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PubMedDate not supplied

[The accident phenomenon in a naval shipyard].

The paper analyses the rate and severity of accidents in a shipyard in the period 1 January-31 December, 1987. Data were collected by consulting the shipyards' accident register, which recorded each single case of injury, and the medical certificates sent to the shipyard management by the worker's physicians. The shipyard employed 996 blue collar workers and 210 white collar workers in 1987, all of whom were subject to obligatory industrial accident insurance. For each of the 1375 accidents that occurred in the period under study, the time, place and cause of the accident and the type and site of the injury were recorded. The aim of the statistical analysis of the data was to assess the risk in each area of the shipyard and the causes of the accidents in relation to the work station and job. The severity rate of injury increased in those workers recently assigned to new jobs; climate had a negative influence since accidents were more frequent in spring/summer. Accident prevention measures are suggested that can be achieved by improving work organisation and by a more appropriate use of personal safety devices.

Accidents, Occupational↗
PubMed1990

[Accident and injuries situations in accidents at school and on the way to and from school].

In the Federal Republic of Germany, where accidents to schoolchildren are covered by the statutory accident insurance, a total of 991,947 accidents of this kind occurred in 1987, 133 of which were fatal. In this study, the accidents and injuries sustained by 1059 schoolboys and schoolgirls who received medical treatment in our clinics are analysed. We are concerned here with 887 accidents actually at school and 172 accidents on the way to or from school. In the case of accidents at school, the proportion of 6-, 7- and 8-year-olds affected was below 3% for each of these age groups. The percentage of children involved in accidents at school increased steeply with increasing age, reaching a peak in girls at 12 years of age, with 15.4%, and in boys at 13 years, with 14.5%. After this, the proportion in each individual age group lay between 10% and 12% up to 17 years of age and decreased to 7% in 19-year-olds. The proportion of accidents among 20- and 21-year-olds was less than 2%. Of the 887 accidents at school, 53% occurred during sports lessons, 28% during break times, 11% in the course of the general coming and going involved in attendance on the school premises, 3% during instruction in academic subjects and 3% during extracurricular activities, e.g. school outings. Each of these accident areas has its typical accident risks, and often its characteristic accident pattern in addition. Furthermore, there are age-specific and sex-specific features. The frequency of injuries to the upper extremities, including the hand, was 11% higher in girls than in boys.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents↗
PubMed2000

[Rehabilitation networking illustrated by case management after occupational accidents].

No net without a spider! After work accidents the victims can rely on the infrastructure created by the German accident insurance scheme (Berufsgenossenschaften). A surgeon, a so-called transit physician, is responsible after acute treatments also for all phases of rehabilitation. A Case Manager (Berufshelfer), an employee of the Berufsgenossenschaften, advises the victim in all matters, including vocational rehabilitation and personal concerns. Both factors combine to form a network that orientates on the social needs of the injured worker, on the financial tasks of the insurance agency and on incentives to the rehabilitation facilities. The goals comprise "rehabilitation before compensation" and "job retention instead of job loss".

Accidents, Occupational↗
PubMed2003

Germany: toxicology information on the World Wide Web.

Following a brief introduction to the history of toxicology in Germany, this article deals with institutions concerned with toxicological information and research in Germany. The web addresses, responsibilities and main topics of federal authorities, federal state authorities, institutions for statutory accident insurance and prevention, non-university and university research institutes, funding institutions, scientific societies, industry representatives and poison information centers are described and links are given to databases provided on the web sites of these institutions.

Academies and Institutes↗
PubMed1978

No-fault malpractice insurance: Swedish plan shows us the way.

No-fault medical accident insurance could help solve some of the medical malpractice insurance problems that plague American physicians and hospitals. In Sweden, the Patient Injury Insurance Plan has been working for two years, and, with the statistics that are now available, the claims experiences under the new Swedish system can be compared with the claims experience in the United States under the traditional liability system. The author believes that an insurance system similar to the Swedish plan can work in the United States, but only if certain conditions are created.

Accidents↗
PubMed1998

[Self-mutilating hand and finger injuries among physicians suspected of insurance fraud].

27 cases of questionable self-mutilation among physicians (concerning finger and hand injuries) were analyzed retrospectively. The evaluation based on files of the insurance companies, reconstructive examinations and experimental investigations. Three typical cases are described in detail, the "victims" were suspected to have committed a special kind of fraud in order to claim financial compensation from their accident-insurance companies; the contract included special invalidity payments for finger injures (so-called "Gliedertaxe"). Many of these physicians had worked in the surgical field: apart from one 38-year-old female all of them were males, aged between 41 and 66 years. The mutilating instruments were often circular saws, sometimes chain saws and a great variety of other tools, for example hatchet, big scissors and other sharp instruments. By means of forensic-medical expertise and criminalistic investigations the insurance companies were able to demonstrate clearly that the amputation was voluntarily self-inflicted. The forensic-medical argumentation concerning intentional self-mutilation included the so-called execution position of the finger, the injury pattern, the investigations of blood stains and ergonometric aspects.

Adult↗
PubMed1996

Occupational disease surveillance using disability insurance at an automotive stamping and assembly complex.

Sickness and accident-insurance (sick leave) claims at an automotive stamping and assembly complex were analyzed using Poisson regression over a 4-year period to identify occupational health problems. The incidence of lower-respiratory disability (excluding asthma) was higher in painting operations (rate ratio [RR] = 2.9, 95% confidence interval [CI] = 1.2 to 6.8), and final assembly and processing areas (RR = 2.7, 95% CI = 1.0 to 7.4) at the assembly plant, and in metal assembly (welding) areas (RR = 2.8, 95% CI = 1.4 to 5.7) at the stamping plant. Disability rates for upper-extremity musculoskeletal disorders were statistically significantly higher (RR = 3.1 to 3.8) in major assembly plant production areas, as were back disability rates (RR = 1.5). During the first 6 months of new work assignments in painting or final assembly, respiratory problem rates were four times higher than in other areas. Upper-extremity musculoskeletal rate ratios ranged from 4.4 to 5.7 for new assignments in body, hard trim, and chassis areas. Higher rates in new assignments appeared to result from assignment changes precipitated by developing health problems, or from routine assignments to new tasks, some of which conferred high risk and were tolerated for less than 6 months. Musculoskeletal disability was consistent with known ergonomic hazards and paralleled that reported on the Occupational Safety and Health Administration log. Work-related musculoskeletal and other problems can be readily identified from disability insurance claims without dependence on plant medical visits or workers' compensation records. Disability insurance appears to absorb considerable work-related medical and absence costs.

Accidents, Occupational↗
PubMed1996

[Drugs and occupational accident].

In a case of a fatal occupational accident (construction worker, fall from roof, urine test positive for cocaine and THC, e.g. cannabis) the question arised to what extent those drug-related occupational accidents occur. In the literature only few cases, mainly dealing with cannabis influence, have been reported, however, a higher number is suspected. Cocaine and other stimulating drugs (amphetamine) are more often used to increase physical fitness. By direct or indirect interference with vigilance these compounds may provoke accidents. Due to the lack of a legal basis proving of the influence of drugs at the working place is still very limited, although highly sensitive chemical-toxicological assay procedures are available to detect even the chronic abuse (in hair). In the general conditions of accident insurances a compensation is excluded when alcohol is involved, but drugs are not mentioned. It is indeed difficult to establish a concentration limit for drugs like that existing for alcohol (1.1%). In each case the assay of the drug involved and exact knowledge of its specific effects is in an essential prerequisite to prove the causal relationship.

Accidents, Occupational↗
PubMed2003

Early secondary prevention of occupational skin disease in Germany: the dermatologist's procedure in perspective.

The dermatologist's procedure was introduced in 1972 as a "procedure of early detection of occupational skin disease" by industrial, agricultural and public-sector employers' liability insurance funds of Germany's statutory occupational accident insurance. To date, it represents the most relevant tool for secondary prevention in industrial dermatology in Germany. According to the intention of this procedure, insured parties who are likely to have an occupational skin disease have to be offered preventive measures and, if necessary, given appropriate treatment to avoid job-loss. In co-operation with the Central Federation of the Industrial Professional Associations, the Task Force on Occupational and Environmental Dermatology of the German Dermatological Society, and the Professional Organisation of German Dermatologists, a study group was constituted in 1999 to improve the traditional dermatologist's procedure. In October 2002 a controlled intervention study was started in North-western Germany to establish the definitive value of the "optimised" dermatologist's procedure. Past, present, and future of this specific procedure are discussed.

Dermatology↗
PubMedDate not supplied

Sports-related injuries in school-aged children.

Most studies of sports-related injuries have been investigations of specific injuries resulting from specific, organized sports at the high school, college, or professional level. This study documented all types of sports-related injuries received by all school-aged children in a midwestern community of 100,000 for a 1-year period. Public and private schools, community sports programs, hospital emergency rooms, the schools' accident insurance company, and local physicians provided initial accident reports. Injuries were sustained by 3% of all elementary school students, 7% of all junior high school (grades 7 and 8) students, and 11% of all high school students. Nonorganized sports and physical education classes each produced nearly twice as many injuries as organized sports. One-fifth of the injuries were considered serious and one-fourth of all injuries could have been avoided had nominal safety precautions been observed.

Adolescent↗
PubMed1979

[An Austrian model of rehabilitation after severe traumata (author's transl)].

After a short survey of the Austrian Social Insurance System, provisions for the rehabilitation of accident victims as carried in Austria are briefly described. This description includes the medical and social aspects as well as the coordinated function of both components of rehabilitation. The question of prosthetic appliances as well as rehabilitation and special care for paraplegics is also dealt with. Future developments such as day-centres for rehabilitation and a possible departure from the causeoriented principle in legal accident-insurance are also briefly outlined in prospective.

Amputation, Traumatic↗
PubMed1990

[Expert assessment of "traumatic" lumbar intervertebral disk displacement].

A prolapse of a lumbar intervertebral disc as a consequence of trauma is rather often the subject of medical litigation. This paper shows the different aspects of federal and private insurance companies that insure accident consequences. Items hinting at a causal connection between trauma and prolapse are shown. A prolapse of a lumbar intervertebral disc can only very seldom be certified as being traumatic.

Diagnosis, Differential↗
PubMed1996

[Second opinion--from the medical insurance viewpoint].

The history of the initial second opinion programmes is summarized. The original expectations in these programmes and their goals are stated. Some studies on second opinion programmes showed cost-savings in health care expenditure. However, there are no valid studies proving that the health care budget had been decreased. Improvements in the patient doctor relationship were demonstrated although improvements in the quality of patient care through second opinion programmes could not be ascertained. This lack of consistency reflects the limited reliability of clinical judgements. J. R. Clarke demonstrated that analysing the decision path leading to a surgical procedure was superior to second opinion programmes in achieving a correct surgical therapy. The Swiss Accident Insurance Company (SUVA) is organized in regionally assigned physicians and a dense network of administrative offices providing proficient advisory (support?) services to physicians in practice. Additional programmes are therefore not advocated and a mandatory confirmation of the need for certain surgical indications through second opinion programmes is not required. Instead, we advise to employ decision analysis in order to strengthen the foundation of clinical judgments and to improve the selection of therapies. It is proposed that elaborating medical-surgical decision paths should include psychological, socio-economical and cultural issues affecting the patient's welfare, in addition to anatomical and technical aspects determining the therapeutic feasibility.

Cost-Benefit Analysis↗
PubMed1986

[Reasonableness of surgical interventions and compliance responsibilities in various insurance fields and under the social compensation law].

According to the German Social Legal Code I (I. Sozialgesetzbuch, SGB I) the recipient of social benefits is under obligation to submit to medical treatment if such treatment would result in an improvement of his/her condition or in the prevention of further deterioration (section 63 SGB I). In certain situations, lack of cooperation may result in total or partial refusalor withdrawal of benefits (section 66 SGB I). This social law parallels the civil law which can recognize, in the area of private liability, co-delinquency in cases of refusal of reasonable treatment (section 157. section 242 and 254 GBG). In private liability insurance, the acceptance of reasonable medical treatments is contractually anchored. - In practice, the underwriter is generally unable to enforce surgical interventions. In the administration of social benefits surgical measures are exempt from the obligation of cooperation through administrative rules and guidelines of the regional state departments. The entitlement to pensions for the visually handicapped ("Blindengeld"), based on the Federal Social Benefit Law (BSHG), is regulated at the state level through state organizations. The corresponding state laws do not provide for the termination of support in cases of refusal of reasonable and prognostically promising operations. The recipients of pensions for the blind are not addressed in SGB I. Benefit recipients are therefore not penalized for refusing reasonable medical measures. - In legal accident insurance and legal social security insurance there exist, under certain conditions, obligations to cooperate in line with SGB I.(ABSTRACT TRUNCATED AT 250 WORDS)

Ethics, Medical↗
PubMed1978

[Insurance and preventive medicine].

Not only do insurance companies have to pay in case of death, injuries or disease, they are also concerned with their prevention. This is particularly true for the "Swiss National Accident Insurance Fund" (Caisse nationale suisse d'assurance en cas d'accidents--(CNA): for them the prevention of work related accidents and occupational diseases is required by law. Preventive activities in this area are very promising. The progress in the sickness insurance programmes for preventive medicine in the general population has, however, not been as successful. To date, the legislation denies payment for preventive medical care. Why is there this difference? In the case of accidents and occupational diseases, the cause of the pathologies are for the most part exogenous and develop in well known and controlled environments. In the case of disease or invalidity in the general population, the factors are in a large part endogenous and therefore very difficult to supervise, as they develop in much more complex and uncontrolled environments. Nevertheless progress has been done in this field as well. At present, some selected scientifically proven preventive examinations could be included in insurance programmes as part of a general plan and with strict quality control of laboratory findings.

Accidents, Occupational↗
PubMed2006

The BG measurement system for hazardous substances (BGMG) and the exposure database of hazardous substances (MEGA).

German employers' liability insurance associations or Berufsgenossenschaften (BGs)--institutions for statutory accident insurance--maintain a measurement system for hazardous substances, the so-called BGMG. The aim of the BGMG is to determine and document valid results of measurements of exposure primarily for prevention purposes. The data are collected systematically, in parallel to the sampling in a company. Parameters which are supposed to have a visible effect on exposure levels are documented. The MEGA database (documentation of measurement data relating to workplace exposure to hazardous substances) holds 1,629 million measurement values, which have been compiled in since 1972. The database offers a host of selection possibilities for assessments depending on the evaluation strategy.

Databases as Topic↗