Dr. Jake’s Notes
A recent study of Washington State WC data confirms the absence of
benefit, and potential adverse consequences, of having early Magnetic
Resonance Imaging or MRI after injury.
1226 workers with acute low back injuries were analyzed, of which 78%
had “sprains” and 22% were diagnosed with radiculopathy (irritation of
spinal nerve roots).
In both segments, early MRIs (within 6 weeks of injury) correlated
with a higher likelihood of work disability at one year. Early MRI
recipients fared no better than other workers. And those diagnosed
with radiculopathy did no better than those with sprains, meaning that
these diagnostic categories do not necessarily predict outcomes.
The message is that an early MRI in the course of a low back injury
may not be useful or necessary.
Of course, there are specific red-flag indicators that suggest an
emergent MRI is critical, but these are rare occurrences.
Thinking about aluminum
An Italian study recently tested the effects of aluminum on naval
welders. An ongoing controversy about the metal’s effect on the
neurocognitive system persists despite many studies.
Shipyard workers, compared to a control group, demonstrated deficits
in cognitive function, particularly related to attention and memory
performance. These alterations in function were directly proportional
to the duration of exposure and the quantity of aluminum absorbed.
Speaking up against noise pollution
A recent audiology study in New Zealand concluded that occupational
noise is a significant contributor to disabling hearing loss
worldwide. Noise-induced hearing loss (NIHL) has resulted in huge
human and economic consequences.
While hearing protection devices (HPDs) are available, inconsistent
and improper use of these devices has hindered efforts to prevent
The authors believe that further research to identify personal and
environmental factors is necessary, followed by renewed interventions
to promote HPD amongst workers.
Climb every mountain (but take 600 mg of ibuprofen)…
Workers at high altitudes, as well as recreational climbers, should take
note of a recent randomized controlled trial in California’s White
Mountains, addressing the prevention of mountain (altitude) sickness.
The trial studied hikers climbed from 4000 to more than 12,000 feet levels
over 12 hours. Compared to hikers receiving a placebo, those who received
ibuprofen (e.g. Motrin) throughout the day, had a significantly lower risk
of developing mountain sickness, and also had less severe symptoms if they
did develop it.
The safety profile of ibuprofen makes it more attractive than various
prescription drugs used for the same purpose.
At least it doesn’t cause cirrhosis…
It had been believed that occupational exposure to vinyl chloride was
associated with cirrhosis, a liver condition leading to liver failure and
A recent Italian meta-analysis does not support this relationship. (A
meta-analysis is an aggregation of data from multiple separate studies,
which permits conclusions to be drawn from a larger population, with greater
The analysis demonstrated that: “Overall, our findings indicate the
absence of increased risk of death from cirrhosis in vinyl chloride-exposed
workers.” However, this chemical is a known carcinogen
(cancer-causing agent) and should be carefully monitored.
Vinyl chloride is used to manufacture plastic products, including polyvinyl
chloride (“PVC”) plastics.
Occupational exposure to inhaled particles predisposes workers to
strokes, according to a Swedish study, spanning 18 years of data.
Job exposure to environmental particles increased the risk of both
ischemic and hemorrhagic stroke. (Ischemic stroke is caused by
disruption of blood supply to a brain region. Hemorrhagic stroke is
due to leakage of blood from a vessel into brain tissue.)
The risk was higher for women than men, and for those with 5 or more
years of exposure.
Working Data From The U.K…
A recent analysis compiled by the UK’s Health and Occupational
Reporting network in General Practice (THOR-GP) offers a picture of
work injury and absence derived from 2006-2009 data from Great
Some of the key observations:
- 53% of claims were musculoskeletal (MSK); 31% were mental
- 56% of reported cases had work-absence.
- 81% of mental cases had absence, compared to 50% of MSK cases.
- Public sector employees had higher absence rates than private
- Self-employed individuals had lower absence rates.
In the United States, a 1990 study by the National Institute for
Occupational Safety and Health (NIOSH) found similar findings here.
The study showed 48.7% of claims were muscolskeletal and represent
ambulatory presentations similar to the UK study.
Spending too much is not the only risk…
The U.S. Department of Labor’s Occupational Safety and Health
Administration is encouraging major retail employers to take precautions
to prevent worker injuries during major sales events during the holiday
In 2008, a worker was trampled to death while a mob of shoppers rushed
through the doors of a large store during a Black Friday sales event.The
store was not using the kind of crowd management measures recommended in
OSHA’s fact sheet, which is available online at http://www.osha.gov/OshDoc/data_General_Facts/Crowd_Control.html
The fact sheet provides employers with recommended elements for crowd
management plans. Plans should include having trained security personnel
or police officers on-site. Barricades or rope lines should be set up
for pedestrians well in advance of customers arriving at the store.
These barricades should be set up so that the customers’ line does not
start right at the entrance of the store. Emergency procedures address
potential dangers. Having security personnel or customer service
representatives explain entrance procedures to the arriving public can
also help ensure safe shopping.
Erionite is the new asbestos…
Erionite is a naturally occurring mineral that belongs to a group of
silicate minerals called zeolites. It is usually found in volcanic ash
that has been altered by weathering and ground water. Like naturally
occurring asbestos, deposits are present in many Western states.
Disturbance of this material can generate airborne fibers with physical
properties and health effects similar to asbestos.
Until recently, erionite was not generally considered to be a potential
hazard in North America, in part because relatively little risk for
exposure was seen. However, evidence has slowly accumulated linking
exposure to erionite with serious adverse health effects in North
America, and suggesting that some workers may have a greater potential
for exposure than previously recognized.
There have been several documented cases, involving road construction
workers and pit miners, in which lung disease (fibrosis) and
mesothelioma was attributable to erionite deposits in lung tissue.
Risk reduction recommendations to limit erionite exposures of workers
who engage in activities that disturb erionite-containing gravel/soil or
crush rocks that contain erionite can include:
- Training workers about the potential hazards of erionite and control
methods for reducing the potential for exposure
- Avoiding the use of erionite containing aggregate whenever possible
- Using wet methods to reduce dust generation for road and other work such
as in quarries where erionite is present (e.g., when drilling rock,
apply water through the drill stem to reduce airborne dust, or use a
drill with a dust collection system)
- Establishing decontamination protocols including change of clothing,
showering before leaving the worksite, and appropriate cleaning/disposal
of personal protective equipment
- Ensuring work clothing is not washed at home to prevent erionite fibers
from being brought home
- Protecting employees with personal protective equipment, including
These recommendations appeared in a NIOSH blog recently (National
Institute for Occupational Safety and Health).
As long as the surgeon is still sharp…
Surgeons and their assistants are especially at risk of exposure to
blood due to glove perforations and needle stick injuries during
operations.The use of blunt needles can reduce this risk because they
don’t penetrate skin easily but still perform sufficiently in other
A Finnish analysis derived this conclusion based on 10 randomized
clinical trials involving nearly three thousand surgeons.
Surgeons using sharp needles typically sustain one glove perforation per
3 operations. Blunt needles reduce the risk by about 50%. Additional
force is needed to use blunt needles, but was still deemed acceptable by
the majority of surgeons.
Chemical solvents and Parkinson’s Disease…
An NIH (National Institutes of Health) funded study compared sets of
twins in which only one twin had Parkinson’s.
Both twins’ occupational histories were examined for exposure to six
chemicals.Researchers concluded that two common chemical solvents,
trichloroethylene(TCE) and perchloroethylene (PERC), are significantly
linked to development of this disease. Job categories implicated in
exposures included: industry machine repair, industrial workers, dry
The team evaluated 99 pairs of twins; twin studies are helpful for
identifying the purely environmental influences in disease, since the
genetic backgrounds are identical.
Not enough fires to fight…
A Harvard School of Public Health study revealed that 45% of on-duty
fatalities in male firefighters are due to cardiovascular disease (CVD).
Apparently firefighters are not particularly fit. There is a high
prevalence of obesity and sedentary behavior, and 28% of them meet
criteria for metabolic syndrome (MetSyn), a condition which is a
precursor for CVD events. MetSyn is a constellation of risk factors
(abdominal obesity; abnormal lipid levels such as triglycerides and
cholesterol; high blood pressure; abnormal blood sugar levels).
The authors conclude that firefighters should be incentivized to improve
their fitness, in order to reduce the CVD burden in this population.