American journal of industrial medicine, Jan 29, 2015
While smoking is the major cause of chronic obstructive pulmonary disease (COPD), occupational ex... more While smoking is the major cause of chronic obstructive pulmonary disease (COPD), occupational exposures to vapors, gases, dusts, and fumes (VGDF) increase COPD risk. This case-control study estimated the risk of COPD attributable to occupational exposures among construction workers. The study population included 834 cases and 1243 controls participating in a national medical screening program for older construction workers between 1997 and 2013. Qualitative exposure indices were developed based on lifetime work and exposure histories. Approximately 18% (95%CI = 2-24%) of COPD risk can be attributed to construction-related exposures, which are additive to the risk contributed by smoking. A measure of all VGDF exposures combined was a strong predictor of COPD risk. Construction workers are at increased risk of COPD as a result of broad and complex effects of many exposures acting independently or interactively. Control methods should be implemented to prevent worker exposures, and sm...
BACKGROUND: Treatment of carcinomatosis may involve the use of heated intraperitoneal chemotherap... more BACKGROUND: Treatment of carcinomatosis may involve the use of heated intraperitoneal chemotherapy; the cytotoxic solution is administered in the operating room with the abdomen open so that manual distribution results in uniform treatment. The potential risk of this procedure to the operating room personnel has not been previously investigated.METHODS: Mitomycin C was perfused through the peritoneal cavity, which was partially covered by a plastic sheet. Large volumes of air were suctioned from 5 and 35 cm above the abdominal skin edge. Urine from the surgeon and from the perfusionist were assayed. Sterile gloves worn in the operating room for manipulating the viscera during treatment were assayed for their permeability to mitomycin C. All samples were analyzed by high-performance liquid chromatography.RESULTS: Analysis of samples of operating room air and urine from 10 procedures showed no detectable levels of mitomycin C. Six tests of three different types of gloves showed a 10-fold range of mitomycin C penetration. The least permeable gloves leaked a mean of 3.8 parts per million over 90 minutes.CONCLUSIONS: No detectable safety hazard to the surgeon or other operating room personnel was demonstrated.
BACKGROUND: To investigate the intersection of aging with work limitations, chronic medical and m... more BACKGROUND: To investigate the intersection of aging with work limitations, chronic medical and musculoskeletal conditions, and physical functioning we undertook a cross-sectional study of U.S. construction roofers who were current union members between the ages of 40 and 59.METHODS: Participants were asked about the presence of medical conditions and musculoskeletal disorders (MSDs); the Work Limitations Questionnaire, the SF-12, and other validated assessments of social and economic impact of injury were included.RESULTS: Sixty-nine percent had at least one of these conditions in the previous two years; 31% missed work. Workers with medical and musculoskeletal conditions were older, had the highest prevalence of work activity limitations, and had the lowest SF-12 scores.CONCLUSIONS: Older age was associated with the presence of a medical condition, and with reduced physical functioning. Medical and musculoskeletal conditions were strongly associated with work limitation, missed work, and reduced physical functioning. Older workers may be at higher risk of disability retirement compared to younger workers with similar medical conditions and work limitations.
Work-related musculoskeletal disorders (WMSD) among construction workers remain high. Participato... more Work-related musculoskeletal disorders (WMSD) among construction workers remain high. Participatory ergonomics (PE) interventions that engage workers and employers in reducing work injury risks have shown mixed results. Eight-six workers from seven contractors participated in a PE program. A logic model guided the process evaluation and summative evaluation of short-term and intermediate impacts and long-term outcomes from surveys and field records. Process measures showed good delivery of training, high worker engagement, and low contractor participation. Workers' knowledge improved and workers reported changes to work practices and tools used; contractor provision of appropriate equipment was low (33%). No changes were seen in symptoms or reported physical effort. The PE program produced many worker-identified ergonomic solutions, but lacked needed support from contractors. Future interventions should engage higher levels of the construction organizational system to improve co...
Data Revues 10553207 V12i3 S1055320703000450, Aug 26, 2011
This article reviews a single institution's experience wi... more This article reviews a single institution's experience with 68 patients (21 females, 47 males) prospectively treated over the last 2 decades with an aggressive local-regional approach, combining maximal cytoreductive surgery with heated intraoperative intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy. This multimodality treatment has resulted in a median survival of 67 months. Female patients had a significantly better prognosis than males. The other significant predictive factors of survival were: age, diagnosis by incidental findings, tumor extent, pathology, and completeness of cytoreduction.
ABSTRACT Introduction: Manufacturers equipment for the construction industry have been engaged ca... more ABSTRACT Introduction: Manufacturers equipment for the construction industry have been engaged case by case in research on innovations, but there is no formal mechanism to explore the transfer of safety and health technologies in the construction industry. Methods: We will present findings from a symposium sponsored by The Center for Construction Research and Training in May 2012. The meeting will identify drivers for and barriers to moving new, safer tools and equipment from research to practice in the construction industry. Participants will include academics, construction professionals, manufacturers, and trade association representatives. Results and discussion: The symposium will develop recommendations for building and sustaining a technology transfer function for the construction industry. Issues for discussion include: (1) Intellectual property/patents and the role of exclusive vs. non-exclusive licenses for inventions. (2) Cost factors that impact adoption, such as how to quantify the expenses related to implementing, operating, and/or maintaining new safety and health technologies; degree of worker training needed; impact of innovation on job performance and/or quality of work);. (3) Incentives for tech transfer, including the impact of existing regulations on adoption, whether other incentives are sufficient in absence of regulation, and the availability and access to financial incentives for research, manufacturing, and industry adoption (e.g., research funding, subsidized tool evaluation, tax breaks, insurance premium reductions). (4) How to apply diffusion of innovation theory, including the attributes of an innovation that affect diffusion (relative advantage, compatibility, complexity, trialability and observability) and the role of innovators and early adopters in the construction industry.
Little is known about the transfer into the workplace of interventions designed to reduce the phy... more Little is known about the transfer into the workplace of interventions designed to reduce the physical demands of sheet metal workers. We reviewed videos from a case series of 15 sheet metal worksite assessments performed in 2007-2009 to score postures and physical loads, and to observe the use of recommended interventions to reduce physical exposures in sheet metal activities made by a NIOSH stakeholder meeting in 2002. Workers showed consistent use of material handling devices, but we observed few uses of recommended interventions to reduce exposures during overhead work. Workers spent large proportions of time in awkward shoulder elevation and low back rotation postures. In addition to the development of new technologies and system designs, increased adoption of existing tools and practices could reduce time spent in awkward postures and other risks for musculoskeletal disorders in sheet metal work.
To describe the clinical presentation of peritoneal mesothelioma and its impact on survival. Data... more To describe the clinical presentation of peritoneal mesothelioma and its impact on survival. Data was collected from 51 patients with peritoneal mesothelioma treated at the Washington Cancer Institute. The demographic, clinical and pathologic information were analyzed. Pain was the most common symptom (recorded in 33% of patients); increased abdominal girth occurred in 31%, increased abdominal girth and pain in 5%, and a new onset hernia in 12%. In an additional 14% of patients, a variety of other clinical findings led to the diagnosis. There was a statistically significant difference in survival by gender, weight loss and volume of disease. Pain was the most common initial presenting symptom, with increased abdominal girth as a second. A more favorable prognosis occurred in women with a small disease volume.
Background and Objectives: Rates of musculoskeletal injuries among workers in construction remain... more Background and Objectives: Rates of musculoskeletal injuries among workers in construction remain high. Participatory ergonomics (PE) is an approach to engage workers and employers in identifying and implementing injury prevention solutions. When evaluated by decreased symptoms or injuries, PE has shown mixed results. Better evaluation of PE efficacy requires measurement of short-term and intermediate impacts. In this presentation we will: 1) describe this PE study implemented in groups of construction workers; 2) present short-term (learning), intermediate (actions), and long-term results; and 3) discuss multi-level factors for improving the implementation and dissemination of PE based on our identified barriers to implementation in construction. Methods: We recruited 96 workers from seven contractors in three trades. We trained workers in ergonomic problem identification and implementation of task-specific solutions. We evaluated our program using mixed methods including data from...
International journal of occupational and environmental health
The proportion of peritoneal mesotheliomas among all mesotheliomas has been decreasing, leading s... more The proportion of peritoneal mesotheliomas among all mesotheliomas has been decreasing, leading some to suggest that peritoneal mesothelioma occurs only after high levels of exposure to asbestos. To investigate the relationship between asbestos exposure and the development of peritoneal mesothelioma, a case-control study examined 40 cases of primary peritoneal mesothelioma from a single institution. This series differed from previous reports in that 75% of the cases and controls had attended college. Results show an odds ratio of 6.6 for asbestos exposure among this group of primary peritoneal mesothelioma cases with relatively slight asbestos exposures.
This article reviews a single institution's experience with 68 patients (21 females, 47 males... more This article reviews a single institution's experience with 68 patients (21 females, 47 males) prospectively treated over the last 2 decades with an aggressive local-regional approach, combining maximal cytoreductive surgery with heated intraoperative intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy. This multimodality treatment has resulted in a median survival of 67 months. Female patients had a significantly better prognosis than males. The other significant predictive factors of survival were: age, diagnosis by incidental findings, tumor extent, pathology, and completeness of cytoreduction.
... Tristan D. Yan Raffit Hassan Laura Welch Paul H. Sugarbaker ... Since the disease was first d... more ... Tristan D. Yan Raffit Hassan Laura Welch Paul H. Sugarbaker ... Since the disease was first described by Miller and Wynn in 1908 few therapeutic advances occurred [3]. Systemic chemotherapy, palliative surgery and/or total abdominal radiation therapy were used selectively, ...
Compare rates of medical insurance claims for musculoskeletal disorders (MSD) between workers in ... more Compare rates of medical insurance claims for musculoskeletal disorders (MSD) between workers in a construction trade and a general worker population to determine if higher physical exposures in construction lead to higher rates of claims on personal medical insurance. Health insurance claims between 2006 and 2010 from floor layers were frequency matched by age, gender, eligibility time and geographic location to claims from insured workers in general industry obtained from MarketScan. We extracted MSD claims and dates of service from six regions of the body: neck, low back, knee, lower extremity, shoulder and distal arm, and evaluated differences in claim rates. Fifty-one per cent of floor layers (n=1475) experienced musculoskeletal claims compared with 39% of MarketScan members (p<0.001). Claim rates were higher for floor layers across all body regions with nearly double the rate ratios for the knee and neck regions (RR 2.10 and 2.07). The excess risk was greatest for the neck ...
Floor layers have high rates of musculoskeletal disorders yet few studies have examined their wor... more Floor layers have high rates of musculoskeletal disorders yet few studies have examined their work exposures. This study used observational methods to describe physical exposures within floor laying tasks. We analyzed 45 videos from 32 floor layers using Multimedia-Video Task Analysis software to determine the time in task, forces, postures, and repetitive hand movements for installation of four common flooring materials. We used the WISHA checklists to define exposure thresholds. Most workers (91%) met the caution threshold for one or more exposures. Workers showed high exposures in multiple body parts with variability in exposures across tasks and for different materials. Prolonged exposures were seen for kneeling, poor neck and low back postures, and intermittent but frequent hand grip forces. Floor layers experience prolonged awkward postures and high force physical exposures in multiple body parts, which probably contribute to their high rates of musculoskeletal disorders.
... We also examined Mb concentration in emperor penguins that had been in captivity from a pre-f... more ... We also examined Mb concentration in emperor penguins that had been in captivity from a pre-fledging age in order to evaluate Mb concentration in birds that had never performed the long, deep dives which occur in the wild. ... Individual birds gained 1.9–6.8 kg during captivity. ...
American journal of industrial medicine, Jan 29, 2015
While smoking is the major cause of chronic obstructive pulmonary disease (COPD), occupational ex... more While smoking is the major cause of chronic obstructive pulmonary disease (COPD), occupational exposures to vapors, gases, dusts, and fumes (VGDF) increase COPD risk. This case-control study estimated the risk of COPD attributable to occupational exposures among construction workers. The study population included 834 cases and 1243 controls participating in a national medical screening program for older construction workers between 1997 and 2013. Qualitative exposure indices were developed based on lifetime work and exposure histories. Approximately 18% (95%CI = 2-24%) of COPD risk can be attributed to construction-related exposures, which are additive to the risk contributed by smoking. A measure of all VGDF exposures combined was a strong predictor of COPD risk. Construction workers are at increased risk of COPD as a result of broad and complex effects of many exposures acting independently or interactively. Control methods should be implemented to prevent worker exposures, and sm...
BACKGROUND: Treatment of carcinomatosis may involve the use of heated intraperitoneal chemotherap... more BACKGROUND: Treatment of carcinomatosis may involve the use of heated intraperitoneal chemotherapy; the cytotoxic solution is administered in the operating room with the abdomen open so that manual distribution results in uniform treatment. The potential risk of this procedure to the operating room personnel has not been previously investigated.METHODS: Mitomycin C was perfused through the peritoneal cavity, which was partially covered by a plastic sheet. Large volumes of air were suctioned from 5 and 35 cm above the abdominal skin edge. Urine from the surgeon and from the perfusionist were assayed. Sterile gloves worn in the operating room for manipulating the viscera during treatment were assayed for their permeability to mitomycin C. All samples were analyzed by high-performance liquid chromatography.RESULTS: Analysis of samples of operating room air and urine from 10 procedures showed no detectable levels of mitomycin C. Six tests of three different types of gloves showed a 10-fold range of mitomycin C penetration. The least permeable gloves leaked a mean of 3.8 parts per million over 90 minutes.CONCLUSIONS: No detectable safety hazard to the surgeon or other operating room personnel was demonstrated.
BACKGROUND: To investigate the intersection of aging with work limitations, chronic medical and m... more BACKGROUND: To investigate the intersection of aging with work limitations, chronic medical and musculoskeletal conditions, and physical functioning we undertook a cross-sectional study of U.S. construction roofers who were current union members between the ages of 40 and 59.METHODS: Participants were asked about the presence of medical conditions and musculoskeletal disorders (MSDs); the Work Limitations Questionnaire, the SF-12, and other validated assessments of social and economic impact of injury were included.RESULTS: Sixty-nine percent had at least one of these conditions in the previous two years; 31% missed work. Workers with medical and musculoskeletal conditions were older, had the highest prevalence of work activity limitations, and had the lowest SF-12 scores.CONCLUSIONS: Older age was associated with the presence of a medical condition, and with reduced physical functioning. Medical and musculoskeletal conditions were strongly associated with work limitation, missed work, and reduced physical functioning. Older workers may be at higher risk of disability retirement compared to younger workers with similar medical conditions and work limitations.
Work-related musculoskeletal disorders (WMSD) among construction workers remain high. Participato... more Work-related musculoskeletal disorders (WMSD) among construction workers remain high. Participatory ergonomics (PE) interventions that engage workers and employers in reducing work injury risks have shown mixed results. Eight-six workers from seven contractors participated in a PE program. A logic model guided the process evaluation and summative evaluation of short-term and intermediate impacts and long-term outcomes from surveys and field records. Process measures showed good delivery of training, high worker engagement, and low contractor participation. Workers' knowledge improved and workers reported changes to work practices and tools used; contractor provision of appropriate equipment was low (33%). No changes were seen in symptoms or reported physical effort. The PE program produced many worker-identified ergonomic solutions, but lacked needed support from contractors. Future interventions should engage higher levels of the construction organizational system to improve co...
Data Revues 10553207 V12i3 S1055320703000450, Aug 26, 2011
This article reviews a single institution&amp;amp;amp;amp;amp;amp;amp;amp;#39;s experience wi... more This article reviews a single institution&amp;amp;amp;amp;amp;amp;amp;amp;#39;s experience with 68 patients (21 females, 47 males) prospectively treated over the last 2 decades with an aggressive local-regional approach, combining maximal cytoreductive surgery with heated intraoperative intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy. This multimodality treatment has resulted in a median survival of 67 months. Female patients had a significantly better prognosis than males. The other significant predictive factors of survival were: age, diagnosis by incidental findings, tumor extent, pathology, and completeness of cytoreduction.
ABSTRACT Introduction: Manufacturers equipment for the construction industry have been engaged ca... more ABSTRACT Introduction: Manufacturers equipment for the construction industry have been engaged case by case in research on innovations, but there is no formal mechanism to explore the transfer of safety and health technologies in the construction industry. Methods: We will present findings from a symposium sponsored by The Center for Construction Research and Training in May 2012. The meeting will identify drivers for and barriers to moving new, safer tools and equipment from research to practice in the construction industry. Participants will include academics, construction professionals, manufacturers, and trade association representatives. Results and discussion: The symposium will develop recommendations for building and sustaining a technology transfer function for the construction industry. Issues for discussion include: (1) Intellectual property/patents and the role of exclusive vs. non-exclusive licenses for inventions. (2) Cost factors that impact adoption, such as how to quantify the expenses related to implementing, operating, and/or maintaining new safety and health technologies; degree of worker training needed; impact of innovation on job performance and/or quality of work);. (3) Incentives for tech transfer, including the impact of existing regulations on adoption, whether other incentives are sufficient in absence of regulation, and the availability and access to financial incentives for research, manufacturing, and industry adoption (e.g., research funding, subsidized tool evaluation, tax breaks, insurance premium reductions). (4) How to apply diffusion of innovation theory, including the attributes of an innovation that affect diffusion (relative advantage, compatibility, complexity, trialability and observability) and the role of innovators and early adopters in the construction industry.
Little is known about the transfer into the workplace of interventions designed to reduce the phy... more Little is known about the transfer into the workplace of interventions designed to reduce the physical demands of sheet metal workers. We reviewed videos from a case series of 15 sheet metal worksite assessments performed in 2007-2009 to score postures and physical loads, and to observe the use of recommended interventions to reduce physical exposures in sheet metal activities made by a NIOSH stakeholder meeting in 2002. Workers showed consistent use of material handling devices, but we observed few uses of recommended interventions to reduce exposures during overhead work. Workers spent large proportions of time in awkward shoulder elevation and low back rotation postures. In addition to the development of new technologies and system designs, increased adoption of existing tools and practices could reduce time spent in awkward postures and other risks for musculoskeletal disorders in sheet metal work.
To describe the clinical presentation of peritoneal mesothelioma and its impact on survival. Data... more To describe the clinical presentation of peritoneal mesothelioma and its impact on survival. Data was collected from 51 patients with peritoneal mesothelioma treated at the Washington Cancer Institute. The demographic, clinical and pathologic information were analyzed. Pain was the most common symptom (recorded in 33% of patients); increased abdominal girth occurred in 31%, increased abdominal girth and pain in 5%, and a new onset hernia in 12%. In an additional 14% of patients, a variety of other clinical findings led to the diagnosis. There was a statistically significant difference in survival by gender, weight loss and volume of disease. Pain was the most common initial presenting symptom, with increased abdominal girth as a second. A more favorable prognosis occurred in women with a small disease volume.
Background and Objectives: Rates of musculoskeletal injuries among workers in construction remain... more Background and Objectives: Rates of musculoskeletal injuries among workers in construction remain high. Participatory ergonomics (PE) is an approach to engage workers and employers in identifying and implementing injury prevention solutions. When evaluated by decreased symptoms or injuries, PE has shown mixed results. Better evaluation of PE efficacy requires measurement of short-term and intermediate impacts. In this presentation we will: 1) describe this PE study implemented in groups of construction workers; 2) present short-term (learning), intermediate (actions), and long-term results; and 3) discuss multi-level factors for improving the implementation and dissemination of PE based on our identified barriers to implementation in construction. Methods: We recruited 96 workers from seven contractors in three trades. We trained workers in ergonomic problem identification and implementation of task-specific solutions. We evaluated our program using mixed methods including data from...
International journal of occupational and environmental health
The proportion of peritoneal mesotheliomas among all mesotheliomas has been decreasing, leading s... more The proportion of peritoneal mesotheliomas among all mesotheliomas has been decreasing, leading some to suggest that peritoneal mesothelioma occurs only after high levels of exposure to asbestos. To investigate the relationship between asbestos exposure and the development of peritoneal mesothelioma, a case-control study examined 40 cases of primary peritoneal mesothelioma from a single institution. This series differed from previous reports in that 75% of the cases and controls had attended college. Results show an odds ratio of 6.6 for asbestos exposure among this group of primary peritoneal mesothelioma cases with relatively slight asbestos exposures.
This article reviews a single institution's experience with 68 patients (21 females, 47 males... more This article reviews a single institution's experience with 68 patients (21 females, 47 males) prospectively treated over the last 2 decades with an aggressive local-regional approach, combining maximal cytoreductive surgery with heated intraoperative intraperitoneal chemotherapy and early postoperative intraperitoneal chemotherapy. This multimodality treatment has resulted in a median survival of 67 months. Female patients had a significantly better prognosis than males. The other significant predictive factors of survival were: age, diagnosis by incidental findings, tumor extent, pathology, and completeness of cytoreduction.
... Tristan D. Yan Raffit Hassan Laura Welch Paul H. Sugarbaker ... Since the disease was first d... more ... Tristan D. Yan Raffit Hassan Laura Welch Paul H. Sugarbaker ... Since the disease was first described by Miller and Wynn in 1908 few therapeutic advances occurred [3]. Systemic chemotherapy, palliative surgery and/or total abdominal radiation therapy were used selectively, ...
Compare rates of medical insurance claims for musculoskeletal disorders (MSD) between workers in ... more Compare rates of medical insurance claims for musculoskeletal disorders (MSD) between workers in a construction trade and a general worker population to determine if higher physical exposures in construction lead to higher rates of claims on personal medical insurance. Health insurance claims between 2006 and 2010 from floor layers were frequency matched by age, gender, eligibility time and geographic location to claims from insured workers in general industry obtained from MarketScan. We extracted MSD claims and dates of service from six regions of the body: neck, low back, knee, lower extremity, shoulder and distal arm, and evaluated differences in claim rates. Fifty-one per cent of floor layers (n=1475) experienced musculoskeletal claims compared with 39% of MarketScan members (p<0.001). Claim rates were higher for floor layers across all body regions with nearly double the rate ratios for the knee and neck regions (RR 2.10 and 2.07). The excess risk was greatest for the neck ...
Floor layers have high rates of musculoskeletal disorders yet few studies have examined their wor... more Floor layers have high rates of musculoskeletal disorders yet few studies have examined their work exposures. This study used observational methods to describe physical exposures within floor laying tasks. We analyzed 45 videos from 32 floor layers using Multimedia-Video Task Analysis software to determine the time in task, forces, postures, and repetitive hand movements for installation of four common flooring materials. We used the WISHA checklists to define exposure thresholds. Most workers (91%) met the caution threshold for one or more exposures. Workers showed high exposures in multiple body parts with variability in exposures across tasks and for different materials. Prolonged exposures were seen for kneeling, poor neck and low back postures, and intermittent but frequent hand grip forces. Floor layers experience prolonged awkward postures and high force physical exposures in multiple body parts, which probably contribute to their high rates of musculoskeletal disorders.
... We also examined Mb concentration in emperor penguins that had been in captivity from a pre-f... more ... We also examined Mb concentration in emperor penguins that had been in captivity from a pre-fledging age in order to evaluate Mb concentration in birds that had never performed the long, deep dives which occur in the wild. ... Individual birds gained 1.9–6.8 kg during captivity. ...
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Papers by Laura Welch