult LTPA, using a multiple logistic regression model, after adjusting for sociodemographic variables including current occupational factors. RESULTS: Participating in organized school age sporting activities predicted LTPA as an adult [adjusted odds ratio (OR) 3.55, 95% confidence intervals (95% CI) 2.97-4.23]. This association was consistent in the various subgroups of marital status, age, smoking, shift work, body mass index, and religious observance. CONCLUSIONS: Organized school age sporting activities influenced future LTPA in this cohort. Attempts to promote these activities may lead to increased levels of LTPA in adults.

Influence of lack of full-time employment on attempted suicide in Manitoba, Canada.

OBJECTIVES: Unemployment has been repeatedly associated with suicide; however, whether the association is causal remains unclear. Little is known about the relationship between part-time work and either attempted or completed suicide. The objective of this study was to compare the relationships of unemployment, part-time work, nonlaborforce participation, and full-time work with attempted suicide. METHODS: This study utilized a database consisting of 27446 potential laborforce participants that combines information on health care utilization in Manitoba, Canada, with detailed information from the 1986 census. Persons who attempted suicide after the census (N=144) were identified using established definitions based on hospital claims to identify serious attempts only. RESULTS: Step-wise multiple logistic regression, which controlled for multiple confounding variables, revealed that unemployment [odds ratio (OR) 3.68, 95% confidence interval (95% CI) 1.76-7.71, part-time work (OR 1.99, 95% CI 1.07-3.71) and being out of the labor force (OR 2.11, 95% CI 1.12-3.97)] were all associated with attempted suicide. A dose-response relationship was observed between weeks worked in 1985 and suicide attempts after the census. CONCLUSIONS: All three groups of those who were not working full-time had an elevated likelihood of attempted suicide after adjustment for potential confounding factors. This finding suggests that working full-time is protective against suicide attempts. Suicide attempts related to lack of full-time work may be more preventable than other causes of attempted suicide and may be decreased by social policies that limit "under" and unemployment.

Behavioral change with influenza vaccination: factors influencing increased uptake of the pandemic H1N1 versus seasonal influenza vaccine in health care personnel.

BACKGROUND: Many health care personnel (HCP) choose not to get vaccinated against influenza despite recommendations to do so. The pH1N1 epidemic gave a unique opportunity to evaluate the attitudes to influenza vaccination of a group of HCP who routinely choose not to get vaccinated, but accepted the pH1N1 vaccine. METHODS: HCP employed at a tertiary care hospital in Winnipeg, Canada who received the pH1N1 vaccine were invited to participate in an online survey asking about attitudes and experiences regarding seasonal and pH1N1 influenza and vaccination. Those eligible included primarily nurses, other clinical staff, and support staff, as few physicians work as employees. RESULTS: Of the 684 respondents (29% return rate), 504 reported routinely getting vaccinated (RV) for seasonal influenza and 180 reported routinely not getting vaccinated (NRV). These two groups had different attitude towards the two strains of influenza, with markedly lower level of concern about seasonal influenza than pH1N1 for the NRV group. The contrast was especially notable regarding the NRV's view of the seriousness of the illness, their sense of exposure risk, and their confidence in the vaccine effectiveness (for all, seasonal