Following a work refusal at a plant manufacturing ice cream novelties in Ontario, we were asked to document cases of cumulative trauma disorders (CTDs) and carpal tunnel syndrome (CTS) in this workplace. There were 17 employees with possible hand and wrist problems identified from Workers Compensation Board (WCB) Forms, and from a list prepared at the time of the refusal. After obtaining consents, confirmations of the diagnoses of CTDs, CTS, and of surgical procedures for CTS were obtained from the physicians involved. The relative risk for these disorders among plant employees was estimated in two ways: 1) the rate of CTS operations between 1979 and 1990 was compared to that in the general population using Ontario Health Insurance Plan (OHIP) data on physicians' billings for these operations; and 2) the frequency of WCB first payment claims for tendinitis and CTS during 1987 to 1989 at the plant was compared to that among the entire labor force of Ontario. CTDs had been diagnosed in all 17 workers: 9 had had operations for CTS, but one had had this operation prior to working at the plant. Compared to the remaining 8 workers who had CTS operations, an estimated 0.08 CTS operations would be expected among the 150 employees on the plant's seniority lists between 1979 and 1990, if the estimated rates in the general population were present at the plant, giving a Standardized Morbidity Ratio of 10.0 (95% confidence interval [CI] 4.3-19.7; one-sided p = 2.1 x 10(-6)). There were 6 WCB claims for tendinitis and CTS among plant employees during 1987 through 1989. This frequency was about 68 times that in the entire Ontario labor force (95% CI 24.7-150). This investigation has shown that CTDs, and particularly CTS, documented by medical records, have occurred at least 10 times more frequently than expected at this plant. Use of health insurance billing data to estimate CTS operation rates represents a simple method for estimating the burden of illness at the individual plant level due to CTS (at least for that portion proceeding to surgery), using an objective outcome that can be confirmed from medical records.
Cor pulmonale has been reported in the past to be associated with pneumoconiosis as an end-stage complication. However, whether the association can be demonstrated among cases of pneumoconiosis acquired in more recent decades is not clear. We examined the relation between these conditions using data summarized in hospital records in Ontario for males discharged between 1979 and 1990 with a diagnosis of chronic cor pulmonale or one of the pneumoconioses. Based on the age-specific frequency rates, cor pulmonale was diagnosed 17 (95% confidence interval 13-22) times more frequently than expected among men diagnosed with pneumoconiosis than among other men admitted to hospital. Our investigation indicates that cor pulmonale still appears to be associated with dust exposure in the workplace, and it demonstrates the usefulness of hospital discharge information in addressing questions in occupational health. However, we recommend that hospital medical records be examined to confirm the diagnoses and to determine the smoking histories of these men.
A 1993 study examined the association between pneumoconiosis and cor pulmonale using a computerized data base of hospital records in Ontario (Hospital Medical Records Institute, HMRI)
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