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Background: A significant decrease in back injury claims was observed in a single employer., Objective: The aim of this study was to validate whether back injury claims are decreasing in a multiemployer environment within a non-monopolistic state and quantify the risk of delayed return-to-work and adverse cost of injured workers with back injuries., Methods: Thirty-six thousand four hundred sixty-three claims from 1998 to 2015 were analyzed with descriptive statistics and multivariate logistic and Cox-Proportional Hazards models., Results: Back injury claims decreased three-fold (5.02 to 1.60 per 1000 employees) and were more likely to have claim costs over $100,000 (odds ratio = 2.41) and delayed return-to-work (hazard ratio = 1.16)., Conclusion: Back injury claims are decreasing in a multiemployer environment within a non-monopolistic state.

Background: Minor events that occur in the workplace sometimes are evaluated with MRI, which may reveal age-related changes in the symptomatic body part. These age-related changes are often ascribed to the event. However, evidence of similar or worse pathophysiology in the contralateral joint would suggest that the symptoms might be new, but the pathophysiology is not., Questions/purposes: Using a convenience sample of occupational injury claimants with bilateral MRI to evaluate unilateral knee or shoulder symptoms ascribed to a single event at work, we sought to determine whether MRI findings of the shoulder and knee are more often congruent or incongruent with new unilateral symptoms., Methods: Two hundred ninety-four occupational injury claimants employed at companies throughout Texas that do not subscribe to workers' compensation insurance, who were older than 40 years, and with unilateral shoulder or knee symptoms, were studied. Starting in 2012, all patients seen by OccMD Group PA who present with unilateral symptoms ascribed to work undergo bilateral MRI, based on several previous occasions where bilateral MRI proved to be a compelling demonstration that perceived injuries are more likely age-related, previously well-adapted pathophysiology. MRI findings (anything described as abnormal by the radiologist; eg, defect size or signal change) was considered congruent if the abnormality of one or more structures on the symptomatic side was greater than that of the corresponding structures in the asymptomatic joint. Bivariate analysis was used to compare the frequency of MRI findings congruent and incongruent with symptoms. Logistic regression was used to evaluate factors associated with MRI findings of the shoulder or knee., Results: Less than half of the patients with shoulder (90 of 189; 48%; p = 0.36) or knee (45 of 105; 43%; p = 0.038) symptoms had worse pathologic features on the symptomatic side. Older age was associated with disorders in the infraspinatus tendon (59 ± 8 versus 56 ± 8 years; p = 0.012), glenoid labrum (60 ± 9 versus 57 ± 8 years; p = 0.025), and biceps tendon (60 ± 8 versus 57 ± 8 years; p = 0.0038). Eighty-seven percent of patients (91 of 105) had structural changes in the medial meniscus described by the radiologist., Conclusions: Occupational injury claimants 40 years of age and older with unilateral knee and shoulder symptoms ascribed to a work event tend to have bilateral age-related MRI changes. Age-related disorders should be distinguished from acute injury., Level of Evidence: Level IV, diagnostic study.

Rationale: Interferon-γ release assays have significant advantages over tuberculin skin testing in many clinical situations. However, recent studies have called into question their reliability in serial testing of healthcare workers because of reportedly high rates of positivity and high conversion/reversion rates on retesting., Objectives: To define the performance characteristics of the T-SPOT.TB test, an interferon-γ release assay, during serial screening programs of healthcare workers at 19 U.S. hospitals., Methods: A total of 42,155 T-SPOT.TB test results from healthcare workers at 19 geographically diverse hospitals obtained for routine tuberculosis screening programs were analyzed to determine the rates of positivity, reversion, and conversion in serial testing data., Measurements and Main Results: In 19,630 evaluable serial pairs from 16,076 healthcare workers, the mean test positivity rate was 2.3% (range, 0.0-27.4%). The mean conversion rate was 0.8% (range, 0.0-2.5%), and the mean reversion rate was 17.6%. Positivity and conversion rates correlated with known tuberculosis risk factors including age and sex. The observed specificity of the T-SPOT.TB test was at least 98.6%., Conclusions: The high concordance and test completion rates in this study suggest that the T-SPOT.TB test is a reliable tool for healthcare worker serial screening. As expected, the observed positivity rates were lower compared with the tuberculin skin test, likely reflecting the higher specificity of this test. Furthermore, the observed rates of conversion were low and significantly correlated with the geographic incidence of tuberculosis. Our findings suggest that the T-SPOT.TB test is an accurate and reliable way to screen healthcare workers.

Objective: To investigate the association between opioid utilization and catastrophic claim (≥$100,000) cost., Method: A total of 12,226 workers' compensation indemnity claims that were opened and closed from January 1, 2006 to February 28, 2010 in the State of Michigan were selected for multivariate logistic regression analyses., Result: Controlling for sex, age, claim duration, number of distinct International Classification of Diseases-Ninth Revision codes per claim, and legal involvement, the presence of short-acting opioids on a claim were 1.76 (95% confidence interval: 1.23 to 2.51) and long-acting opioids 3.94 (95% confidence interval: 2.35 to 6.89) more likely to have a final cost $100,000 or more than a claim without any prescription., Conclusion: The use of opioid medications, particularly long-acting opioid medications, is an independent risk factor for the development of catastrophic claims.

Objective: To determine the price point at which an interferon-γ release assay (IGRA) is less costly than a tuberculin skin test (TST) for health care employee tuberculosis screening., Methods: A multidecision tree-based cost model incorporating inputs gathered from time-motion studies and parallel testing by IGRA and TST was conducted in a subset of our employees., Results: Administering a TST testing program costs $73.20 per person screened, $90.80 per new hire, and $63.42 per annual screen. Use of an IGRA for employee health testing is cost saving at an IGRA test cost of $54.83 or less per test and resulted in higher completion rates because of the elimination of the need for a second visit to interpret the TST., Conclusions: Using an IGRA for employee health screening can be an institutional cost saving and results in higher compliance rates.

The National Institute of Occupational Safety and Health (NIOSH) recommends that exposure to waste anesthetic gas (WAG) be minimized to the greatest extent possible. Current recommendations include 2 parts per million (ppm) for 1 hour sample to halogenated agents level or 25 ppm based on nitrous oxide level or combination of 0.5 ppm for halogenated agents and 25 ppm nitrous oxide. The Occupational Safety Health Administration requires that work practices and engineering controls be implemented so that occupational exposure to WAG is controlled. This pilot study was conducted to (1) evaluate the level of WAG in the PACU, (2) analyze the relationship between nurse exposure and self-reported symptoms, and (3) test methods used to describe occupational exposure of PACU staff to WAG. Air sampling to measure levels of WAG in the patient and PACU nurse environment was performed with MIRAN SapphRE (Foxboro Company, Foxboro, MA), a nondispersive infrared spectrophotometer. A personal sampling method was used to measure the level of nurse exposure to WAG on 2 separate days. Self-report of 9 health symptoms using a 10-cm visual analogue scale was obtained before and after the shift from 6 (PACU) nurses. Three nurses from the Medical Intensive Care Unit (MICU) served as a control. Descriptive statistics summarized exhaled gas level and staff exposure. The highest concentrations of nitrous oxide were 283 to 295 ppm in the patient's breathing zone, whereas halogenated agents were below the limit of detection. Staff exposure to nitrous oxide ranged from 2.9 to 8.2 ppm, averaged over the work shift. T test of the pre- and postshift symptoms showed no significant difference in both PACU and MICU nurses. This pilot study identified the potential for staff exposure to WAG in the PACU setting. The methods to detect this exposure were also evaluated. It is recommended that further study be conducted to evaluate PACU staff exposure to WAG. Modifications in some of the measurement methods tested here are also suggested, including the use of procedures to measure the efficacy of air exchange and other engineering controls related to staff exposure., (Copyright 2002 by American Society of PeriAnesthesia Nurses.)

Nurses working in the PACU are occupationally exposed to volatile anesthetics that are exhaled by patients. Few studies have quantified this exposure using breath analysis or have characterized biological effects associated with this exposure. Isoflurane is a widely used anesthetic and is a strong respiratory depressant. Exposure to isoflurane has been shown to cause changes in breathing patterns at low doses. However, biological effects of isoflurane exposure have never been addressed in the occupational setting. This study investigates whether occupational exposure to anesthetic gases has a depressive effect on central neural control of breathing. In this study, concentrations of halogenated anesthetics were quantified in pre- and postshift breath samples of nurses working in the PACU on a Friday and the following Monday. After each breath sample was collected, an occlusion pressure measurement was taken as an indicator of central inspiratory drive. Cumulative nitrous oxide and halogenated anesthetics exposure was measured each day using personal sampling monitors placed close to the nurse's mouth. Exposure to nitrous oxide and isoflurane was significantly higher on Monday than on Friday (P <.001). Monday breath isoflurane concentrations (mean +/- SD) increased significantly from 43 +/- 30 parts per billion (ppb) in preshift breath samples to 124 +/- 57 ppb in postshift breath samples (P <.002). On Monday, there was a significant decrease in occlusion pressure from 1.2 +/- 0.37 cm H(2)O in preshift samples to 0.85 +/- 0.43 cm H(2)O in postshift samples (P =.05). There was no statistical difference in pre- versus postbreath isoflurane or occlusion pressure on Friday. These data indicate that after increased exposure to isoflurane, central neurorespiratory activity was depressed., (Copyright 2002 by American Society of PeriAnesthesia Nurses.)

An Early Return to Work Program was initiated at The Johns Hopkins Hospital and Associated Schools of Medicine, Hygiene and Nursing in Baltimore, Maryland, in April 1992 as part of a comprehensive effort to control the incidence and costs of work-related illnesses and injuries. The program was similar to others that incorporate employee and supervisory training and job accommodation, but it also included an industrial hygienist trained in ergonomics to facilitate the placement of individuals with restrictions. The return to work program was studied over a 10-year period, comparing the number of lost workday cases, lost workdays, and restricted duty days before (1989 to 1992) and after (1993 to 1999) initiation of the program. A significant decrease (55%) was observed in the rate of lost workday cases before versus after the return to work program. Furthermore, the number of lost workdays decreased from an average of 26.3 per 100 employees before, to 12.0 per 100 employees after, the return to work initiative, and the number of restricted duty days went from an average of 0.63 per 100 employees to 13.4 per 100 employees (a twentyfold increase). The study suggests that a well-structured early return to work program is an integral part of a comprehensive effort to control the duration of disability associated with occupational injuries and illness. It also indicates that to be most effective, an early return to work program must include participation by medical providers, safety professionals, injured employees, and supervisors. Our work suggests that even with these elements in place, the effectiveness of return to work programs may be increased by including an individual trained in ergonomics to facilitate the job placement process.

Epithelioid angiomyolipoma is a recently recognized clinicopathologic entity first described by Martignoni et al. in 1995. Since then, several articles have further clarified its histogenesis and histologic features. Due to the presence of polygonal cells with voluminous cytoplasms, this neoplasm is often mistaken for renal-cell carcinoma. In this case presentation, we describe the cytologic features of an epithelioid angiomyolipoma obtained by fine-needle aspiration. The histogenesis and how it relates to diagnosis is briefly discussed. The importance of ancillary techniques in the differential diagnosis of epithelioid cells obtained in a renal aspirate is reviewed., (Copyright 2000 Wiley-Liss, Inc.)

Background: In the industrial setting, employee perceptions regarding their organization's commitment to safety (i.e., safety climate) have been shown to be important correlates to both the adoption and maintenance of safe work practices and to workplace injury rates. However, safety climate measures specific to the hospital setting have rarely been evaluated. This study was designed to develop a short and effective tool to measure hospital safety climate with respect to institutional commitment to bloodborne pathogen risk management programs and to assess the relationship between hospital safety climate and (1) employee compliance with safe work practices and (2) incidents of workplace exposure to blood and other body fluids., Methods: A questionnaire, which included 46 safety climate items, was developed and tested on a sample of 789 hospital-based health care workers at risk for bloodborne pathogen exposure incidents., Results: A 20-item hospital safety climate scale that measures hospitals' commitment to bloodborne pathogen risk management programs was extracted through factor analysis from the 46 safety climate items. This new hospital safety climate scale subfactored into 6 different organizational dimensions: (1) senior management support for safety programs, (2) absence of workplace barriers to safe work practices, (3) cleanliness and orderliness of the work site, (4) minimal conflict and good communication among staff members, (5) frequent safety-related feedback/training by supervisors, and (6) availability of personal protective equipment and engineering controls. Of these, senior management support for safety programs, absence of workplace barriers to safe work practices, and cleanliness/orderliness of the work site were significantly related to compliance (P<.05). In addition, both senior management support for safety programs and frequent safety-related feedback/training were significantly related to workplace exposure incidents (P<.05). Thus the most significant finding in terms of enhancing compliance and reducing exposure incidents was the importance of the perception that senior management was supportive of the bloodborne pathogen safety program., Conclusions: Hospital safety climate with regards to bloodborne pathogens can be measured by using a short, 20-question scale that measures 6 separate dimensions. Whereas all 6 dimensions are essential elements of overall safety climate, 3 dimensions are significantly correlated with compliance, and 1 dimension (senior management support) is especially significant with regard to both compliance and exposure incidents. This short safety climate scale can be a useful tool for evaluating hospital employees' perceptions regarding their organization's bloodborne pathogens management program. In addition, because this scale measures specific dimensions of the safety climate, it can be used to target problem areas and guide the development of intervention strategies to reduce occupational exposure incidents to blood and other body fluids.

In 1992, the Johns Hopkins Hospital and University initiated a program aimed at the early diagnosis and treatment of potential upper extremity work related musculoskeletal disorders (UEWMSDs), ergonomic assessment and abatement of work areas where individuals with UEWMSDs are employed, as well as the identification and correction of areas throughout the hospital and university where UEWMSDs could possibly occur. The program resulted in an initial increase in the number and cost for the treatment of UEWMSDs. Subsequently, there was a significant decrease in the number of UEWMSDs reported and virtual elimination of the need to use surgical procedures to correct these conditions. This article suggests that a coordinated program of medical care, ergonomic assessment, and intervention can be efficacious in the primary, secondary, and tertiary prevention of UEWMSD.

This work evaluates the imposition of managed care techniques on the rate of claims and surgeries utilizing a pre- versus post-program analysis. The purpose was to ascertain whether managed care techniques--specifically, an ergonomic program, medical treatment guide-line, nurse case management, and utilization of a preferred provider organization consisting of academic physicians--would reduce the rate of the claims and surgery in a population of predominantly health care and university workers. The claims frequency rate and surgical frequency rates per 1,000 employees and per 1,000 claims was significantly lower during the managed care period than during the year prior to the initiation of managed care. The distribution of surgical procedures, as well as the duration of disability in the years of injury, after the initiation of managed care (1993-1997) were different from those same parameters in the fiscal years prior to the initiation of managed care (1990-1992). The results suggest that even in the workers' compensation environment, where financial incentives encourage a higher claims and surgical frequency rate than do the fee-for-service or prepaid medical environments, managed care techniques can be successfully utilized. A unique feature of the study was the use of university-based physicians as a specific managed care technique to influence surgical rates.

A comprehensive safety and managed care initiative was instituted in 1991 at a large self-insured medical center in an effort to reduce workers' compensation costs. It features an on-site case management team, a preferred provider organization, and safety engineering efforts and ergonomic controls used proactively to aggressively identify and abate workplace hazards. Two worker populations were followed up longitudinally for three years before and after the initiative. Costs incurred by each cohort were compared. A 50% reduction in total expenditures was seen in the managed care cohort. The hospital component of the system saw a decrease in compensation of 62% for temporary total disability and 38% for permanent partial disability. Medical expenditures decreased 50%. Dramatic reductions in costs are achievable, without compromising quality of care, when managed care principles and safety efforts are emphasized.

Spindle epithelial tumor with thymus-like differentiation (SETTLE) is a rare and distinctive low-grade neoplasm of thymic or related branchial pouch differentiation. The tumor usually presents in the thyroid or lateral neck of children and adolescents and could mimic spindle-cell carcinoma, synovial sarcoma, or malignant teratoma. We report the clinical, cytologic, histologic, immunohistochemical, and ultrastructural features of a SETTLE present for 10 years in a 15-year-old boy. The fine-needle aspirate, initially interpreted as synovial sarcoma, contained numerous clusters of bland spindle cells, with a few detached sheets of columnar mucous cells in a homogeneous background of dissociated spindle cells. Mitoses, necrosis, and atypia were not present. The excised tumor was a well-circumscribed, white-tan mass, with occasional microcysts. Microscopically, the mass consisted of a lobulated, highly cellular, spindle-cell neoplasm arranged in intersecting, whorled, and storiform fascicles separated by fibrous bands. Entrapped within the fibrous bands were squamous-lined cysts and benign-appearing glands lined by columnar epithelium with goblet cells or ciliated pseudostratified epithelium. Immunohistochemically, the spindle cells showed diffuse reactivity for cytokeratins, smooth muscle actin, muscle-specific actin, and MIC-2, and they were negative for epithelial membrane antigen, calcitonin, and thyroglobulin. Ultrastructurally, numerous perinuclear tonofilaments, some aligned with mature desmosomes, were identified in the spindle cells. Occasional cells showed thin filaments with fusiform dense bodies occupying the peripheral cytoplasm. These findings distinguish SETTLE from ectopic thymoma, synovial sarcoma, medullary carcinoma, and teratoma, and they support a thymic epithelial origin for SETTLE, possibly with myoepithelial differentiation.

Objective: To study the spectrum of cytologic changes seen in cellular pleomorphic adenoma (CPA) and to determine features that would allow a more specific diagnosis., Study Design: We reviewed 11 fine needle aspirates of surgically confirmed salivary gland CPA in addition to three discrepant cases in which CPA was strongly considered in the cytologic diagnosis., Results: Pleomorphic adenoma was considered in the differential diagnosis, but a difinitive cytologic diagnosis was not made in the 11 cases. Acinic cell carcinoma, basal cell adenoma, adenoid cystic carcinoma; myoepithelioma and spindle cell neoplasm accounted for most of the other diagnostic considerations. The three discrepant cases included a malignant myoepithelioma, acinic cell carcinoma and mucoepidermoid carcinoma., Conclusion: Familiarity with the variable aspirate appearance of CPA in addition to well-defined cytologic and architectural criteria can help establish the proper diagnosis in the majority of cases. There remain, however, few cases in which a definitive diagnosis is not possible.

Managed care techniques are becoming increasingly available to manage the medical indemnity losses associated with injuries paid for under the workers' compensation system. The authors describe 3 years' experience of identifying and abating workplace hazards and medically managing cases utilizing a preferred provider organization established solely for workers' compensation cases. In the model described, the occupational physician/nurse case-management team coordinates the entire process, from prevention of accidents to facilitated return to work. During the study period (1992 to 1995), per-capita losses were reduced by 23%, from $241 in fiscal year 1992 (the year before the managed care initiative), to $185 in fiscal year 1995. (Hereafter, each year referred to indicates that fiscal year.) In 1992, 22 lost-time cases per 1000 employees occurred, whereas the number of lost-time cases in the years 1993 to 1995 averaged 12 to 14 per 1000 employees. The rate of "medical only" cases dropped significantly from 155 per 1000 in 1992 to 96 per 1000 in 1995. The per-capita amount of monies spent on medical care decreased from $81 in 1992 to $63 in 1995. The most significant savings in medical costs related to claims associated with new occupational injuries, injuries that occurred during the fiscal year. In 1992, the per-capita loss on such cases was $23 and in 1995 it was $13, a 43% decrease. The number of temporary/total days dropped significantly from 163 per 100 employees in 1992 to 70 days in 1995. Concurrently, the per-capita loss for temporary total disability was reduced from $53 in 1992 to $26 in 1995. Per-capita administrative costs, as well as other indemnity losses (predominantly permanent partial disability), decreased only slightly over the study period ($58 to $54 and $60 to $51, respectively). We feel that these results indicate that environmental-risk management and medical-care management can be integrated to produce substantial savings. It also suggest that managed-care techniques, which are becoming more available to employers, can even be applied in status that do not have managed care legislation.

A comprehensive initiative utilizing an in-house preferred provider organization, medical case management, and application of ergonomic techniques was implemented in an effort to control the incidence and cost of workplace injuries. The program was evaluated utilizing OSHA 200 Logs to compare the incidence and lost time due to compensable injury and illnesses before and after beginning the program. After the introduction, there was a significant decrease in injuries and illnesses (53/1000 vs 27/1000, P<.01) and average days lost per event (10.4 vs 6.6 days, P<.01). A significant increase in restricted-duty days (.2 vs 1.5 days, P<.01) and an 18% reduction in medical and indemnity costs of the institution's workers' compensation expenditures were observed. This study demonstrates the initial effectiveness of an aggressive ergonomic and managed care approach to reducing the incidence, severity, and cost of occupationally related injury and illness. It also highlights the effectiveness of an outcomes analysis approach, using lost time as an end point, to measure the effectiveness of preventive and management strategies in the workers' compensation setting.

To delineate baseline seroprevalence rates before job placement, applicants for employment (n = 300) at a large urban medical center were screened for serologic markers to the hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) during a 15-week period in 1992. Eighteen applicants (6%) were positive for antibodies to HBV, nine (3%) for HCV, and 3 (1%) for HIV. There was no association by gender for any of these viral markers; however, both HBV and HCV were significantly more often detected in persons applying for hourly positions who were black. In an urban setting, preemployment screening of health care workers for HBV and HCV markers appears warranted, and serum banking for later HIV analysis, should a claim arise, is suggested.

Salivary duct carcinoma (SDC) is an extremely rare and highly aggressive primary epithelial neoplasm of the salivary glands associated with increased tendency for lymph node and vascular metastases. Histologically, this lesion resembles intraductal cribriform and comedo carcinoma of the breast. Fine-needle aspiration (FNA) cytology of SDC in two patients with parotid masses (ages 65 and 67) is presented. The aspirates were sparsely to richly cellular and contained predominantly broad flat and branching sheets of large polygonal epithelial cells with abundant eosinophilic cytoplasm, round to oval nuclei, finely granular chromatin and prominent nucleoli. Few sheets showed cribriforming and papillary configuration. The cytologic differential diagnosis included oncocytoma, acinic cell carcinoma, muco-epidermoid carcinoma, and metastatic adenocarcinoma. To the best of our knowledge, this is the first report to describe a spectrum of cytologic features that may allow a specific FNA diagnosis of SDC. Preoperative diagnosis of this neoplasm may warrant a more extensive radiologic workup and therapy including radical surgery and neck dissection followed by radiation therapy.

During identical 2-month periods in 1989 and 1991, all applicants for employment at a major teaching hospital participated in preemployment drug screening. In 1989, before establishment of a formal preemployment testing program, screening was conducted without identifying information. Of 593 applicants screened, 64 (10.8%) were confirmed positive for one or more drugs. Marijuana metabolites were detected with the greatest frequency (35 samples, 55% of positive screens), followed by cocaine (36%), then opiates (28%). In 1991, after a formal preemployment testing program was in place, 365 applicants were screened, and 21 (5.8%) were confirmed positive. Opiates were most often detected (48% of positive screens), followed by cocaine (38%), then marijuana metabolites (28%). During both periods, positive urine screens were associated with ethnicity (non-White) and occupational category (blue-collar). Whereas in 1989 positive screens were associated with male gender, in 1991, females were more likely to test positive. The decline in prevalence following implementation of a screening program supports the notion that preemployment testing can serve as a deterrent for drug-using persons in applying for employment.

The diagnostic cytomorphologic findings in a case of elastofibroma dorsi are described in this report. The correct diagnosis was initially overlooked on fine-needle aspiration, and was subsequently made by open biopsy. Review of the FNA material, however, demonstrated scanty but diagnostic material. Cytologic examination revealed a mixture of fibroblasts, adipose tissue, and swollen lightly staining cyanophilic elastic fibers in a background of collagenous matrix. Cross sections of the elastic fibers had the typical serrated and globular appearance. These fibers stained positive with elastin stains. The cytomorphology of elastofibroma dorsi with diagnostic pitfalls and differential diagnostic dilemmas are discussed in this article.

Despite national objectives for extending health promotion programs to blue-collar workers and to small work sites, baseline behavior information for planning such programs is lacking. This study seeks to describe the health risks and norms specific to a population of male, blue-collar gas pipeline workers in remote sites. These workers (n = 395) completed a health risk appraisal and a "health gauge" survey designed to measure nutrition, physical activity, tobacco use, participatory patterns in health-enhancing activities, group norms, and change efforts. Selected behaviors were similar to those of other Texas men (eg, smoking 27% versus 26%) although others were not (eg, smokeless tobacco 18% versus 8%). Multivariate analysis confirmed the relationship of friends' behavior patterns, risk-taking, and interpersonal experience to four lifestyle health behaviors. With 75% or more of workers expressing an interest in various programs, the findings suggest that programming for this population can be successful if tailored to current behaviors and the worksite culture.

The fine needle aspiration (FNA) cytologic features of two cases of renal infarction are presented. Both patients did not have a classic clinical history for infarction, and the radiologic findings were suggestive of neoplasia. In one of our cases, necrotic glomeruli and tubules were present, which suggested the correct diagnosis of renal infarction and permitted appropriate early treatment. In the other case, groups of atypical renal tubular cells undergoing repair secondary to the infarction was misinterpreted as renal cell carcinoma. This case illustrates that renal infarction, like pulmonary infarction, can be a potential pitfall for a false-positive cytologic diagnosis of malignancy in FNA biopsy. A conservative approach is warranted when there is scanty cellularity and atypical cells having features of a repairlike reaction are present.

A case-control study of occupational injuries sustained by 914 male hourly workers employed in two Tenneco manufacturing divisions in 1987 was undertaken to examine the association between occupational and non-occupational injuries. Its aim was to evaluate whether employees who experienced a work-related injury were more likely to have sustained a previous non-work-related injury compared to individuals who did not experience a work-related injury. A statistically significant association between occupational injuries and past non-occupational injuries was seen when all workers compensation (WC) claims were analyzed (OR = 1.41) and when claims involving indemnity for lost time were analyzed (OR = 1.82). In addition, both workers who had occupational low-back injuries and workers who had occupational non-low-back injuries also had significantly higher risks of such injuries from a non-occupational origin (OR = 1.91 for low-back injuries and OR = 1.44 for non-low-back injuries). The findings suggest that elements other than workplace hazards (such as life-style and physical and psychological factors) may predispose an individual to both occupational and non-occupational injuries.

This article presents the incidence and costs for non-work-related injuries among 15,408 employees and their families based on health insurance claims data analysis. The treatment of injuries accounted for 11.3% of the plan's total health care costs ($31 million) for the 1986 policy year. For adults, women had a higher incidence rate than men; but for children, males had a higher incidence rate than females. A disproportionately high share of claims and charges for adults were attributed to low back disorders. Hospital admissions, length of stay and hospital days per 1,000 persons were similar for males and females, but much higher for adults than for children. This article provides an example of the utility of health insurance claims data as a source of morbidity information for disease surveillance and epidemiologic research. The analysis of claims data can be seen as a prerequisite to the development of preventive programs aimed at reducing injury rates and health care costs for injuries in a corporate setting.

Using both occupational (workers' compensation) and non-occupational (group health insurance) data, the nature and magnitude of injuries were determined in a working population of 20,705. Approximately one third of the population sustained an injury in 1986 (the year of study). Men experienced a significantly higher injury rate than women (33.3 per 100 v 24.9 per 100) and hourly employees had significantly higher incidence rates than salaried employees (42.0 per 100 v 22.5 per 100). The majority of nonoccupational injury claims were for low back disorders, whereas most occupational injury claims were related to superficial wounds and contusions. Overall, the incidence of nonoccupational injuries (21.1 per 100) was twofold higher than that of occupational injuries (10.8 per 100). Total costs for occupational and nonoccupational injuries were $4.97 million. The per-capita costs were $120 for both nonoccupational and occupational injuries. However, if only health care expenses are included in this calculation, nonoccupational injury costs would be almost 3 times as high as occupational injury costs ($120 v $46). These findings argue for increasing the share of corporate resources for off-the-job injury prevention programs aimed at reducing injury incidence and resultant health care costs.

This article presents the health care experience of 14,162 employees and their families, covered under a private third-party insurance plan of a large multinational corporation for the 1984 policy year. A total of $29.5 million was charged by health care providers to deliver medical care for the studied employees and their families. This amounted to $2,083 per employee and his/her family. Approximately 51% of the employees submitted claims, with females having greater utilization than males. The highest expenditures were for diseases of the circulatory system among adults (3.2 million or 23% for employees, $1.5 million or 14% for spouses). Among employees, neoplasms accounted for $1.4 million or 10% of costs, and musculoskeletal system $1.2 million or 9% of costs. Among spouses, pregnancy and diseases of the female reproductive system accounted for $1.2 million (12%) and $1.1 million (10%), respectively. Among dependents, the top three cost categories were mental disorders ($1.2 million or 24%), accident-related illnesses ($0.7 million or 14%), and diseases of the respiratory system ($0.6 million or 12%). Hospital care expenditures, including room and board, ancillary, and physician services, accounted for approximately 60% of total health care spending. The percentage of health care costs paid for by this insurance plan was 75% for active employees, 34% for retirees, 60% for female spouses, 38% for male spouses, and 64% for dependents. The analyses and parameters measured can be viewed as the first step toward the development of a health care cost containment and disease prevention strategy.

Electrothermal atomic absorption spectrometry was employed for analyses of nickel concentrations in urine samples from nickel-exposed workers in 10 occupational groups and from non-exposed workers in two control groups. Mean concentrations of nickel in urine were greatest in workers who were exposed to inhalation of aerosols of soluble nickel salts (e.g., workers in nickel plating operations and in an electrolytic nickel refinery). Less marked increases in urine nickel concentrations were found in groups of metal sprayers, nickel battery workers, bench mechanics and are welders. No significant increases in mean concentrations of nickel were found in urine samples from workers who performed grinding, buffing and polishing of nickel-containing alloys or workers in a coal gasification plant who employed Raney nickel as a hydrogenation catalyst. Measurements of nickel concentrations in urine are more sensitive and practical than measurements of serum nickel concentrations for evaluation of nickel exposures in industrial workers.

Nickel analyses were performed by electrothermal atomic absorption spectrometry upon urine specimens obtained from electroplating workers at the beginning, middle and end of the work-shift. The means (+/- S.D.) for nickel concentrations in urine specimens from seven electroplating workers on three regular workdays were: 34 +/- 32 micrograms/L (pre-shift); 64 +/- 63 micrograms/L (mid-shift) and 46 +/- 32 micrograms/L (end-shift), compared to 2.7 +/- 1.6 micrograms/L (pre-shift) in 19 controls (hospital workers). Nickel concentrations in urine specimens from six electroplating workers on the first workday after a two-week vactation averaged: 5 +/- 3 micrograms/L (pre-shift); 9 +/- 6 micrograms/L (mid-shift), and 12 +/- 6 micrograms/L (end-shift). Nickel concentrations in personal air samples (seven hours) collected from the breathing zones of five electroplating workers on three regular workdays averaging 9.3 +/- 4.4 micrograms/m3. Nickel concentrations in the air samples were correlated with nickel concentrations in end-shift urine specimens (corr. coef. = 0.70; P less than 0.05), but were not correlated with nickel concentrations in pre-shift or mid-shift urine specimens. In view of the fluctuations of urine nickel concentrations that occur during the work-shift, the authors recommend that nickel analyses of eight hour urine specimens be used routinely to monitor occupational exposures to nickel. In situations where timed urine collections are impractical, analyses of end-shift urine specimens are the best alternative.