Preventing low back pain in industry.
Explore the source record for details and available documents.
Humans↗
Biomedical subjects
J F Kraus
Publications and source records attributed to J F Kraus.
Epidemiologic features of facial injuries among motorcyclists.
STUDY OBJECTIVE: To describe the extent, nature, and severity of facial injuries among motorcyclists injured in a crash requiring hospital treatment. METHODS: The study population consisted of 5,790 motorcycle riders who sustained a nonfatal crash injury during 1991, 1992, or 1993 in 10 California counties. The injured riders were identified in 28 hospitals during 1991 and 1992 and in 18 of these 28 hospitals in 1993. Information was collected from crash reports and hospital records. All injuries were coded according to the 1990 Abbreviated Injury Scale. RESULTS: Facial injury was present in 24.3% of injured riders, a high proportion of them young men. Among riders wearing helmets, 36.8% had facial injuries, compared with 53.8% of those not wearing helmets. Soft tissue injuries and facial fractures were present in 72% and 22% of the injured, respectively. The maxilla (22%), orbit (16%), and nasal (16%) bones were the most frequently fractured facial bones. The frequency of multiple facial injuries, severity of facial injuries, and incidence of high-severity facial fractures was greater among nonhelmeted riders compared with helmeted riders. Upper facial fractures were more common among riders without helmets compared with those wearing helmets. CONCLUSION: This study provides evidence of the protective value of helmets to reduce risk of facial injury. Information on the positive effect of facial injury sparing provided by helmet use should be incorporated into helmet promotion programs.
Adult↗
Fatal and hospitalized injuries resulting from the 1994 Northridge earthquake.
BACKGROUND: The Northridge earthquake struck Los Angeles on 17 January 1994, originating from a previously unknown thrust fault. The earthquake measured 6.7 on the Richter scale and caused extensive damage to buildings, utilities and roadways. This report describes injuries occurring in the Northridge earthquake which resulted in death or hospital admission. METHODS: Earthquake-related deaths were identified by the Los Angeles Department of the Coroner. All 78 hospitals in Los Angeles County were screened for earthquake-related admissions and were found in 16 of them. Coroner's records and medical records from the 16 hospitals were individually reviewed to identify earthquake-related injuries and to obtain information about the injury. RESULTS: A total of 171 earthquake-related injuries was identified in Los Angeles County, 33 were fatal and 138 required hospital admission. Injury rates were approximately equal by gender and increased significantly with increasing age. Most of the fatalities were due to building collapse, and most of the hospital-admitted injuries were caused by falls or being hit by objects. Motor vehicle injuries and burns were also common causes of injury. Head and chest injuries were common among fatalities, and extremity injuries were the most common among those admitted to a hospital. CONCLUSION: Earthquakes cause injuries through many mechanisms, and a clearer understanding of these pathways can help focus prevention strategies. Research combining comprehensive surveillance with risk factor assessment can help identify behaviours and circumstances increasing the risk of injury in an earthquake.
Adolescent↗
Surveillance of non-fatal workplace assault injuries, using police and employers' reports.
Although the majority of work-related homicides are routinely reported in the United States, information on non-fatal events is less complete. Comprehensive surveillance of non-fatal events depends on understanding reporting trends to different agencies. This study characterizes workplace assaults reported to police and through employers in eight southern California cities. Employers' reports filed from October 1, 1994, through January 31, 1995, and police reports filed from June 1, 1994, through March 31, 1995, that involved a non-fatal workplace assault injury were included. Reports from police and employers were linked, and annualized rates combining non-duplicative reports were calculated and event characteristics compared. The combined annualized rate of workplace assault injury for the eight cities was 184.6 per 100,000 workers, which was almost twice the rate found in either reporting source individually. Police reports differed from employers' reports by industry and occupation of victim but not type of event or weapons used. Examination of multiple reporting sources for non-fatal workplace assault injuries is essential to identifying the magnitude of these events. Understanding trends in reporting is important for the effective design of prevention programs.
California↗
Epidemiology of acute low back injury in employees of a large home improvement retail company.
Acute low back injuries are described in a cohort of about 31,000 material handlers employed in all Home Depot, Inc., retail stores in California from 1990 through 1994. With over 87 million work hours, incidence density rates, rate ratios, and confidence intervals are given by age, sex, length of employment, and job-lifting requirements. Injuries are further described by lost work days, activity at time of injury, work restrictions, and time frames. The unadjusted low back injury rate per million work hours was 1.6 times higher for men compared with women, and rates were highest for those less than 25 years of age, those with less than 2 years of current job experience, and employees with the greatest materials lifting and handling job requirements. These findings in unadjusted rates and rate ratios persisted when each was adjusted through a Poisson regression model, with the exception of sex. The adjusted risk ratio for males was reversed with significantly higher risk in females when the rate ratio was adjusted for age, lifting intensity, and length of job experience. Injuries were most commonly associated with lifting activities and, while injury occurrence was highest from 10 a.m. to 4 p.m., rates were greatest during those hours when the store was closed to retail activities. Merchandise stocking that requires heavy and frequent materials handling is done during these hours. Fewer injuries than expected were reported on weekends, days with considerably less materials handling activities.
Absenteeism↗
Design factors in epidemiologic cohort studies of work-related low back injury or pain.
The connection between work-related exposures and the onset of back injury or pain is complex and not clearly understood. This paper raises design issues related to the planning and conduct of cohort studies of industrial low back pain (or injury)(LBP), with care given to definition and measurement of exposure and outcome events. These issues include sample size, outcome definition, study biases, and practical considerations when seeking and maintaining company collaboration with a research effort. Without resolving these issues, the authors conclude: (1) cohort studies of worksite-based LBP are needed to elucidate the causal associations between work tasks and LBP onset, (2) both acute and cumulative exposures should be assessed as risk factors for low back injury or pain, and (3) attention should be paid to the planning of such studies and minimization of potential biases that can limit the validity of the results. These design issues will benefit researchers and companies engaged in the planning and conduct of cohort studies of industrial LBP.
Accidents, Occupational↗
Estimates of injury impairment after acute traumatic injury in motorcycle crashes before and after passage of a mandatory helmet use law.
STUDY OBJECTIVE: This study estimates trends in impairment before and after the 1992 California Mandatory Helmet Use Law using the injury impairment Scale (IIS). METHODS: We linked medical records and police reports for a cohort of 4,790 nonfatally injured motorcycle riders who crashed between January 1, 1991, and December 31, 1993, and were treated for injuries in 1 of 18 hospitals in 10 California counties. All injuries were coded according to the Abbreviated Injury Scale and matched to corresponding codes in the IIS. The IIS provides an estimate of the likelihood of impairment from any given injury. Impairment is not directly measured. RESULTS: After implementation of the law, the proportion of riders likely to sustain head injury-related impairments decreased by 34.1%. Impairments resulting from head injuries were the most common type before passage of the law, but they were surpassed by leg injury-related impairments after passage. Helmet nonuse, speeding, and drinking were among variables associated with increased odds ratios of head injury estimated to cause impairment. CONCLUSION: The proportion of motorcycle riders with head injury impairment as estimated with the IIS decreased significantly after the introduction of mandatory motorcycle helmet legislation.
Accidents, Traffic↗
Incidence of non-fatal workplace assault injuries determined from employer's reports in California.
Although fatal work-related assault assault injury rates are routinely reported in the United States, reports of non-fatal injuries are not routinely examined. Non-fatal workplace assault injuries can be reported through many agencies. One of the most common reporting mechanisms in California is the Employer's Report of Occupational Illness and Injury. Employer's Reports filed from October 1, 1994 through January 31, 1995 in the state of California were the source of workplace assault information for this study. All reports indicating an assault-related injury were identified and characterized by gender and occupation of the victim, type of assault and weapon used, and industry. Annual rates were determined based on the number of estimated annual reports and the civilian working population. The estimated annual rate of workplace assault injuries for California based on Employer's Reports is 72.9 per 100,000 workers, which is approximately 50 times the fatal rate. Rates differed by industry, with retail, hospital, transportation and police workers exhibiting the highest rates. Assaults were predominantly Type I, which involve criminal activity, and Type II, which involve an assault by a client, patient, or inmate. The rates of non-fatal work-related assault injury are much greater and have different characteristics than fatal injuries. These non-fatal injury patterns need to be considered when estimating the burden of assault injuries on businesses, and can help identify the most effective prevention strategies.
Absenteeism↗
Relationship between driver's record and automobile versus child pedestrian collisions.
OBJECTIVES: The purpose of this study was to explain the relationship of a history of driver's violations as a factor in motor vehicle versus child pedestrian injury incidents. METHODS: A case-control study was conducted utilizing police reports from 1 January 1993, to 30 June 1995, to identify drivers (cases) whose car struck a child pedestrian less than 15 years of age. Controls were randomly selected drivers identified from the license files of the California Department of Motor Vehicles (DMV) who had no record of striking a child pedestrian in the 30 month study period. Two controls per case were selected based on postal code of residence and incident date of case. Prior driver citations, safety violations, license suspension/revocation, and negligent operator points were analyzed from 1 April 1991, to the incident date for cases and controls. RESULTS: Of 327 drivers who met the case definition, 237 (73%) had information on file in the California DMV driver records. Analysis was based on 237 cases and 474 controls. Drivers who hit a child pedestrian were more likely to have had a prior citation, more citations, more safety violations, a suspended or revoked license, or more negligent operator points than drivers who did not hit a child pedestrian in the study period. A positive association exists between the number of citations, safety violations, or negligent operator points and the likelihood that a driver hit a child pedestrian. CONCLUSIONS: Drivers with a history of driving infractions represent a high risk source of danger to child pedestrians. Possible routes of intervention include more rigorous sanctions against these drivers, more intensive education of the involved driver regarding pedestrians, higher insurance and monetary penalties, and a need to pursue more rigorously hit-and-run and unlicensed drivers, including modification of driver code violations for such cases.
Accidents, Traffic↗
Undetermined manner of death. A comparison with unintentional injury, suicide, and homicide death.
Injury deaths can be grouped into four general categories: accident, homicide, suicide, and undetermined. The present study investigates the use of the "undetermined" category. External cause of death, as well as demographic and other variables, were abstracted from death certificates of the 386,936 Californians who died of an injury between 1969 and 1991. Differences among the four manner-of-death groups were examined, and characteristics of the decedent and the injury event were used to predict a classification of undetermined. Coroners classified 1.9% of the deaths as undetermined in manner. Deaths of women, Blacks, Asians, and Native Americans; the very young and the middle aged; or those involving poisoning or submersion were most likely to be classified as undetermined. Acknowledging that individual coroner judgment may not be free of bias, these findings can help provide a better estimate of the frequency and the epidemiologic features of injury deaths that are assigned to the category of undetermined.
Accidents↗
Coroner-reviewed infant and toddler deaths. Many "undetermineds" resemble homicides.
Although homicide is a leading cause of death of infants and toddlers, there is some suspicion that an unknown number of additional deaths are unrecognized homicides. The authors used California mortality data from 1969 to 1991 to examine 12,246 injury deaths that occurred before age 5. Characteristics of the dead child, injury event, and postmortem were compared for accidents, homicides, and undetermined deaths. A logistic model was developed to differentiate homicides from accidental deaths and then was used to predict whether undetermined deaths were likely to be homicides or accidents. Unlike accidental deaths, undetermineds and homicides had similar distribution patterns of age, race, sex, and place of injury. The predictive model indicates that 43.8% of the undetermined injury deaths were similar to homicides on several characteristics. True rates of homicide for infants and toddlers may, unfortunately, be nearly one fifth and one tenth higher, respectively, if the undetermined deaths that resemble homicides are taken into account.
Accidents↗
Determining injury at work on the California death certificate.
OBJECTIVES: This study examined decisions of California Country Coroner's offices in determining injury at work and identified factors influencing this decision. METHODS: Surveys were sent to California County Coroner's offices (response rate = 93%). The survey included 23 vignettes that required the respondent to determine whether the fatality involved an injury at work. The Rasch method was used to determine internal consistency in endorsing vignettes and to determine overall endorsability of vignettes based on underlying factors. RESULTS: Respondents showed internal consistency but much disagreement in their endorsement of vignettes. Decedents who were performing paid work or were on their work site during working hours were almost unanimously endorsed as having incurred an injury at work. Non-payment, travel/transportation, suicide, and nontraditional work sites and work hours led to disagreement and uncertainty among respondents. CONCLUSIONS: Coroners have different methods of determining injury at work on the death certificate, and available guidelines do not define many of the ambiguous situations encountered by coroners.
Accidents, Occupational↗
Cerebral hyperglycolysis following severe traumatic brain injury in humans: a positron emission tomography study.
Experimental traumatic brain injury studies have shown that cerebral hyperglycolysis is a pathophysiological response to injury-induced ionic and neurochemical cascades. This finding has important implications regarding cellular viability, vulnerability to secondary insults, and the functional capability of affected regions. Prior to this study, posttraumatic hyperglycolysis had not been detected in humans. The characteristics and incidence of cerebral hyperglycolysis were determined in 28 severely head injured patients using [18F]fluorodeoxyglucose-positron emission tomography (FDG-PET). The local cerebral metabolic rate of glucose (CMRG) was calculated using a standard compartmental model. In six of the 28 patients, the global cerebral metabolic rate of oxygen (CMRO2) was determined by the simultaneous measurements of arteriovenous differences of oxygen and cerebral blood flow (xenon-133). Hyperglycolysis, defined as an increase in glucose utilization that measures two standard deviations above expected levels, was documented in all six patients in whom both FDG-PET and CMRO2 determinations were made within 8 days of injury. Five additional patients were found to have localized areas of hyperglycolysis adjacent to focal mass lesions. Within the 1st week following the injury, 56% of patients studied had presumptive evidence of hyperglycolysis. The results of this study indicate that the metabolic state of the traumatically injured brain should be defined differentially in terms of glucose and oxygen metabolism. The use of FDG-PET demonstrates that hyperglycolysis occurs both regionally and globally following severe head injury in humans. The results of this clinical study directly complement those previously reported in experimental brain-injury studies, indicating the capability of imaging a fundamental component of cellular pathophysiology characteristic of head injury.
Adolescent↗
Injuries sustained by motorcycle riders in the approaching turn crash configuration.
A common crash configuration involving a motorcycle and another vehicle is termed the 'approaching turn collision', which occurs when a vehicle turns left into the path of an oncoming vehicle. Although research has explained some causes of approaching turn collisions, few studies have described injury outcomes specific to approaching turn collisions involving motorcycles. All fatally injured and a sample of over 3500 nonfatally injured motorcycle riders treated in one of 28 hospitals in 11 California counties were included in this analysis if the crash occurred in 1991 or 1992 and both a police crash report and matching medical diagnoses were available. Injuries sustained by motorcycle riders in approaching turn collisions were compared with injuries sustained by motorcycle riders in other crash types. Injuries occurring when the motorcycle was the left-turning vehicle were compared to those occurring when the car is the left-turning vehicle. Riders in approaching turn collisions had increased lower extremity and abdominal injuries, but less frequently had head, chest, and facial injuries than riders in other crash types. The average ISS score, percent fatally injured, and average number of days in the hospital were greater for riders in approaching turn collisions than riders in other crash types, except the head-on collision. Possible strategies to reduce injuries from approaching turn collisions are discussed. The complexity of turning actions, particularly judgements of speed, could potentially be an intervention point to reduce crash occurrence.
Abdominal Injuries↗
Epidemiologic aspects of brain injury.
Approximately 2 million head injuries occur each year in the United States, producing a brain injury rate of 175 to 200 per 100,000 population and causing as many as 56,000 deaths per year. The economic and emotional toll of this public health burden is staggering. By identifying risk factors, perhaps effective legislation and environmental and educational intervention strategies can be developed to prevent brain injury.
Accidents, Traffic↗
Alcohol use, driver, and crash characteristics among injured motorcycle drivers.
BACKGROUND: Motorcycle drivers have the highest frequency of alcohol use among all road users. This study examines alcohol use among a large sample of injured motorcycle drivers and examines how crash characteristics differ with the use of alcohol. METHODS: Over 3000 motorcycle drivers who crashed between January 1, 1991, and December 31, 1992, were studied. All fatally injured drivers in 11 California counties and a sample of nonfatally injured drivers treated in 28 hospitals were included in the study if a crash report and medical record were available. RESULTS: Among drivers tested for alcohol use, 42% tested positive for the presence of alcohol. Drinking drivers were more likely to be speeding and less likely to wear a helmet, and more frequently had single motorcycle crashes than nondrinking drivers. Crash characteristics, but not alcohol use, were predictive of increased injury severity. CONCLUSIONS: Alcohol use remains a significant factor in motorcycle crashes and is an important area for injury prevention efforts.
Accidents, Traffic↗
Child pedestrian and bicyclist injuries: results of community surveillance and a case-control study.
OBJECTIVES: To describe the dimensions of childhood pedestrian and bicyclist injuries in Long Beach, California, and to identify risk factors for these injuries. POPULATION: Long Beach residents aged 0-14 years who were involved in an auto versus pedestrian or bicyclist incident that resulted in a hospital visit and/or police response, between 1 September 1988 and 31 August 1990. METHODS: Cases were identified retrospectively using hospital charts, police records, and coroner's reports; demographic, clinical, and situational information were abstracted from the same. A nested case-control study was conducted to examine the street environments where children were injured, and to identify environmental risk factors at these case sites. RESULTS: 288 children comprised the sample population. Midblock dart-outs emerged as the single most common type of incident. Most incidents happened on residential streets, but the risk of injury was greatest on larger boulevards, and tended to cluster by region within the city. Adjusted odds ratios show that case sites had a larger proportion of traffic exceeding posted speed limits, and were also four times more likely to be near a convenience store, gas station, or fast food store than control sites. CONCLUSIONS: The findings of this study suggest three possible routes for the prevention of childhood pedestrian and bicyclist injuries: education, law enforcement, and environmental modification.
Accidents, Traffic↗
The accuracy of death certificates in identifying work-related fatal injuries.
Three national US agencies report on work-related fatal injuries, and one uses the "injury at work" designation on the death certificate to identify and characterize these fatalities. The accuracy of the "injury at work" notation has not been validated. The authors used selected external causes of death (from the International Classification of Diseases, Ninth Revision, Clinical Modification) that are highly likely to be work-related or not work-related as a standard to compare with the California death certificate "at work" designation for the years 1979-1989. Data from the National Center for Health Statistics for the years 1979-1984 were used to measure prevalence for purposes of determining the predictive value of a positive or negative work-related notation on the death certificate. The sensitivity of the "at work" designation was 77.6%, with a specificity of over 99%. Sensitivity but not specificity varied by age, sex, and specific external cause of death. The predictive value positive of the "at work" designation was about 60%, which suggests caution in using it for some epidemiologic purposes.
Accidents, Occupational↗