The Experts below are selected from a list of 318 Experts worldwide ranked by ideXlab platform
Melissa J Perry - One of the best experts on this subject based on the ideXlab platform.
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a case crossover study of Laceration injuries in pork processing
Occupational and Environmental Medicine, 2012Co-Authors: Lina Lander, Gary S Sorock, Terry L Stentz, Murray A Mittleman, Melissa J Perry, Lynette M SmithAbstract:Objectives The authors estimated the associations between transient risk factors and Laceration injuries in workers at two meatpacking plants in the Midwest. Methods The case-crossover design was used to collect within-subject transient work task and personal-level exposure information. RRs of Laceration injuries were estimated by comparing exposures during the ‘hazard’ period (just before the Laceration injury) with exposures in the ‘control’ period (the previous workweek). Stratified analyses were utilised to estimate the effects of gender, ethnicity, training and the number of adjacent coworkers on each transient risk factor. Results The authors interviewed 295 meatpacking workers with Laceration injuries (mean age 36.6 years, SD 11.2, 75% men, 48% Hispanic). Recent tool sharpening (RR 5.3, 95% CI 3.8 to 7.4) and equipment malfunction (RR 5.3, 95% CI 3.9 to 7.3) were associated with the highest RR for Laceration injury, followed by using an unusual work method to accomplish a task (RR 4.1, 95% CI 2.6 to 6.4) and performing an unusual task (RR 2.3, 95% CI 1.8 to 3.0). Rushing and being distracted were not significantly associated with an elevated RR of a Laceration injury. In stratified analyses, there were a number of significant differences in Laceration risk factors by gender, ethnicity, training, and number of workers on the line. Conclusions Sharpening tools, equipment malfunction, using an unusual work method to accomplish a task and performing an unusual task were all associated with increased risk of Lacerations. Expanded training in atypical work circumstances and evaluation of tool sharpening procedures are intervention areas in meatpacking that need examination.
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a case crossover study of occupational Laceration injuries in pork processing methods and preliminary findings
Occupational and Environmental Medicine, 2010Co-Authors: Lina Lander, Gary S Sorock, Terry L Stentz, Ellen A Eisen, Murray A Mittleman, Russ Hauser, Melissa J PerryAbstract:Objectives Meatpacking remains a hazardous and largely unexamined industry. Despite prevention efforts, Laceration injuries, among others, remain high. We estimated the magnitude of associations between transient exposures such as equipment malfunction, performing an unusual work task, rushing, and occurrence of Laceration injuries. Methods Injured workers were recruited from two pork-processing plants, one in Iowa and one in Nebraska. A telephone interview was conducted within 7 days of the injury, on average to collect information on fixed and transient exposures preceding the injury event. Case-crossover methodology was used to evaluate case and control data within the same subject, thus controlling for between-subject confounding. A Mantel–Haenszel estimator for person-time data was used to estimate the relative risks of injury and transient exposures of interest. Results Of the 362 workers with Lacerations between April 2006 and October 2007, 153 (42%) were interviewed (74% male, 41% Hispanic). Forty-eight per cent were injured by a knife or a knife-like object such as scissors or a band saw. Other sources of Lacerations included sharp edges and hooks. Tool sharpening was associated with the highest RR of Laceration (RR 8.4, 95% CI 5.4 to 12.8) followed by slipping (RR 74.8, 95% CI 30.5 to 183.3), equipment malfunction (RR 3.8, 95% CI 2.8 to 5.3), and performing an unusual task (RR 3.7, 95% CI 2.6 to 5.2). Being tired, distracted, or rushing were not significant risk factors for a Laceration. Conclusions Aspects of the physical environment and work practices appear to be significant risk factors for Laceration injury in meatpacking. Personal risk factors were less significant in this study.
Niaman Nazir - One of the best experts on this subject based on the ideXlab platform.
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epidural analgesia and severe perineal Laceration in a community based obstetric practice
Journal of The American Board of Family Practice, 2003Co-Authors: Timothy G Carroll, Michael Engelken, Michael C Mosier, Niaman NazirAbstract:Background: This study assessed whether epidural analgesia was an independent risk factor for severe perineal Laceration. Methods: A retrospective cohort study analyzed 2,759 patients at St. Francis Regional Medical Center who had vertex, spontaneous or induced, singleton, live, vaginal deliveries of neonates of at least 36 weeks’ gestation. Patients with diabetes or severe cardiac disease were excluded. Outcomes measured were third- or fourth-degree perineal Lacerations. Results: Overall rate of severe perineal Laceration was 6.38% (n = 176). Epidural analgesia was given to 634 (22.98%) women. Among women who had epidural analgesia, 10.25% (65 of 634) had severe perineal Lacerations compared with 5.22% (111 of 2,125) of the women who did not have epidural analgesia. After controlling for major variables in a logistic regression analysis, epidural analgesia remained a significant predictor of severe perineal injury (odds ratio [OR] = 1.528, 95% confidence interval [CI] = 1.092–2.137). When instrument use was included in the model, epidural analgesia was no longer a statistically significant, independent predictor of severe perineal injury. (OR = 1.287, 95% CI = 0.907–1.826). Instrument use was found to be a strong predictor of severe Laceration (OR = 3.245, 95% CI = 2.162–4.869). A logistic regression model examining predictors of instrument use found that epidural analgesia does significantly predict instrument use (OR = 3.01, 95% CI = 2.225–4.075). Conclusion: Epidural analgesia is associated with an increase in severe perineal trauma as a result of an associated threefold increased risk of instrument use. Instrument use in vaginal delivery more than triples the risk of severe perineal Laceration.
Enrique Hernandez - One of the best experts on this subject based on the ideXlab platform.
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Risk of recurrence of anal sphincter Lacerations.
Obstetrics and gynecology, 2005Co-Authors: Vani Dandolu, John P. Gaughan, Ashwin Chatwani, Ozgur H. Harmanli, Bruce Mabine, Enrique HernandezAbstract:OBJECTIVE To estimate the rate of recurrence of anal sphincter Lacerations in subsequent pregnancies and analyze the risk factors associated with recurrent Lacerations METHODS Data were obtained from the Pennsylvania Health Care Cost Containment Council, Division of In-Patient Statistics, regarding all cases of third- and fourth-degree perineal Lacerations that occurred during a 2-year period (from January 1990 through December 1991). All subsequent pregnancies in this group of women over the next 10 years were identified, and the rate of recurrence of sphincter tears and risk factors for recurrence were analyzed. RESULTS The rate of anal sphincter Lacerations was 7.31% (n = 18,888) during the first 2 years of study (1990-1991). In the next 10 years, these patients with prior Lacerations were delivered of 16,152 pregnancies. Of these, 1,162 were by cesarean. Among the 14,990 subsequent vaginal deliveries, 864 (5.76%) had a recurrence of a third- or fourth-degree Laceration. Women with prior fourth-degree Lacerations had a much higher rate of recurrence than those with prior third-degree Laceration (7.73% versus 4.69%). The rate for recurrent Lacerations was significantly lower than the rate for initial Lacerations (odds ratio 1.29, 95% confidence interval [CI] 1.2-1.4). Forceps delivery with episiotomy had the highest risk for recurrent Laceration (17.7%, odds ratio 3.6, 95% CI 2.6-5.1), whereas vacuum use without episiotomy had the lowest risk (5.88%, odds ratio 1.0, 95% CI 0.6-1.7). CONCLUSION Prior anal sphincter Laceration does not appear to be a significant risk factor for recurrence of Laceration. Operative vaginal delivery, particularly with episiotomy, increases the risk of recurrent Laceration as it does for initial Laceration. LEVEL OF EVIDENCE III.
Zilma Silveira Nogueira Reis - One of the best experts on this subject based on the ideXlab platform.
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Risk factors for severe obstetric perineal Lacerations.
International urogynecology journal, 2015Co-Authors: Marilene Vale De Castro Monteiro, Glaucia Miranda Varella Pereira, Regina Amélia Lopes Pessoa De Aguiar, Rodrigo Leite Azevedo, Mário Dias Correia-junior, Zilma Silveira Nogueira ReisAbstract:The aim of this study was to assess the occurrence of severe perineal Lacerations in vaginal delivery and its relationship with predisposing clinical and obstetric factors. A retrospective cohort analysis using an electronic clinical database at a University Referral Center for high-risk pregnancies was performed. A total of 941 vaginal deliveries were analyzed, over 10 consecutive months in 2013 and 2014. The relationship between obstetric and clinical characteristics and Lacerations, especially severe forms, was analyzed. The frequency and severity of birth canal Lacerations were compiled and classified as mild (unintentional Laceration grades I and II, and mediolateral episiotomy) and severe (grades III and IV). The crude and adjusted odds ratios and 95 % confidence intervals were estimated in univariate and multivariate logistic regression models. The overall incidence of perineal Lacerations in vaginal delivery was 78.2 % (n = 731). Lacerations were considered mild in 708 women (75.7 %) and severe in 23 women (2.5 %). Maternal age, parity, use of forceps, mediolateral episiotomy, and birth weight influenced the occurrence of some degree of tear. The chance of severe Lacerations increased 1.77-fold per week with the gestational age (1.03–3.03, P = 0.025), while primiparity increased the chance of Laceration 5.32-fold. Episiotomy did not show a protective effect against severe Laceration occurrence (P = 0.999). Severe perineal Lacerations were associated with operative delivery, primiparity, gestational age, and epidural anesthesia. Episiotomy was not protective.
Timothy G Carroll - One of the best experts on this subject based on the ideXlab platform.
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epidural analgesia and severe perineal Laceration in a community based obstetric practice
Journal of The American Board of Family Practice, 2003Co-Authors: Timothy G Carroll, Michael Engelken, Michael C Mosier, Niaman NazirAbstract:Background: This study assessed whether epidural analgesia was an independent risk factor for severe perineal Laceration. Methods: A retrospective cohort study analyzed 2,759 patients at St. Francis Regional Medical Center who had vertex, spontaneous or induced, singleton, live, vaginal deliveries of neonates of at least 36 weeks’ gestation. Patients with diabetes or severe cardiac disease were excluded. Outcomes measured were third- or fourth-degree perineal Lacerations. Results: Overall rate of severe perineal Laceration was 6.38% (n = 176). Epidural analgesia was given to 634 (22.98%) women. Among women who had epidural analgesia, 10.25% (65 of 634) had severe perineal Lacerations compared with 5.22% (111 of 2,125) of the women who did not have epidural analgesia. After controlling for major variables in a logistic regression analysis, epidural analgesia remained a significant predictor of severe perineal injury (odds ratio [OR] = 1.528, 95% confidence interval [CI] = 1.092–2.137). When instrument use was included in the model, epidural analgesia was no longer a statistically significant, independent predictor of severe perineal injury. (OR = 1.287, 95% CI = 0.907–1.826). Instrument use was found to be a strong predictor of severe Laceration (OR = 3.245, 95% CI = 2.162–4.869). A logistic regression model examining predictors of instrument use found that epidural analgesia does significantly predict instrument use (OR = 3.01, 95% CI = 2.225–4.075). Conclusion: Epidural analgesia is associated with an increase in severe perineal trauma as a result of an associated threefold increased risk of instrument use. Instrument use in vaginal delivery more than triples the risk of severe perineal Laceration.
