Cellulitis incidence in a defined population ELLIS SIMONSEN, S. M.; VAN ORMAN, E. R.; HATCH, B. E. ...
Epidemiology and infection,
04/2006, Letnik:
134, Številka:
2
Journal Article
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A population-based insurance claims database was used to examine cellulitis incidence, anatomical sites of infection, complicating diagnoses, source of health service, and recurrence rates. Insurance ...claim files were searched for cellulitis ICD-9-CM codes 681.0–682.9. Complications of cellulitis including erysipelas, lymphadenitis, lymphangitis, and necrotizing fasciitis were also identified by ICD-9-CM codes. We found a cellulitis incidence rate of 24·6/1000 person-years, with a higher incidence among males and individuals aged 45–64 years. The most common site of infection was the lower extremity (39·9%). The majority of patients were seen in an outpatient setting (73·8%), and most (82·0%) had only one episode of cellulitis during the 5-year period studied. There was a very low incidence of cellulitis complications, including necrotizing fasciitis. Cellulitis is fairly common, usually treated in outpatient settings, and is infrequently complicated by erysipelas, lymphadenitis, lymphangitis, or necrotizing fasciitis.
A cohort of 536 workers was enrolled from 10 diverse manufacturing facilities and was followed monthly for six years. Job physical exposures were individually measured. Worker demographics, medical ...history, psychosocial factors, current musculoskeletal disorders (MSDs) and nerve conduction studies (NCS) were obtained. Point and lifetime prevalence of carpal tunnel syndrome (CTS) at baseline (symptoms + abnormal NCS) were 10.3% and 19.8%. During follow-up, there were 35 new CTS cases (left, right or both hands). Factors predicting development of CTS included: job physical exposure (American conference of governmental industrial hygienists Threshold Limit Value (ACGIH TLV) for Hand Activity Level (HAL) and the Strain Index (SI)), age, BMI, other MSDs, inflammatory arthritis, gardening outside of work and feelings of depression. In the adjusted models, the TLV for HAL and the SI were both significant per unit increase in exposure with hazard ratios (HR) increasing up to a maximum of 5.4 (p = 0.05) and 5.3 (p = 0.03), respectively; however, similar to other reports, both suggested lower risk at higher exposures. Data suggest that the TLV for HAL and the SI are useful metrics for estimating exposure to biomechanical stressors.
This study was conducted to determine how well the TLV for HAL and the SI predict risk of CTS using a prospective cohort design with survival analysis. Both the TLV for HAL and the SI were found to predict risk of CTS when adjusted for relevant covariates.
The recently revised ACGIH TLV for Hand Activity (TLV2018) is a widely used tool for assessing risk for upper limb musculoskeletal disorders. The purpose of this analysis was to compare the strength ...of the exposure-response relationships between the TLV2018 and carpal tunnel syndrome (CTS) between men and women and across age strata. Heterogeneity of the effect size by sex or age would be important to specialists using the method for prevention of CTS among working populations. Data from two large prospective studies were combined to allow for stratification of exposure-response models assessing the association between the TLV2018 and CTS by gender and age. Results show greater risk for women than men and for younger workers than older workers for TLV2018 values above the action limit. Although the TLV2018 is an effective surveillance tool for estimating increased risk of CTS with increasing exposure, these analyses show that such increase are not homogeneous across sex and age.
Information is limited regarding the effectiveness of the two-dose messenger RNA (mRNA) vaccines BNT162b2 (Pfizer-BioNTech) and mRNA-1273 (Moderna) in preventing infection with severe acute ...respiratory syndrome coronavirus 2 (SARS-CoV-2) and in attenuating coronavirus disease 2019 (Covid-19) when administered in real-world conditions.
We conducted a prospective cohort study involving 3975 health care personnel, first responders, and other essential and frontline workers. From December 14, 2020, to April 10, 2021, the participants completed weekly SARS-CoV-2 testing by providing mid-turbinate nasal swabs for qualitative and quantitative reverse-transcriptase-polymerase-chain-reaction (RT-PCR) analysis. The formula for calculating vaccine effectiveness was 100% × (1 - hazard ratio for SARS-CoV-2 infection in vaccinated vs. unvaccinated participants), with adjustments for the propensity to be vaccinated, study site, occupation, and local viral circulation.
SARS-CoV-2 was detected in 204 participants (5%), of whom 5 were fully vaccinated (≥14 days after dose 2), 11 partially vaccinated (≥14 days after dose 1 and <14 days after dose 2), and 156 unvaccinated; the 32 participants with indeterminate vaccination status (<14 days after dose 1) were excluded. Adjusted vaccine effectiveness was 91% (95% confidence interval CI, 76 to 97) with full vaccination and 81% (95% CI, 64 to 90) with partial vaccination. Among participants with SARS-CoV-2 infection, the mean viral RNA load was 40% lower (95% CI, 16 to 57) in partially or fully vaccinated participants than in unvaccinated participants. In addition, the risk of febrile symptoms was 58% lower (relative risk, 0.42; 95% CI, 0.18 to 0.98) and the duration of illness was shorter, with 2.3 fewer days spent sick in bed (95% CI, 0.8 to 3.7).
Authorized mRNA vaccines were highly effective among working-age adults in preventing SARS-CoV-2 infection when administered in real-world conditions, and the vaccines attenuated the viral RNA load, risk of febrile symptoms, and duration of illness among those who had breakthrough infection despite vaccination. (Funded by the National Center for Immunization and Respiratory Diseases and the Centers for Disease Control and Prevention.).
Objectives Most studies of carpal tunnel syndrome (CTS) incidence and prevalence among workers have been limited by small sample sizes or restricted to a small subset of jobs. We established a common ...CTS case definition and then pooled CTS prevalence and incidence data across six prospective studies of musculoskeletal outcomes to measure CTS frequency and allow better studies of etiology. Methods Six research groups collected prospective data at >50 workplaces including symptoms characteristic of CTS and electrodiagnostic studies (EDS) of the median and ulnar nerves across the dominant wrist. While study designs and the timing of data collection varied across groups, we were able to create a common CTS case definition incorporating both symptoms and EDS results from data that were collected in all studies. Results At the time of enrollment, 7.8% of 4321 subjects met our case definition and were considered prevalent cases of CTS. During 8833 person-years of follow-up, an additional 204 subjects met the CTS case definition for an overall incidence rate of 2.3 CTS cases per 100 person-years. Conclusions Both prevalent and incident CTS were common in data pooled across multiple studies and sites. The large number of incident cases in this prospective study provides adequate power for future exposure— response analyses to identify work- and non-work-related risk factors for CTS. The prospective nature allows determination of the temporal relations necessary for causal inference.
A cohort of 536 workers was enrolled from 10 diverse manufacturing facilities and was followed monthly for six years. Job physical exposures were individually measured. Worker demographics, medical ...history, psychosocial factors, current musculoskeletal disorders (MSDs) and nerve conduction studies (NCS) were obtained. Point and lifetime prevalence of carpal tunnel syndrome (CTS) at baseline (symptoms + abnormal NCS) were 10.3% and 19.8%. During follow-up, there were 35 new CTS cases (left, right or both hands). Factors predicting development of CTS included: job physical exposure (American conference of governmental industrial hygienists Threshold Limit Value (ACGIH TLV) for Hand Activity Level (HAL) and the Strain Index (SI)), age, BMI, other MSDs, inflammatory arthritis, gardening outside of work and feelings of depression. In the adjusted models, the TLV for HAL and the SI were both significant per unit increase in exposure with hazard ratios (HR) increasing up to a maximum of 5.4 (p = 0.05) and 5.3 (p = 0.03), respectively; however, similar to other reports, both suggested lower risk at higher exposures. Data suggest that the TLV for HAL and the SI are useful metrics for estimating exposure to biomechanical stressors.
Practitioner Summary: This study was conducted to determine how well the TLV for HAL and the SI predict risk of CTS using a prospective cohort design with survival analysis. Both the TLV for HAL and the SI were found to predict risk of CTS when adjusted for relevant covariates.
This study investigated endurance times as percentages of maximum voluntary contractions (MVCs) in 12 healthy females (mean 25.8±4.3 years) in 5 postures and at 7% MVCs. The shoulder postures ...utilized were 30/90 (shoulder forward flexion=30° and included elbow angle=90°), 60/90, 90/120, 120/150, and 150/180. The %MVCs were 5%, 15%, 30%, 45%, 60%, 75%, and 90% of MVC at each of these postures. Outcome measures included: endurance times, ratings of perceived exertion, fatigue ratings, pain ratings, and surface electromyography (trapezius and mid-deltoid). As expected the endurance time decreased non-linearly with an increase in %MVC. However, the relationship between endurance time and %MVC differed significantly from Rohmert's curve and suggests it considerably overestimates endurance times for %MVCs <45% and it underestimates endurance times for %MVCs >45%. This study's curve did not become asymptotic even at 5% MVC. Shoulder posture (shoulder forward flexion angle) had a significant effect on endurance time. In general, endurance time decreased with an increase in shoulder flexion angle up to 120° and then it increased. Thus, overhead work (hands above the head) would appear to be better designed with a greater degree of forward flexion, rather than in front of the worker at lower degrees of forward flexion.
Published data on endurance times for the shoulder girdle are scant, yet shoulder injuries are neither rare nor inexpensive. This study completely redefines the relationship between endurance time and %MVC for the shoulder girdle. It will allow for a better definition of worker capabilities for the design of overhead work.
A job exposure matrix may be useful for the study of biomechanical workplace risk factors when individual-level exposure data are unavailable. We used job title-based exposure data from a public data ...source to construct a job exposure matrix and test exposure-response relationships with prevalent carpal tunnel syndrome (CTS). Exposures of repetitive motion and force from the Occupational Information Network were assigned to 3,452 active workers from several industries, enrolled between 2001 and 2008 from 6 studies. Repetitive motion and force exposures were combined into high/high, high/low, and low/low exposure groupings in each of 4 multivariable logistic regression models, adjusted for personal factors. Although force measures alone were not independent predictors of CTS in these data, strong associations between combined physical exposures of force and repetition and CTS were observed in all models. Consistent with previous literature, this report shows that workers with high force/high repetition jobs had the highest prevalence of CTS (odds ratio = 2.14-2.95) followed by intermediate values (odds ratio = 1.09-2.27) in mixed exposed jobs relative to the lowest exposed workers. This study supports the use of a general population job exposure matrix to estimate workplace physical exposures in epidemiologic studies of musculoskeletal disorders when measures of individual exposures are unavailable.
Injuries caused by hazardous materials (hazmat) accidents are common in the United States, and emergency departments should be capable of decontaminating these patients. There are, however, no ...national studies that assess emergency department preparedness. The purpose of this survey was to assess the hazmat readiness of US Level 1 trauma centers (TCs). All 1996 Hospital Blue Book TCs (256) were queried by anonymous survey; 61 % (156) responded to the survey. The TCs treated 43,046 ± 28,455 patients (median, 40,500; range, 600 to 220,000); 15 ± 29 (median, 6; range, 0 to 200) were hazmatcontaminated. Only 6% acknowledged having all necessary equipmen required for safe decontamination. Many (83%) had hazmat response plans, but few (30%) of these plans were complete. Approximately 36% of the staff had received training. Thirteen staff required medical attention themselves after rendering care to a contaminated patient. Only 58% of the TCs performed a single drill. The preparedness of US Level 1 TCs to safely decontaminate hazmat patients seems to be inadequate.
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