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1.  The challenge of cross‐cultural collaborative research: lessons learnt from a pilot case–crossover study of severe occupational hand trauma in the People's Republic of China 
Injury Prevention  2007;13(2):133-136.
Objective
A pilot epidemiologic study was conducted in the People's Republic of China to assess the feasibility of applying the study protocol from a US case–crossover study on transient work‐related exposures and the risk of an acute occupational hand injury.
Design
Injured workers were recruited from a hand surgery center in Ningbo, Zhejiang, People's Republic of China. A structured face‐to‐face interview questionnaire was administered.
Results
156 workers with hand injury completed the study (73% men). The enrollment rate was 91%. Of those who refused participation, most indicated their reluctance was due to the requirement to sign the written consent form. Considerable variability was found among interviewers in ascertaining responses from participants to important exposure questions (21.3% v 97%).
Conclusions
Recommendations include the following: (1) exploring effective oral‐consent protocols that reduce participant concern and still meet human participant protection requirements; (2) using non‐physician interviewers; and (3) increasing the intensity and standardization of interviewer training.
doi:10.1136/ip.2006.012534
PMCID: PMC2610584  PMID: 17446256
2.  Physicians' Initial Management of Acute Low Back Pain Versus Evidence-Based Guidelines 
Journal of General Internal Medicine  2005;20(12):1132-1135.
Background
Little information is available on physician characteristics and patient presentations that may influence compliance with evidence-based guidelines for acute low back pain.
Objective
To assess whether physicians' management decisions are consistent with the Agency for Health Research Quality's guideline and whether responses varied with the presentation of sciatica or by physician characteristics.
Design
Cross-sectional study using a mailed survey.
Participants
Participants were randomly selected from internal medicine, family practice, general practice, emergency medicine, and occupational medicine specialties.
Measurements
A questionnaire asked for recommendations for 2 case scenarios, representing patients without and with sciatica, respectively.
Results
Seven hundred and twenty surveys were completed (response rate=25%). In cases 1 (without sciatica) and 2 (with sciatica), 26.9% and 4.3% of physicians fully complied with the guideline, respectively. For each year in practice, the odds of guideline noncompliance increased 1.03 times (95% confidence interval [CI]=1.01 to 1.05) for case 1. With occupational medicine as the referent specialty, general practice had the greatest odds of noncompliance (3.60, 95% CI=1.75 to 7.40) in case 1, followed by internal medicine and emergency medicine. Results for case 2 reflected the influence of sciatica with internal medicine having substantially higher odds (vs case 1) and the greatest odds of noncompliance of any specialty (6.93, 95% CI=1.47 to 32.78), followed by family practice and emergency medicine.
Conclusions
A majority of primary care physicians continue to be noncompliant with evidence-based back pain guidelines. Sciatica dramatically influenced clinical decision-making, increasing the extent of noncompliance, particularly for internal medicine and family practice. Physicians' misunderstanding of sciatica's natural history and belief that more intensive initial management is indicated may be factors underlying the observed influence of sciatica.
doi:10.1111/j.1525-1497.2005.0230.x
PMCID: PMC1490268  PMID: 16423103
back pain; guidelines; practice variation; clinical vignette; decision making
3.  Perception of slipperiness and prospective risk of slipping at work 
Objectives
Falls are a leading cause of injury at work, and slipping is the predominant cause of falling. Prior research has suggested a modest correlation between objective measures (such as coefficient of friction, COF) and subjective measures of slipperiness (such as worker perceptions) in the workplace. However, the degree of association between subjective measures and the actual risk of slipping at the workplace is unknown. This study examined the association between perception of slipperiness and the risk of slipping.
Methods
475 workers from 36 limited-service restaurants participated in a 12-week prospective cohort study. At baseline, demographic information was collected, participants rated floor slipperiness in eight areas of the restaurant, and work environment factors, such as COF, were measured. Restaurant-level and area-level mean perceptions of slipperiness were calculated. Participants then reported their slip experience at work on a weekly basis for the next 12 weeks. The associations between perception of slipperiness and the rate of slipping were assessed.
Results
Adjusting for age, gender, body mass index, education, primary language, mean COF, use of slip-resistant shoes, and restaurant chain, each 1-point increase in mean restaurant-level perception of slipperiness (4-point scale) was associated with a 2.71 times increase in the rate of slipping (95% CI 1.25 to 5.87). Results were similar for area-level perception within the restaurant (rate ratios (RR) 2.92, 95% CI 2.41 to 3.54).
Conclusions
Perceptions of slipperiness and the subsequent rate of slipping were strongly associated. These findings suggest that safety professionals, risk managers and employers could use aggregated worker perceptions of slipperiness to identify slipping hazards and, potentially, to assess intervention effectiveness.
doi:10.1136/oemed-2012-100831
PMCID: PMC3534256  PMID: 22935953

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