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PubMed1986

Computed tomography of the spine in older children and teenagers.

In this short discussion, I have attempted to demonstrate the usefulness of reformatted thin-section spine CT in the evaluation of back syndromes in older children. It is most important to realize that subtle diagnosis requires strict attention to technical detail in performing CT scans, as well as sophistication in computer software to make easily understandable pictures. Axial images alone are totally inadequate for diagnosing some of the abnormalities presented herein. Several of the entities included in this article have never been described by any other radiographic examination, to my knowledge. I believe that reformatted thin-section CT is the single most important radiographic examination of the spine.

Adolescent↗
PubMed2005

Autonomic nervous system function among individuals with acute musculoskeletal injury.

OBJECTIVE: To determine differences in peripheral and cardiovascular autonomic function between individuals with acute musculoskeletal injury (<1 week) and healthy controls. METHODS: Autonomic cardiovascular modulation, baroreceptor sensitivity, skin conductance, and peripheral skin temperature were obtained in 6 subjects with acute musculoskeletal injury and 6 age- and sex-matched controls. Power spectral analysis was performed on both beat-to-beat R-R intervals and continuous systolic blood pressure (SBP) peaks. Baroreceptor sensitivity was derived using both heart rate and blood pressure spectral analysis components. RESULTS: The SD of R-R intervals was significantly different for the acute injury group relative to controls (49.8 +/- 10.5 vs 76.8 +/- 12.7 ms; P < .01). Continuous SBP peaks and skin conductance (sympathetic vasomotor and sudomotor indices, respectively) were significantly higher (59.6 +/- 6.7 vs 23.8 +/- 6.4 mm Hg2 /Hz, and 3.87 +/- 1.04 vs 2.19 +/- 0.3 mhos; P < .01, respectively) and baroreceptor sensitivity lower (0.97 +/- 0.07 vs 1.10 +/- 0.08 mm Hg; P < .02) in the acute injury group compared with controls. Regression analysis revealed a significant relationship between skin conductance and continuous SBP peaks (r = 0.75; P < .01). CONCLUSIONS: These findings suggest that interaction between cutaneous and vasomotor sympathetic neurons in response to acute musculoskeletal injury, reflected as increased afferent input from sensitized nociceptors and other sensory neurons, results in alterations in autonomic function.

Acute Disease↗
PubMedDate not supplied

Health risks to fire fighters.

Fire fighters work in varied and dangerous environments and face unique health hazards that increase their risk for line-of-duty injury and death. While working with sophisticated equipment within such environments, the fire fighter is exposed to high noise levels, changing thermal conditions, and hazardous breathing atmospheres. In addition, his or her protective equipment can impose limitations on efficiency and performance. These conditions have been related to specific physical performance requirements that will reduce line-of-duty injury, disability, and even death. Physical fitness and health maintenance programs that reduce the risk for cardiovascular disease and musculoskeletal injuries have been prescribed for fire fighters. These programs are essential components of any modern fire service.

Accidents, Occupational↗
PubMed1999

The effects of converting wheels on housekeeping carts in a large urban hotel. Program evaluation.

Occupational and environmental health nurses can identify the causes of injuries and use analytical skills to show how the prevention of a problem can save the company money and demonstrate a caring attitude from management. Nurses can expand their traditional roles to position themselves as both advocates for the employees and profit enhancers to management as demonstrated by this program evaluation project. Initial outcomes included improved employee morale and reduced soft tissue injuries in hotel housekeeping employees. Changes in the workplace made by a proactive occupational and environmental health nurse and a committed management can reap rewards beneficial for both the employer and the work force.

Back Injuries↗
PubMed1978

Anterior intervertebral disc herniations (report of six cases).

Six new patients with anterior intervetebral disc herniations are reported. This is probably one of the most common causes of back pain in children. Excessive sport activity and osteoporosis are probably two main causes of anterior intervertebral disc herniations. Anterior intervertebral disc herniation is a severe complication of prolonged, mild trauma.

Adolescent↗
PubMed2004

Glass foreign body in the spinal canal of a child: case report and review of the literature.

Retained foreign bodies pose a risk to the patient from the perspective of potential morbidity. We describe a previously healthy 8-year-old boy with head and back trauma from a glass picture frame that fell off the wall. He sustained a closed head injury and a back laceration several centimeters lateral to the spine. A persistent drainage from the back laceration contained glucose and protein levels consistent with cerebral spinal fluid. A foreign body was easily visible on subsequent plain radiograph. The glass foreign body was removed by neurosurgeons after computed tomography and magnetic resonance imaging clarified the exact location of the glass fragment. Physicians should have a low threshold for obtaining plain radiographs in patients with glass foreign bodies and consider that projectiles may rest some distance from the laceration site.

Accidents, Home↗
PubMed2006

Changing trends in US injury profiles: revisiting non-fatal occupational injury statistics.

The purpose of this paper is to review the current trends in non-fatal injury profiles of workers in the United States. It is generally accepted that occupational injury and illness rates are affected by many factors, such as the amount and quality of training, employee turnover rates, work experience, extent of mechanization and automation, job-related parameters, and worker gender. In the last decade, not only have the technologies used in the workplace changed significantly, there has been a greater awareness among employers and employees as to the importance of containing work injuries. Additionally, the extent of outsourcing for labor-intensive jobs has increased dramatically owing to cheaper labor costs in places such as China and Mexico. These changes have affected the manufacturing sector of US industry more than any other sector. How these changes have influenced the injury and illness profiles of the American worker is of considerable interest given the increased attention paid to work-workplace design, injury hazard control, and ergonomics in general. In this paper, we compare the injury and illness profiles of US workers separated by nearly a decade. The trends from early 1990s are compared to those from early 2000s. Data from the Bureau of Labor Statistics were used to compile the injury statistics. The results of our comparison show that while the absolute numbers of work-related injuries and illnesses have declined over the last 10 years, the basic trends associated with different factors remain almost unchanged. The reasons for this decline are discussed in this paper.

Back Injuries↗
PubMed1990

Fatigue, recovery, and low back pain in varsity rowers.

The purpose of this study was to determine whether surface electromyography (EMG) from the erector spinae muscles could correctly identify individuals with low back pain without a population of elite athletes. A similar technique had previously been successful in identifying low back pain patients within a non-athletic population. A Back Analysis System was used to compute the median frequency of the EMG power density spectrum to monitor metabolic changes in back muscles associated with muscle fatigue. Twenty-three members of a men's collegiate varsity crew team consisting of port (N = 13) and starboard (N = 10) rowers were tested in a laboratory during a fatigue-inducing isometric contraction sustained at a relatively high, constant force. Six of the rowers tested were further classified as having low back pain. A brief test contraction was repeated at a fixed interval following the fatiguing contraction to monitor recovery. A two-group discriminant analysis procedure correctly classified 100% of the rowers with low back pain and 93% of the rowers without back pain on the basis of the median frequency data. The median frequency parameters related to recovery were the best discriminators of back pain. A similar analysis correctly classified 100% of the port rowers and 100% of the starboard rowers on the basis of their spectral parameters. The best discriminating variables in this instance were the median frequency parameters relating to both fatigability and recovery. Results from this study demonstrate that low back pain and asymmetrical muscle function in rowers can be assessed on the basis of EMG spectral analysis.

Adult↗
PubMedDate not supplied

An overview of the California workers' compensation system.

Nearly every working Californian is protected by workers' compensation for any job-related injury. Because of its size and the nature of its program, California pays out twice as much in benefits as any other state. The author describes the administration of the compensation system, its costs and the results.

Adult↗
PubMed2001

Testing a risk assessment tool for manual handling.

Nurses may be reluctant to use safer methods of manual handling or equipment because they are time-consuming or because patients dislike using hoists. Injuries can be prevented only if the organisation takes an ergonomic approach to risk reduction. A risk assessment tool may help nurses recognise the dangers of certain lifts and encourage them to assess the situation thoroughly before moving or handling a patient.

Back Injuries↗
PubMed1987

Trauma and multiple sclerosis. An hypothesis.

An obligatory event in the pathogenesis of the multiple sclerosis plaque appears to be an increase in the permeability of the blood-brain barrier. Neuropathological observations of the brain of persons suffering from concussion after relatively minor head injury, as well as of animals subjected to experimental brain injury, have shown that alterations of the blood-brain barrier constitute a common result of such trauma. It is postulated that the alterations of the blood-brain barrier secondary to trauma of the brain or spinal cord of patients with already established multiple sclerosis may result in an exacerbation or recurrence of a previously symptomatic plaque, in the appearance of symptoms from a silent lesion, or in the formation of a new plaque in such an area of selected vulnerability. In other persons injury to the nervous system may cause the development of multiple sclerosis plaques in the previously damaged areas when the disease has its onset after the trauma. There is no evidence to support the idea that trauma ever causes multiple sclerosis.

Adult↗
PubMed1990

[When sports no longer is a game ... the clinical aspects of competitive sports in children].

Physical and psychic vulnerability in children performing competitive sports may turn an accidental injury into a starting-point for chronic pain. This pain may give rise to serious physical and social restraints. The case histories of two fourteen years old girls are presented. Both patients suffered from overburdening. This phenomenon had not been recognized, or was not explicitly stated at least. Probably, too high expectations from medical help by parents and child played a crucial role. Expectations were twofold: the chronic pain should fit a specific defect caused by the injury, or it should be due to a (serious) disease. Both types of expectations led to disappointments, repeated diagnostic procedures and ineffective therapies. A comprehensive assessment without delay by a multidisciplinary pediatric team is recommended.

Adolescent↗
PubMed2004

Legal requirements for safe handling in community care.

CASE STUDY: Andrea, a district nurse, together with home carers from the local social services department, has been caring for a wheelchair-bound patient with multiple sclerosis for 3 years. The patient requires assistance with going to the toilet and going to bed. She has always been reluctant to be moved using a hoist because of sudden spasms and this causes her great anxiety. Now the patient is refusing to be move mechanically and will only consent to being lifted manually. Andrea and the home care staff are concerned that this might place them at risk of injury and argue that it is against the trust and local authority moving and handling policy, which has a no-lift clause. Andrea would like to refuse to manually lift the patient but decides to check the legal position first.

Accidents, Occupational↗
PubMed1990

Geriatric injury: an analysis of prehospital demographics, mechanisms, and patterns.

STUDY OBJECTIVE: To evaluate emergency medical services (EMS) system use, injury mechanisms, and prehospital assessments among elderly victims of trauma. DESIGN: We analyzed all prehospital data for injuries among patients 70 years old or older for whom 911 EMS dispatch was requested in a medium-sized metropolitan area during a 12-month period. RESULTS: A total of 1,154 cases occurred (women, 65.1%), which represented 30.3% of all 911 dispatches involving elderly patients. Injury mechanisms were fall (60.7%), motor vehicle accident (MVA; 21.5%), fight (2.4%), accidental poisoning (2.3%), and choking (2.1%). Persons in their 90s had a lower frequency of MVAs (3.4%) than did younger patients (23.0%) (P less than .005). The most frequent injuries determined by prehospital assessment were head or face (25.1%), upper extremity (17.2%), hip (14.5%), lower extremity (13.8%), back (9.8%), and chest or abdomen (5.0%). The frequency of serious neurologic injuries was less for falls or MVAs than for other mechanisms (P less than .005). Suspected hip (P less than .001) and pelvic (P less than .005) injuries occurred more frequently during falls than during other mechanisms of injury, whereas back injuries occurred most frequently in MVAs (P less than .001). Seventy-one fall victims (10.1%) had suspected medical causes of their fall. Twelve patients (1.0%) were in cardiac arrest. CONCLUSION: We report injury patterns and mechanisms among elderly victims of trauma presenting to an EMS system. A knowledge of these patterns will be useful to emergency physicians and EMS administrators.

Accidents↗
PubMedDate not supplied

Occupational injuries among emergency medical services personnel.

BACKGROUND: Emergency medical services (EMS) personnel treat 22 million patients a year in the United States, yet little is known of their injury risks. OBJECTIVES: To describe the epidemiology of occupational injuries among EMS personnel, calculate injury rates, and compare the findings with those for other occupational groups. METHODS: This was a retrospective review of injury records kept by two urban agencies. The agencies submitted all 617 case reports for three periods between January 1, 1998, and July 15, 2002. The agency personnel worked an estimated 2,829,906 hours during the study periods. Cases were coded according to U.S. Department of Labor (DOL) criteria. RESULTS: Four hundred eighty-nine cases met the DOL inclusion criteria. The overall injury rate was 34.6 per 100 full-time (FT) workers per year (95% confidence interval [CI] 31.5-37.6). "Sprains, strains, and tears" was the leading category of injury; the back was the body part most often injured. Of the 489 cases, 277 (57%) resulted in lost workdays, resulting in a rate of 19.6 (95% CI 17.3-21.9) per 100 FT workers; in comparison, the relative risks for EMS workers were 1.5 (95% CI 1.35-1.72) compared with firefighters, 5.8 (95% CI 5.12-6.49) compared with health services personnel, and 7.0 (95% CI 6.22-7.87) compared with the national average. CONCLUSIONS: The injury rates for EMS workers are higher than rates reported by DOL for any industry in 2000. Funding and additional research are critical to further defining the high risks to EMS workers and developing interventions to mitigate this serious problem.

Accidents, Occupational↗
PubMedDate not supplied

Antecedent factors and disabling occupational morbidity--insights from the new BLS data.

Since 1992 the United States Bureau of Labor Statistics' (BLS) annual survey of occupational injuries and illnesses (SOII) has collected data on occupational injuries and illnesses involving 1 or more days away from work (DAW). However, to date, the BLS has not published a comprehensive set of cross-tabulated part of body (BP), nature of injury or illness (NOI), and exposure/event (EE) data. To improve the understanding of the causes of disabling occupational morbidity in the United States, the present study used a special data call and data reduction strategy to identify the leading BP-NOI-EE combinations for DAW cases by frequency, incidence rate, and severity (median DAW) for 1996. The results indicated that the majority of injury and illness morbidity reported by the BLS was related to musculoskeletal conditions of either gradual or sudden onset and traumatic injuries of sudden onset. In particular, traumatic injuries from sudden events such as falls resulted in the most disabling cases. The results indicate that the occupational morbidity identified in the SOII requires interventions focused on overexertion and falls, as well as more traditional injury prevention approaches. The BLS can improve the utility of the system by adding provisions for a second event code to the coding structure and by improving direct access to these data for occupational health and safety professionals.

Absenteeism↗
PubMed1999

Physical load during work and leisure time as risk factors for back pain.

This systematic review assessed aspects of physical load during work and leisure time as risk factors for back pain. Several reviews on this topic are available, but this one is based on a strict systematic approach to identify and summarize the evidence, comparable with that applied in the clinical literature on the efficacy of intervention for back pain. A computerized bibliographical search was made of several data bases for studies with a cohort or case-referent design. Cross-sectional studies were excluded. A rating system was used to assess the strength of the evidence, based on the methodological quality of 28 cohort and 3 case-referent studies and the consistency of the findings. Strong evidence exists for manual materials handling, bending and twisting, and whole-body vibration as risk factors for back pain. The evidence was moderate for patient handling and heavy physical work, and no evidence was found for standing or walking, sitting, sports, and total leisure-time physical activity.

Adult↗
PubMed1991

Lumbar pain in fast bowlers.

Lumbar pain is common among cricket's fast bowlers, leading to premature retirement. The cause of a high incidence of back problems lies in the repetitive spinal movements necessary in the art of fast bowling. This combines repetitive lateral flexion, thoraco-dorsal rotation, spinal flexion and compression. The causes are basically too much bowling by young players with relatively immature pars interarticularis, poor physical fitness and a poor bowling action.

Athletic Injuries↗