Returning to work after a hand injury: Does ethnicity matter?

BACKGROUND: Hand injuries (HI) are common and may limit participation in work. The objective of this study is to examine the effect of ethnicity and other prognostic variables on return-to-work (RTW) among male manual workers after acute HI. METHODS: A cohort of 178 subjects (90 Arabs, 88 Jews) aged 22 to 65 was studied. Trained bilingual occupational therapists evaluated and interviewed the subjects, using structured validated questionnaires for evaluating personal and environmental factors, body function and structure, and activity limitation and participation restrictions. Employment status 3 months post injury was assessed by a telephone interview. To establish a predictive model for RTW, ethnicity and certain variables of the four domains mentioned above were analyzed using logistic regression analysis. RESULTS: A significant difference in the rate of RTW between Jews and Arabs was found (45.5% for Jews, 28.9% for Arabs, p = 0.03) three months post HI. In the univariate regression analysis, ethnicity was associated with RTW (OR = 2.05; CI: 1.10-3.81) for Jews vs. Arabs. Using a multivariate analysis, only legal counseling, educational attainment, and the severity of disability were significantly associated with RTW. CONCLUSION: RTW three months post HI among manual workers is directly related to variables such as education and legal counseling and only indirectly related to ethnicity. Patients with a lower level of education and those who were engaged in legal counseling need special attention and close guidance in the process of RTW.

Occupational medicine clinical practice data reveal increased injury rates among Hispanic workers.

BACKGROUND: Minnesota has an ethnically diverse labor force, with the largest number of refugees per capita in the United States. In recent years, Minnesota has been and continues to be a major site for immigrant and refugee resettlement in the United States, with a large population of both immigrant and native born Hmong, Hispanic, and East Africans. This study seeks to evaluate the injury risk among the evolving minority workforce in the Minnesota Twin Cities region. METHODS: A retrospective cohort study identifying work-related injuries following pre-employment examinations was performed using electronic health records from a large multi-clinic occupational medicine practice. Preplacement examinations and subsequent work-related injuries were pulled from the electronic health record using representative ICD-10 codes for surveillance examinations and injuries. This study included patient records collected over a 2-year period from January 1, 2015, through December, 2016. The patients in this cohort worked in a wide-array of occupations including production, assembly, construction, law enforcement, among others. RESULTS: Hispanic minority workers were twice as likely to be injured at work compared with White workers. Hispanics were 2.89 times more likely to develop back injuries compared with non-Hispanic workers, and 1.86 times more likely to develop upper extremity injuries involving the hand, wrist, or elbow. CONCLUSION: Clinical practice data shows that Hispanic workers are at increased risk for work-related injuries in Minnesota. They were especially susceptible to back and upper extremity injuries. Lower injury rates in non-Hispanic minority workers, may be the result of injury underreporting and require further investigation.

Experience With Patient Referrals for Upper Extremity Transplantation at a U.S. Academic Medical Center.

PURPOSE: To date, there have been over 100 upper extremity transplantations (UET) performed worldwide. However, little data are available regarding institutional screening practices or description of the population of patients that seek transplantation as a treatment modality for their upper extremity disabilities. We performed a review of our institutional experience in an attempt to better understand our referral patterns and identify factors that may be associated with successful screening. METHODS: Contact demographic data, injury characteristics, and mode of referral were retrospectively reviewed from 2010 through 2015. Differences in demographic data, injury-related characteristics, and clinical trial outcomes were assessed with the Chi-square test or Fisher exact test. RESULTS: There were a total of 89 UET contacts. The average age was 35.2 years, with most contacts being white (n = 24). The majority were male (n = 66; 75.0%) and the most common indication for referral was trauma (n = 43; 55.8%). Of the 89 contacts, 20 (22.5%) were physician referrals and 69 (77.5%) were self-referrals. Physician referrals led to the most screened and accepted contacts, whereas self-referrals more often led to immediate exclusion. CONCLUSIONS: This study gives an overview of the demographic composition of our UET contacts, with a specific emphasis on mode of referral. We have identified that physician referrals have led to more screened and accepted patients versus self-referred individuals. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, Level IV.

Association between -174G/C and -572G/C interleukin 6 gene polymorphisms and severe radiographic damage to the hands of Mexican patients with rheumatoid arthritis: a preliminary report.

Several interleukin 6 gene (IL6) polymorphisms are implicated in susceptibility to rheumatoid arthritis (RA). It has not yet been established with certainty if these polymorphisms are associated with the severe radiographic damage observed in some RA patients, particularly those with the development of joint bone ankylosis (JBA). The objective of the present study was to evaluate the association between severe radiographic damage in hands and the -174G/C and -572G/C IL6 polymorphisms in Mexican Mestizo people with RA. Mestizo adults with RA and long disease duration (>5 years) were classified into two groups according to the radiographic damage in their hands: a) severe radiographic damage (JBA and/or joint bone subluxations) and b) mild or moderate radiographic damage. We compared the differences in genotype and allele frequencies of -174G/C and -572G/C IL6 polymorphisms (genotyped using polymerase chain reaction-restriction fragment length polymorphism) between these two groups. Our findings indicated that the -174G/C polymorphism of IL6 is associated with severe joint radiographic damage [maximum likelihood odds ratios (MLE_OR): 8.03; 95%CI 1.22-187.06; P = 0.03], whereas the -572G/C polymorphism of IL6 exhibited no such association (MLE_OR: 1.5; 95%CI 0.52-4.5; P = 0.44). Higher anti-cyclic citrullinated peptide antibody levels were associated with more severe joint radiographic damage (P = 0.04). We conclude that there is a relevant association between the -174G/C IL6 polymorphism and severe radiographic damage. Future studies in other populations are required to confirm our findings.

Upper body musculoskeletal symptoms of Latino poultry processing workers and a comparison group of Latino manual workers.

BACKGROUND: Upper body musculoskeletal injuries are often attributed to rapid work pace and repetitive motions. These job features are common in poultry processing, an industry that relies on Latino immigrants. Few studies document the symptom burden of immigrant Latinos employed in poultry processing or other manual jobs. METHODS: Latino poultry processing workers (n = 403) and a comparison population of 339 Latino manual workers reported symptoms for six upper body sites during interviews. We tabulated symptoms and explored factors associated with symptom counts. RESULTS: Back symptoms and wrist/hand symptoms lasting more than 1-day were reported by over 35% of workers. Poultry processing workers reported more symptoms than comparison workers, especially wrist and elbow symptoms. The number of sites at which workers reported symptoms was elevated for overtime workers and workers who spoke an indigenous language during childhood. CONCLUSION: Workplace conditions facing poultry processing and indigenous language speaking workers deserve further exploration.

Cross-cultural adaptation, validation, and reliability process of the Michigan Hand Outcomes Questionnaire in a Turkish population.

PURPOSE: The Michigan Hand Outcomes Questionnaire (MHQ) is a domain-specific questionnaire that was developed to be used as a standardized instrument capable of measuring outcomes for patients with all types of hand disorders. The purpose of this study was to develop the Turkish version of the MHQ and to examine whether it is a valid and reliable tool for assessing the outcomes in hand disorders. METHODS: Translation and back-translation of the MHQ were performed, according to published guidelines. A total of 70 patients with hand complaints completed the final version of the MHQ and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire Turkish version (DASH-T) twice, on their first visit and after an interval of 7 days. Visual analog scale (VAS) results for pain intensity and grip strength measurements of the individuals were also taken in both assessments consecutively. RESULTS: Translation and back-translation revealed no major difficulties. The Turkish version of the MHQ met set criteria of reliability and validity. The intraclass correlation coefficient of the test-retest reliability for the 6 subscales ranged from 0.79 to 0.96. The internal consistency of the MHQ, estimated by Cronbach's alpha, ranged from 0.85 to 0.96 for all subscale scores. There were high to moderate correlations between MHQ and DASH scores and VAS and grip strength scores of the injured side. CONCLUSIONS: The Turkish version of the MHQ has excellent test-retest reliability and validity, and it is an adequate and useful instrument for measuring functional disability in hand disorders of Turkish-speaking patients.

Against the odds or odds-on chance: pathways of coming back among hand-injured workers in the Chinese context.

In this study, I used a hermeneutic phenomenological approach by means of thematic analysis to examine the lived experiences of hand-injured workers in Hong Kong. Twenty-seven informants with moderate to severe disabilities were interviewed over ten years about how they lived through their disability and their discourses were examined in the cultural context. Three categories (survivors, achievers, strugglers) were synthesized from the informants' life courses. Each category was analyzed under three themes: biographical disruption, working with a disability, and linking family and significant others, but these three categories proved fluid and subject to individual life course and contextual factors. All informants had to work "against the odds." Most returned to work after recovery but some tended to drift within the labor market. Human agency and situated context facilitated achievers to progress through "odds-on chance." Outcome measures of rehabilitative interventions that focus on returning to employment might underestimate the sequelae of being disabled in society.

The role of culture in primary health care. Two case studies.

The purpose of this article is to show the importance of traditional healers in primary health care (PHC) services. Most countries, despite adopting PHC, have not incorporated traditional healers into this service. The article also illustrates how traditional healers fulfil three of Morrell's four PHC objectives, and how incorporating traditional healers into health services will fulfil the fourth objective. The first contact between a black African patient and health care services usually takes place in the traditional healing system. Therefore health workers should realise that the traditional care system is important if PHC is to succeed. Traditional healers are the most important primary health care service in an African setting. This is highlighted by 2 cases described in the article.