Journal of occupational medicine. : official publication of the Industrial Medical Association最新文献

Occupational medicine residents at the University of Arizona have been introduced to administrative skills and issues as part of residency training since 1983. A questionnaire survey of 17 program graduates was conducted to assess effectiveness of training and applicability of skills to present job position. Seventeen of the graduates surveyed (100%) returned a completed questionnaire. Graduates rated the extent to which certain training activities improved administrative skills, such as community-based rotations, a 1-month administration rotation, chief resident responsibilities, committee work, program or clinic administration, and residency training overall. Although ratings overall were low, we believe this stems from the need for training that residents discover on the job. The survey emphasized the importance of administrative training during the residency years and underscored the need for renewed training efforts on our part.

Colorectal cancer affects more than 157,000 Americans annually. Occupational risk from exposure to asbestos dust has been implicated, leading us to explore further the possible association between colorectal cancer and asbestos. Two hundred sixty-one cases of colon and rectal cancer and 183 control cases were identified within a large, population-based case-control study conducted in southeast Michigan. Employment in occupations historically known to involve heavy exposure to asbestos was used as a surrogate for asbestos exposure. Cancers of the colon showed reduced odds ratios. Our findings differ substantially from those of the previous studies showing elevated risk. Further study is needed to address the same question, with specified asbestos exposure assessment and control for potentially significant confounders such as physical activity and diet.

Loss of vibration sensibility has been suggested as an early indicator of peripheral compression neuropathy, including carpal tunnel syndrome. Although vibration sensibility has been used frequently to evaluate carpal tunnel syndrome, the day-to-day reliability of vibration measurements in an industrial population measured at the workplace has not been assessed. Vibration sensibility testing was performed at the university ergonomics laboratory on 50 volunteers (100 hands) and at a newspaper company on 50 workers (100 hands). Vibration perception and disappearance thresholds were measured on two occasions separated by 3 to 5 days. Student's t tests indicated no significant differences between the first and second tests or between the two groups. Pearson product-moment correlations for test-retest reliability were lower in the industry group but were relatively high despite the less than optimal testing conditions. Our findings suggest that vibration sensibility measurements are reliable from day to day not only in the laboratory but also in the workplace.

Epidemiological studies hold that depressive disorders are among the most common forms of mental illness in the population and should produce a substantial economic impact upon corporate America. However, only a few studies have examined the economic impact of depression in the workplace. A study of the medical and disability costs of depressive disorders was conducted at the First Chicago Corporation. In this analysis, short-term disability data, medical plan costs and Employee Assistance Program referral data for depressive disorders were compared with selected common chronic medical conditions. The average length of disability and the disability relapse rate was greater for depressive disorders than for the comparison medical groups. Depressive disorders were also found to have the largest medical plan costs of all behavioral health diagnoses. Finally, depressive disorders proved to be the most common Axis-I-level diagnosis encountered in the Employee Assistance Program. These findings have important implications for medical benefit plan design, disability plan management, and occupational health professionals' training. The observed higher prevalence of these disorders in women force their recognition as a women's health issue.

The need for standardization and validation of quantitative tests for vibratory sensitivity has been increasingly recognized. Conventional vibrometers have been of limited use for the assessment of vibratory perception threshold (VPT) due to wide intraindividual variations. This study describes the determination of VPT for the medial malleolus (MM), the styloid process of the radius (SPR), and the pulp of the index finger (PIF) in normal subjects, using a new vibrometer, the TM-31A. This apparatus expresses results in terms of actual vibration amplitude and has a feedback mechanism that avoids damping of the stimulator in tissue. Repeated VPT measurements revealed good reproducibility of the test. The intraday and day-to-day variations of VPT were fairly small. VPT was found to differ significantly among sites (MM > SPR > PIF). The distribution in MM was substantially log-normal, whereas the SPR and PIF were normal. VPT values on each site correlated with advancing age, especially on the MM. It is concluded that TM-31A provides a reliable and valid assessment of VPT and contributes to the standardization of VPT testing.

This study examined the interrater reliability and validity of a newly developed test of physical work abilities, the Physical Work Performance Evaluation. Eleven physical therapists were trained to administer and score this evaluation. From this group, two therapists at a time simultaneously and independently evaluated 50 patients with musculoskeletal disorders as they performed the tasks of the Physical Work Performance Evaluation. At the conclusion of the evaluation, each therapist determined the safe level of physical work for each patient. A comparison of the two independent evaluations was used to determine reliability. To determine validity, the predicted level of work was compared with the actual level of work. Kappa coefficient between the two therapists on the level of work was .83. Spearman rho correlations between the predicted and actual levels of work ranged from .41 to .55. Only 14 to 18% were working above the level predicted by the Physical Work Performance Evaluation. These results indicate high interrater reliability. Given the lack of a perfect standard for validity comparisons, these results also provide evidence in support of convergent validity. The test can be used in making decisions regarding return to work after injury, preemployment placement, and vocational exploration.

Eighty-four workers participated in a work-site screening program designed, in part, to estimate the prevalence of carpal tunnel syndrome (CTS). Each worker completed a discomfort survey, limited electrodiagnostic testing of the median and ulnar sensory nerves in each wrist, and current perception threshold (CPT) testing in the right 2nd digit using the NEUROMETER CPT device. A subset of study participants also completed CPT testing in digit 5 on the right (n = 33). Comparisons were made among the CPT results, symptoms consistent with CTS, and electrophysiologic findings. The CPT results correlated poorly with electrophysiologic parameters from the same nerve distribution, and CPT results were statistically unrelated to self-reported symptoms that may be suggestive of CTS. The test performance characteristics of CPT testing (sensitivity, specificity, positive predictive value, and negative predictive value) were low in comparison with electrodiagnostic measurements and self-reported symptoms consistent with CTS. The electrophysiologic results were significantly associated with the constellation of symptoms that are consistent with CTS. On the basis of these results, CPT testing cannot be recommended as a screening procedure for identification of possible cases of CTS among active industrial workers.

To evaluate the association of participation in IBM's "A Plan for Life" program with changes in blood pressure, serum total, high-density lipoprotein, and non-high-density lipoprotein cholesterol, body mass index, and cigarette smoking, we compared changes in these measures over a 1- to 5-year period among program participants and nonparticipants initially found to be at risk. After adjustment for age, sex, time to follow-up, and baseline values, the proportion of participants no longer at high risk was significantly greater than the corresponding proportion of nonparticipants in the areas of blood pressure total and non-high-density lipoprotein cholesterol and smoking cessation.