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Physicians and other health care workers involved in the delivery of occupational health care can be confronted with difficult questions about fairness, justice and professional ethics. These issues and other ethical considerations are discussed.
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Five men (mean age 39 years) were followed up for 6 to 60 months for tricuspid valve regurgitation caused by a front-to-back injury (in a car in four cases, in an aircraft in one case). The time elapsed between the accident and the signal symptoms varied from 28 days to 20 years. The condition was diagnosed on clinical data (stage 2) and on the results of echocardiography and cardiac catheterization. Four patients were operated upon and provided with a bioprosthetic valve. The post-operative period was marked by resolutive atrioventricular block in one case and inferior myocardial infarction in one case. Four points ought to be highlighted: 1. The long-term development of dilatation of the annulus, cicatricial fibrosis or altered left ventricular contractility; 2. The usefulness of pulsed Doppler echocardiography for the diagnosis and surgical indications (quantification of the regurgitation, right ventricular kinetics); 3. The adaptation of treatment to the lesion: repair whenever possible, or annuloplasty, or bioprosthetic valve replacement (mechanical valves must be excluded); 4. The time for surgery is difficult to determine in view of the asymptomatic period, which may be very long. The decision to operate is based on clinical, echocardiographic, haemodynamic and dromotropic (complete arrhythmia due to atrial fibrillation) data. This decision must be reached before right ventricular myocardial deterioration sets in.
In an investigation of the effect of heavy physical work on the back 217 concrete reinforcement workers aged 25-54 and a reference group of 202 house painters of similar age were interviewed about their back symptoms. Data on occupational history, accidents, and leisure time activities were collected with a questionnaire. The cumulative incidence rate of sciatic pain was significantly higher among the reinforcement workers than the painters. As regards the occurrence of lumbago and non-specific back pain, however, the groups were alike. In both occupational groups sciatic pain during the previous 12 months was associated with earlier back accidents (odds ratio 2.8, 95% confidence interval 1.8-4.5). The accident rate of the reinforcement workers was higher than that of the painters, and this difference seemed to explain their higher rate of sciatic pain.
Physicians and patients must recognize the demands of the sport involved, as well as the individual's ability to meet those demands. Careful analysis of the sport and examination of the patient to assess recovery and chances of reinjury are mandatory, if he is to enjoy sports after injury. Physicians should become familiar with padding, shoes, warm-up programs, preparticipation examinations, and protective equipment and devices, all of which are helpful in preventing sports injuries. We have touched only briefly on the epidemic problem of quality of life trauma that is part of our society. Because injuries result in punishment to the soul as well as to the body of a person, the sports participant deserves a comprehensive, scientific, multidisciplinary approach in order to return to the state of physical and emotional well-being he enjoyed before the injury. For this reason a physician must examine each patient carefully and with regard for the individual's ability to be sure of the diagnosis for subsequent treatment.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
A strain, by definition, is a stretching or tearing of a musculotendinous unit. The degree of disability associated with this injury is dictated by the location and severity of the injury and the specific needs of the patient. A strain can be arbitrarily classified as first, second, or third degree. A first-degree strain consists of minimal stretching of the musculotendinous unit without permanent injury; a second-degree strain indicates partial tearing of the musculotendinous unit; and a third-degree strain indicates complete disruption of a portion of this unit. Swelling, bleeding, and localized discomfort accompany the injury which may produce temporary disability. Initial treatment following an acute strain should consist of the use of ice, immobilization of the musculotendinous unit, and subsequent rehabilitation. Depending on the degree of disability and the specific structure injured, surgery may be indicated. Rehabilitation to a normal state following the initial healing phase is required prior to return to athletic competition.