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Dimensions of the Problem
Pages 38-64

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From page 38...
... population the National Health Interview Surveys (1988 and 1995) , the National Health and Nutrition Examination Survey (1976-1988)
From page 39...
... all musculoskeletal disorders, (2) upper extremity disorders (including carpal tunnel syndrome)
From page 41...
... 41 oo ON a u ~ ~ 5-' ~ ' 5_,' c ~ ~ o ~ ~ ~ ~ o ~ ~ ~ ~ o ~ ~ ~ ~ ~ ¢ ~ ~ ~ ~ ~ ~~ ~ o hi in u ~ ~ - ~ ~ a a ·u ~ in ant ; ~ ~ ¢ Lr)
From page 43...
... (1998) , studying the catchment area of the Marshfield Clinic, documented 378 new cases of carpal tunnel syndrome among a total population of 55,000 over three years, equaling a new diagnosis for about 1 percent of all adults in the region.
From page 44...
... Furthermore, the National Ambulatory Medical Care Survey of 1989, on the basis of a probability sample of all outpatient health care facilities in the United States, ranks musculoskeletal disorders second after respiratory conditions as the most common reason for seeking health care. For 1989, it was estimated that there were 19.9 million visits for low back pain, 8.1 million for neck pain, and 5.2 and 2.7 million for hand and wrist pain, respectively.
From page 45...
... Only the National Health Interview Survey contributes to estimating prevalence by type of work and musculoskeletal disorder. In 1988, these data were collected by a supplemental survey on work and selected musculoskeletal conditions, with self-report of work-relatedness for those conditions.
From page 46...
... ~ , worked recordable with at least one missed day Self-reported conditions (1988 supplement on musculo skeletal disorders) Accepted self-employed cases, gender/race Insured Difficult to None Algorithms need to be created populations characterize BLS codi: body p Nature None ICD9 ICD9 NOTE: BLS = Bureau of Labor Statistics; ICD = International Classification of Disease; NHIS = National Health Interview Survey; 0SHA = Office of Safety and Health Administration; SIC = Standard Industrial Classification; SOC = Standard Occupational Classification.
From page 47...
... Bureau of Labor Statistics. Since 1982, the source for these data has been a national sample of private industry reports of injury and illness according to the requirements of the Occupational Safety and Health Administration (OSHA Form 200~.
From page 48...
... The Mine Safety and Health Administration requires all mines to report the full details of all cases. Information extracted from this supplemental form provides the following details about the lost-time cases: date of event, days away from work, days of restricted work activity, length of service, race, age, gender, and occupation.
From page 49...
... For example, event includes information that allows classification into categories relevant to musculoskeletal disorders, such as overexertion or repetitive trauma, and nature includes relevant categories such as sprain/strain/tears, carpal tunnel syndrome, tendinitis, back pain, and other pain. If the data OSHA requires for all injuries and illnesses were reported to BLS, the data system would be much more robust and would allow a better understanding of these conditions.
From page 50...
... Manufacturing is responsible for only 22 percent of sprains/strains, carpal tunnel syndrome, or tendinitis, while the service industry accounts for 26 percent. When the incidence rates for carpal tunnel syndrome alone are examined (the only specific musculoskeletal disorder)
From page 51...
... Injuries or illnesses attributed to repetitive motion were examined. The proportion of repetitive motion events attributed to typing or key entry was determined for three conditions: carpal tunnel syndrome, tendinitis, and sprains or strains (the only conditions common enough not to be suppressed)
From page 52...
... They show the highest percentage increase in restricted work activity days among those with carpal tunnel syndrome. The increased fraction was from 31 to 47 percent of lost-workday cases between 1992 and 1996.
From page 53...
... Survey Results for Back Pain The NHIS survey data for those who reported to have worked in the past 12 months were used to estimate that 22.4 million people (prevalence of 17.6 percent) suffered from back pain, without regard to whether it was related to work.
From page 54...
... Postal Service, men reported average lost workdays of only 1.9 days per case, one-thirtieth of that found among women. Survey Results for Hand Discomfort The survey questions about hand discomfort elicited information about carpal tunnel syndrome, tendinitis and related syndromes, and arthritis.
From page 55...
... · For the general population, the gender ratio was 3:1 and average age of onset for carpal tunnel syndrome was 51 years (Franklin et al., 1991~. Analyses of the Washington State Fund data also provide information about the leading industries in which workers' compensation claims are awarded for back or upper extremity disorders.
From page 56...
... Department of Labor Office of Workers' Compensation Programs data have been used to examine characteristics of compensated claims for upper extremity disorders. Since this dataset also provides ICD specific diagnostic information, carpal tunnel syndrome can be identified with confidence.
From page 57...
... National Occupational Exposure Survey The National Occupational Exposure Survey was designed by NIOSH to provide data descriptive of health and safety conditions in the work environment in the United States. Almost 4,500 facilities were visited to evaluate working conditions and potential exposures to workplace risks in most types of work settings in the country.
From page 58...
... Estimating the additional costs associated with these uncompensated components yields estimates of total costs associated with reported musculoskeletal disorders as high as $45 to $54 billion, a figure around 0.8 percent of the nation's gross domestic product. As noted above, there is substantial reason to think that a significant proportion of musculoskeletal disorders that might be attributable to work are never reported as such.
From page 59...
... This problem stems in part from the difficulty associated with diagnosis of many of the conditions of concern, such as low back or wrist pain, which are, even in physicians' evaluation, judged largely on patient complaints. While other conditions, such as carpal tunnel syndrome and herniated disc, may be more amenable to specific testing approaches (albeit each with substantial controversy within the medical community)
From page 60...
... Work-Related Musculoskeletal Disorders Annual Survey of Occupational Injuries and Illnesses The Annual Survey of Occupational Injuries and Illnesses survey is the only resource that currently provides ongoing, consistent reporting of injuries and illnesses that permits examination of trends over time. Therefore, it is the only national resource that can be used for the surveillance goal of tracking trends in injury and illness rates.
From page 61...
... There are some important limitations that could be corrected, however, as is seen in the NIOSH-funded 1988 supplement to the National Health Interview Survey:
From page 62...
... Workers' Compensation Records and the Washington State Fund The data available from the Washington State Fund are valuable because they have a well-defined population base to which they refer. However, while the Washington State Fund data are among the best, the occupation and industry distribution in one state does not provide an adequate national representation of either those occupations and industries and cannot provide information about occupations and industries not prevalent in Washington.
From page 63...
... It also does not provide exposure characterization of the risk factors present in emerging industrial sectors. Medical Care Utilization Data Data from medical care records could be particularly valuable in providing much greater detail about the nature, distribution, time course, and disability associated with musculoskeletal disorders.
From page 64...
... Taken collectively, review of all available data sources underscores the need for more complete, more frequent, and better standardized databases that include, at a minimum, uniform coding of musculoskeletal disorders and sufficient information about industry, occupation, and tasks to allow accurate quantification of the musculoskeletal disorder problem, separation into those aspects that are and those that are not related to work factors, and tracking to determine the effects of interventions as they are undertaken.


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