Speaking Up in Ethical Dilemmas

Medical Schoolhttps://deepblue.lib.umich.edu/bitstream/2027.42/148162/1/franzblaul.pd

Using job-title-based physical exposures from O*NET in an epidemiological study of carpal tunnel syndrome

OBJECTIVE: We studied associations between job title based measures of force and repetition and incident carpal tunnel syndrome (CTS). BACKGROUND: Job exposure matrices (JEMs) are not commonly used in studies of work-related upper extremity disorders. METHODS: We enrolled newly-hired workers into a prospective cohort study. We assigned a Standard Occupational Classification (SOC) code to each job held and extracted physical work exposure variables from the Occupational Information Network (O*NET). CTS case definition required both characteristic symptoms and abnormal median nerve conduction. RESULTS: 751 (67.8%) of 1107 workers completed follow-up evaluations. 31 subjects (4.4%) developed CTS during an average of 3.3 years of follow-up. Repetitive Motion, Static Strength, and Dynamic Strength from the most recent job held were all significant predictors of CTS when included individually as physical exposures in models adjusting for age, gender, and BMI. Similar results were found using time-weighted exposure across all jobs held during the study. Repetitive Motion, Static Strength, and Dynamic Strength were correlated, precluding meaningful analysis of their independent effects. CONCLUSION: This study found strong relationships between workplace physical exposures assessed via a JEM and CTS, after adjusting for age, gender, and BMI. Though job title based exposures are likely to result in significant exposure misclassification, they can be useful for large population studies where more precise exposure data are not available. APPLICATION: JEMs can be used as a measure of workplace physical exposures for some studies of musculoskeletal disorders

Impact of the Affordable Care Act on the Cooper Women’s Care Center

Background: The Affordable Care Act (ACA) increased access to women’s health care by expanding Medicaid eligibility and requiring that insurance plans cover many gynecologic preventive services at no cost to patients. Before implementation of the ACA, pregnant women with low incomes qualified for Medicaid but childless adults of the same income did not, and though prenatal obstetrical visits were covered by plans at no or low cost to patients, most gynecologic services required out of pocket payments. Objective: This study aimed to identify changes in the types of visits (gynecologic or obstetric) and patient demographics (including age, race, and insurance type) at the Cooper Women’s Care Clinic (WCC) as markers of the impact of the ACA. Methods: This is a cross-sectional study that utilized billing data from the Cooper WCC to understand the changes in visit type and demographics (age, race, and insurance type) over two pre-selected time periods, pre-ACA (2005-2009) and post-ACA (2011-2015). Our primary outcome was the proportion of total visits for each time period that were gynecologic vs. obstetrical. Our secondary outcomes were patient demographics, including age, race, and insurance type. Results: The proportion of gynecology visits in the post-ACA time period increased (71.4%) compared to the pre-ACA time period (62.7%), a statistically significant change (p\u3c0.0001) Conclusions: Our study demonstrates measurable changes that occurred in an urban Ob/Gyn practice as a result of the implementation of the ACA. Using gynecology visit volume as a marker of expanded access to Medicaid and free preventive services, it is clear that the ACA is changing the type of care provided by ob/gyns

Ulnar Neuropathy Among Active Workers Based Upon Hand Diagram Ratings

BackgroundLimited studies have estimated the prevalence of ulnar neuropathy (UN) in the workplace. Hand diagrams have been demonstrated to have a good sensitivity and specificity when attempting to identify patients with UN.ObjectiveTo determine the prevalence and associated risk factors for UN among active workers based on results of a hand diagram, and to determine the reliability of hand diagram scoring.DesignCross‐sectional study.SettingSeven different industrial and clerical work sites.MethodsA total of 501 active workers were screened. Subjects completed a hand diagram and the Job Content Questionnaire, and had ergonomic assessment of their job. Each hand diagram was scored independently by 2 raters.Main Outcome MeasuresRating of the hand diagram for UN.ResultsInterrater reliability of scoring the hand diagram for UN was very high. The estimated prevalence of UN was 3.6%. Suspected UN was associated with positioning of the elbow but not by contact stress at the elbow or force at the hand. Smokers had a lower prevalence, but smokers with suspected UN had higher‐pack year histories. Workers with suspected UN had a greater sense of job insecurity and lower job satisfaction rating.ConclusionsHand diagram rating has a high interrater reliability. Suspected UN has a relatively high prevalence among active workers in comparison to prior estimates of the prevalence of UN among the general population and is not strongly associated with ergonomic factors.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/146927/1/pmr2571.pd

Use of hand diagrams in screening for ulnar neuropathy: Comparison with electrodiagnostic studies

Introduction: The objective of this study was to determine whether a hand diagram could be used to predict ulnar mononeuropathy. Methods: This was a prospective study of 117 consecutive patients referred for hand symptoms. Each subject filled out a hand diagram of symptoms and had median and ulnar sensory and motor nerve conduction studies, including ulnar conduction across the elbow. Results: The best model for predicting an ulnar mononeuropathy included hand diagram scores of definite or possible. The model had a sensitivity of 50% and specificity of 93% with an ROC area of 0.90. Conclusions: The ulnar hand diagram scoring system can be useful as a screening tool in the electrodiagnostic laboratory or for epidemiologic studies. Muscle Nerve, 2012Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/94454/1/23452_ftp.pd

A Qualitative Study of the Adult Patient’s Experience after Complete Avulsion Traumatic Brachial Plexus Injury: Subjective Outcomes and Implications for Patient Education

Honors (Bachelor's)Interdisciplinary PhysicsUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/98897/1/laurenfr.pd

Natural history and predictors of long-term pain and function among workers with hand symptoms

OBJECTIVE: To evaluate predictors of hand symptoms and functional impairment after three years of follow-up among workers with different types of hand symptoms including carpal tunnel syndrome (CTS). Functional status and job limitations were also analyzed as key secondary objectives. DESIGN: Cohort design of 3-years duration SETTING: Working population-based study PARTICIPANTS: 1107 newly employed workers without a pre-existing diagnosis of CTS. Subjects were categorized into four groups at baseline examination: no hand symptoms, any hand symptoms but not CTS (recurring symptoms in hands, wrist or fingers without neuropathic symptoms), any hand symptoms of CTS (neuropathic symptoms in the fingers and normal nerve conduction study), or confirmed CTS (CTS symptoms and abnormal nerve conduction study). Among workers with hand pain at baseline, subject and job characteristics were assessed as prognostic factors for outcomes, using bivariate and multivariate regression models. INTERVENTIONS: Not applicable MAIN OUTCOME MEASURE: The primary outcome assessed by questionnaire at 3 years was “severe hand pain” in the past 30 days. RESULTS: At baseline, 155 workers (17.5% of 888 followed workers) reported hand symptoms, 21 had confirmed CTS. Presence of hand pain at baseline was a strong predictor of future hand pain and job impairment. Subjects with confirmed CTS at baseline were more likely to report severe hand pain, (adjusted prevalence ratios 1.98 [1.11 – 3.52]) and functional status impairment (adjusted prevalence ratios 3.37 [1.01 – 11.29]) than workers with other hand pain. Among subjects meeting our case definition for CTS at baseline, only 4 (19.1%) reported seeing a physician in the 3 year period. CONCLUSIONS: Hand symptoms persisted among many workers after 3 year follow-up, especially among those with CTS, yet few symptomatic workers had seen a physician