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PubMed1996

Recording, notification, compilation, and classification of statistics of occupational accidents and diseases: the Thai experience.

An International Labour Organization (ILO) project was conducted in July and August 1995 in Thailand to assist with the development of an information system on occupational accidents and diseases for the Workmen's Compensation Fund (WCF). The WCF provides cash benefits and medical care to insured workers who suffer employment injuries. The project included literature research based on the facilities of the ILO in Bangkok, and those of the Thai government, and a thorough review of the ILO Code of Practice (the Code) on recording and notification of occupational accidents and diseases, and of other international recommendations on statistics of occupational accidents and diseases. A comparative study of various notification systems of occupational accidents and diseases in Australia, Canada, the Philippines, Sweden, Thailand, and the United States was conducted. The project also included fact-finding sessions among various information suppliers and users in Thailand. The Thai notification form for collecting data for the database was redesigned and pretested. Results of the project indicated that the Code is appropriate for the recording and notification of occupational accidents and diseases in Thailand. In addition, a number of information requirements, which were included in the notification systems in the countries studied but not listed in the Code, were found to be useful for the database. A list of the baseline variables to be included in the proposed database was developed, the notification form was redesigned, and coding schemes for the information collected on the redesigned form were constructed on the basis of international standard classification systems for economic activity, employment status, occupation, nature of injury, occupational disease, body part, type of accident, and agency. A number of mechanisms were suggested for cross-checking the accuracy of data in the database. Based on the review of the Code and other international recommendations on statistical reporting, a list of baseline statistics was formulated for inclusion in the WCF annual report. Lastly, some suggestions for future statistical analysis of the database were given.

Accidents, Occupational↗
PubMed1981

Respiratory cancer in a cohort of nickel sinter plant workers.

A study was undertaken of a cohort of nickel refinery workers from a sinter plant that operated from 1948 to 1962. A complete follow-up of the 495 workers has been carried out by searching death records and other measures. Incidence cases known to the Workmen's Compensation Board of Ontario have been included. Fifty-four cases of lung cancer and eight of sinus cancer (including two in men who subsequently developed primary lung cancer) were located. The risk of lung and sinus cancer was much higher in the earlier days of operation of the plant, with an increase rate of over 40% for those employed in the first year of operation. The dose-response relationship has been examined by regressions of standardised morality ratios (SMR) and standardised incidence ratios (SIR). The SIR suggests that the risk doubled at levels of exposure of 12 months (six months in the earlier years).

Adult↗
PubMed1979

The understanding and teaching of reaction to pain.

Pain is both the commonest and one of the most enigmatic symptoms in medicine. Its subjective nature renders management difficult and its conceptualization is complex. Reaction to pain cannot be easily generalized; group differences are postulated, based on sex, age, culture, psychiatric diagnosis and personality variables. Early developmental aspects of pain and discussed in animal studies and case reports but little systematic data exist. Experimental findings show the influence on pain response of cognitive and emotional factors. Clinically, the variables determining perception, reporting and reaction to pain are numerous and harder to study scientifically. Acute and chronic pain should be distinguished: the latter is more complicated, leading of ten to diagnostic problems and management stalemates. Discovering the relationship of pain to emotional phenomena, as cause or effect, is difficult, though essential to effective treatment. Various frames of reference apply: e.g., individual medical, familial, and "workmen's compensation" models. Reaction by family, lawyer, or work commission involves potential secondary gain and may reinforce or discourage pathological responses by the patient. The potential of pain for symbolic meaning and its acceptance as a "legitimate" medical symptom renders it ideal for both expression and masquerading of intrapsychic and interpersonal conflicts involving anger, punishment, control and dependency. Teaching about pain and its significance is best done in clinical settings such as obstetrical units and multidisciplinary pain clinics. Videotaped modular presentations with discussion provide a satisfactory though less desirable alternative.

Acute Disease↗
PubMed1991

Predicting prognosis by means of the DSM-III multiaxial diagnoses.

This clinically based retrospective study compares the DSM-III multiaxial characteristics of psychiatric inpatient and outpatient treatment-seekers with those of workmen's compensation and disability payment-seekers. It shows that 1. the groups were significantly different in their DSM-III multiaxial characteristics; 2. multiaxial diagnoses statistically predicted clinical psychiatrists' estimations of disability applicants prognosis for work; and 3. payment-seekers were more likely than treatment-seekers to have Axis II personality disorders in addition to their Axis I diagnoses.

Adaptation, Psychological↗
PubMed1995

Microsurgical carpal tunnel release.

Carpal tunnel release has been performed in our institution on 378 patients (a total of 461 hands) since 1987. Of these operations, 175 were right-sided, 120 were left-sided, and 83 were bilateral. The technique used for the operations was outpatient microsurgery (with most patients under local anesthesia). During this surgery, a longitudinal incision of 3 cm was made; the incision never crossed the wrist flexion crease. Five patients had the recurrent thenar branch exit through the middle or ulnar part of the ligament, and in all these patients, the branch was preserved. Perioperative complications included four stitch abscesses managed on an outpatient basis and three wound infections for which the patients were admitted to the hospital for wound care and for intravenous administration of antibiotics. One wound dehisced after a steroid-dependent patient had fallen; this was primarily repaired; in another patient, a trigger finger developed 6 months after surgery. The mean time before the patients returned to work was 6 weeks (range, 2 d-16 wk). The mean follow-up for these patients was 37 months (range, 6-72 mo). In 332 patients, all painful dysethesias completely disappeared. In another 30 patients, marked improvement was seen in dysethesias, so that the overall improvement rate was 96%. Motor improvement occurred in 349 (97%) of 360 patients who had experienced motor weakness before surgery. In seven patients with bilateral symptoms, the symptoms in the contralateral side resolved after unilateral surgery. Eight patients had persistent incisional wound pain that required persistent medication and that delayed or prevented return to work; six of these patients were receiving workmen's compensation.(ABSTRACT TRUNCATED AT 250 WORDS)

Ambulatory Surgical Procedures↗
PubMed2004

Transforaminal lumbar interbody fusion: surgical technique and results in 24 patients.

OBJECTIVE: The advantage of anterior column support and fusion in addition to pedicle fixation in patients with degenerative spinal disorders has become increasingly clear. With the increase in popularity of this treatment, a variety of techniques have been used to achieve the goal of anterior column support, fusion, and segmental instrumentation. Posterior lumbar interbody fusion has been used since the late 1940s in the treatment of degenerative lumbar spine. We evaluated a modification to posterior lumbar interbody fusion called transforaminal lumbar interbody fusion (TLIF). METHODS: A retrospective analysis was performed on 24 patients (9 women, 15 men) who underwent TLIF. The approach involved a unilateral laminectomy and inferior facetectomy at the level of fusion. The interbody fusion was achieved from this unilateral approach by performing discectomy, arthrodesis, and insertion of one or two titanium cages packed with autologous bone. The average age of the patients in this study was 42.6 +/- 12.5 years. Five patients were smokers. Five cases were related to workmen's compensation. Seventeen patients' original symptoms were a combination of low back pain and radiculopathy. Ten patients had had a previous spine operation. RESULTS: Eleven patients had L4-S1 TLIFs. The rest of the patients had a single-level TLIF (L2-S1). Average intensive care unit and floor days were 1.1 +/- 1.0 and 5.8 +/- 2.2 days, respectively. The number of days to ambulation was 2.8 +/- 1.6 days. There were a total of six self-limited complications in 24 patients (including one transient neurological complication). The average follow-up time was 16.9 +/- 9.1 months. Twenty-two patients had solid fusions. A modified Prolo scale (4 worst, 20 best) was used to evaluate the clinical outcome. The average score was 16.1 +/- 4.1. CONCLUSION: TLIF is a reliable and safe technique for interbody support that can be performed with excellent clinical outcome. In the authors' experience, TLIF offers excellent exposure with minimal risk. This applies particularly in cases of repeat spine surgery, in which the presence of scar tissue makes traditional posterior lumbar interbody fusion techniques difficult or impossible. In addition, TLIF seems to be a viable alternative to anteroposterior circumferential fusion and/or anterior lumbar interbody fusion.

Adult↗
PubMed1982

Occupational hearing loss: an Ontario perspective.

In the past 11 years over 6,500 patients referred by the Workmen's Compensation Board for evaluation of hearing loss of possible industrial etiology have been evaluated at Mount Sinai Hospital. Various groups of workers have been studied from the audiological, otological, and epidemiological standpoint. Problems of assessment include the accurate quantification of hearing loss which may be difficult for a number of reasons including lack of understanding of the test and lack of willingness to cooperate. An accurate diagnosis may be difficult to achieve because of lack of previous history, poor memory, etc. The method of use in Ontario for quantifying hearing loss will be reviewed and its relationship to handicap discussed. The success of rehabilitation by means of hearing aid use will be analysed. This is surprisingly good.

Adult↗
PubMed2004

Occupational health and safety situation and research priority in Thailand.

The aims of this article are to review the situation of occupational health and safety and to describe research priority in this field in Thailand. Thailand is one of newly industrialized countries in Southeast Asia. Approximately half of the working population is still in agriculture. The data from Thai Workmen's Compensation Fund showed that incidence rate of occupational injuries and diseases was 3-4% each year. Almost were occupational injuries from various accidents in workplaces. At least 3 relevant governmental agencies, including Ministry of Labour, Ministry of Public Health, and Ministry of Industry, are responsible in occupational health and safety in the country. Nowadays, those agencies collaborate and develop projects and activities to prevent and control of the problems. Because of lack of staff and other resources, research priority is needed and has been developed recently. The framework of research needed focuses on research and development such as how to improve occupational health and safety management at all levels, setting up and development of standard guidelines for health and environmental assessment, and implementation of suitable control measures in workplaces. Finally, improvement of research system in the country is essential to cope with new occupational health problems in the near future.

Humans↗
PubMed1995

Multiple chemical sensitivities--public policy.

The phenomenon of multiple chemical sensitivities is a peculiar manifestation of our technophobic and chemophobic society. It has been rejected as an established organic disease by the American Academy of Allergy and Immunology, the American Medical Association, the California Medical Association, the American College of Physicians, and the International Society of Regulatory Toxicology and Pharmacology. It may be the only ailment in existence in which the patient defines both the cause and the manifestations of his own condition. Despite this, it has achieved credibility in workmen's compensation claims, tort liability, and regulatory actions, all of which are briefly reviewed.

Humans↗
PubMed1976

Results of treatment of chronic low-back pain at the Portland Pain Center.

We have evaluated 100 consecutive patients with low-back pain admitted to the Portland Pain Center. The average patient had been disabled for about 6 years, and had had an average of two surgical attempts to improve his symptoms. Most of the patients considered had open claims with their Workmen's Compensation carriers. Significant gains were demonstrated in drug reduction, general well behavior, and increased range of motion and exercise tolerance. The Pain Center setting provides a multidisciplinary approach to the treatment of chronic low-back pain. Significant increases in functional capacity are demonstrated.

Adult↗
PubMed1986

The long-term results of chymopapain chemonucleolysis for lumbar disc disease. Ten-year follow-up results in 268 patients injected at the Mayo Clinic.

The long-term clinical outcome is evaluated for 268 patients after chymopapain chemonucleolysis for radicular complaints referrable to documented intervertebral disc disease. The follow-up period for 92% of these patients was 10 years. No complications due to chymopapain toxicity were observed; 80.1% of patients were relieved of their presenting radicular leg pain and 75.1% were employed at a capacity equal to or more strenuous than before injection. Chemonucleolysis was demonstrated to be a safe and effective treatment modality, with long-term results that compare favorably with those of similarly selected patients undergoing open surgical procedures. In the patients whose chymopapain therapy failed, the outcome of subsequent open surgical procedures was not necessarily compromised by prior chemonucleolysis. A higher rate of failure and subsequent surgical intervention was seen in those patients with injections performed soon after an unsuccessful open procedure on the same side and at the same interspace, those with workmen's compensation or litigation pending, those with a history of work-related injury, those whose employment involved heavy manual labor or extensive driving, and those whose preinjection spine x-ray films indicated retrograde spondylolisthesis.

Adult↗
PubMed1987

Chemonucleolysis with chymopapain: results in 150 patients.

Chemonucleolysis with chymopapain has been advocated for the treatment of lumbar disc disease. When polled by a mail questionnaire, 150 consecutive patients who had undergone chemonucleolysis reported an overall success rate of only 40% and a failure rate of 60%. However, 57% of the patients were active or had only mild restriction of daily activities. Of those patients employed prior to injection, only 63% had returned to work. Those with workmen's compensation benefits fared considerably worse than those covered by third-party insurance (17% vs. 51% success). These results cast doubt on the long-term benefits of chymopapain in the treatment of lumbar disc disease.

Adolescent↗
PubMed1999

Comparison of the hospital cost of primary and revision total hip arthroplasty after cost containment.

This study compared the hospital cost of primary and revision total hip arthroplasty (THA) after the introduction of cost-containment programs (clinical pathway, hip implant standardization, and competitive bid purchasing of hip implants). Hospital financial records for 290 primary and 85 revision THAs performed from October 1993 through September 1995 were analyzed. A cost-accounting system provided actual hospital cost data for each procedure. Accurate calculation of hospital income or loss was determined. Average hospital length of stay was 4.9 days for primary THA and 5.9 days for revision THA. Average hospital cost was $11,104 for primary THA and $14,935 for revision THA. Average net income (hospital revenue hospital expense) for primary THA was $2486. Average loss from revision THA was $401. The payer mix included commercial insurance, Blue Cross/Blue Shield, managed care, Medicare, Medicaid, and workmen's compensation. For primary THA, all payers were profitable except Medicaid and selected managed care contracts. For revision THA, profit was achieved with payment from commercial insurance only. Despite the introduction of cost-containment programs, revision THA did not achieve profitability at our institution.

Aged↗
PubMed1999

Comparison of the hospital cost of primary and revision total knee arthroplasty after cost containment.

Revision total knee arthroplasty (TKA) consumes more time, more work, and more supplies than primary TKA. This study compared the hospital cost of primary and revision TKA after the introduction of cost-containment programs (implant standardization, clinical pathway, and competitive bid implant purchasing) at our hospital. Hospital financial records of 207 primary unilateral TKA operations and 32 revision TKA operations performed from October 1993 through September 1995 were analyzed. A cost-accounting system provided actual hospital cost data for each procedure. Accurate calculation of hospital income or loss was determined for all 239 procedures. The average hospital length of stay was 4.7 days for primary unilateral TKA and 5.1 days for revision TKA. There were 26 three-component revision operations and 6 one- or two-component revision operations. The average hospital cost was $10,421 for primary TKA and $11,906 for revision TKA. The average net hospital income (hospital revenue - hospital expense) was $3211 for primary TKA and $1853 for revision TKA. The payer mix included indemnity insurance, Medicare, Medicaid, managed care, and workmen's compensation. All payers were profitable except for Medicaid and selected managed care contracts for both primary and revision TKA. As a result of cost-containment programs, revision TKA can be profitable at our institution.

Aged↗