J. Mac Crawford

A cross-sectional case control study of work-related injuries among Ohio farmers

The agricultural industry has consistently been ranked among the most hazardous in the U.S. To date, few analytic studies of occupational injury among farm operators and workers have been conducted. A case control study was undertaken to investigate risk factors for agricultural work-related injury among Ohio farm operators. Cases were selected from among 1,793 respondents to a questionnaire administered during the first phase of the NIOSH-sponsored Ohio Farm Family Health and Hazard Study (OFFHHS). Analysis consisted of description of the injury experience of the sample as a whole, followed by logistic estimation of prevalence odds ratios (pORs) measuring the effect of potential risk factors on injury risk. The case series consisted of 90 white male principal operators (POs) injured doing farm work in the 12 months prior to questionnaire completion. Controls consisted of 1,475 white male POs who reported no injuries. The overall rate of injury was 5 per 100 person-years. The most notable result is the relationship between self-reported neurotoxic symptoms and injury, suggesting those with more reported symptoms were at greater risk of injury. The crude OR, when compared to the reference score of < or = 27, increased from 1.74 (95% CI = 0.60-5.09) in the 28-30 category, to 1.89 (95% CI = 0.71-5.03) in the 31-35 category, to 2.96 (95% CI = 1.10-7.96) in the highest category of test score. The P value for trend was 0.0218. These associations largely persisted after controlling for potential confounders with multiple logistic regression. Risk was inversely related to age. The results show marked increases in risk of injury associated with farmers younger than 30 and increased severity of self-reported neurological symptoms, controlling for potential confounding.

An Assessment of Key Health Indicators among Emergency Medical Services Professionals

Abstract Introduction. Ensuring the health and productivity of emergency medical services (EMS) professionals is important. However, there has been no known national baseline assessment of the health and wellness of EMS professionals in the United States. According to Healthy People 2010, top indicators of personal health include physical activity, body mass index (BMI), and smoking prevalence. Objectives. The objectives of this study included quantifying existing health conditions and describing key health indicators among EMS professionals. It was hypothesized that work-life characteristics were associated with existing health conditions and key health indicators. Methods. Data utilized for this analysis were obtained from a 2007 questionnaire included in biennial national recertification packets. This questionnaire utilized validated items from the Behavioral Risk Factor Surveillance System (BRFSS) and the Longitudinal EMT Attributes and Demographics Study (LEADS). Along with common demographic characteristics, items inquired about existing health conditions (diabetes, asthma, hypertension, myocardial infarction, angina, stroke, and/or high blood cholesterol level), general health, physical activity, and smoking status. Descriptive analyses were performed utilizing chi-square tests, and logistic regression was utilized to describe associations between existing health conditions and the key health indicators. Results. There were 58,435 individuals who became recertified in 2007, with 30,560 (52%) returning questionnaires. Individuals with missing data were removed, leaving 19,960 individual records. There were 4,681 (23.5%) individuals who reported at least one existing health condition. The mean BMI for the study participants was 27.69 kg/m2. . There were 5,742 (28.8%) individuals classified as having normal weight and 5,146 (25.8%) who were obese. The overwhelming majority of individuals did not meet the Centers for Disease Control and Prevention (CDC) recommendations for physical activity (15,022, 75.3%). There were 3,394 (17.0%) individuals classified as current smokers. Finally, logistic regression analysis indicated that when controlling for work-life characteristics and age, BMI and level of physical fitness were associated with preexisting health conditions. Conclusion. This study was the first known baseline assessment of EMS professionals regarding the key health indicators identified by Healthy People 2010. Investigations regarding the impact of health and wellness in relation to workforce stability should be undertaken. Further research should also be conducted to identify strategies to improve the health of the EMS workforce.

Hearing loss among Ohio farm youth: A comparison to a national sample

BACKGROUND Hearing loss is prevalent among adults in the farming community, with some evidence it begins in childhood. Our objective was to compare hearing thresholds of Ohio farm youth to published data on national norms. METHODS Baseline data were collected on youth (n = 212) in 1994-1996 with follow-up (n = 132) in 2003-2004 including pure-tone air conduction thresholds at 0.5, 1, 2, 3, 4, 6, and 8 kHz. RESULTS When compared to nationally-representative data, study youth had a higher prevalence of hearing loss. The high-frequency range was most affected, particularly at 6 kHz where nearly 50% of the farm youth exhibited some degree of hearing loss at baseline testing. The prevalence of noise-induced threshold shifts, characterized by an audiometric notch, was nearly twice that of the national sample. CONCLUSIONS These data suggest that hearing loss, which is common among adult farmers, may be problematic for farm youth as well.

Studying Critical Values Adverse Event Identification Following a Critical Laboratory Values Study at the Ohio State University Medical Center

No study to date has used laboratory critical values to evaluate variations in patient adverse events. We retrospectively analyzed a database of critical values to determine their distribution by hospital unit over time. The data were drawn from the Ohio State University Medical Center Information Warehouse (Columbus) for a 58-month period. Critical values were plotted over time on statistical control charts and analyzed for unusual peaks in monthly occurrence rates. Chart review of individual patient results yielded several predictor variables for the unusual peaks. Of these, occurrence of patient adverse events was the most relevant independent predictor variable for a month with an unusual number of critical values vs a normal month. This result epidemiologically confirms the basic premise of critical value reporting and suggests that the control-chart method of this type could be a new statistical tool to compare clinical activity of different hospital locations at different times.

Evaluation of occupational injuries in an urban emergency medical services system before and after implementation of electrically powered stretchers.

Musculoskeletal injuries are frequently reported among Emergency Medical Services (EMS) professionals. The objective of this study was to evaluate occupational injuries in an urban EMS system before and after implementation of hydraulic stretchers. Data for this analysis were obtained from Austin Travis County EMS (A/TCEMS). In December 2006, A/TCEMS placed into service electrically powered patient stretchers. The pre-intervention period was between 01/01/1999 and 12/31/2006, and the post-intervention period was between 01/01/2007 and 4/30/2008. Incidence rate calculations were performed for four injury sub-groups and rate ratios (RRs) and corresponding 95% confidence interval (CI) were presented. There were 2087 and 706 person-years of observation pre- and post-intervention, respectively. The incidence rates for overall injury pre-intervention and post-intervention were 61.1 and 28.8 per 100 FTE, with a corresponding RR of 0.47 (95% CI 0.41-0.55) indicating a significant decrease in the rate of injury. The subcategory of stretcher-related injuries had the lowest RR (0.30; 95% CI 0.17-0.52) when comparing pre- and post-intervention time periods.

Using Participant Event Monitoring in a Cohort Study of Unintentional Injuries Among Children and Adolescents

OBJECTIVES We conducted a 3-year cohort study of 407 youths aged 9 to 18 years to develop multivariable risk prediction models of agriculture-related injuries. METHODS Data were obtained via participant event monitoring, with youths self-reporting injuries and exposures in daily diaries over a 13-week period. We evaluated data quality by comparing injury self-reports with other injury data. RESULTS Semilogarithmic plots of rates of all unintentional injuries combined (US data from 2000) as well as of agriculture-related injuries (US and Canadian data from 19 previous studies) graphed as a function of injury severity exhibited linearity, as did plots based on the present results. Severity-specific unintentional injury rates were 1.4- to 4.3-times higher than national rates, suggesting that our methodology can significantly reduce injury underreporting. In addition, at each severity level, estimated agriculture-related injury rates were 5.8- to 9.3-times higher than rates from previous national, regional, and state-based studies. CONCLUSIONS Our approach to participant event monitoring can be implemented with youths aged 9 to 18 years and will yield reliable daily data on unintentional injuries.

Identification of factors that affect the adoption of an ergonomic intervention among Emergency Medical Service workers

This study explored factors contributing to intervention adoption decisions among Emergency Medical Service (EMS) workers. Emergency Medical Service workers (n = 190), from six different organisations, participated in a two-month longitudinal study following the introduction of a patient transfer-board (also known as slide-board) designed to ease lateral transfers of patients to and from ambulance cots. Surveys administered at baseline, after one month and after two months sampled factors potentially influencing the EMS providers’ decision process. ‘Ergonomics Advantage’ and ‘Patient Advantage’ entered into a stepwise regression model predicting ‘intention to use’ at the end of month one (R 2 = 0.78). After the second month, the stepwise regression indicated only two factors were predictive of intention to use: ‘Ergonomics Advantage,’ and ‘Endorsed by Champions’ (R 2 = 0.58). Actual use was predicted by: ‘Ergonomics Advantage’ and ‘Previous Tool Experience.’ These results relate to key concepts identified in the diffusion of innovation literature and have the potential to further ergonomics intervention adoption efforts. Practitioner Summary. This study explored factors that potentially facilitate the adoption of voluntarily used ergonomics interventions. EMS workers were provided with foldable transfer-boards (slideboards) designed to reduce the physical demands when laterally transferring patients. Factors predictive of adoption measures included perceived ergonomics advantage, the endorsement by champions, and prior tool experience.

Back problems among emergency medical services professionals: The LEADS health and wellness follow-up study

OBJECTIVE Describe work-life and demographic characteristics associated with reporting recent back pain, and estimate back pain severity among Emergency Medical Services (EMS) professionals. METHODS A 58-item postal questionnaire was used to collect relevant health and wellness information from a national sample of EMS professionals. The outcome variables were self-reported pain in the back or legs, and severity of recent back pain as indicated by the Aberdeen Back Pain Scale (ABPS). RESULTS There were 470/930 (50.5%) participants who reported one or more days of pain in the back or legs over a 2-week period. The variables most strongly associated with recent back pain and pain severity were prior back problems, self-reported health, and job satisfaction. CONCLUSION This study indicated that work-life, health, and demographic characteristics of EMS professionals were associated with reporting recent back pain.

The carbon footprint of Australian ambulance operations.

To determine the greenhouse gas emissions associated with the energy consumption of Australian ambulance operations, and to identify the predominant energy sources that contribute to those emissions.

Application and Modification of the Integrative Model for Environmental Health

The Integrative Model for Environmental Health (IMEH) has guided research, literature reviews, and practice initiatives since 2002. This article presents the Modified IMEH that was developed based on using the IMEH as a guiding conceptual framework in a community-based participatory research environmental health project. Concepts from the Model of Risk Information Seeking and Processing as well as emergent themes from the data analysis were instrumental in this process. The Modified IMEH alters the structure of the IMEH in that the Vulnerability and Epistemological Domains are more prominent and feedback between domains is included.