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PubMed2002

Impairment and return to work after intra-articular fractures of the calcaneus.

Intra-articular fractures of the calcaneus typically occur in individuals working on ladders, scaffolding or roofs. Male individuals in their productive age are most at risk. The functional problems that frequently persist are a well-known risk since they may obstruct a safe resumption of the former job. According to the data of the National Institute for Sickness and Invalidity Insurance the number of calcaneal fractures in Belgium have stabilised over the last ten years. These figures indicate the necessity for a better prevention policy. Scientific literature about the problem of impairment and disability in these cases is rare and lacks uniformity. A retrospective study was therefore performed on 65 private insurance compensation patients who were treated for intra-articular calcaneal fractures. The mean period of work incapacity was 260.5 days and the mean percentage of impairment was 12.3%. A large group (86.2%) were able to resume their former activities including the height workers. More than half of the patients (57%) needed a supportive device. Working at heights and falls from a height were a significant risk factor for long-term work incapacity. The figures are compared with the limited literature and further discussed.

Accidental Falls↗

PubMedDate not supplied

Nicotine dependence and alcoholism epidemiology and treatment.

Nicotine dependence in alcohol-involved adults is a long-ignored treatment problem. The absence of its discussion in the literature is difficult to defend in light of medical and epidemiological data on the cost and prevalence of this dual addiction. Most descriptive studies of alcohol abusers published in the past 20 years have reported tobacco use rates of at least 90%. There is a crucial need to educate treatment professionals and their clients about the additional health risks associated with joint nicotine dependence and alcoholism. Historically, certain barriers to active intervention have existed in drug abuse treatment facilities, including (1) concerns that urging clients to quit smoking might have an adverse effect on their maintenance of sobriety, (2) a tendency to minimize the strength and severity of nicotine addiction, (3) a lack of informative data on how best to treat smoking in recovering alcoholics, and (4) financial issues related to marketing and insurance compensation. Recent data obtained from recovering alcoholics who have tried to quit smoking and anecdotal reports from alcoholism treatment centers that have begun addressing nicotine addiction are now challenging these barriers. Education, role modeling, environmental control, and development of staff expertise can be incorporated into standard alcoholism treatment programs to jointly treat these paired addictions.

Alcoholism↗

PubMedDate not supplied

Nicotine dependence and alcoholism epidemiology and treatment.

Nicotine dependence in alcohol-involved adults is a long-ignored treatment problem. The absence of its discussion in the literature is difficult to defend in light of medical and epidemiological data on the cost and prevalence of this dual addition. Most descriptive studies of alcohol abusers published in the past 20 years have reported tobacco use rates of at least 90%. There is a crucial need to educate treatment professionals and their clients about the additional health risks associated with joint nicotine dependence and alcoholism. Historically, certain barriers to active intervention have existed in drug abuse treatment facilities, including (1) concerns that urging clients to quit smoking might have an adverse effect on their maintenance of sobriety, (2) a tendency to minimize the strength and severity of nicotine addition, (3) a lack of informative data on how best to treat smoking in recovering alcoholics, and (4) financial issues related to marketing and insurance compensation. Recent data obtained from recovering alcoholics who have tried to quit smoking and anecdotal reports from alcoholism treatment centers that have begun addressing nicotine addiction are now challenging these barriers. Education, role modeling, environmental control, and development of staff expertise can be incorporated into standard alcoholism treatment programs to jointly treat these paired addictions.

Alcoholism↗

PubMed1993

Medically related motor vehicle injury costs by body region and severity.

For motor vehicle crashes, we estimated the medically related costs of nonfatal injury by body region and severity. Our primary data sources were paid charges reported in the Detailed Claims Information data base of the National Council on Compensation Insurance and injury incidence and severity reported in the National Highway Traffic Safety Administration's National Accident Sampling System (NASS). Brain and lower extremity injuries account for the largest portion of medical costs. Spinal cord and severe brain injuries cost more per case. Our average costs per case are very close to those in a report to Congress but come from completely different data sources. Thus, national data bases are providing consistent medical cost estimates.

Abdominal Injuries↗

PubMed2004

Documentation of posttraumatic nerve compression in patients with normal electrodiagnostic studies.

BACKGROUND: Electrodiagnostic evaluation may suggest the absence of posttraumatic nerve compression in the presence of patient symptoms. Computer-assisted neurosensory testing documents peripheral nerve sensory impairment. In the setting of trauma, where there are often legal implications, documentation of peripheral nerve compression is important. This is highlighted in the diabetic, who may have neuropathy. METHODS: A prospective study tracked trauma-related peripheral nerve problems in patients with "normal" electrodiagnostic studies, and for whom surgical care or legal outcome was determined by documentation of abnormalities by testing with the Pressure-Specified Sensory Device. Eight patients were identified, four of whom had diabetes. RESULTS: In all eight patients, neurosensory testing documented peripheral nerve problems, which was critical in obtaining approval from workers' compensation insurance carrier for decompression of the nerve and facilitating legal settlement. CONCLUSION: Neurosensory testing with the Pressure-Specified Sensory Device identifies peripheral nerve compression related to trauma, facilitating management of the patient, even in the presence of diabetic neuropathy.

Diabetic Neuropathies↗

PubMed1996

Implementing a community initiative for the prevention of injury on farms in New Zealand.

Among New Zealand occupational injuries, farm-related injuries are second only to forestry in importance. A three-year Farm Safety Study, funded by the Accident Rehabilitation and Compensation Insurance Corporation, researched the epidemiology of farm injury in New Zealand, the safety behaviour and attitudes of people living on farms and the international literature on farm safety strategies. The Farm Safety Study made funds and regional injury information available to a local farm women's network in Southland to initiate work on farm safety through a series of workshops. Evaluation indicated effective coverage of farm types and localities. Outcomes included increased safety awareness, suggestions for a range of individual, community and institutional strategies and proposals for a local fieldworker. Over half the women responding to an evaluation questionnaire reported taking specific action to make their own farm safer. This project indicates that linking integrated, locally based research with action by community groups can be an effective mechanism to advance change.

Accidents, Occupational↗

PubMed1999

Evaluating Tackling Rugby Injury: the pilot phase for monitoring injury.

OBJECTIVE: To assess the suitability of two previously unused data sources for monitoring rugby injury throughout New Zealand. METHOD: Interviews were conducted with respondents sampled from players registered with the Rugby Football Unions (RFUs) and players claiming for rugby injuries from the Accident Rehabilitation and Compensation Insurance Corporation (ACC) in Auckland and Dunedin. RESULTS: Of the 500 RFU players sampled, 63% were interviewed and of these 39 (12%) had been injured playing rugby union. Of the 456 ACC claimants sampled, 66% were interviewed and 265 (88%) had been injured playing rugby union. CONCLUSION: Identifying injured players through ACC claims was more efficient, both procedurally and because a smaller sample size was required to detect changes in incidence. IMPLICATIONS: With no routine surveillance of sports injury being undertaken, recording sporting codes in national injury surveillance systems would assist the monitoring of sports injury.

Adolescent↗

PubMed1995

Contemporary transatlantic developments concerning compelled medical treatment of pregnant women.

This paper had identified a contemporary ethicolegal dilemma concerning the circumstances, if any, in which a pregnant woman's refusal of medical treatment may be judicially overridden either in her interests or those of the unborn child. On the one hand, the obstetrician will be concerned about the interests of both his patients in potentially life-threatening situations when they can be protected by what might be regarded as relatively straightforward procedures and where to fail to take those steps might expose the practitioner (at least outside New Zealand where its accident compensation legislation has impact in this regard) to allegations of negligence. On the other hand, the imposition of treatment in these circumstances will necessarily interfere with the woman's rights of autonomy and self-determination. In such cases also, the conduct of medical procedures in the face of an express prohibition by the woman may give rise to liability for battery. (In New Zealand, such a potential liability would not, in the writer's view, be affected by the prohibition on proceedings for damages for medical misadventure as contained in the Accident Rehabilitation and Compensation Insurance Act 1992.) At the heart of an analysis of this issue is the status of the fetus as it is the fact of the woman patient's pregnancy which distinguishes the cases discussed in this paper from others in which the Courts have had to deal with refusals of treatment by those competent to do so. In regard to this aspect, the approach of the Courts in various jurisdictions has arguably been confused and contradictory.(ABSTRACT TRUNCATED AT 250 WORDS)

Abortion, Legal↗

PubMed1982

Occupational contact dermatitis among rubber workers.

The occurrence of occupational contact dermatitis among workers in a rubber factory from 1976 to 1980 was studied. Insurance compensation was paid to 50 workers with dermatitis. 21 of the cases were allergic and 27 toxic contact dermatitis, giving a contact dermatitis frequency of 5.6/1000 workers. Paraphenylenediamine compounds were the main cause of allergic contact dermatitis and solvents the main cause of toxic contact dermatitis.

Dermatitis, Contact↗

PubMed1994

The New Zealand Rugby Injury and Performance Project: II. Previous injury experience of a rugby-playing cohort.

The Rugby Injury and Performance Project (RIPP) is a prospective cohort study by a multidisciplinary research group. Rugby injuries constitute an important area for research because rugby union is New Zealand's national sport and because of the considerable cost of all sports injury acknowledged by the Accident Rehabilitation and Compensation Insurance Corporation (ACC). The initial phase of data collection in the RIPP involved a pre-season questionnaire which, among other things, sought to establish variables relating to the past injury experience of players. The influence of previous injury, the use of safety equipment and the availability and significance of medical advice were among the variables identified by individual questionnaires. This paper analyses the responses to pre-season questions about injury experience in the previous 12 months. In so doing, it identifies baseline data which will be used to address a possible relationship between past injury experience and the prediction of injury during the season.

Adult↗

PubMed1997

Changes in Swedish Workers' Compensation: An American Perspective.

In response to escalating costs, substantial changes are being made to the Swedish workers' compensation insurance system. They include increased employer responsibility for sick leave payments, longer waiting periods, benefit reductions, tightened criteria for determining work-relatedness, and decreased support for worksite occupational health services. These changes will make Sweden's system more closely resemble the arrangement that has traditionally existed in the United States. Experience in the United States can illustrate the potential benefits and problems inherent in the Swedish changes. Some of the potential dangers are greater difficulty in determining the true costs of work injuries, less emphasis on prevention, increased pressure for the premature return to work of injured workers, and heightened dissention between patients, doctors, and social insurance officers. Collective discussion of these potential problems by Swedish employers, workers, doctors, social insurance officers, and government officials is needed.

Journal Article↗

PubMed2005

Karojisatsu in Japan: characteristics of 22 cases of work-related suicide.

With the rapidly increasing number of work-related suicides in Japan (Karojisatsu, in Japanese), both applications for worker's compensation insurance and civil suits are proliferating. The phenomenon of work-related suicide is examined along with the process and related factors. With informed consent from bereaved families, two certified psychiatrists independently reviewed and summarized 22 insurance and legal reports filed by psychiatrists on employee suicides that were related to heavy workloads. A clinical epidemiologist participated in discussions with psychiatrists to reach a consensus concerning the cause of the suicides. Only one case involved a female. Seventeen had experienced personnel changes, such as a promotion or transfer. Low social support was recognized in 18, high psychological demand in 18, low decision latitude in 17, and long working hours in 19 cases (more than 11 hours per day for 3 months or more, and without a day off in 9). The subjects had depressive episodes by the ICD-10 criteria and showed suicidal signs. Ten of them saw a general practitioner because of unspecified somatic complaints, but no effective measures were taken. None of them had a history of psychiatric consultation or had received mental health education dealing with job stress management. Although causality cannot be made from this case series report, we hypothesize that long working hours, heavy workloads, and low social support may cause depression, which can lead to suicide. Appropriate countermeasures are urgently needed and the present findings suggest some of them are possible.

Adult↗

PubMed2005

[Development of a checklist for evaluation of mental health activities at the workplace].

"The Checklist for Evaluation of Mental Health Activities at the Workplace" was developed for workplace staff evaluating mental health activities in their own workplace. The validity and reliability of the checklist were examined and criteria for evaluation were developed for workplace/organization/companies with 50 or more employees in Japan. The checklist initially included 33 items covering seven major domains of occupational mental health, with a four-point response option, based on the Japanese Guideline for Worker Mental Health in the Workplace and a relevant literature review. A questionnaire was send to 60 members of the Occupational Mental Health Committee (OMHC) of the Japan Society for Occupational Health to ask their opinions on the checklist and on the minimum requirement for each item on the checklist; 30 (50%) responded. A random sample of 1,335 workplaces from a contractor list of workplaces for worker compensation insurance and a questionnaire was send to the personnel department to fill in the checklist; 412 (31.5%) responded and data from 335 of them with 50 or more employees were analyzed. Some OMHC members felt that one of the items (concerning the Total Health Promotion program) should be dropped; thus the checklist was revised to include 32 items, still covering the seven domains. Based on the workplace survey data, most domain scales showed internal consistency reliability at an acceptable level; explanatory factor analysis yielded a four-factor structure that was well concordant with the hypnotized seven-domain structure. Three levels of adequacy of mental health activities were set for each domain scale: "red" (inadequate), "yellow" (minimal), and "green" (adequate). One third of occupational health professionals from 49 workplaces rated the evaluation result based on the checklist as concordant with their view; 95% of them said the checklist would be useful in promoting occupational mental health activities. The study indicated that the checklist had reliability (based on internal consistency reliability) and content- and construct-validity (based on expert opinions, a factor-structure concordant with empirical data, and evaluation by workplace staff). The checklist seems useful in promoting occupational mental health activities.

Counseling↗

PubMed1990

[Epidemiological surveillance system for occupational accidents: experience in the northern area of the municipality of São Paulo (Brazil)].

The epidemiological approach to occupational accidents and diseases adopted in Brazil is inadequate for many reasons, among them being: 1) the fact that only employers may notify work accidents, thus permitting notorious undernotification of these occupational hazards; 2) the available information does not permit a better understanding of the causal relationship between work accidents and diseases; 3) the official policy exists only for purposes of insurance compensation. The official documents for occupational disease and accident registration are the CTA (Work accident report) and FTA (Casualty treatment card). The Worker's Health Program of SUDS-R-6 proposed, in October, 1988 a method for the codification, registration in a micro-computer data bank and analysis of this information, based on the records presently in use (CAT) for public health service planning and accident prevention purposes. The major interest was in identifying the most common types of accidents in the region and the work environments in which they most frequently occur. The target population were the workers who attended the health units lisenced to deal with work accidents and diseases, in the Northern region of S. Paulo City. The data presented below refer to the months of October, November and December, 1988, the first three months of the project. During that period a total of 2,339 accidents were registered. They were classified as: typical work accidents - 87%: commuting accidents which occurred between the home and the work-place--18% and work diseases (only 2 cases). The majority of workers (50%) were between 25 and 45 years of age, approximately 7% were under 18. Male workers represented 83.2% of accident cases.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Occupational↗

PubMed2004

Independent of what? The independent medical examination business.

Workers suffering from a work-related health condition frequently are required to undergo examination by a physician chosen by the employer or a Workers' Compensation Insurance Carrier. While the opinions of physicians performing these "Independent Medical Examinations" (IMEs) have been criticized as biased by a conflict of interest, IME advocates assert that the methods used by the IME result in an objective and superior opinion. This article explores this claim to objectivity and superiority. It argues that pro-employer/carrier bias is embedded in the methodology IMEs advocate, and that the practical impact of the IME approach is to reduce the recognition of occupationally related health conditions and to minimize the disability associated with such conditions. The IME approach is more accurately characterized as a tool to standardize a product that can be marketed to corporate clients, rather than a way to precisely assess work-related health conditions.

Journal Article↗

PubMed2006

Study on a model for future occupational health: proposal for an occupational health service model in Japan.

The Study Model for Future Occupational Health (funded by a research grant from the Ministry of Health, Welfare and Labor) is a joint research project involving various organizations and agencies undertaken from 2002 to 2004. Society has undergone a dramatic transformation due to technological developments and internationalization. At the same time a low birth rate and an aging population have resulted in an increase in both the percentage of workers experiencing strong anxiety and stress in relation to their jobs and the working environment and the number of suicides. As a natural consequence, occupational health services are now expected to provide EAP, consulting and other functions that were formerly considered outside the realm of occupational health. In consideration of this background, the present study propose the following issues to provide a model for future occupational health services that meet the conditions presently confronted by each worker. 1. How to provide occupational health services and occupational physicians' services: 1) a basic time of 20 minutes of occupational health services per year should be allotted to each worker and to all workers; 2) the obligatory regulations should be revised to expand the obligation from businesses each with 50 or more employees under the present laws to businesses each with 30 or more employees. 2. Providers of occupational health services and occupational physicians' services: (1) reinforcement of outside occupational health agencies; (2) fostering occupational health consultant firms; (3) development of an institute of occupational safety and health; (4) support of activities by authorized occupational physicians in the field; (5) expanding of joint selection of occupational physicians including subsidy increase and the extension of a period of subsidy to five hears; (6) licensing of new entry into occupational health undertaking. 3. Introduction of new report system: (1) establishment of the obligation to submit reports on risk evaluation and improvement measures; (2) establishment of the obligation to prepare a report on results of medical examinations in all sizes of businesses. 4. Introduction of a merit system into businesses in establishment of a new system: the application of the special merit system of the workers' compensation insurance shall be revised to add occupational health activities, cover business with 20 or more to 100 or less employees and expand the period of application for three years under the present laws to five years. 5. Ensuring of international coordination: harmonization of standards of individual countries for occupational health and safety; thorough (1) ensuring of international agreement on high-level specialist qualifications; (2) mutual recognition of qualifications of occupational physician, nurse, occupational hygienist, ergonomist, and counselor; (3) preparation of guidelines for occupations relating to occupational health businesses.

Adult↗

PubMed1984

Reimbursement in private practice.

Occupational therapists in private practice must develop sound business policies and procedures to help ensure third party reimbursement for their services. Carefully delineated protocols and proper documentation in treatment are of utmost importance. Fee schedules are established within the framework of local government regulations, using one or a combination of the following methods: unit value system, modalities and procedures, cost-plus or overhead, and state relative value system or maximum allowable fees. Blue Cross/Blue Shield or other private third party payers, Medicare or Medicaid, and workers' compensation insurers are the usual parties billed for services rendered. Therapists must use good public relations methods to educate their present and future reimbursers and act as advocates for private practitioners in occupational therapy.

Documentation↗

PubMed1987

Finger thermometry in the assessment of subjects with vibration-induced white finger.

The measurement of finger skin temperature (FST) is one of the most commonly used methods for evaluating the response of the digital vessels to cold stimulation. In well-controlled experiments a significant correlation has been observed between FST and digital blood flow over a wide range of water temperatures. On the contrary, FST in air is considered an inadequate index of digital skin circulation since, at a given ambient temperature, FST depends not only on the rate of blood flow through the digit but also on environmental conditions. Despite these limitations, FST recording after a cooling procedure has been used in surveys of vibration-induced white finger (VWF), and a delayed finger rewarming time has been proposed as an indicator of digital vasospasm in workers with VWF. Finger skin thermometry can differentiate between VWF groups and healthy groups, but it is unsuitable for diagnosing Raynaud's phenomenon on an individual basis. The thermometric method has good specificity but its sensitivity is lower than that of plethysmographic techniques. FST after cold provocation may be considered a useful screening test in field studies, while more sensitive methods should be employed to confirm VWF symptoms in individuals objectively, especially for insurance compensation purposes.

Fingers↗