December 17, 2008     LARGER WAIST, SMALLER LIFESPAN

A study by T. Pischon in the New England Journal of Medicine involving 359,387 people in 9 countries with an average age of 59 years showed that excess abdominal fat is associated with the substantial increase in a person’s risk of dying even when the Body Mass Index [BMI] is within the normal range. 

The study showed that the risk of premature death in those with a larger waist measuring approximately 40” for men and 35” for women was about double that of individuals with a smaller waist [less than 34” for men and 27.5” for women]. 

Also, for each 2” increase in waist circumference the mortality risk increased by 17% in men and 13% in women.  JAMA 12/17/08, Vol. 300, No. 23, Page 2717

April 10, 2008     FIRST-AID CLARIFIED

The Division of Worker’s Compensation issued a clarification to the rules for reporting first-aid incidents.

DWC defines first-aid as any one time treatment and a follow-up visit for the purpose of observation of minor scratches, cuts, burns, splinters, etc., which do not ordinarily require medical care.  Such one-time treatments and follow-up visits for the purpose of observation are considered first-aid, even if provided by physician or registered professional.  Though employers do not have to file an employer’s report [Form 5020] and the “employee claim form [DWC-1]”, the treating physician is still required to file a doctor’s first report of injury [DFR, Form 5021] with the claims administrator.

“Employers and medical providers are reminded that any arrangements allowing the employer to dictate how an injury is classified violate state rules and may constitute fraud.”  Worker’s Comp Executive, Vol. 18, No. 7, April 9, 2008.

OBESITY RELATED TO WORK COMP CLAIMS 

An excellent study done at Duke University involving a retrospective study of 11,728 health care and university employees between January 1997 and December 31, 2004 indicates a “clear linear relationship between Body Mass Index and rate of claims.”  Those employees in the obesity class III [BMI ? 40] had 11.65 claims compared to “recommended weight employees” with 5.8 claims.  Even more importantly, based on 100 full-time equivalent workers, the number of lost work days for obese employees was 183.6 versus 14.2 for normal weight employees and the cost of medical claims for obese workers was $51,091 versus $7,503 per 100 full-time equivalent employees!  This information indicates that maintaining healthy weight is not only important to workers, but should be a high priority for employers given the strong effect of high Body Mass Index [obesity] on workers injuries.  They recommend complimenting general interventions to make workplaces safer with work-based programs targeting healthy eating and physical activity.  Archive of Internal Medicine [abstract printed in JAMA volume 297, #24, p. 2678 (6/27/07)].

November 26, 2007     DO PERSONAL MUSIC PLAYERS [CD PLAYERS, IPODS, ETC.] CAUSE HEARING LOSS?

Dr. Charles Fankhauser notes in the December 2007 issue of New Occupational News that it is “well established that personal music listening devices are capable of sound levels potentially damaging to human hearing.”  However, there is no well developed criterion for users of such devices as there are damage risk criteria for workers exposed to loud noises on the job.  Personal earphone sound output is measured in the same way one might measure the output level of a hearing aid.  The A scale damage risk criteria for workers are based on sound field measurements and the two measurement techniques yield significantly different results, by as much as 10-15 decibels.

So what is one to do in order to limit potential hearing loss from these disc players and IPODs? 

We know that the sound levels associated with recreational music depend on earphone type and the environment where listening is taking place.  Dr. Fankhauser recommends the following:

Keep the volume down.  Half volume is a good guide.

1. Limit listening time.  Give your ears some quiet time.
2. Upgrade your earphones or ear buds to the kind that block unwanted sound. 
3. Go to www.listentoyourbuds.org for parental and educator resources.  MEDI New Occupational News, Issue 20, December 2007.

November 14, 2007     THE CHANGING RELATIONSHIP OF OBESITY AND DISABILITY FROM 1988 – 2004

Obesity is associated with a variety of poor health outcomes, but over the last several decades several studies suggest that the obese population may have grown healthier since the 1960’s.  High cholesterol levels and high blood pressure levels have declined with treatment among obese individuals.  However, obesity does continue to be associated with excess mortality.

It has been unclear however, whether improvements in cardiovascular risk factors and mortality have been accompanied by improvements in other health outcomes, particularly disability from the inability to perform tasks such as walking ¼ mile, walking up 10 steps, stooping, lifting 10 pounds, walking between rooms and standing from an armless chair. 

A recent study in Journal of American Medical Association showed that the improvements in cardiovascular health have not been accompanied by reduced disability within the obese older population.  Rather, obese participants surveyed between 1999 – 2004 were more likely to report functional impairments than obese participates surveyed during the 1988 – 1994 period.

These results seem to indicate that over time “declines in obesity-related mortality along with the younger age at onset of obesity, could lead to an increase burden of disability within obese older populations.” JAMA, 2007; 298 [17]: 2020-2027 

This information strongly suggests that it will be to the employer’s financial benefit to encourage obese employees to lose weight since the long term costs of their disability can significantly affect the employer’s bottom line.

October 9, 2007     OVERWEIGHT & OBESITY AS PREDICTORS OF ABSENTEEISM

Here is another article indicating that employees who are overweight or obese tend to have more absenteeism from work than normal weight employees. 

In the Netherlands, the study consisted of 1,742 employees aged 18-59 years who have been employed for at least 1 year and who worked 24 hours per week or more.  They were classified as normal weight BMI [body mass index, which is defined as weight in kilograms divided by height in meters squared] 18.5-24.9, overweight as BMI 25.0-29.9, or obese BMI equal to or greater than 30.  After excluding underweight employees, of the 1,284 remaining employees in the study, 32% where overweight and 7% obese.  In the overweight employees the frequency of medium long term absenteeism was significantly higher than in normal weight employees; and among the obese they had significantly more sick days and a higher frequency of absenteeism than did employees of a normal weight.  On the average, obese employees were absent 14 days per year more than normal weight employees. 

This study also showed that among employees who did not practice sports on a regular basis, obesity was related to a higher duration and a higher frequency of medium and long term absenteeism.

This study shows that excess body weight should be a concern to the business world, since absenteeism is associated with increasing cost of doing business.  JOEM, VOL 49, #9, September 2007, P 975-980.

September 21, 2007     OBESITY RELATED TO LOST WORK DAYS

In a study involving 11,728 health care and university employees with at least one health risk appraisal between 1/1/97 and 12/31/04 there was a clear linear relationship between Basal Metabolic Index [BMI] and rate of claims.  Employees with a BMI of 40 or more [marked obesity] had 11.5 claims per 100 full-time equivalent employees, while employees in the recommended weight range had 5.80; also, lost work days were 183.63 for the obese individuals versus only 14.19 per 100 FTEs; and medical claims costs were $51,091 versus $7,503 per 100 full-time equivalent employees; also, indemnity claims cost $59,178 versus $5,396 per 100 FTEs.  The body areas most strongly affected in terms of claims for the obese were the following: lower extremity, wrist or hand, and back, pain or inflammation, sprain or strain, and contusion or bruise, falls or slips, lifting and exertion.  This provides strong incentives for employers to encourage health-related and weight loss-related programs for their overweight or obese employees. Archives of Internal Medicine 2007: 167: 766-773.

September 21, 2007     CIGARETTE ADDITIVES DETRIMENTAL TO HEALTH

UCLA scientists have found that more than 100 cigarette additives have actions that camouflage the odor of cigarette tobacco smoke and enhance or maintain nicotine delivery.  Some additives make it easier for cigarette smoke to penetrate the lungs thereby possibly increasing the addictiveness of cigarettes.  Other additives have properties that may help mask symptoms such as anesthetizing the throat to make it easier for smokers to avoid coughing.  This article was published in the American Journal of Pubic Health, July 31, 2007.

Cigarettes contain approximately 2,000 chemicals including nicotine, many of which are very hazardous to health and now we find that even the additives tend to make cigarette smoking even more dangerous.  JAMA, 9/12/07, VOL 298, No. 10, Page 1152.

September 14, 2007     MARIJUANA WORSE THAN TOBACCO IN AIRWAYS OBSTRUCTION

A study published in Thorax 2007 [EPub] indicates that smoking a single joint of marijuana has the same impact on lung function as up to five cigarettes.  Researchers in New Zealand studied 339 adults divided into four similar-sized groups according to whether they smoked marijuana, only tobacco, both, or were nonsmokers.  The marijuana smokers had regularly smoked marijuana for at least five years and the tobacco smokers had smoked cigarettes for at least one year.  Urine tests were used to verify marijuana and/or tobacco use.  Each participant underwent pulmonary function tests, a CT scan to measure lung density, and completed a survey about smoking habits.

The results demonstrated dose-related obstructive impairment of lung function among smokers.  The effect on airways obstruction of one marijuana joint was 2.5 – 5 times greater than the effect of one tobacco cigarette.  The researchers say this difference may be due to differences in how marijuana and tobacco are smoked. 

This study provides one more significant challenge to the proposition that “smoking marijuana is innocuous”.  ACOEM Medical Review Officer Update, August 2007, p3.