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NIOSH has identified noise-induced hearing loss as one of ten leading work-related diseases and injuries (8). A national strategy for the prevention of such hearing loss will be included in a NIOSH publication entitled Proposed National Strategies for the Prevention of Leading Work-Related Diseases and Injuries, Part II, which is to be published soon. The three main recommendations for preventing hearing loss among workers are 1) developing technology that will substitute quiet processes for noisy ones; 2) controlling the noise of existing processes; and 3) developing hearing conservation programs, including proper use of personal protective equipment.

The existing Occupational Safety and Health Administration standard for occupational exposure to noise specifies a maximum permissible exposure level of 90 dBA for 8 hours, with higher levels allowed for shorter durations (9). After a review of epidemiologic and laboratory data, NIOSH has proposed a limit of 85 dBA (10). Recommended or required levels vary depending on the number of hours of exposure during the work day (Table 2).

The study presented here demonstrates the practical value of linking information from an exposure surveillance survey (NOHS) with information from a survey that measures health status on a national level (NHIS). By identifying associations between potential environmental and occupational exposures and self-reported adverse health outcomes, it is possible to develop a better focus for research studies. When conducting large studies or assessing the impact of prevention strategies at the national level, such self-reported measures of adverse health outcomes may be more practical than actual testing.

FIGURE 1. Prevalence of self-reported hearing loss among white males with workplace exposure to ≥85 decibels (dBA) of noise, by age group and exposure levels United States, 1971-1977*

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*National Institute for Occupational Safety and Health (NIOSH) analysis of data from the National Health Interview Survey conducted by the National Center for Health Statistics. Worksites were classified by noise level using data from the 1972-1974 National Occupational Hazard Survey conducted by NIOSH.

*Workers employed in industries with <10% of employees exposed to noise at ≥85 dBA. $Workers employed in industries with 10%-24% of employees exposed to noise at 85 dBA. "Workers employed in industries with ≥25% of employees exposed to noise at 85 dBA.

Hearing Loss - Continued

A comparison of the current results with future studies that use data from similar surveys will permit an evaluation of overall progress toward the prevention of work-related hearing loss. As intervention strategies are applied successfully, there should be no differential hearing loss between workers in industries with low, medium, or high noise levels. Improvement should be evident first in the younger age groups and later among older employees.

TABLE 2. National Institute for Occupational Safety and Health (NIOSH) recommendations and Occupational Safety and Health Administration (OSHA) standards for permissible noise levels at various durations of exposure

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*OSHA does not allow any exposure to impact or impulse noise above a 140 dBA peak sound-pressure level.

*No exposure to continuous noise above 115 dBA.

References

1. Ramazzini B. Diseases of workers (De morbis artificum, 1713). Trans. Wilmer Cave Wright. New York: Hafner Publishing, 1964:231,437.

2. Simpson M, Bruce R. Noise in America: the extent of the noise problem. Washington, DC: Bolt, Beranek, and Newman, 1981; BBN report no. 3318R.

3. Ginnold RE. Occupational hearing loss. Workers' compensation under state and federal programs. Washington, DC: Environmental Protection Agency, 1979; EPA report no. 550/9-79-101.

4. Wilder CS. Prevalence of selected impairments, United States- 1971. Rockville, Maryland: National Center for Health Statistics, 1975; DHEW publication no. (HRA)75-1526. (Vital and health statistics: data from the National Health Survey; series 10; no. 99).

5. Feller BA. Prevalence of selected impairments, United States-1977. Hyattsville, Maryland: National Center for Health Statistics, 1981; DHEW publication no. (HRA)81-1562. (Vital and health statistics: data from the National Health Survey; series 10; no. 134).

6. Ries PW. Hearing ability of persons by sociodemographic and health characteristics: United States. Hyattsville, Maryland: National Center for Health Statistics, 1982; DHHS publication no. (PHS)82-1568. (Vital and health statistics: data from the National Health Survey; series 10; no. 140).

7. National Institute for Occupational Safety and Health. National Occupational Hazard Survey. 3 volumes. Rockville, Maryland: National Institute for Occupational Safety and Health, 1974, 1977, 1978; DHEW publication nos. (NIOSH)74-127, 77-213, 78-114.

8. Centers for Disease Control. Leading work-related diseases and injuries-United States. MMWR 1983;32:24-6,32.

9. Office of the Federal Register. Code of federal regulations: labor. Washington, DC: Office of the Federal Register, National Archives and Records Administration, 1986. (29 CFR 1910.95). 10. National Institute for Occupational Safety and Health. Criteria for a recommended standard ... occupational exposure to noise. Rockville, Maryland: National Institute for Occupational Safety and Health, 1972; DHEW publication no. (HSM)73-11001.

FIGURE I. Reported measles cases United States, Weeks 6-9, 1988

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The Morbidity and Mortality Weekly Report is prepared by the Centers for Disease Control, Atlanta, Georgia, and available on a paid subscription basis from the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402, (202) 783-3238.

The data in this report are provisional, based on weekly reports to CDC by state health departments. The reporting week concludes at close of business on Friday; compiled data on a national basis are officially released to the public on the succeeding Friday. The editor welcomes accounts of interesting cases, outbreaks, environmental hazards, or other public health problems of current interest to health officials. Such reports and any other matters pertaining to editorial or other textual considerations should be addressed to: Editor, Morbidity and Mortality Weekly Report, Centers for Disease Control, Atlanta, Georgia 30333.

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During the period 1986-1987, a study of the use of break-away bases to reduce sliding injuries was conducted in Ann Arbor, Michigan (1). The break-away base that was used in the study is anchored by rubber grommets to a rubber mat that is flush with the infield surface. The mat is anchored to the ground by a metal post similar to that used with standard stationary bases. Seven hundred foot-pounds of force, or one-fifth the force needed to dislodge a stationary base from its mooring, is required to release the break-away portion of the base.

The study evaluated injuries sustained during 633 games on two fields with break-away bases and 627 games on six fields with stationary bases. The players were college students, laborers, executives, physicians, and others ranging from 18 to 55 years of age. Players were assigned to one of four leagues on the basis of skill level and experience. Teams were assigned to playing fields on a random and rotating basis. All fields were maintained in the same manner.

All injuries requiring a player to leave the game were documented by the umpires. Local hospital emergency rooms, the University of Michigan Student Health Service, and private practice orthopedic surgeons were asked to keep logs of patients seen with softball-related injuries. All persons identified by these three surveillance systems were contacted to see whether their injuries had occurred while sliding. Patients who had been playing on the study fields were included in the analysis.

During the study period, there were 45 sliding injuries on the fields with stationary bases (7.2/100 games) and two sliding injuries on the fields with break-away bases (0.3/100 games) (rate ratio = 22.7; 95% confidence intervals, 5.6 to 71.4). Forty-three of the 45 injuries to players sliding into stationary bases involved the lead foot or hand. Twenty-four of the 45 injuries were ankle injuries; five were skin abrasions; five were knee injuries; three were finger fractures; and eight were from other causes. Medical charges for these 45 players were approximately $55,050 ($1,223/injury). The two injuries involving break-away bases comprised a nondisplaced medial malleolar ankle fracture and an ankle sprain. The total medical expense for these two players was approximately $700 ($350/injury).

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES/PUBLIC HEALTH SERVICE

AFR 15 19

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Reported by: DH Janda, MD, EM Wojtys, MD, FM Hankin, MD, ME Benedict, MA, Univ of Michigan, Ann Arbor, Michigan. Epidemiology Br, Div of Injury Epidemiology and Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note: In 1986, the National Electronic Injury Surveillance System of the U.S. Consumer Product Safety Commission estimated that 361,552 baseball-related injuries were treated in emergency rooms in the United States (2). This figure probably underestimates the actual number of injuries. The Amateur Softball Association of America estimates that 32 million individuals participate in softball leagues and that teams consist of an average of 15 persons and play approximately 22 games per year (unpublished data). Based on these data, it may be further estimated that about 23 million softball games are played annually in the United States.

Studies of recreational softball injuries have found that base sliding is responsible for 35% to 71% of injuries occurring during play, including abrasions, sprains, ligament strains, and fractures (3,4). These injuries are caused by the impact of rapid deceleration against stationary bases. Methods suggested to reduce base-sliding injuries have included prohibiting sliding, offering better instruction on sliding techniques, using recessed bases, and using quick-release bases (4,5). Prohibiting base sliding would be effective but might be met with resistance from some fans and participants. Holding instructional clinics on proper sliding techniques is a possibility for school-related organizations; however, this method might be impractical for community-based teams.

The prospective study in Michigan suggests that modifying the bases can alter the pattern and frequency of sliding injuries. If the stationary-base sliding injury rate of 7.2/100 games and the cost per injury of $1,223 reported in the study are representative, then approximately 1.7 million sliding injuries occur annually at a cost of over $2 billion. Similar calculations indicate that exclusive use of break-away bases would reduce injuries to just over 70,000 (a 96% reduction) and medical costs to $24 million (a 99% reduction).

The umpires indicated that break-away bases did not significantly delay play, even though sliding players dislodged the bases up to six times per game. Properly seated bases did not detach during routine base running, and the umpires did not have difficulty with judgment calls when the bases released. The bases were durable and easy to replace and lasted both seasons.

The use of break-away bases in recreational softball leagues might provide a significant, cost-effective reduction in softball injuries from sliding. However, injuries may still occur from runners' errors in judgment, improper sliding technique, poor timing, inadequate physical conditioning, and alcohol consumption.

References

1. Janda DH, Wojtys EM, Hankin FM, Benedict ME. Softball sliding injuries: a prospective study comparing standard and modified bases. JAMA 1988;259:1848-50.

2. US Consumer Product Safety Commission. The National Electronic Injury Surveillance System: January-December 1986. NEISS Data Highlights 1988;10.

3. Wheeler BR. Ankle fractures in slow-pitch softball: the Army experience. Milit Med 1987;152:626-8.

4. Janda DH, Hankin FM, Wojtys EM. Softball injuries: cost, cause and prevention. Am Fam Physician 1986;33:143-4.

5. Wheeler BR. Slow-pitch softball injuries. Am J Sports Med 1984;12:237-40.

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