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The effectiveness of a comprehensive work hardening program as measured by lifting capacity, pain scales, and depression scores.

OBJECTIVE: The purpose of this pilot study was to examine the effectiveness of a four-week work rehabilitation program. METHOD: Investigators conducted a retrospective chart review of 312 clients participating in the Work Evaluation and Rehabilitation Clinic (WERC) Program from 1994-2000. Only 196 charts were sufficiently complete to be included in the study. Of these 196 prospective clients, 166 began the WERC program and 141 completed the program and were included in the database. Data were gathered from the initial history and evaluations conducted upon admission to the program and from the final evaluation conducted at the time of discharge. Demographic information was recorded. Data from the following assessments were collected: pre- and post-scores for subjective measures of pain using the Oswestry Back Pain Scale and a self-report of pain, the Beck Depression Inventory, the Waddell Sign, and pre- and post-scores of several physical performance tasks. RESULTS: Statistically significant post-test improvements were shown in all six outcome measures used in this study. A decrease in pain correlated with the Floor to Waist Lift test and with the Carrying An Object 20 Feet test. The percentage increase in Waddell's Sign correlated with a decrease in the Carrying An Object 20 Feet test. The Floor to Waist Lift test correlated with the Carrying an Object 20 Feet test. The Oswestry Test correlated with the Beck Depression Scale. There was no significant relationship found between diagnosis of back injury and Waddell's Sign, between either the Waddell's Sign and the Oswestry, or the Waddell's Sign and depression. A regression analysis revealed diagnosis, level of education, gender, and pre-injury work load as significant predictors of improvements made during the work program. CONCLUSION: The program was shown to be effective as measured by the post-test improvements in all 6 performance tests. Although more research is warranted into the effectiveness of treatment for clients with chronic pain, it appears that there is a relationship between pain and physical performance and pain and depression in clients completing a work hardening program.

Adult↗

Impact of illness and non-combat injury during Operations Iraqi Freedom and Enduring Freedom (Afghanistan).

Historically, non-combat injuries and illnesses have had a significant impact on military missions. We conducted an anonymous cross-sectional survey to assess the prevalence and impact of common ailments among U.S. military personnel deployed to Iraq or Afghanistan during 2003-2004. Among 15,459 persons surveyed, diarrhea (76.8% in Iraq and 54.4% in Afghanistan), respiratory illness (69.1%), non-combat injuries (34.7%), and leishmaniasis (2.1%) were commonly reported. For all causes, 25.2% reported that they required intravenous fluids, 10.4% required hospitalization, and 5.2% required medical evacuation. Among ground units, 12.7% reported that they missed a patrol because of illness, and among air units, 11.7% were grounded because of illness. The incidence of diarrhea and respiratory infections doubled from the pre-combat to combat phases, and the perceived adverse impact of these illnesses on the unit increased significantly during the combat phase. Despite technologic advances in warfare and preventive medicine, illness and non-combat injuries have been common during operations in Iraq and Afghanistan, resulting in frequent transient decreases in operational efficiency.

Afghanistan↗

Cupric keratosis: green seborrheic keratoses secondary to external copper exposure.

Exogenous copper is a well-known cause of blue-green dyspigmentation of the hair, nails, and skin. We report the case of a patient with a blue-green discoloration of multiple seborrheic keratoses on his chest and back after swimming in a pool for rehabilitation of a back injury. Metallic analysis using atomic absorption spectrometry was performed on water samples from both the swimming pool and the hot tub the patient was using. Our dermatology clinic tap water was used as a control. Results of this analysis revealed an elevated level of copper in the swimming pool (2.750 ppm) and normal levels in the hot tub (0.502 ppm) and the control sample (0.891 ppm). The copper level in the swimming pool was more than double the recommended maximum set forth by the US Environmental Protection Agency. After the patient discontinued water exercises in the swimming pool, the green discoloration of the seborrheic keratoses disappeared rapidly. We believe this case represents the first report in the literature of the discoloration of epidermal growths secondary to exogenous heavy metal exposure.

Copper↗

Injuries to New Zealanders participating in adventure tourism and adventure sports: an analysis of Accident Compensation Corporation (ACC) claims.

AIMS: The aim of this study was to examine the involvement of adventure tourism and adventure sports activity in injury claims made to the Accident Compensation Corporation (ACC). METHODS: Epidemiological analysis of ACC claims for the period, July 2004 to June 2005, where adventure activities were involved in the injury. RESULTS: 18,697 adventure tourism and adventure sports injury claims were identified from the data, representing 28 activity sectors. Injuries were most common during the summer months, and were most frequently located in the major population centres. The majority of injuries were incurred by claimants in the 20-50 years age groups, although claimants over 50 years of age had highest claims costs. Males incurred 60% of all claims. Four activities (horse riding, mountain biking, tramping/hiking, and surfing) were responsible for approximately 60% of all adventure tourism and adventure sports-related injuries. Slips, trips, and falls were the most common injury initiating events, and injuries were most often to the back/spine, shoulder, and knee. CONCLUSIONS: These findings suggest the need to investigate whether regulatory intervention in the form of codes of practice for high injury count activities such as horse riding and mountain biking may be necessary. Health promotion messages and education programs should focus on these and other high-injury risk areas. Improved risk management practices are required for commercial adventure tourism and adventure sports operators in New Zealand if safety is to be improved across this sector.

Adolescent↗

Back up and wait.

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Accidents, Occupational↗

Preemployment physical examinations. Report of a pilot program.

1. Due to costly workers' compensation claims, the state of Arizona instituted a preemployment physical exam program for state jobs. 2. Thorough job analyses are conducted for working conditions and physical ability requirements on high risk jobs, and medical/physical guidelines are established for those jobs. Physical exams are specific for the job class. 3. The program is projecting a net annual savings of over $208,000 for workers' compensation back injury claims.

Arizona↗

A pain in the back.

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Back Injuries↗

Penetrating abdominal trauma.

The management of patients with penetrating abdominal trauma is outlined in Figure 1. Patients with hemodynamic instability, evisceration, significant gastrointestinal bleeding, peritoneal signs, gunshot wounds with peritoneal violation, and type 2 and 3 shotgun wounds should undergo emergency laparotomy. The initial ED management of these patients includes airway management, monitoring of cardiac rhythm and vital signs, history, physical examination, and placement of intravenous lines. Blood should be obtained for initial hematocrit, type and cross-matching, electrolytes, and an alcohol level or drug screen as needed. Initial resuscitation should utilize crystalloid fluid replacement. If more than 2 liters of crystalloid are needed to stabilize an adult (less in a child), blood should be given. Group O Rh-negative packed red blood cells should be immediately available for a patient in impending arrest or massive hemorrhage. Type-specific blood should be available within 15 minutes. A patient with penetrating thoracic and high abdominal trauma should receive a portable chest x-ray, and a hemo- or pneumothorax should be treated with tube thoracostomy. An unstable patient with clinical signs consistent with a pneumothorax, however, should receive a tube thoracostomy prior to obtaining roentgenographic confirmation. If time permits, a nasogastric tube and Foley catheter should be placed, and the urine evaluated for blood (these procedures can be performed in the operating room). If kidney involvement is suspected because of hematuria or penetrating trauma in the area of a kidney or ureter in a patient requiring surgery, a single-shot IVP should be performed either in the ED or the operating room. An ECG is important in patients with possible cardiac involvement and in patients over the age of 40 going to the operating room. Tetanus status should be updated, and appropriate antibiotics covering bowel flora should be given. Operative management should rarely be delayed by procedures in the ED. Only lifesaving procedures necessary to prevent further deterioration should temporarily delay sending a patient to a waiting surgical team. Stable patients can be further evaluated in the ED. Those with stab wounds to the abdomen, flank, and selected cases of back injuries should undergo LWE. Those with negative LWE can be discharged after appropriate wound care and patient education. Patients with equivocal or positive LWE should undergo DPL. Patients with tangential gunshot wounds and possible type 2 shotgun injuries can undergo DPL. Table 8 lists the recommended thresholds for DPL. Patients with positive DPL should undergo exploration.(ABSTRACT TRUNCATED AT 400 WORDS)

Abdominal Injuries↗

End stage running problems.

What is the problem of a runner who is not recovering? It may be that the diagnosis is incorrect or that the treatment is improper. This article reviews uncommon problems of the lower extremities that may provide the answer.

Athletic Injuries↗