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PubMedDate not supplied

Ballet injuries. An analysis of epidemiology and financial outcome.

The financial outcome and epidemiology of ballet dancers' injuries were studied by examining workers' compensation insurance records covering 3 seasons (3 years) of activity for a large professional ballet company. One hundred four dancers sustained 309 injuries that resulted in insurance payouts for medical costs of $398,396. The average cost per injury was $1289. Although only 4.2% of the injuries resulted in medical costs exceeding $5000, these represented 60.0% of the total medical costs. Nine injuries resulted in medical costs in excess of $10,000 each. Overall, there were 2.97 injuries per injured dancer. Twenty-four dancers (23.0% of the injured) sustained 5 or more injuries each and thus were responsible for 51.9% (161) of all injuries. The foot (74 injuries, 23.9%), lumbar spine (71, 23.0%), and ankle (41, 13.3%) were the most frequently injured anatomic regions. The experience of this ballet company is similar to that of a college athletic department or a professional sports team. All could employ similar strategies to reduce injuries and associated costs.

Cost of Illness↗

PubMed2000

Diagnoses and treatment recommendations on workers compensation medical certificates.

OBJECTIVE: To review the diagnostic descriptions and treatment recommendations for back and neck pain on the new workers compensation medical certificates and compare these with evidence-based guidelines. DESIGN: Retrospective analysis of 251 medical certificates of workers with compensable neck and back pain held by a workers compensation insurer. MAIN OUTCOME MEASURES: Diagnoses given and treatments prescribed by the nominated treating doctors. RESULTS: The diagnoses most frequently used were "sprain/strain" and "pain/ache". Physiotherapy was the most frequently prescribed treatment, followed by rest and medication. Rest was prescribed for 68 (27%) workers, 87% of whom were classified as having an acute injury. Activity-based treatments were prescribed for 45 (18%) workers. CONCLUSIONS: Not all doctors used diagnostic terms consistent with recommended anatomical taxonomy. The drug therapy prescribed was consistent with current evidence-based treatment guidelines. However, the prescribing of rest, and the omission, in most cases, of explicit recommendations to resume normal activities, including work, are not consistent with current guidelines.

Analgesics↗

PubMed2006

Impairment in workers with isocyanate-induced occupational asthma and removed from exposure in the province of Québec between 1985 and 2002.

OBJECTIVE: The objective of this project was to assess both the outcome for patients diagnosed with proven isocyanate-induced occupational asthma (IIOA) by specific inhalation challenge (SIC) and the functional impairment, 2 years after cessation of exposure to isocyanates, using the compensation insurance scale proposed in the province of Quebec. METHODS: We used a retrospective cohort of 233 patients diagnosed in the province of Quebec between 1985 and 2002 and randomly chose 105 of those patients. We kept 89 subjects with complete data at T0 (the time of diagnosis) and 79 were reevaluated at T2, approximately 2 years after their removal from exposure, for final impairment-disability assessment. At each evaluation (T0 and T2), a clinical examination and lung function tests, including spirometry and methacholine challenge, were performed. RESULTS: At T2, 79 of 89 patients were reassessed (89%). The remaining patients were lost to follow up (8) or too unstable to be reassessed for final impairment-disability settlement (2). No statistical difference was observed for spirometry data and antiasthmatic medication use between T0 and T2 (P = 0.11). At T2, 73% of patients were still using short-acting beta2 agonists and 39% inhaled glucocorticoids. A forced expiratory volume in 1 second variation of +/-10% from T0 to T2 occurred in 31 subjects (40%). Forced expiratory volume in 1 second worsened in 14 (18%), remained significantly unchanged in 51 (64%), and improved in 14 (18%). Nonspecific bronchial hyperresponsiveness (BHR) improved in significantly in 19 (24%); the others remained unchanged. Both were not associated with smoking status (P > 0.05). Nonspecific BHR was normalized in nine of 79 (11%) patients. Clinical remission occurred in only four (5%) subjects. The mean impairment-disability score was 21% +/- 13% at 2 years according to the scale used by the Workers' Compensation Board. CONCLUSIONS: These results show the generally poor medical outcome of IIOA and suggest the importance of early detection and withdrawal of the workers from exposure to isocyanates. They also emphasize the need for medical surveillance program and adequate treatment of patients with IIOA.

Adult↗

PubMedDate not supplied

Costs of occupational injuries in agriculture.

OBJECTIVE: This study was conducted to estimate the costs of job-related injuries in agriculture in the United States for 1992. METHODS: The authors reviewed data from national surveys to assess the incidence of fatal and non-fatal farm injuries. Numerical adjustments were made for weaknesses in the most reliable data sets. For example, the Bureau of Labor Statistics (BLS) Annual Survey estimate of non-fatal injuries is adjusted upward by a factor of 4.7 to reflect the BLS undercount of farm injuries. To assess costs, the authors used the human capital method that allocates costs to direct categories such as medical expenses, as well as indirect categories such as lost earnings, lost home production, and lost fringe benefits. Cost data were drawn from the Health Care Financing Administration and the National Council on Compensation Insurance. RESULTS: Eight hundred forty-one (841) deaths and 512,539 non-fatal injuries are estimated for 1992. The non-fatal injuries include 281,896 that led to at least one full day of work loss. Agricultural occupational injuries cost an estimated $4.57 billion (range $3.14 billion to $13.99 billion) in 1992. On a per person basis, farming contributes roughly 30% more than the national average to occupational injury costs. Direct costs are estimated to be $1.66 billion and indirect costs, $2.93 billion. CONCLUSIONS: The costs of farm injuries are on a par with the costs of hepatitis C. This high cost is in sharp contrast to the limited public attention and economic resources devoted to prevention and amelioration of farm injuries. Agricultural occupational injuries are an underappreciated contributor to the overall national burden of health and medical costs.

Accidents, Occupational↗

PubMed2002

Disabling occupational injury in the US construction industry, 1996.

In 1996 the US construction industry comprised 5.4% of the annual US employment but accounted for 7.8% of nonfatal occupational injuries and illness and 9.7% of cases involving at least a day away from work. Information in the published literature on the disability arising from construction injuries is limited. The construction claims experience (n = 35,790) of a large workers' compensation insurer with national coverage was examined. The leading types and sources of disabling occupational morbidity in 1996 in the US construction industry were identified. Disability duration was calculated from indemnity payments data using previously published methods. The average disability duration for an injured construction worker was 46 days with a median of 0 days. The most frequently occurring conditions were low back pain (14.8%), foreign body eye injuries (8.5%), and finger lacerations (4.8%). Back pain also accounted for the greatest percentage of construction claim costs (21.3%) and disability days (25.5%). However, the conditions with the longest disability durations were sudden-onset injuries, including fractures of the ankle (median = 55 days), foot (42 days), and wrist (38 days). Same-level and elevated falls were the principal exposures for fractures of the wrist and ankle, whereas elevated falls and struck by incidents accounted for the majority of foot fractures. Manual materials handling activities were most often associated with low back pain disability. The results suggest that these most disabling injuries can be addressed by increasing primary prevention resources in slips and falls and exposures related to injuries of sudden-onset as well as in reducing manual materials handling and other exposures associated with more gradual-onset injuries.

Absenteeism↗

PubMed1985

The Mental-Mental Muddle and Work Comp in Oregon. II.

To summarize, in the state of Oregon at this time, mental illness caused by employment is covered by workers' compensation insurance. There have recently been some legislative attempts to seriously restrict this and there probably will be some more in the future. As the law now stands, the job stress must be the major contributing cause as measured against any off the job stress. The on the job events producing the stress must exist in reality. A stress emanating primarily from a worker's misperception or paranoid thinking does not constitute an acceptable causative agent. Obviously it is not always that easy to distinguish between on the job causes and off the job causes and objective stresses and merely perceived stresses. And what about the individual who has faulty perceptions which lead to actions that provoke an objective response? As a psychiatrist, I am glad to see more recognition given to mental illness caused by the work place. I applaud the Oregon Supreme Court for pointing out that an organization has an obligation to somehow deal with stress-producing supervisors. I think we have to be on guard against those forces working through the legislature which try to minimize or deny the importance of mental illness. At the same time, though, we have to try to enlighten rather than confuse. Our expertise is in diagnosing and treating, not in constructing legal terminology. In my evaluation of the Leary case, I tried to explain to the best of my ability just what was going on.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed2007

The economic burden of carpal tunnel syndrome: long-term earnings of CTS claimants in Washington State.

BACKGROUND: The long-term earnings losses borne by injured workers, beyond those covered by workers' compensation insurance, are rarely estimated. The post-claim earnings of a cohort of carpal tunnel syndrome (CTS) claimants are tracked over a period of 6 years and compared to the earnings of claimants with either upper extremity fractures or dermatitis. METHODS: Quarterly earnings records of 4,443 workers in Washington State who filed claims with the State Fund in 1993 or 1994 for CTS are compared to those of 2,544 with upper-extremity fracture claims and 1,773 with medical-only dermatitis claims. Multivariate regression was used to identify the effect of injury type on earnings from that of other potential predictors. RESULTS: CTS claimants recover to about half of their pre-injury earnings level relative to that of comparison groups after 6 years; they also endured periods on time-loss three times longer than claimants with upper extremity fractures. CTS surgery claimants had better outcomes than those who did not have surgery. Earnings recovery fractions among CTS claimants were better for workers who: (1) were younger; (2) had stable pre-claim employment; (3) lived in the Puget sound area; (4) worked for large businesses; (5) worked in non-construction/transportation industries; or (6) were in the higher pre-injury earnings categories. Cumulative excess loss of earnings of the 4,443 CTS claimants was 197 million dollars to 382 million dollars over 6 years, a loss of 45,000-89,000 dollars per claimant. This underscores the importance of prevention, early diagnosis, and accommodation for return to work.

Adult↗

PubMed1999

Priority care for employees: a blessing in disguise?

This paper discusses the efficiency and equity effects of priority care for employees. Recent privatization of workers' compensation insurance in the Netherlands caused an increasing tension between public responsibility for health care cost-containment and private responsibility for sick pay. As a result of strict supply side regulation, waiting lists increased, while at the same time employers became fully responsible for sick pay. To reduce sick pay and production losses, employers are prepared to pay for priority care by using available excess capacity. We argue that the criteria of Pareto and Rawls can provide a rationale for the resulting differential treatment of employees and non-employees. However, such a justification crucially depends on weights society assigns to absolute versus relative improvements in access to health care.

Cost-Benefit Analysis↗

PubMed2004

Overcoming recruitment challenges in construction safety intervention research.

BACKGROUND: Recruiting workers in small construction companies and securing their participation in voluntary safety programs or safety research poses unique challenges. Worker turnover and worksite changes contribute to difficulties in locating and enrolling participants. Economic pressures and time demands potentially threaten ongoing participation. METHODS: Six simulation exercises designed to reduce back and fall injuries in small construction companies were developed based on data from focus groups of workers and company owners. Working with a workers' compensation insurer, we had access to owner-operators of general, heavy, and special trade construction companies reporting less than $10,000 in payroll expenses. Recruitment methods included a participation incentive, mailed invitations followed by phone contacts, and follow-up reminders. RESULTS: Despite using recruitment methods recommended in the literature, participation rates were low over a 2-year intervention period. Because of these difficulties, factors affecting participation or nonparticipation became an additional research focus. Owners' perceptions of already having a good safety record and of the time demands of participation were the most commonly cited reasons for not participating. CONCLUSIONS: Literature on recruitment emphasizes processes and procedures under investigator control rather than understanding potential participants' judgments about the adequacy of their existing practices and the potential benefits of intervention participation relative to potential time and productivity trade-offs. Greater attention to such judgments may enhance recruitment and participation in under-studied and difficult to access populations.

Accidental Falls↗

PubMed1988

Screening for occupational disease among workers in a high-risk trade: examination of cost, yield, and potential for increased efficiency.

We evaluated the cost and yield of a general health surveillance program emphasizing the identification of occupationally related diseases among workers in a high-risk trade. Of approximately 4,000 eligible members of two local plumbers and pipefitters unions, 639 were screened in this program. Screening tests indicated either by specific occupational exposures (eg, chest X-ray, spirometry, and audiometry) or general clinical risk factors (urine analysis for those with a positive urine dipstick, and stool heme occult testing for those over 45 years of age) proved to be far less costly for each positive finding than those procedures (physical examination, complete blood count, and blood chemistry panel) that were not specifically indicated. A discriminant analysis revealed predictor variables (age, years in the trade, and presence of respiratory symptoms) that, in subsequent screening efforts, could be used in the unscreened population either to identify individuals who are more likely to have any positive test result or to "tailor" the content of the initial screening program for a single individual. Increasing the yield and decreasing the direct costs of screening activities may make programs like these more affordable. In addition, this program assisted workers in filing for compensation and thus served to promote the appropriate transfer of cost for the identification and management of occupational diseases from traditional forms of payment to workers' compensation insurance programs.

Adolescent↗

PubMed1989

Occupational disease in New York State: a comprehensive examination.

In order to obtain information on the current magnitude of occupational disease in New York State, four data sources were reviewed: Workers' Compensation records, disease registries maintained by the state department of health, data from the Bureau of Labor Statistics (BLS), and data from the California's physician reporting system. A proportionate attributable risk approach is used to develop estimates of mortality due to occupational diseases. The distribution of occupational hazards was assessed using data from the Occupational Safety and Health Administration (OSHA), the National Institute for Occupational Safety and Health (NIOSH), and the New York State Department of Environmental Conservation (NYDEC). Finally, econometric estimates of the direct and indirect costs of occupational illness were developed. The best available data indicate that 5,000 to 7,000 deaths are caused each year in New York State by work-related illnesses, and at least 35,000 new cases of occupational illness develop each year in the State. It is also estimated that between 150,000 and 750,000 workers in New York State are employed in the 50 most hazardous industries. OSHA standards regulating exposure to selected chemicals were found to have been violated frequently. The annual costs of occupational disease in New York State are approximately $600,000,000; only a small fraction is covered by workers' compensation insurance. Of the 52,000 physicians in New York State, only 73 are board-certified in occupational medicine. Most of these are involved in administrative, teaching, and research aspects of occupational medicine. Of the 300 industrial hygenists in New York State, two-thirds are employed by major corporations. Recommendations are described to improve the recognition of occupational disease in New York State and to reduce the burden of this disease. A statewide network of occupational health clinical services is proposed and has been funded by the New York State Legislature. Other recommendations are also given.

California↗

PubMed1997

Memory recovery and repression: what is the evidence?

Both the theory that traumatic childhood memories can be repressed, and the reliability of the techniques used to retrieve these memories are challenged in this paper. Questions are raised about the robustness of the theory and the literature that purports to provide scientific evidence for it. Evidence to this end is provided by the authors which surveyed New Zealand families in which one member had accused another (or others) of sexual abuse on the basis of recovered memories. It is shown that a number of these allegations involve very low probability events. Since memory repression theory is not currently scientifically substantiated it is argued that care needs to be taken in the mental health, legal and insurance compensation arenas. Memories recalled during therapy may be treated as metaphorical but, in the absence of corroborative evidence, should not be considered factually true. Clinicians who wish to use memory recovery techniques should inform patients of their experimental and controversial nature, point out adverse effects, and obtain consent before proceeding.

Child↗

PubMed2006

Neuropsychologic aspects of post-traumatic headache and chronic daily headache.

The management of patients with chronic refractory head pain remains a treatment challenge. Treatment focus should be multidisciplinary as patients evolve into a deteriorated status with psychologic, social, vocational, and cognitive dysfunction. The neuropsychologist will gather premorbid and comorbid information, assess cognitive functioning, and be involved in every behavioral medicine and treatment decision. The patient with post-traumatic head pain copes with head injury sequelae. Issues related to worker's compensation, insurance, disability decisions, and litigation are intrinsic to these patient groups.

Craniocerebral Trauma↗

PubMed1994

Conservative management of carpal tunnel syndrome: a reexamination of steroid injection and splinting.

The awareness of carpal tunnel syndrome by the lay public has increased dramatically in recent years, with an apparent shift in patient-population presentation. We prospectively studied steroid injection and wrist splinting in 76 hands in 57 patients, presenting without advanced disease or associated medical conditions, by standard evaluation and protocol of treatment. The average age of the patients was 38 years; 50 women and 7 men were included. Follow-up examination after simultaneous steroid injection and splinting averaged 11 months. Ten hands were noted to be symptom-free at the final evaluation. Women were noted to have a significant decrease in the rate of symptom resolution when compared to men. Patients, 40 years of age or younger, were also noted to have a significant decrease in the rate of symptom resolution when compared to patients over 40 years of age. No significant differences were noted when comparing symptom duration prior to treatment or workers' compensation insurance status to final symptom resolution. Young women are the least likely to have resolution of carpal tunnel syndrome symptoms when treated conservatively.

Adrenal Cortex Hormones↗

PubMed2007

Pain scores in the management of postoperative pain in shoulder surgery.

PURPOSE: Recent public opinion has focused on the lay perception that postoperative pain control is inadequate. The Joint Commission on Accreditation of Healthcare Organizations has attempted to address this issue by mandating patient-reported numeric pain scores as part of postoperative pain assessment. No studies exist to validate these scores in orthopaedics. The purpose of this study was 3-fold: (1) to determine which preoperative variables were associated with elevated postoperative pain scores, (2) to identify whether pain scores correlated with more traditional signs and symptoms of pain, and (3) to identify whether patients with a high pain score (HPS) affect perioperative and postoperative complication rates. METHODS: We retrospectively evaluated 105 patients who underwent routine arthroscopic rotator cuff repair over a 12-month period. Correlations and linear regression analysis were used to assess factors associated with postoperative pain scores. Logistic regression analysis was used to construct a model of preoperative, demographic, surgical, and postoperative variables associated with HPSs. RESULTS: Wide variability existed in pain scores despite the similarity of the surgical stimulus. What subtle differences that were present in the surgical procedures had no bearing on pain scores. No correlation existed between pain scores and any physiologic correlate of pain. Pain scores were correlated with Workers' Compensation insurance, preoperative antianxiety medications, antidepressant medications, preoperative narcotics, and alcohol use. HPS patients had a longer recovery room stay (P < .05) and a higher incidence of postoperative nausea than those with a normal pain tolerance. HPS patients also had a significantly delayed return to work, as well as significantly lower Simple Shoulder Test scores at 6 weeks, although the final shoulder scores were similar to those in patients with a normal pain tolerance. CONCLUSIONS: Patient-reported pain scores have been mandated, but they vary widely among patients undergoing virtually the same procedure and correlate poorly with physiologic manifestations of pain. Pain scores tend to correlate with other types of variables, most of which would be expected by the experienced surgeon. The exclusive use of pain scores in postoperative pain management should be limited to prevent complications. LEVEL OF EVIDENCE: Level IV, prognostic case series.

Aged↗

PubMed2002

The rise and fall of occupational medicine in the United States.

Thirty years ago, occupational medicine was one of the smallest of all the medical specialties, ignored by most physicians and medical schools. Occupational physicians were more likely to have entered the field through career transition than by residency training. In 1970, governmental agencies sought to transform occupational medicine into a major clinical specialty. Influential groups projected a need for large numbers of physicians in the field. Residency training was expanded, as were other teaching programs. However, industry and its workers' compensation insurance partners were not widely included in these plans. For that reason, among others, many physicians entering the field met with disappointment. About half the corporate positions for occupational physicians have disappeared in the last decade. Private practice opportunities turned out to be much more limited than planners had anticipated. Attempts to bring occupational medicine into the curriculum of the medical schools failed. Many of the residency programs that had been created are now closing. The proposal that occupational medicine create a joint specialty with environmental medicine is not widely accepted by the rest of medicine. Because so few physicians obtain board certification, it appears that the specialty of occupational medicine is returning to its former obscurity.

Certification↗

PubMed1978

First year hospitalisation costs for the spinal cord injured patient.

This retrospective, descriptive study presents the actual first year hospitalisation costs for a series of 85 spinal cord injured patients, covered by Workmen's Compensation Insurance and cared for in a variety of United States institutions. Mean first year hospital costs for all patients was $35,767. For quadriplegics, $42,240; and paraplegics, $32.619. During initial hospitalisation only, the average length of stay was 184 days and mean cost was $28.637. Room and board comprised 52 per cent of cots; special services, 36 per cent and professional services, 11 per cent. Major special service costs were private duty nursing, medications, medical supplies, respiratory and physical therapy. Major professional charges were centred in the surgical and physical medicine specialties. Home care costs averaged $4000 per patient or $37.00 per day. When compared with the other studies, the costs presented here are higher though the differential is reduced markedly when median rather than mean costs are presented. When compared with the one other known study based on actual and not estimated costs, the results are markedly similar. Differences in costs between this and other studies and the reasons for same are discussed.

Costs and Cost Analysis↗

PubMed1991

Long-term follow-up after thoracic outlet decompression: an analysis of factors determining outcome.

We reviewed our 12-year experience with transaxillary first rib resection in 136 patients screened by neurologists and thought to have neurologic thoracic outlet syndrome to determine what factors affected outcome. These patients represented 85% of the operative experience in a referral area of 1.2 million people. Patients were recalled every 2 years for surveillance. The mean follow-up was 60 +/- 7 months. There were no brachial plexus or vascular injuries. Secondary operations in the neck were required in 20 patients. The quality of the operative result was determined by whether the patient was able to return to preillness activities and whether the patient would undergo operation again if the same result would be obtained. The most important determinant of result was a history of trauma precipitating the neurologic symptoms, particularly in women. Only 25 of the 53 patients (47%) with a history of trauma returned to preillness activities compared to 65 of the 83 patients (78%) without such a history. Overall patient satisfaction was not affected by trauma. Thirty-eight of the 53 patients with trauma (72%) and 69 of the 83 patients (83%) without trauma were satisfied. When the men and women were analyzed separately men were found to have better results after trauma than did women. Other factors with a negative impact on operative results were the need to return to an activity that required repetitive arm movements, coverage under a worker's compensation insurance policy, and fixed joint abnormalities or neurologic findings in the upper extremity. The presence of an anatomic abnormality had no effect on operative results.(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗