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[Industrial accidents].
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An educational program to prevent disabling low back pain.
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The prevalence of occupational injuries in EMTs in New England.
OBJECTIVE: To characterize the prevalence and morbidity of injuries to emergency medical technicians EMTs) in New England [United States]. DESIGN: A survey was mailed to a 2% random sample of all registered EMTs in the six New England States. The identity of the EMTs remained anonymous, and a second mailing was used to improve return rate. The EMTs were requested to recall events that occurred during the previous six months. RESULTS: A total of 439 of the 786 (56%) surveys were returned representing 13,875 hours of duty time in the six-month period. Seventy-one percent of the EMTs were male with a mean age of 35 years. Sixty-six percent were basic-EMTs. Injury attack rates (number of injuries/100 EMTs/6 months) were: stress, 11.2; back, 10.5; extremity, 9.8; assault, 8.4; ambulance collision, 4.1; hearing loss, 2.5; and eye injury, 1.4. Twelve percent of the EMTs were injured more than once in the six-month period. The paramedics more frequently were involved in ambulance collisions, suffered from stress, and were less likely to injure their back. There were minor interstate differences. Disability due to back injury affected 2.5% of those surveyed, four EMTs lost duty time secondary to an assault, and 0.5% of the EMTs were out of work due to stress. CONCLUSIONS: This survey begins to characterize the occupational risks of EMTs. The prevalence of back injuries, assault, stress, and extremity injuries seems to be too high. Educational programs and preventive interventions should be designed to minimize back injuries, stress, and assault. There is a need for more research nationwide in order to better characterize these injuries.
The effect of the unrestrained back seat passenger on the injuries suffered by drivers and front seat passengers in head-on collisions.
In head-on collisions, loose items in the rear of the car, such as luggage or unrestrained back seat passengers can cause substantial loading on the back of the front seats. The purpose of this paper is to study if such loading increases the injury severity for the front seat occupants. Data were collected from all fatal automobile accidents for a period of 1 year in Sweden. Information was collected about the survivors as well as the decreased. Head-on collisions were selected, and the injuries of the front seat occupants were scored according to the Abbreviated Injury Scale (AIS) and the Injury Severity Score (ISS). In evaluating the injury severity, the collision energy was taken into account. The results indicate that belted front seat passengers sustain a higher injury risk with an unrestrained passenger in the back seat. These results are valid for collision speeds below 45 km/h.
U.K. national statistics on handling accidents and lumbar injuries at work.
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SC: prior injury and pre-existing injury dilemma: court affirms workers' compensation award.
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Predictors of registered nurses' lifting behavior.
1. Nurses continue to experience back pain and injury as a result of occupational stressors, with most attributed to lifting clients. 2. Research found that only 2% of nurses lifted clients as prescribed by current nursing textbooks. 3. Nurses' lifting behavior was related to the age of the nurse and the type of client movement. 4. Ongoing education regarding prescribed lifting behavior in clinical settings and continued research regarding strategies to increase the prevalence of safe behavior in the workplace are recommended.
Etodolac: analgesic effects in musculoskeletal and postoperative pain.
Numerous clinical trials have shown etodolac to be an effective analgesic. The purpose of the present report is to review results of 14 studies that demonstrate the effectiveness of etodolac in a variety of painful conditions. Presented are the results of four postsurgical pain studies, one study of acute gouty arthritis and nine studies of acute musculoskeletal disorders: acute low back pain, acute painful shoulder, tendinitis and bursitis, and acute sports injuries. A single oral dose of etodolac (25, 50, 100, 200, or 400 mg) was compared with aspirin (650 mg) or a combination of acetaminophen (600 mg) plus codeine (60 mg) for the relief of pain up to 12 h following oral, urogenital or orthopedic surgery. In multiple dose studies of acute gouty arthritis and musculoskeletal conditions, etodolac 200 or 300 mg twice a day (b.i.d.) or 200 mg three times a day (t.i.d.) was compared with naproxen 500 mg b.i.d. or t.i.d., diclofenac 50 mg b.i.d. or t.i.d., and piroxicam 20 or 40 mg once a day (o.d.) administered over 5 to 14 days. The efficacy of etodolac was at least equal and in some ways superior to aspirin and acetaminophen plus codeine in the relief of postsurgical pain. In studies of acute gouty arthritis, significant improvement from baseline were seen for all efficacy parameters evaluated for both the etodolac- and naproxen-treated patients. All the present studies of musculoskeletal conditions have shown etodolac to be effective and comparable in analgesic efficacy to naproxen, diclofenac or piroxicam. In summary, etodolac therapy for pain following surgery, in acute gouty arthritis and in acute musculoskeletal conditions resulted in analgesia comparable to that provided by several well-established analgesic or anti-inflammatory agents.
Relation between health problems and sickness absence: gender and age differences--a comparison of low-back pain, psychiatric disorders, and injuries.
Women have higher long-term sickness absence rates than men, and higher rates of most health problems. The rates vary with type of problem and diagnosis. The objectives were to examine whether equal proportions of women and men had sickness absence when they had a given health problem, and if disparities were diagnosis specific. Prevalence of low-back pain, psychiatric disorders, and injuries was assessed in random samples of two populations in Norway. Prevalence of long-term sickness absence for the same diagnostic categories was estimated for the same time period (1990). For injuries, the prevalence ratios between a health problem and a sickness absence were equal for women and men. For psychiatric health problems, there were 1.7 more women than men behind each sickness absence. Low-back pain showed an intermediate gender ratio of 1.3, indicating that also for this condition women tended to have less sickness absence. Musculoskeletal and psychiatric health problems (fluctuating, chronic) may result in more gender-biased, subjective, and random assessment of work ability than injuries (acute health problem).
Low back pain in the adolescent: differential diagnosis.
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Ankle joint injuries as a reconstruction parameter in car-to-pedestrian accidents.
The study has assessed the usefulness of ankle joint injuries for deducing about the presumable location of a pedestrian in relation to a motor vehicle at the moment of collision. A statistically significant correlation was found between the direction of impact and the mechanism of ankle joint injuries. Such injuries were found in 113 of 317 pedestrian, fatal victims of road traffic accidents (36%). In the cases of impacts on the medial surface of the lower limb, the injuries associated with the supination mechanism were six times more frequent than the injuries associated with the pronation mechanism, while in the group of impacts on the limbs from the lateral side those connected with the pronation mechanism were four times more frequent. In victims hit from the back, the injuries connected with the plantarflexion mechanism were found almost four times more frequent than the dorsiflexion mechanism and in victims hit from the front in three of the five damaged joints the dorsiflexion component was observed (without any plantarflexion case). Less frequent "pronation injuries" in the limbs hit from the medial side and "supination injuries" in the limbs hit from the lateral side as well as "dorsiflexion injuries" in victims hit from the back predominantly occurred in impacts to the pelvic area, i.e. resulting from collisions with a van or lorry. Injuries of upper ankle joints are, thus, useful for reconstructing the presumable location of the pedestrian in relation to the vehicle at the moment of collision, especially, when the vehicle involved in the accident is known.
Reporting of injuries, diseases and dangerous occurrences.
Case Scenario: Clematis, a staff nurse in an orthopaedic ward, injured her back when lifting a patient with another nurse from the bed to a wheelchair. She was admitted to hospital and was off sick for many weeks. When she returned to work she noticed that the accident from which she had completed was still on the ward and copies did not appear to have been circulated. What is the law and what is her responsibility?
A comparison of risk assessment of single and combination manual handling tasks: 1. maximum acceptable weight measures.
Many manual handling activities involve combinations of pull, lift, carry, lower and push, yet few studies have investigated how to assess the risk of such combination tasks. Most recommendations assume that a combination task can be split into its components for assessment. The aim of this study was to compare the risks assessed in single manual handling tasks with those in combination tasks. Nine male and nine female students participated in a study to determine Maximum Acceptable Weights (MAWs) in single and combination tasks at different frequencies (1 min-1 and 3 min-1 for combination tasks and 3 min-1 and 6 min-1 for single tasks) and heights (floor, knuckle, shoulder). Combination tasks consisted of one each of the single tasks (pull, lift, carry, lower and push). The MAW of each combination task was compared to the MAWs of the single tasks of which it was composed using repeated measures analysis of variance with specified contrasts. In at least one of the 12 comparisons each single task MAW was found to be different from its related combination task MAW. It was concluded that the current use of single task MAWs to estimate the risk in combination tasks was unacceptable. Prediction models for combination task MAWs based on single tasks MAWs were also developed, using step-wise regression. Although coefficients of determination of around 0.8 were achieved it was argued that owing to their situation-specific nature the prediction of combination task risk using single task MAWs was likely to result in unacceptable risk errors.
Effect of discharge recommendations on outcome.
STUDY DESIGN: The incidence of two common discharge recommendations, return to work unrestricted (RTWU) and restricted (RTWR) suggested that most restrictions were applied on the basis of patients' subjective reports of pain or therapists' unfounded fears that return to full duty would result in physical harm. OBJECTIVES: This prospective study compares the therapist's return to work recommendation to the patient's actual work status and analyzes the effect of that recommendation on outcome. METHODS: There were 1438 consecutive patients reviewed by structured telephone interviews during the two halves of the study: the control group when pain was accepted as a reason for restriction and the study group when it was not. SUMMARY OF BACKGROUND DATA: In the control group, 44% of the patients were recommended to RTWU; for the study group, 81% received this recommendation. Compliance was 84% for the control subjects and 78% for the study group. RESULTS: The absolute number of patients who returned to unrestricted work doubled in the study group. CONCLUSIONS: The probability of a successful return to normal duty increased with a recommendation of RTWU (P = 0.0001), whereas the probability of failure increased when restrictions were imposed (P = 0.0001).
Mechanisms of action of lumbar supports: a systematic review.
STUDY DESIGN: A systematic review and meta-analysis of studies on the putative mechanisms of action of lumbar supports in lifting activities. OBJECTIVE: To summarize the evidence bearing on the putative mechanisms of action of lumbar supports. SUMMARY OF BACKGROUND DATA: A restriction of trunk motion and a reduction in required back muscle forces in lifting are two proposed mechanisms of action of lumbar supports. Available studies on these putative mechanisms of action of lumbar supports have reported contradictory results. METHODS: A literature search for controlled studies on mechanisms of action of lumbar supports was conducted. The methodologic quality of the studies was assessed. The evidence for the two proposed mechanisms of action of lumbar supports was determined in meta-analyses. RESULTS: Thirty-three studies were selected for the review. There was evidence that lumbar supports reduce trunk motion for flexion-extension and lateral bending, with overall effect sizes of 0.70 (95% confidence interval [CI] 0.39-1. 01) and 1.13 (95% CI 0.17-2.08), respectively. The overall effect size for rotation was not statistically significant (0.69; 95% CI -0. 40-4.31). There was no evidence that lumbar supports reduce the electromyogram activity of erector spinae muscles (effect size of 0. 09; 95% CI -0.41-0.59) or increase the intra-abdominal pressure (effect size of 0.26; 95% CI -0.07-0.59). CONCLUSION: There is evidence that lumbar supports reduce trunk motion for flexion-extension and lateral bending. More research is needed on the separate outcome measures for trunk motion before definite conclusions can be drawn about the work conditions in which lumbar supports may be most effective. Studies of trunk motion at the workplace or during specified lifting tasks would be especially useful in this regard.
Epidemiology of musculoskeletal injuries among Norwegian conscripts undergoing basic military training.
Compulsory military service entails a change in the patterns of physical activity of many conscripts, and an accompanying risk of musculoskeletal injury. The present study was carried out to determine the incidence and types of musculoskeletal injury among Norwegian conscripts, and their consequences in the form of sick leave and discharge from the service. The study population consisted of 6488 conscripts in all, drawn from the Army, the Air Force and the Navy. They were monitored through an initial 6-10-week period of basic military and physical training. Every injury for which a conscript had to consult a doctor was registered. Slightly more than every fourth Army, every fifth Air Force and every eighth Navy conscript suffered one or more injuries during basic training. Incidence rates for the Army, Air Force and Navy respectively were 15.3, 13.4 and 9.3 injuries per 100 conscripts-months. The sites of the majority of the injuries were in the lower limbs (63%). The most common types of injury were low back pain; overuse knee injuries; Achilles tendinitis; sprains of joint capsules or ligaments; and periostitis or compartment syndromes of lower leg. In the doctors' opinions, contributory or triggering causes of the injuries could be attributed to organized service activities in 67% of the cases. The number of days of partial or total sick leave as a result of injury amounted to 3.4% and 0.2% respectively of the total basic training period. Of Army, Air Force and Navy conscripts, 23%, 16% and 11% respectively had sick leave. Injury was also the direct cause of the discharge of 2.1% of the Army conscripts and 0.1% of the Air Force and Navy conscripts. The results of the study show that musculoskeletal injuries occur frequently during basic training and that injuries contribute to lost training time.
Occupational injury and disease among patients presenting to general practitioners in a community health centre.
A prospective survey was conducted of all patients presenting over a six-month period to the primary medical care unit of a community health centre in an urban industrial area to determine the number and types of work-related injuries and disease, the causes, and details of the injured workers and their workplaces. Two-hundred and eighty-three patients, 7.2 per cent of the total number of patients attending, were diagnosed as having a work-related injury or disease; 250 patients had occupational injuries and 33 had occupational diseases. The most common injuries were open wounds, sprains and strains, contusions and eye injuries; the most frequent diseases were musculoskeletal strain syndromes, dermatitis and respiratory conditions. Most of those injured were skilled tradesmen or labourers from small (less than 30 employees) or medium-sized (30 to 99 employees) manufacturing workplaces. In five of the local medium-sized workplaces, more than 10 per cent of the workforce presented with occupational injury or disease in the six months. The mechanisms of injury for common injuries such as back strain and eye injuries are described. Most patients were managed totally within the primary care setting. Thirty per cent of all patients surveyed received a worker's compensation certificate. It is possible that occupational diseases were underdiagnosed and that worker's compensation was underutilized. The information obtained from the survey is being used in planning prevention.