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PubMed1999

[Skin diseases related to work: how to approach them?].

Work-related skin problems are frequent and mainly affect the hands. They can be approached by looking for indications of the 3 principal underlying types of dermatitis: irritant, allergic, or chronic. Irritation and contact allergy are closely associated: the irritation facilitates the flowering of the allergy. Skin irritation due to working conditions is often multi-causal and repetitive. Cutaneous atopy--but not that which is only respiratory or mucosal--is the main genetic risk factor for the development of a work-related skin disease. The characteristics of irritation and allergy tend to merge when the lesions become chronic. An 8-step process is suggested to establish the causal relationship between potentially damaging substances in the workplace and the resulting skin problems. In Switzerland, professional dermatitis falls under the purview of the accident insurance laws. These laws recognize causal responsibility whenever the work substances or activities are preponderant over non-professional causes.

Accidents, Occupational↗
PubMed1980

Injuries of competitive skiers in Finland: a three year survey.

The present investigation reports on the injuries of competition skiers in Finland during the period 1976 to 1978. This investigation was made possible through the present system in Finland where an obligatory competition licence is always linked with accident insurance and the authors were able to base their work on an insurance company's records. The total number of licensed competition skiers in 1978 was 7814, 7052 being cross-country skiers, 275 skijumpers and 487 downhill skiers. During the period under investigation 180 accidents leading to an injury were rcorded. Cross-country skiers had 47% of these injuries, downhill skiers 23% and skijumpers 30%. The injury risk in skijumping (47%) proved to be highly significantly (p < 0.001) greater than in the other events (3% and 18%). In the comparison of the injury risk, men (8.5%) outnumbered women (4.4%) (p < 0.001). Men under 30 had more injuries than the older age group (p < 0.001). Muscle and tendon injuries were most common in cross-country skiing. The risk of sustaining a fracture was higher in skijumping than in the downhill events (p < 0.001) and higher in downhill skiing than in cross-country (p < 0.001). On the basis of the present investigation cross-country skiing seems to be a safe activity, but downhill skiers and especially skijumpers seem to be subject to a relatively high risk of injury.

Adult↗
PubMed2003

Pediatric care report of spinal cord injury without radiographic abnormality (SCIWORA): case report and literature review.

STUDY DESIGN: Case report of SCIWORA following trivial trauma in childhood and review of the literature. OBJECTIVES: To describe a case of 'spinal cord injuries without radiographic abnormality (SCIWORA)', which was diagnosed 2 years after the event, and define its relevance from a differential diagnostic and medico-legal viewpoint. SETTING: An Austrian neuro-traumatological rehabilitation and workers' insurance appraisal center. METHODS: A 12-year-old patient is presented who suffered an ischemic spinal lesion of unknown origin on her way home from school. The patient was reinvestigated as part of an insurance appraisal 2 years later. The aim of this investigation was to elucidate the origin of the spinal cord lesion, in particular, whether it was because of accidental trauma or because of a preexisting condition (eg vascular malformation). RESULTS: SCIWORA due to a trivial trauma was diagnosed during the reinvestigation. This was of importance for the patient because of accident insurance coverage. CONCLUSION: In children developing a quadroparesis following a minor trauma, spinal cord injury without radiographic abnormality must be considered in the differental diagnosis.

Child↗
PubMed1986

Medical screening and monitoring as noted by the insurance industry.

Medical screening and monitoring have a long and varied history as part of the insurance industry's safety and health relations with its policyholders. Many workers' compensation insurance carriers have assisted policyholder management in understanding the requirements of cost-effective health programs, in planning and undertaking steps necessary to comply with state-of-the-art medical practices, and in locating knowledgeable physicians to supervise employee health systems. Managing employees' health and associated records has become, for many employers, a complex operational and regulatory problem because of the amount and type of health information being collected. Administration of group health and accident insurance plans, workers' compensation, treatment for the ill and injured employees, voluntary health screening and counseling programs, preplacement and periodic physical examinations, and control mechanisms for health hazard exposures all contribute to this huge pool of acquired and stored health information.

Humans↗
PubMed2006

International research into occupational safety and health protection.

Are we doing the right thing? Are we setting the right priorities for the future in occupational safety and health research? How does BG (Institution for Statutory Accident Insurance and Prevention) research compare nationally and internationally? As a mosaic of answers to these questions, this article explores international research on priorities in occupational research and analyses these against the backdrop of the nearly 1,000 research projects conducted by 9 institutions from 8 countries in the year 2003.

Accidents, Occupational↗
PubMed1993

[Fractures of the proximal femur: rehabilitation and socioeconomic repercussions].

Only insufficient statistical data for epidemiologic analysis and calculations of socioeconomic costs are available in Switzerland. The total number of fractures of the proximal femur per year has nearly doubled in the 10 years from 1980 to 1990, climbing from 5500 to 9800 cases. A number of 15,000 cases is foreseen for the year 2020. In 85% of the cases the patients are older than 65 years. The global annual incidence is estimated to be 145/100,000, the partial incidence for the population of more than 65 years being 825/100,000. The mean hospitalization is 30 days. The total number of hospital days per year climbed from 200,000 to 300,000 in ten years, thus increasing the number of required beds by 50%. The mean costs for primary hospitalization is estimated to 15,000.-Swiss francs per case in 1990 and 146 Million francs globally per annum, i.e. the double of the amount in 1980. In the statistics of the National Accident Insurance Company the mean global economic costs for a fracture of the proximal femur in the active population is 57,000.-Swiss francs approximately and 72,000.-francs for patients of more than 45 years of age. Only roughly 20% of the costs are caused by medical treatment, whereas pensions, per diems and other compensations produce 80% of the costs. The mortality for patients over 65 varies from 2-7% during the primary hospitalization and rises up to 30% after 1 to 2 years after the accident. The relationship between the duration of acute hospitalization and rehabilitation is essential for planning. The evaluation of the chances for a successful rehabilitation is very important, the general medical conditions of the patients before the accident being the main determinant factor. A mean hospitalization of 3 weeks in a surgical unit and 6 to 7 weeks in a rehabilitation hospital seems to be realistic. Appropriate criteria for the selection of patients amenable to successful rehabilitation are essential. The question of the social outcome of these patients should be analyzed on a large scale nationwide study.

Adolescent↗
PubMed1998

Prevention of work-related disability.

INTRODUCTION: The cost of work-related injury is large and is rising in many states. Managed care providers are being asked to assist with solutions, particularly in the area of facilitating return to work. Kaiser Permanente of the Northwest responded by developing the Kaiser on-the-job program, which includes processes to facilitate the primary, secondary, and tertiary prevention of work-related disability. METHODS: This paper describes the role that managed care can play in the prevention of work-related disability through consultation, training, immunization programs, and targeted screening and case management interventions. A quality and case management system is described, which gives physicians feedback on modified work and time-off authorization by diagnosis. RESULTS: The results demonstrate statistically significant decreasing physician-authorized average time loss for low back cases from 1991 through 1995 (17.8 disability days per case in 1991 and 15 per case in 1995, P = .01). According to Oregon State Accident Insurance Fund (SAIF Corporation) data, the Kaiser on-the-job average total claims cost was reduced 33% for disabling cases as compared to two other health care organizations (P = .002). CONCLUSION: The methods utilized here to prevent work-related disability appear effective. They are relevant to many managed care program models and their efforts to improve workplace health and productivity.

Accidents, Occupational↗
PubMed2003

Biomechanical assessment of soft tissue neck injuries in cases with long sick leave times.

A database was established by collecting 919 cases of claimed cervical spine disorders (CSDs) sustained in automotive accidents. All cases had a sick leave time of more than 4 weeks. Data was obtained from a major Swiss accident insurer. An assessment scheme was developed that took into account technical, medical, and biomechanical aspects. All cases were evaluated according to this scheme. The overall biomechanical assessment, that stated the extent to which the symptoms claimed could be explained by the impact, was found to be significantly influenced by the patient's history of CSD in terms of preexisting damage or preexisting symptoms. In 52% of the assessed cases, the CSD claimed could be explained with a combination of neck loading and also by considering the patient's medical history. Performing a solely technical analysis of the collision circumstances or a purely medical evaluation based on a Quebec Task Force (QTF) grade alone are insufficient to assess the accident-related explicability of claimed CSD. Biomechanically relevant individual factors have to be considered.

Accidents, Traffic↗
PubMed1998

[Injury profile in school sports. A sports medicine analysis in an annual report on schools].

A current injury profile was constructed on the data of the accident reports (n = 6366) in school sport coming in with the municipality accident insurance association for Schleswig-Holstein. The largest injury frequency occurred at the period from 9 o'clock until 10 o'clock. In this way, the "2nd hour" showed the highest injury risk referring to the lessons. In this case, a significant connection appeared between motivation and injury risk. The upper extremities were affected with a part of about 48% of all injuries most frequently. Within the injury kinds the distortion in 45% of the cases dominated. Cause of the injuries was the ball in 28% of the cases. The most injuries within the ball games resulted at the basketball (17%). By far most injuries of upper extremities occurred during a game phase. In about 80% the cases the injuries were on the fingers identified caused by the ball. The present results can help to analyze causes of accident and discuss measures for the prevention of sport injuries during the school sport.

Accidents↗
PubMed1995

Long-term outcome after whiplash injury. A 2-year follow-up considering features of injury mechanism and somatic, radiologic, and psychosocial findings.

With the increased incidence of whiplash injury following the introduction of compulsory car seat belts, a large number of reports have dealt with the aftermath of this condition. Previous studies, however, focused on somatic symptoms on the one hand or considered only psychological or neuropsychological variables on the other hand, often in loosely defined or selected groups of patients. No study so far has analyzed the long-term outcome in a nonselected group of patients using a clear injury definition considering patient history; somatic, radiologic, and neuropsychological findings; and features of the injury mechanisms assessed soon after trauma and during follow-up. the present investigation was designed to assess these combined factors. According to a strict definition of whiplash injury, we assessed a consecutive nonselected sample of 117 patients with recent injury who had similar sociocultural and educational backgrounds. The patients had been in automobile crashes and were all equally covered by accident insurance according to the country-wide scheme. Initial examination was performed 7.2 +/- 4.2 days after trauma, and follow-up examinations 3, 6, 12, and 24 months later. At baseline, features of injury mechanism, subjective complaints, and different aspects of patient history were documented and cervical spine X rays performed. At all examinations patients underwent neurologic examination and cognitive and psychosocial factor assessment. At 2 years, patients were divided into symptomatic and asymptomatic groups and then compared with regard to the initial findings. In addition, symptomatic patients who were disabled at the 2-year follow-up examination and symptomatic patients not disabled (that is, they were able to work at the pretraumatic level) were compared regarding initial and 2-year findings. At 2 years, 18% of patients still had injury-related symptoms. With regard to baseline findings the following significant differences were found: Symptomatic patients were older, had higher incidence of rotated or inclined head position at the time of impact, had higher prevalence of pretraumatic headache, showed higher intensity of initial neck pain and headache, complained of a greater number of symptoms, had a higher incidence of symptoms of radicular deficit and higher average scores on a multiple symptom analysis, and displayed more degenerative signs (osteoarthrosis) on X ray. In addition, symptomatic patients scored higher with regard to impaired well-being and performed worse on tasks of attentional functioning and showed more concern with regard to long-term suffering and disability.(ABSTRACT TRUNCATED AT 400 WORDS)

Accidents, Traffic↗
PubMed1997

Work-related musculoskeletal disorders: comparison of data sources for surveillance.

Work-related upper extremity musculoskeletal disorders "associated with repeated trauma" account for more than 60% of all newly reported occupational illness, 332,000 in 1994 according to the U.S. Department of Labor. These numbers do not include, for example, those disorders categorized as "injuries due to overexertion in lifting," approximately 370,000. Early identification of potential disorders and associated risk factors is needed to reduce these disorders. There are a number of possible methods for conducting surveillance for work-related musculoskeletal disorders (WMDs) based on health outcome: workers' compensation, sickness and accident insurance, OSHA 200 logs, plant medical records, self-administered questionnaires, professional interviews, and physical examinations. In addition, hazard surveillance based on evaluation of job exposures to physical stressors by nonoccupational health personnel is possible. As part of a large labor-management-initiated intervention study to reduce the incidence of WMDs in four automotive plants, we were able to compare the strengths and limitations of each of these surveillance tools. University administered health interviews yielded the highest rate of symptoms; combined physical examinations plus interview (point prevalence) rates were similar to self-administered questionnaires (period prevalence) rates. Plant medical records yielded the lowest rate of WMDs. WMD status on self-administered questionnaire and on physical examination were associated with risk factor exposure scores. This study suggests that symptoms questionnaires and checklist-based hazard surveillance are feasible within the context of joint labor-management ergonomics programs and are more sensitive indicators of ergonomic problems than pre-existing data sources.

Cumulative Trauma Disorders↗
PubMed1998

Occupational obstructive airway diseases in Germany.

In industrialized countries, occupational asthma caused by allergens and irritants due to workplace exposure is increasing. More than 8,000 such claims were made in Germany (10.5% of all decided occupational disease claims) in 1995; 1,900 were confirmed (6.5% of all confirmed claims). The legal basis and the occupational disease-related regulations of trade-assigned statutory accident insurance institutions ('Berufsgenossenschaften') in Germany are described. Hitherto, three occupational disease categories for obstructive airway disorders existed: due to sensitizing agents, due to chemical-irritative or toxic agents, and due to isocyanates. Approximately 40% of accepted claims for occupational asthma and rhinitis result from exposure to flour. Ongoing changes in the recognition of work-related airway disease symptoms account for differences in the incidence and prevalence as reported over the years. Recently, chronic obstructive bronchitis and/or emphysema of hard coal miners have been included in the German list of occupational diseases.

Germany↗
PubMed1978

[Organization and tasks of occupational medicine in Switzerland].

Industrial health aims to harmonize man's relation to his work. In our country indusprial health is promulgated by the medical services of SUVA (Swiss Accident Insurance Institute) and BIGA (Federal Office for Industry and Labour) on one hand and by the lecturers of universities and at the ETH (Swiss Federal Institute of Technology) as well as by plant physicians on the other hand. Industrial health is a compulsory discipline with examination at medical faculties.

Occupational Medicine↗
PubMed1982

[Mesothelioma following occupational contact with asbestos].

From 1975 onwards, mesothelioma is by far the most often seen occupational tumour in Switzerland (about 70%). Between 1969 and 1982, there have been 49 cases registered by the SUVA (Schweizerische Unfallversicherungsanstalt, i.e. Swiss National Accident Insurance Fund). 10 together with asbestosis. Of the first 30 cases, the primary tumour only once was in the peritoneum, in all other cases the tumour always could be located in the pleura. The causative asbestos exposure was found in the production of asbestos cement (9), in the construction and reparation of waggons (6), in the insulation work at chemical plants (5) and in several other industrial work conditions (10). The average exposure time was 21 years. The average interval from exposure to diagnosis 35 years. The survival time after diagnosis about 1 year. Technical prevention consists in substitution of asbestos or elimination of respirable dust (or at least reduction below the TLV). Medical prevention: periodic fitness tests and follow up examinations. New cases should be communicated to the mesothelioma-register in Zurich and to the SUVA, for clarification of the industrial origin.

Asbestos↗
PubMed1981

[Health Protection in the Workplace: Special Commission of the Swiss Society for Occupational Medicine, Occupational Hygiene and Occupational Safety].

Fridolin Schuler (1832-1903), physician in Glarus, laid the foundations of the Swiss legislation for the protection of the working population. The law for illness and accident insurance followed in 1911, it was complemented with regulations concerning the protection from occupational diseases. Of great practical importance were coordinated efforts of physicians, technologists, hygienists and safety engineers, who founded in 1956 the "Studiengruppe für Gesundheitsschutz in Industrie und Gewerbe". In 1973 they joined with the "Groupement romand" in the "Swiss Society for occupational medicine, occupational hygiene and occupational safety" (AAA). In 1964 the Association of Swiss occupational physicians has been founded. In order to strengthen the promotion of occupational health in Switzerland a special commission on occupational medicine was constituted in 1980 within the AAA. Several subcommissions are presently working on a steadily increasing number of problems in the field of occupational health.

History, 19th Century↗