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At least 1,243 records · Page 69Linked to original sources
PubMed2006

Endoscopic carpal tunnel release: a review of 753 cases in 486 patients.

BACKGROUND: Endoscopic carpal tunnel release is gaining increasing acceptance relative to the standard open carpal tunnel release for the treatment of carpal tunnel syndrome. Concerns about endoscopic carpal tunnel release include effectiveness of therapy and complication rates. This study attempted to evaluate outcomes of endoscopic carpal tunnel release in a large patient cohort. METHODS: Four hundred eighty-six patients (753 hands) with carpal tunnel syndrome who underwent endoscopic carpal tunnel release by a single surgeon were reviewed retrospectively. Data included demographics, subjective complaints, prior interventions, preoperative examination findings, and postoperative follow-up. All follow-up data were obtained from a single, independent, occupational therapy clinic. RESULTS: Median patient age was 48 years. Three hundred seventy-seven patients were gainfully employed at presentation, and 206 filed a worker's compensation claim. Median symptom duration was 2 years. Nonoperative therapy was ineffective in 151 patients. Preoperative nerve conduction studies were consistent with carpal tunnel syndrome in 472 patients (97 percent); all patients had either physical examination findings or nerve conduction studies consistent with carpal tunnel syndrome. Four hundred eighty-six patients (100 percent) obtained symptom relief. Complications included one transient median nerve neurapraxia, six complaints of residual pain, and one complaint of hypersensitivity. Worker's compensation patients and non-worker's compensation patients returned to work full-duty at similar times postoperatively. Ninety percent of employed patients returned to their original occupation. CONCLUSIONS: The authors' data indicate that an endoscopic approach for the treatment of carpal tunnel syndrome is safe and effective. Patients demonstrated a high return-to-work rate and an extremely low complication rate. The data challenge the belief that endoscopic carpal tunnel release results in higher complication rates.

Adult↗
PubMed1998

[Future occupational plans of patients after orthopedic rehabilitation: how are they expressed? What influences them?].

Perceptions about one's occupational future are regarded as the initial phase in an ongoing process of occupational resettlement towards achieving gainful activity. Actual gainful activity, however, tends to be increasingly dependent on a number of labour market variables. At the end of an orthopaedic rehabilitation measure, 341 patients with pain syndromes of the locomotor system were interviewed concerning their vocational perspectives and notions, and the data obtained were studied in association with anamnestic and psychosocial factors. It is assumed that both plain expectations (such as returning, or not returning, to work) and multi-layered statements alike (such as the dual message of returning and of not returning to work, at first glance incompatible) will frequently be masked in the interview. Distinct, differing patterns were nevertheless found for the various patient groups regarding pain description, pain course, subjective disablement by pain, subjective job burden, subjective well-being, rehab expectations, and judgement of therapy outcome. Similar differences were stated for the social situation, indicated inter alia by (in)capacity for work, or application for benefit award (severely disabled person status, invalidity pension). Pain drawings, pain severity scaling, differentiated description of various pain qualities, the Pain Disability Index, all emerged as useful and practical additional tools in elucidating these patterns.

Adult↗
PubMed1995

Integrated disability management: taking a coordinated approach to managing employee disabilities.

1. Disability management provides opportunities to control costs and improve employee benefits through three levels of prevention: primary prevention of disabilities (work and non-work related); secondary minimization of disability costs; and tertiary facilitation of rehabilitation and early return to work. 2. A totally integrated disability management program has many components, all of which must be effectively coordinated. Management of these components will result in lower disability related costs, increased employee productivity and job satisfaction, and less employee turnover. 3. All employees receive individualized services designed to assist them in returning to work and emphasizing their contributions to the company's overall dedication to global leadership, continuous growth, and success.

Persons with Disabilities↗
PubMed1993

Occupational and educational achievements of head injured Vietnam veterans at 15-year follow-up.

Little is known about the long-term affects of head injury on achievement. The post-injury educational and occupational achievements of 520 survivors of penetrating head injury in Vietnam (and 85 uninjured controls) were examined 15 years after injury. Most patients (82%) had used Veterans Administration educational benefits to return to school, and many of those (64%) had achieved degrees. Return to work was strongly related to level of educational achievement, particularly among the most severely disabled. Though only 56% of the head injured were gainfully employed, the occupational distribution of those who were working differed little from uninjured controls, or the male labor force. Severity of injury affects educational achievement and return to work, but not the occupational distribution of those who do manage to return. Even the most severely injured can sometimes achieve high educational and occupational levels.

Achievement↗
PubMed1998

Postsurgical outcomes assessment following varicocele ligation: laparoscopic versus subinguinal approach.

OBJECTIVES: To prospectively compare and objectively assess the postsurgical outcome parameters of both laparoscopic and open subinguinal techniques for varicocele ligation in infertile men. METHODS: A total of 41 evaluable patients with a history of infertility, abnormal semen analysis, and clinically diagnosed varicoceles underwent surgical ligation either by the insufflative intraperitoneal laparoscopic (n = 15), gasless laparoscopic (n = 7), or the open subinguinal (n = 19) approach. Most procedures (39 of 41) were performed in the outpatient setting, and patients were followed postoperatively for a minimum of 6 months. Postsurgical outcome was assessed by physical examination and review of a patient questionnaire quantifying the graded pain severity, analgesic requirements, and number of days to return to work. RESULTS: The average operative time was 82.3 +/- 26.5 minutes for insufflative intraperitoneal laparoscopic varicocelectomy, 170 +/- 55 minutes for gasless laparoscopic varicocelectomy, and 35.6 +/- 13.5 minutes for the open subinguinal approach. The analgesic requirement was 13.7 +/- 9.9 tablets for the insufflative laparoscopic group, 22.5 +/- 11 tablets for the gasless laparoscopic group, and 10.9 +/- 10.3 tablets for the open subinguinal group. The average number of days to return to work was 4.9 +/- 2.7 for the insufflative group, 6.6 +/- 2.6 for the gasless group, and 5.1 +/- 3.7 for the open subinguinal group. CONCLUSIONS: These results show no superiority of laparoscopic techniques over the standard open subinguinal technique with respect to hospital stay, analgesic requirements, or return to work. Laparoscopic techniques require excessive operative time, may have attendant complications, and require general anesthesia, limitations that preclude their routine application in varicocele ligation. However, the laparoscopic approach may have a role in the setting of other concurrently performed laparoscopic procedures.

Absenteeism↗
PubMed1986

The relation of social class to risk factors, rehabilitation, compliance and mortality in survivors of acute coronary heart disease.

We studied 299 consecutive male 28-day survivors of unstable angina or myocardial infarction aged under 60 years to examine the relationship between social class and initial risk factors, change in risk-factors at one year follow-up, return to work, and 3-year mortality. There was a significant correlation between smoking on admission and social class, with 80% of lower and 31% of upper classes being current smokers. Daily cigarette consumption among smokers was significantly higher in lower-class patients. Lower-class patients also had a significantly higher weekly alcohol intake. Although the proportion of hypertensives did not vary with social class, mean in-hospital blood pressure was higher in lower-class patients. Social class bore no relationship to amount of leisure exercise, serum cholesterol or degree of overweight. There was a 90% 1-year return to work overall, and while there was no relationship between social class and eventual re-employment, lower-class patients took significantly longer to return to work. There were highly significant associations between social class and successful smoking cessation, increase in leisure exercise and weight reduction over the first year after discharge. There was no significant association between social class and 3-year mortality.

Angina, Unstable↗
PubMed2004

Comparison of Shouldice and Lichtenstein repair for treatment of primary inguinal hernia.

PURPOSE: The purpose of this study was to compare the outcome following Lichtenstein open mesh repair or Shouldice repair for the surgical treatment of primary unilateral inguinal hernias. PATIENTS AND METHODS: Patients with primary unilateral inguinal hernia who underwent a Shouldice repair (n: 120) and a Lichtenstein open mesh techniques (n: 121) between 1994 and 1998 were evaluated retrospectively. Operation time, hospital stay, postoperative analgesic consumption and complications, return to work and recurrence after surgery were assessed and compared. RESULTS: The two groups were comparable regarding age, types of hernia and the follow-up interval. There were no significant differences in hospital stay and postoperative complications. The number of recurrences differed significantly between the groups with five in the Shouldice group (4.1%) and one in the Lichtenstein group (0.8%) (p < 0.05). The need of analgesic medication after mesh repair was significantly lower than the Shouldice group (3.9+/-1.4 vs. 4.9+/-1.6 gr. p < 0.05). The operation time was 36+/-14 min. for Lichtenstein repair and 61+/-12 min. for Shouldice repair (p < 0.05). The time for return to work was shorter in Lichtenstein group (17+/-4 days) compared to Shouldice group (25+/-5 days) (p < 0.05). CONCLUSION: Shorter operation time, faster return to work, less need to analgesia and lower recurrence rate, shows the superiority of Lichtenstein repair against Shouldice repair in the surgical repair of primary unilateral inguinal hernia.

Adult↗
PubMed1996

Nonorganic signs of significance in low back pain.

STUDY DESIGN: Medical records and imaging studies including one or more interviews and physical examinations by the author were reviewed in 878 people remaining out of work for 13 weeks or more because of occupational low back pain. OBJECTIVES: To assess the prognostic value of nonorganic signs, including those validated by Waddell et al and two others previously undescribed, limitation of shoulder motion with production of low back pain, and low back pain resulting from movement limited to the cervical spines. SUMMARY OF BACKGROUND DATA: Review of all records of people evaluated by the author over a 3-year period (1990-1993) provided the material for this study. All available medical, insurance, and legal records were reviewed, including reports or examination results of radiographic films, or both. In the majority, more sophisticated investigation had been performed with complete reports of the studies themselves being available to the author. METHODS: A complete history and physical examination were accomplished by the author on each individual, including evaluation of each of the test results for nonorganicity. Medical records, including radiographic films, magnetic resonance imaging, computerized axial tomography, myelography, bone scan, electromyography, etc., were collated. Statistical analysis of results followed. RESULTS: The finding of limitation of shoulder motion resulting in low back pain indicated a worse prognosis for return to work than that of positive Waddell signs alone, 69.6% versus 52.9%. If cervical motion additionally produced low back pain, the outlook was poorer (no return to work in 73.1%). CONCLUSION: When present with a triad of the signs validated by Waddell, the new signs significantly increase the predictability of failure to return to work by workers with compensable low back pain.

Absenteeism↗
PubMed1996

[Multidisciplinary treatment program for chronic low back pain, part 1. Overview].

UNLABELLED: A multimodal treatment program is presented in cases of functional restoration for chronic low back pain. The study comprises four parts. Part I gives an overview of the different results of the study. Part II focuses on the medical and functional examination in comparison with persons who do not suffer from back pain. Part III describes psychosocial aspects (depression, complaints, ways of coping, disability) and psychotherapy. In part IV prognostic factors and their reliability for predicting treatment outcome (return to work, pain intensity, self-assessment of success by patients) are examined. In addition the relevant effects of the program on social and health care systems are also addressed. PROBLEM: The incidence of low back pain is continuously increasing, causing tremendous costs for the health insurance system. Therefore effective treatment methods are needed that take into account somatic, psychological and social factors. Chronic low back pain is conceptualized as a complex phenomenon including biological, social and psychological aspects, all of which should be addressed in a treatment program. A multimodal treatment program for chronic low back pain is presented, in which physical activity and cooperation of the patient are the primary targets. Therapeutic aims focus less on pain reduction and emphasize instead pain control, individual responsibility of the patient, and early reintegration into the working environment. The specific goals of the program are to increase the physical abilities of the patients (i. e., flexibility, strength and endurance), to increase patients' knowledge and the use of body mechanics and back protection techniques, to decrease medication-intake, to decrease dependency on the medical community, to improve patients' own positive coping skills and levels of emotional control, to increase the patient's activity level at home and to facilitate a return to work. METHODS: A total of 90 disabled patients with chronic low back pain were admitted to an 8-week program of functional restoration and behavioral support. The program consisted of a pre-program (3 weeks: education, stretching and calisthenic exercises) and an intensive treatment period (aerobics, functional strength and endurance exercises, back exercises, cognitive behavioral group therapy, relaxation training, socioeconomic and vocational counseling) which took place for 5 weeks, 7 h a day, on an outpatient basis. Apart from a medical examination and a personal interview, the patients' physical impairment, pain descriptions, and psychological distress (according to different criteria for evaluation) were also measured. This includes variables such as depression, psychovegetative complaints, quality of life and workplace satisfaction, disability, and coping with disease. Measurements were repeated at the end of the 8-week program, and after 6 and 12 months. RESULTS: In total 84 patients (94 %) were examined following treatment. There was a statistically significant improvement in flexibility, strength, lifting capacity, and endurance measurements ( p < 0.001) at the end of the treatment. In addition, significant reductions in pain, disability, depression, and psychovegetative signs were demonstrated ( p < 0.001). There was a decreased use of medical treatment for back pain following the program, with 42 % of the patients refraining from the intake of analgesics, followed by a significant reduction in physiotherapy and the consultation of physicians. Assessment of the patients' reported increased activity levels at home also supported findings that statistical improvements were significant. Sixty-three percent of the patients were found to have returned to active, productive work following discharge from the program. Most of the improvements remained stable at the 6- and 12-month follow-up examinations. CONCLUSION: The results demonstrate the effectiveness of the multimodal program of functional restoration, not only concerning positive changes in somatic, psychological and physical variables, but also with respect to the number of patients who returned to work. Our methods are also compared with the discrepant results of multimodal treatment in the United States and Scandinavia.

English Abstract↗
PubMed2002

Degenerative disc disease treated with combined anterior and posterior arthrodesis and posterior instrumentation.

STUDY DESIGN: This study retrospectively reviewed the outcome of 58 patients all diagnosed with severe low back pain secondary to degenerative disc disease and treated with anterior arthrodesis and posterior instrumented arthrodesis. OBJECTIVES: To evaluate the outcome of a select group of patients with degenerative disc disease treated with this surgical intervention at a minimum of 2 years of follow-up. SUMMARY OF BACKGROUND DATA: Patients with degenerative disc disease who fail nonoperative treatment generally have disappointing outcomes with traditional surgical intervention. The literature analyzing posterior instrumented arthrodesis tends to exhibit the best results, but the numbers of patients with degenerative disc disease in these articles are few, and their outcomes are worse than the other low back conditions. Even patients with solid posterior arthrodesis have been noted to have continued low back pain. No articles have evaluated this specific surgical procedure in a group of patients all with the diagnosis of degenerative disc disease and no previous surgery. METHODS: All patients were diagnosed with degenerative disc disease and had failed prolonged nonoperative treatment (average 4.9 years). Fusion levels were delineated by MRI and provocative discography in correlation with history and physical examination. The senior author (M.R.P.) performed the identical operative procedure on all patients, under a single anesthetic. The arthrodesis solidity was evaluated with radiographic studies and operative posterior exploration when necessary. Final outcomes were determined using a functional and satisfaction questionnaire, return to work, narcotic use, and the rate of solid arthrodesis. Charts, radiographs, and questionnaires were reviewed by an independent evaluator at final follow-up (average 35 months). RESULTS: The solid arthrodesis rate was 95%. The three pseudoarthroses were all in patients with a three-level arthrodesis. Eighty-eight percent of the patients were able to return to work. Nineteen percent of patients required long-term narcotics, whereas 48% of the patient population were on narcotics before surgery. Eighty-six percent of the patients had a "better" rating at final follow-up. This included patients with decreased pain by visual analog scale, improved functional questionnaire, and those who would recommend the procedure to a friend or family member. Ten percent of the patients were "the same," and 3% were "worse." Lumbar lordosis was maintained or improved. Complications did not exceed literature controls. CONCLUSIONS: Selected patients with discography-proven severe low back pain secondary to degenerative disc disease, who failed extensive nonoperative treatment, were treated successfully with anterior-posterior instrumented arthrodesis. The good arthrodesis rate, return to work rate, and patient satisfaction may justify the consideration of this aggressive treatment option in this specific patient population.

Adult↗
PubMed1990

[Socio-professional evaluation of 184 patients with hand injuries treated at an emergency microsurgery service].

184 consecutive patients were operated for severe industrial injuries of the hand. Microsurgical techniques were used in 86% of cases, with 41% of replantation (with about 1/3 of failures), and revascularization, and 17% of sutures of median and ulnar nerves. These patients were examined by medical experts from the French National Health Service, independently of their surgeons, in order to determine under which conditions they could resume their professional activities (changes of their working conditions or not, reduction in their wages or not, etc.). Moreover the duration of work interruption, as well as the percentage of professional disabilities, were known for more than 90% of the 115 patients who underwent an official assessment. The average percentage of professional disability was 19%, whereas without specialized surgery it used to be roughly 30 to 40% for the same lesions. The value of microsurgical techniques was obvious when considering the ability of the patients to resume their previous activities, especially as 96% of them were manual workers. Only 12% of the patients did not resume their work (5% were unemployed, and 7% retired or were too disabled to work). 18% were able to return to work, but with modifications of their working conditions or their wages. But, most important, 70% of the patients resumed their previous work with the same pay. On average, they had to stay for ten days in the surgical department and had to stop work for 3 months. This may be due to our great concern with early rehabilitation, aimed at manual work, with early transfer of patients to specialized rehabilitation centers.(ABSTRACT TRUNCATED AT 250 WORDS)

Accidents, Occupational↗
PubMed2002

Functional and psychosocial outcome one year after severe traumatic brain injury and early-onset rehabilitation therapy.

This study evaluates the impact of early-onset continuous rehabilitation treatment on the 1-year outcome of patients after severe traumatic brain injury. Immediately after recovery from mechanical ventilation, a total of 48 patients underwent a complex early rehabilitation treatment until they were discharged from hospital and local ambulant care was deemed sufficient. The follow-up examination took place 12 months after trauma. Data reveal that at 1 year 91.6% of the patients were completely or restrictedly independent of care and capable of carrying out activities of daily living, although they frequently were still suffering from marked behavioural and also from certain sensorimotor deficits. Only 45.8% of the patients were obviously able to work without restrictions or had returned to work. In those subjects who were not or only very restrictedly able to work, behavioural and speech deficits were significantly more frequent. Behavioural and speech deficits seem to represent the major cause that hinders professional reintegration. Rehabilitation therapy therefore should be specifically directed to improve these deficits.

Activities of Daily Living↗
PubMed2000

Outcome following implantation of a peripheral nerve stimulator in patients with chronic nerve pain.

This study evaluated the usefulness of the implanted peripheral nerve stimulator in patients with pain following injury to a peripheral nerve. The patient sample (n = 17) consisted of 7 men and 10 women with a mean age of 48 years (SD = 18 years). The mean follow-up time since implantation of the stimulator was 21 months (SD = 15 months). Workers' compensation and/or litigation were involved in 11 cases. Peripheral nerve stimulators were placed in the upper extremity in 12 patients and in the lower extremity in 5 patients. Pain relief following implantation was rated as excellent by five patients, good by six patients, fair by four patients, and poor by two patients. A statistically significant decrease in reported pain level was found postoperatively (p < 0.0003). There was no statistically significant difference in postoperative pain level between men and women (p = 0.30), between cases involving workers' compensation or litigation and those not involving these issues (p = 1.0), or between patients who received an upper-extremity implant and those who received a lower-extremity implant (p = 0.56). Of the 12 patients who were unable to work before the operation, 6 returned to work after the operation. In conclusion, peripheral nerve stimulators can be useful in decreasing pain in carefully selected patients with severe neurogenic pain.

Adolescent↗
PubMed2006

Work retention and nonspecific low back pain.

STUDY DESIGN: A cohort study of patients with nonspecific low back pain (LBP) participated in a 4-week multidisciplinary rehabilitation program. OBJECTIVE: To identify factors that predict work retention 24 months after treatment in patients with nonspecific LBP. SUMMARY OF BACKGROUND DATA: There is evidence that select physical, psychologic, and psychosocial factors are related to positive outcome for work-related nonspecific LBP. However, there is very little information related to work retention following an episode of nonspecific LBP. This is an exploratory study to identify select physical and psychosocial factors related to work retention. METHODS: Patients who returned to work after treatment (n = 67) were followed for 2 years. Physical baseline measures included tests of flexibility, strength, and functional capacity. Psychosocial baseline measures were The Symptoms Checklist 90-R, The Pain Beliefs and Perceptions Inventory, The Oswestry Scale of perceived disability, The Work Stress Inventory, and The Quality of Life Scale. All physical parameters, perceived disability, and quality of life were tested before and after treatment. The dependent variable, work retention, was defined as the number of days that the subject worked during the 2-year follow-up period. Survival analysis was used to establish the predictive model. RESULT: The average time out of work before treatment was 9 months (standard deviation 12.8) for 67 subjects (mean age 40 years [standard deviation 9.6]), including 18 females and 49 males. There were 18 participants (25%) that had interruption of work retention at follow-up. Average work retention was 362 days (range 47-682). Variables that reached a P value of <0.10 in the bivariate analysis were included in the multivariate analysis. They were trunk flexion (hazard ratio [HR = 2.4], 95% confidence interval [CI] 1.24-4.38; P = 0.01), trunk extension (HR = 2.1, 95% CI 1.02-4.16; P = 0.04), the somatization scale from the Symptom Checklist 90 revised (HR = 2.0, 95% CI 1.03-4.05; P = 0.04), and the obsessive-compulsiveness scale from the Symptom Checklist 90 revised (HR = 0.4, 95% CI 0.12-1.15; P = 0.09). Results showed that post-test trunk flexion, somatization, and obsessive compulsiveness predicted work retention (final trunk flexion HR = 2.5 [95% CI 1.26-4.79; P = 0.01], somatization scale HR = 2.5 [95% CI 1.25-4.93; P = 0.01], and obsessive compulsion HR = 0.2 [95% CI 0.07-0.77; P = 0.02]). CONCLUSION: Psychosocial and physical factors are associated with work retention for patients with nonspecific LBP. The predictive value of certain constructs may vary with the time when they are assessed and how outcome is operationalized. Further studies are needed to confirm these findings.

Absenteeism↗
PubMed2003

Bone reconstruction of the lower extremity: complications and outcomes.

A study was performed to analyze the results and final outcomes of bone reconstruction of the lower extremity. Twenty-six patients presented with type IIIB open fractures, nine with type IIIC open fractures, and 15 with chronic osteomyelitis. Seven patients underwent primary amputation, and reconstruction was attempted for 43 patients. The mean bone defect size was 7.7 cm (range, 3 to 20 cm). Bone reconstruction was achieved with conventional bone grafts in 16 cases, in association with either local (13 cases) or free (three cases) flaps. Vascularized bone transfer was performed in 24 cases, with either osteocutaneous groin flaps (10 cases), soleus-fibula flaps (12 cases), or osteocutaneous lateral arm flaps (two cases). For three patients, bone reconstruction was performed with a technique that combines the induction of a membrane around a cement spacer with the use of an autologous cancellous bone graft. Infections were observed to be responsible for prolonged hospital stays and treatment failures. The cumulative rates of sepsis were 4.6 percent at 1 week after injury and 62.8 percent at 2 months. Vascular complications were also related to infections and were responsible for four secondary amputations. One patient asked for secondary amputation because of a painful nonfunctional lower limb. Bone healing occurred in 37 of 43 cases, and the average time to union was 9.5 months, with an average of 8.7 procedures. The mean lengths of stay were 49 days for conventional bone grafts and 62 days for vascularized bone grafts. All of the 50 patients were able to walk, with an average time of 14 months. All of the patients with amputations underwent prosthetic rehabilitation. Patients mostly complained about the reconstructed limb (62.8 percent). Joint stiffness was present in 40 percent of the cases. Other long-term complications were pain (nine cases), lack of sensation (five cases), infection (five cases), and pseudarthrosis (one case). However, all of the patients with successful reconstructions preferred their salvaged leg to an amputation. Of 41 patients who were working before the injury, 26 returned to work.

Adolescent↗
PubMed1995

Work in a developing country.

Some health professionals seek the exciting challenge of working for a time in a developing country. Uncertainties about taking this step, however, may have to be addressed. It is important to understand your reasons for wanting to work overseas-it is ill advised, for example, to go abroad just to escape job dissatisfaction in Britain. Skills needed for international aid work nowadays centre on low tech community based programmes, and enabling, facilitating, and managing skills are more important than clinical skills. Further training may be necessary. Careful planning both for the work abroad and for a return to work in Britain is advisable; full health insurance cover, for example, is important. Although working in a developing country is largely unrecognised as an asset to a professional career in Britain, attitudes are slowly changing. A spell overseas can be very relevant to a career plan and the NHS.

Developing Countries↗
PubMed2004

Lost working days, productivity, and restraint use among occupants of motor vehicles that crashed in the United States.

BACKGROUND: In 2001, 6.3 million passengers were involved in motor vehicle crashes. This study aimed to determine the number of work days lost as a result of motor vehicle crashes and factors that influenced people's return to work. METHODS: This was a retrospective, population based cohort study of occupants in motor vehicles involved in crashes from the 1993-2001 Crashworthiness Data System produced by the National Highway Traffic Safety Administration. The sample population of people aged 18-65 years included two groups: occupants who survived and were working before the crash and occupants who were injured fatally and were estimated to have been working before the crash. Multivariate linear regression was used to analyze the impact of restraint use and injury type on return to work. RESULTS: Overall, 30.1% of occupants of vehicles that crashed missed one or more days of work. A crash resulted in a mean 28.0 (95% confidence interval 15.8 to 40.1) days lost from work, including losses associated with fatalities. The 2.1 million working occupants of vehicles that crashed in 2001 lost a total of 60 million days of work, resulting in annual productivity losses of over $7.5 billion (2964 to 12 075). Unrestrained vehicle occupants accounted for $5.6 billion in lost productivity. CONCLUSIONS: Motor vehicle crashes result in large and potentially preventable productive losses that are mostly attributable to fatal injuries.

Accidents, Traffic↗
PubMedDate not supplied

Occupational neutrophilic asthma.

Occupational asthma is typically associated with an eosinophilic bronchitis. The case of a 41-year-old woman who developed symptoms of asthma after occupational exposure to metal working fluids is reported. The diagnosis of asthma was confirmed by an forced expiratory volume in 1 s (FEV1) of 1.7 (59% predicted), with 11% reversibility after inhaled bronchodilator and a provocation concentration of methacholine to cause a fall in FEV1 of 20% (PC20) of 0.4 mg/mL. Induced sputum examination showed a marked neutrophilia. Over the next six months, serial sputum analyses confirmed the presence of a marked sterile neutrophilic bronchitis during periods of occupational exposure to metal working fluids, which resolved when the patient was away from work and recurred when she returned to work. The sputum findings were mirrored by corresponding changes in spirometry and PC20 methacholine. The findings indicate the occurrence of occupational asthma associated with an intense, sterile neutrophilic bronchitis after exposure to metal working fluids.

Adult↗