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PubMed1976

Occupational lead exposure in Finland. VI. Final report.

Between 1970 and 1973, 2,209 workers representing 30 different types of work were studied in Finland for lead exposure. The indicator of lead exposure was the blood lead concentrations (Pb-B) of the workers. The highest recommended value for Pb-B in Finland, 70 mug/100 ml of blood, was exceeded in the following types of work: PVC plastic manufacturing, storage tank manufacturing and repairing, machine shop work, treating metal surfaces, paint manufacturing, car radiator repairing, spray painting, machine shop work (railway), and storage battery repair. The types of work with the highest average exposure were lead scrap smelting (Pb-B median 79 mug/100 ml, range 35--118), storage battery manufacturing (Pb-B median 66 mug/100 ml, range 19--101), metal founding, (Pb-B median 53 mug/100 ml, range 6--108) shipbreaking (Pb-B median 49 mug/100 ml, range 26--106) crystal glass manufacturing (Pb-B median 41 mug/100 ml, range 12--82), car radiator repairing (Pb-B median 38 mug/100 ml, range 17--83), and PVC plastic manufacturing (Pb-B median 37 mug/100 ml, range 10--126). During the past 5 years cases of clincial lead poisoning have occurred in all of these types of work, and the patients received workmen's compensation. The usefulness of the national poisoning register in predicting the relative hazard of lead exposure in the types of work studied was evaluated with the aid of rank order correlation statistics. The analysis showed that the poisoning register is a useful indicator of lead exposure in the most exposed types of work. However, the present survey also revealed work in which the hazard had escaped recognition in this country: metal founding, car repairing, and car radiator repairing, for example. Although it seems possible to predict the most heavily exposed work types from national poisoning registers only, the detection of workers with less severe manifestations of toxic effects, or somtimes even poisoning, in other types of work first requires a systematic survey of all types of work with possible lead exposure, and then regular monitoring of all exposed workers.

Automobiles↗

PubMed1995

Lumbar Spine Fusion in the Treatment of Degenerative Conditions: Current Indications and Recommendations.

The role of arthrodesis in the treatment of degenerative disorders of the lumbar spine is controversial. Most patients with these conditions can be successfully treated nonoperatively. Lumbar fusion, with or without instrumentation, is associated with more complications, especially in the elderly population. Therefore, the potential benefits to be obtained by means of arthrodesis must be measured against the risks. Arthrodesis is indicated as an adjunct to decompression for patients with spinal stenosis associated with degenerative or iatrogenic spondylolisthesis and in the treatment of progressive degenerative lumbar scoliosis and iatrogenic instability resulting from extensive decompression. The occurrence of two or more episodes of disk herniation at the same segment is a relative indication for arthrodesis. In patients with incapacitating nonradicular back pain, arthrodesis should be a consideration only after failure of a trial of nonoperative treatment lasting more than 12 months and after secondary gain issues (e.g., workmen's compensation) have been adequately resolved. Arthrodesis has a poor success rate when used to treat back pain associated with multilevel disk degeneration seen on magnetic resonance images.

Journal Article↗

PubMed1979

A hospital self-insurance program: employee medical benefits.

Many hospitals have explored self-insurance to help keep insurance costs down for medical malpractice and workmen's compensation. Before leaping to adopt this new approach, however, a hospital must analyze its its advantages and disadvantages, variables affecting program costs and ways to quantify the risks.

Costs and Cost Analysis↗

PubMed1987

Diversification strategies for mid-size hospitals.

Selecting the correct diversification strategy is one of the key decisions that today's health administrator wil make, for at no time have more options been available. These strategies must, however, be good uses of the hospital's resources. In this article, the author discusses three strategies appropriate for the mid-size hospital, employee drug testing, workmen's compensation and fitness. Each targets the key employer market segment. The author includes how these can be fitted into the overall program of the hospital.

Decision Making↗

PubMed2000

The combat soldier.

The Gulf War illness problem is seen as a post-war syndrome related to veteran discontent rather than as a new phenomenon. It is here proposed that application of social psychiatric thinking and workmen's compensation experience can help in understanding the problem. Social psychiatry has been neglected in the training of so many psychiatrists that many of them fail to understand the Army as a community and to recognize that a community's parts may develop symptom neuroses. Most psychiatrists, however, do know that a symptom neurosis will not disappear until it no longer serves its purpose. The young soldier may know that he is being trained for combat duty but manages to distance himself from the terrible realities of military combat by creating a psychic reality that protects him. Social psychiatric emphasis is used to describe his response when brought face to face with himself as a combatant with overwhelming responsibilities and genuine lethal danger. The brilliance and relevance of social thinking is demonstrated by examples from the works of Gustave LeBon and Georg Simmel so that its application to present--and future--military problems may be brought into focus.

Attitude↗

PubMed1975

Factitious lymphedema of the hand.

Twenty-two patients with factitious lymphedema of the hand were reviewed. Thirteen were female, with a median age of sixteen years at the onset of symptoms. Of the nine males, the median age at onset of symptoms was thirty-two years. The dominant hand was affected more frequently than the non-dominant hand. Edema was usually caused by a tourniquet, irritation of the skin, or blows to the back of the hand. Neurosis, psychosis, or suicidal tendency was diagnosed in twelve of these patients. Characteristically, the edema was not particularly painful; it frequently ended proximally in a circumferential discolored constriction ring; and it occasionally displayed characteristic lymphangiographic findings of normal or dilated lymphatic channels with increased collateral circulation and multiple blowouts. Although ten of the patients received Workmen's Compensation benefits, the course and psychiatric diagnosis indicated that malingering for secondary financial gain was not a primary goal. Hospitalization is usually required to confirm the diagnosis. Psychotherapy is indicated once the diagnosis is made.

Adolescent↗

PubMed2001

Occupational asthma in Singapore.

AIM: Since the first notified case of occupational asthma in 1983, a total of 90 cases were confirmed as on 31st December 1999. In this study, demographic data, causative agents and impact on the workers were described. METHODS: The data was derived from notifications to the Ministry of Manpower and referrals to the Occupational Lung Disease Clinic jointly run with Department of Respiratory Medicine, Tan Tock Seng Hospital. RESULTS: Of the 90 cases, 19 (21%) were females and 71 (79%) were males. There were 48 (53%) Chinese, 22 (24%) Malays, 14 (16%) Indians and 6 (7%) of other ethnic origins. The mean age at diagnosis was 35.8 +/- 9.3 yrs. The mean duration of exposure prior to onset of symptoms was 34.9 +/- 57.3 months. The most common causative agent was isocyanates (28 cases, 31%) followed by solder flux (12 cases, 13%) and welding fumes (8 cases, 9%) respectively. Thirteen (14.4%) workers were assessed to have permanent disability under the Workmen's Compensation Act. CONCLUSIONS: Since 1990, occupational asthma has overtaken silicosis and asbestosis as the most common occupational lung disease in Singapore. The most common causative agent is isocyanates. Occupational asthma is a condition associated with disability in the workplace and may still be largely under-reported.

Adult↗

PubMed1952