Hester J. Lipscomb

Degenerative adult onset scoliosis.

There are people who have no history of scoliosis who develop spinal deformity of a progressive nature as adults, associated with severe degenerative disc disease. The clinical syndrome associated with this deformity is not well documented. In an attempt to describe this clinical syndrome more precisely, 21 patients with the diagnosis of degenerative scoliosis were identified and reviewed. Review included history with pain drawings when available, physical examination, bone densities, and standing spinal roentgenograms. Patients with spinal compression fractures, spondylolyses, prior history of scoliosis or radiographic findings consistent with an idlopathic scoliosis were excluded. Our review shows that these patients can develop, along with progressive scoliosis, loss of lumbar lordosis with a resulting flat back deformity. These patients commonly present in the sixth decade with a predominantly stenotic symptom complex, but often lack the classic feature of relief in a sitting posture. The number of male and female patients was approximately equal. Roentgenogram findings show a high angle deformity over a short number of spinal segments and an absence of bony features associated with idlopathic scoliosis such as lateral vertebral wedging and alterations of the lamina. The Incidence of this condition remains to be established.

Results of surgical treatment of painful adult scoliosis.

Study Design. In a consecutive clinical series, using before and after treatment measures, outcome was evaluated in adults with pain and scoliosis who underwent spinal fusion. Objective. This outcome study tested the hypothesis that adult scoliosis patients with chief complaints of pain can have good results, reflected in decreased pain and increased activity postoperatively, when surgical intervention is based not only on analysis of structural deformity, but also on comprehensive evaluation of pain-producing pathology. Methods. Twenty-eitht adults with idiopathic scoliosis and 25 adults with degenerative scoliosis treated with spinal fusion were followed prospectively for 2 to 7 years. All patients had chief complaints of pain and underwent comprehensive evaluations of pain-producing pathology, as well as evaluations of structural deformity. Before initial evaluations, patients completed questionnaires including pain rating, activity level specifically related to standing, sitting, and walking tolerances, ability to work, and period of disability. At a minimum of 24 months postop, patients completed confidential questionnaires seeking report of pain, activity, and work status. These data were compared to responses obtained before surgery. Pseudoarthroses were assessed by superimposed flexion/extension films. Results. The pseudoarthrosis rate was 17.5%, all occurring in patients fused to the sacrum in single posterior procedures. Pain relief was associated with solid fusion (P = .02). Reported pain reduction was 80% among patients with idiopathic scoliosis and 70% among patients with degenerative scoliosis. Improved sitting and walking tolerances were seen in patients with idiopathic scoliosis, and improved standing and walking were seen in patients with degenerative scoliosis.

A conceptual model of work and health disparities in the United States.

Recent research in medicine and public health highlights differences in health related to race, ethnicity, socioeconomic status, and gender. These inequalities, often labeled “disparities,” are pervasive and pertain to the major causes of morbidity, mortality, and lost life years. Often ignored in discussions of health disparities is the complex role of work, including not only occupational exposures and working conditions, but also benefits associated with work, effects of work on families and communities, and policies that determine where and how people work. The authors argue that work should be considered explicitly as a determinant of health disparities. Their conceptual model and empirical evidence, built on previous contributions, describe how work contributes to disparities in health on multiple levels. The examples focus on the United States, but many of the key conceptual features can also be applied to other countries. The model emphasizes behaviors and characteristics of institutions rather than individual workers. This approach avoids a focus on individual responsibility alone, which may lead to victim blaming and failure to emphasize policies and institutional factors that affect large populations and systematically create and maintain racial, gender, and socioeconomic disparities in health.

Results of lumbosacral fusion for degenerative disc disease with and without instrumentation. Two- to five-year follow-up.

Functional and surgical outcomes are reported in two consecutive groups of patients who underwent one- and two-level lumbosacral fusion. The first group underwent standard posterolateral lumbosacral fusion, and the second group underwent lumbosacral fusion with compression U-rod instrumentation. Fusions were carried out over all painful, abnormal levels documented by discography. The pseudarthrosis rate without instrumentation was 35%, in contrast to 6% with instrumentation. In both groups of patients with chronic low-back pain secondary to degenerative disc disease, solid lumbosacral fusion was associated with decreased pain and higher return to work rates. Poorest results were associated with prolonged periods of preoperative disability and long-term disability claims.

Diagnostic findings in painful adult scoliosis.

The purpose of this study was to document the diagnostic findings in a group of adult patients presenting with both scoliosis and pain. Fifty-five adults were evaluated by medical history, physical examination, radiography, myelography followed by computed tomography, discography followed by computed tomography, and single- and dual-photon densitometry. Curves were 49% adult degenerative onset, 44% idiopathic. The older degenerative patients had myelographic defects most commonly within the primary curve and multiple abnormal, not necessarily painful, discs throughout the lumbar spine on discography. The idiopathic group had myelographic defects most commonly in a compensatory lumbar or lumbosacral curve. On discography, all idiopathic patients had at least one abnormal, painful disc, and 88% had their pain reproduced. Pain-producing pathology was frequently identified in areas that would not have been included in the fusion area according to accepted rules for treatment of idiopathic scoliosis.

Effectiveness of interventions to prevent work-related eye injuries

OBJECTIVE The objective of this review was to describe the effectiveness of interventions designed to prevent work-related eye injuries in construction, manufacturing, and agricultural industries. Two types of interventions were of interest: (1) effectiveness of different types of eye protection and/or environmental controls in the workplace, and (2) evaluation of behavioral interventions focused on increasing the use of eye protection among at-risk workers. METHODS Cochrane Collaboration search strategies were used to identify reports of the effectiveness of interventions designed to prevent eye injuries. To be included, a measurable outcome (change in eye injury rates, use of eye protection or costs for eye injury care) had to be reported. Studies that focused on exposures to lasers, radiation or microwaves were not included. RESULTS Seven reports met inclusion criteria-all from industrial settings. None of the studies was a controlled trial and only one involved a comparison group. CONCLUSIONS Although there is some evidence that policy changes are effective in changing behaviors and reducing eye injuries in manufacturing settings either in conjunction with a broader program focused on eye safety or by policy alone, there is limited scientific literature about the effectiveness of eye injury prevention interventions. There is a need for systematic evaluation of interventions designed to prevent eye injuries and to change the overall safety culture.

Mortality Among North Carolina Construction Workers, 1988-1994

This study evaluated proportionate mortality patterns among all male construction workers in North Carolina who resided and died in North Carolina during the period 1988-1994. Proportionate Mortality Ratios (PMRs) and Proportionate Cancer Mortality Ratios (PCMRs) compared the number of deaths among male construction workers with the number of deaths expected based on the gender, race, and cause-specific mortality experience of the entire North Carolina population by five-year age groups for the same years of study. PMRs based on United States death rates also were calculated. Among all male construction workers, significantly elevated mortality was observed for several causes possibly related to work including malignant neoplasms of buccal cavity (PMR = 143), pharynx (PMR = 134), and lung (PMR = 113), pneumoconiosis (PMR = 111), transportation accidents (PMR = 106), and accidental falls (PMR = 132). Elevated mortality also was observed for causes more related to lifestyle and non-occupational factors including alcoholism (PMR = 145), cirrhosis of the liver (PMR = 129), accidental poisoning (PMR = 136), and homicide (PMR = 141). Patterns of elevated mortality for Whites and Black men were similar and PCMR mortality patterns for Blacks and Whites combined were similar to PMRs. Construction workers were at significantly increased risk for deaths resulting from falls from ladders or scaffolds, falls from or out of buildings or structures, and electrocutions. Construction trades found to have statistically elevated cancer risks include laborers and roofers (buccal cavity), painters (pharynx), laborers (peritoneum), and carpenters, painters, brick masons, and operating engineers (lung). These data are consistent with other reports demonstrating excess mortality from asbestos-related diseases (pneumoconiosis, lung cancer, and mesothelioma) among construction workers. Dry-wall workers and laborers were found to have a statistically elevated risk of death as a result of respiratory tuberculosis.

The relative value of lumbar roentgenograms, metrizamide myelography, and discography in the assessment of patients with chronic low-back syndrome

This prospective study evaluated the relative value of lumbar roentgenograms, metrizamide myelography, and discography in identifying structural sources for chronic low-back syndrome. One hundred and eight patients with chronic low-back syndrome were evaluated. Patients had not previously had pathology identified which could explain their pain. On discography, 83 patients (78%) had their pain reproduced at least one abnormal level, identifying a structural component to their pain. Only 22 patients (21%) had all levels of pathology identified by roentgenograms and an additional 17 (16%) had pathology appropriately identified by a combination of myelograms and roentgenograms. Using roentgenograms, myelography, and discography, organic pathology was identified which could explain the patients symptoms in 100 of 108 patients (93%). Based on this study, we think discography is an important diagnostic tool for use in evaluating patients with chronic low-back syndrome. Discography is essential to adequately identify abnormal levels in patients being considered for fusions. Roentgenograms and myelograms are inadequate evaluation in this chronic pain group in that lack of organic pathology cannot be assumed in the presence of normal roentgenograms and myelograms.

Exploration of work and health disparities among black women employed in poultry processing in the rural south.

We describe an ongoing collaboration that developed as academic investigators responded to a specific request from community members to document health effects on black women of employment in poultry-processing plants in rural North Carolina. Primary outcomes of interest are upper extremity musculoskeletal disorders and function as well as quality of life. Because of concerns of community women and the history of poor labor relations, we decided to conduct this longitudinal study in a manner that did not require involvement of the employer. To provide more detailed insights into the effects of this type of employment, the epidemiologic analyses are supplemented by ethnographic interviews. The resulting approach requires community collaboration. Community-based staff, as paid members of the research team, manage the local project office, recruit and retain participants, conduct interviews, coordinate physical assessments, and participate in outreach. Other community members assisted in the design of the data collection tools and the recruitment of longitudinal study participants and took part in the ethnographic component of the study. This presentation provides an example of one model through which academic researchers and community members can work together productively under challenging circumstances. Notable accomplishments include the recruitment and retention of a cohort of low-income rural black women, often considered hard to reach in research studies. This community-based project includes a number of elements associated with community-based participatory research.

Work-related injuries in residential and drywall carpentry

Findings are reported on the first two years of an active injury surveillance project designed to test the utility of active injury investigations in identifying causes of injury among a large cohort of carpenters who did residential building and drywall installation. Occupational Safety and Health Administration recordable injuries were reported by participating contractors. Injured union carpenters were interviewed by experienced journeymen trained in a standard questionnaire protocol. Enumeration of workers and hours worked were provided by the union. These data allowed the definition of a dynamic cohort of 4429 carpenters, their hours worked, detailed information on the circumstances surrounding recordable injuries, and possible preventive measures from the perspectives of the injured worker and an experienced journeyman investigator. The overall estimated injury rate (16.9 per 200,000 hours worked) was considerably higher than recent Bureau of Labor Statistics rates despite less than complete ascertainment of injuries. Injuries most commonly involved being struck by or against something, manual materials handling injuries, and falls. Manual materials handling injuries often involved very heavy objects or tasks and were injuries carpenters most often reported needs for adequate help and coordinated team work to prevent. Falls from heights occurred from a variety of surfaces and were not just injuries of inexperience. Carpenters reported the need for more attention to common fall protection practices, such as the use of more toe boards and guardrails. Poor housekeeping was involved in the majority of same level falls, as well as some manual materials handling injuries.