Incidence and Risk Factors for Acute Articular Cartilage Tears in Military and Other Occupational Settings: A Systematic Review

Damage to the articular cartilage resulting in an acute tear can lead to functional changes within the joint and increase the risk of osteoarthritis developing. There is limited understanding of the association between occupational risk factors and sustaining an acute articular cartilage tear in the military and other physically demanding occupations. Therefore, the aim of this systematic review was to identify and evaluate original research reporting on occupational risk factors associated with sustaining acute articular cartilage tears.

METHODS

A systematic review following the Preferred Reporting Items for Systematic review and Meta-Analysis-Protocols was conducted and registered with the Open Science Framework. Key academic databases were searched using terms from the following concepts: risk or cause, paid occupations, and acute articular cartilage tears.

RESULTS

Of an initial 941 studies, 2 studies met the eligibility criteria, both reporting data from military contexts; only one evaluated acute articular cartilage tears in both males and females. One paper focused on articular cartilage injury within the knee and the other within the ankle joint with incidence rates being 0.2 and 0.3 per 1000 person-years, respectively. People in more physically active occupations and individuals with an above-normal body mass index were reported as being at higher risk of sustaining an acute articular cartilage tear.

CONCLUSION

Physically demanding occupations, such as the military, may increase the risk for acute tears of the articular cartilage. However, the findings of this review indicate there is a paucity of research to underpin understanding of the injury mechanisms and occupational risk factors for acute articular cartilage tears.

Smart Work Injury Management (SWIM) System: A Machine Learning Approach for the Prediction of Sick Leave and Rehabilitation Plan

As occupational rehabilitation services are part of the public medical and health services in Hong Kong, work-injured workers are treated along with other patients and are not considered a high priority for occupational rehabilitation services. The idea of a work trial arrangement in the private market occurred to meet the need for a more coordinated occupational rehabilitation practice. However, there is no clear service standard in private occupational rehabilitation services nor concrete suggestions on how to offer rehabilitation plans to injured workers. Electronic Health Records (EHRs) data can provide a foundation for developing a model to improve this situation. This project aims at using a machine-learning-based approach to enhance the traditional prediction of disability duration and rehabilitation plans for work-related injury and illness. To help patients and therapists to understand the machine learning result, we also developed an interactive dashboard to visualize machine learning results. The outcome is promising. Using the variational autoencoder, our system performed better in predicting disability duration. We have around 30% improvement compared with the human prediction error. We also proposed further development to construct a better system to manage the work injury case.

Trends in Workplace-Related Eye Injuries in the United States From 2011 Through 2020

Purpose

To provide insight into the current scope of workplace-related eye injuries (WREIs) by describing the demographic profiles and causes of WREIs from the years 2011 through 2020.

Methods

The US Bureau of Labor Statistics (BLS) dataset on WREIs injuries was used. Descriptive data generated included the frequency of eye injuries, the setting, and demographic data.

Results

The BLS reported an estimated 237 590 WREIs in the study timeframe. In that time, the incidence fell from 2.4 to 1.7 per 10 000 workers. These injuries commonly occurred in men (77.1%), White individuals (36.3%), those aged 25 to 34 years (26.9%), and those in the service (23.0%) and production (18.5%) industries. On average, WREIs resulted in a median of 2 missed workdays, with only 5.0% missing more than 1 month of work. Between 2019 and 2020, there was a 15.6% reduction in total WREIs in the US but a 39.3% increase in WREIs among healthcare workers.

Conclusions

Men, White individuals, and younger workers might be at increased risk for WREIs. Public health interventions targeted toward improving access to and the quality of protective equipment in these groups and in fields involved in the primary or secondary sectors of industry and healthcare might be the most cost-effective measure to reduce the impact of WREIs on the US workforce.

[TOPICAL ISSUES OF MEDICAL REHABILITATION OF PATIENTS WITH THE CONSEQUENCES OF SEVERE TRAUMATIC BRAIN INJURY AT THE MUNICIPAL LEVEL]

The article presents the age-sex structure of people who have suffered severe traumatic brain injury on the example of a municipal medical organization providing medical care and medical rehabilitation in outpatient settings. The high prevalence of this type of injury among males of working age has been established. The duration of temporary disability and the timing of referral of this category of people for medical and social examination are reflected. There is a high level of disability among people who have suffered severe traumatic brain injury, and in most cases they are assigned more severe first and second disability groups. The article reflects the personnel problems of a municipal medical organization providing outpatient medical care in the formation of a multidisciplinary rehabilitation team, which require their resolution at the regional level.

Differences between men and women in their risk of work injury and disability: A systematic review

Background

Health responses associated with occupational exposures can vary between men and women.

Aims

This study reviewed the work injury and disability risks associated with similar types of occupational exposures for men and women within and across occupations.

Materials & Methods

A systematic review was undertaken of observational studies published between 2009 and 2019. Studies were required to empirically compare men and women for associations between occupational exposures and work injury or disability outcomes. Included studies were appraised for methodological quality and medium to high rated studies were compared for risk differences between men and women.

Results

Of 14,006 records identified, 440 articles were assessed for methodological quality, and 33 medium to high rated studies were included and reviewed. Among all occupations, the association between physical exposures, job demands, noise, and repetitive tasks, and injury risk were stronger among men. The relationship between repetitive tasks and sickness absence was stronger among women. Most studies examining psychological exposures found no risk differences for men and women across occupations. Men were at higher injury risk in certain occupations in primary and secondary industry sectors involving physical exposures and some chemical/biological exposures. Women were at higher injury risk for the physical demands and repetitive tasks of health care and aluminum production occupations.

Conclusion

This review found that men and women can have different work injury and disability risks, both across and within the same occupations, for some physical exposures and to a lesser extent for some chemical and biological exposures. These differences might be a result of occupation‐specific task differences.

What Social Supports Are Available to Self-Employed People When Ill or Injured? A Comparative Policy Analysis of Canada and Australia

Self-employment (SE) is a growing precarious work arrangement internationally. In the current digital age, SE appears in configurations and contours that differ from the labor market of 50 years ago and is part of a ‘paradigm shift’ from manufacturing/managerial capitalism to entrepreneurial capitalism. Our purpose in this paper is to reflect on how a growing working population of self-employed people accesses social support systems when they are not working due to injury and sickness in the two comparable countries of Canada and Australia. We adopted ‘interpretive policy analysis’ as a methodological framework and searched a wide range of documents related to work disability policy and practice, including official data, legal and policy texts from both countries, and five prominent academic databases. Three major themes emerged from the policy review and analysis: (i) defining self-employment: contested views; (ii) the relationship between misclassification of SE and social security systems; (iii) existing social security systems for workers and self-employed workers: Ontario and NSW. Our comparative discussion leads us toward conclusions about what might need to be done to better protect self-employed workers in terms of reforming the existing social security systems for the countries. Because of similarities and differences in support available for SE’d workers in the two countries, our study provides insights into what might be required to move the different countries toward sustainable labour markets for their respective self-employed populations.

Differences in workers' compensation claim rates for within-province and out-of-province workers in British Columbia, Canada, 2010-2017

BACKGROUND

Little is known about the work-related injury and illness risk of out-of-province workers. This study examines whether there are differences in work-related injury and illness claim rates between within-province and out-of-province workers in British Columbia (BC), Canada.

METHODS

Workers' compensation claim data for injuries and illnesses in BC from 2010 to 2017 were linked with denominator data from Statistics Canada. Multivariable negative binomial regression estimated the claim rate ratio (RR) and 95% confidence intervals (CI) for out-of-province workers with all, health care-only (HCO), short-term disability, long-term disability, and fatality (SLF), and serious injury (SI) claims, compared to within-province workers.

RESULTS

Compared to within-province workers, out-of-province workers had a lower total claim rate (RR: 0.54, 95% CI: 0.52-0.57), adjusting for sex, age, industry sector, and year. Differences in rates differed by claim type, with the largest differences for HCO claims (RR: 0.49, 95% CI: 0.47-0.52) and smallest differences for SI claims (RR: 0.85, 95% CI: 0.78-0.92). Sex-stratified models showed larger differences for males than females, with older female out-of-province workers having elevated SI claim rates. Industry-specific models showed that, even in sectors with high proportions of out-of-province workers' claims, these workers have lower claim rates than within-province workers.

CONCLUSIONS

Out-of-province workers generally have lower claim rates than within-province workers. The overall duration of work exposure, and underreporting or underclaiming, are factors that may explain these lower claim rates. Understanding the determinants and differences of these claim rates may improve the administration and adjudication of claims while also identifying where further prevention measures may be merited.

Geographic variation in work disability burden: Identifying hotspots, coldspots, and associated sociodemographic factors

OBJECTIVES

To identify geographic hotspots and coldspots of work disability burden and their associated sociodemographic factors in Australia.

METHODS

Using Australian workers' compensation and census data, we calculated weeks of compensated time off work per 1000 labor force, an indicator of work disability burden, at Statistical Area Level 4, the smallest level of labor force data produced by the Australian Bureau of Statistics. Records included all claims with at least 1 day of compensated time off work lodged between 2010 and 2015. Work disability burden was z-transformed by state and territory and mapped across Australia. Statistical Areas that were more than 1 standard deviation from the state or territory mean were considered hotspots and coldspots. We tested several sociodemographic factors as predictors of work disability burden.

RESULTS

Work disability burden hotspots were concentrated in lower socioeconomic suburbs and exurbs of state capitals, in addition to several regional areas. Coldspots were primarily in wealthy central urban and suburban areas. Factors associated with greater work disability burden include higher area socioeconomic disadvantage, rurality, lower labor force participation, higher unemployment, higher proportion of work in production industries and in blue-collar occupations, and higher numbers of those with core activity limitations, those aged 65+ years, and foreign-born residents.

CONCLUSIONS

Work disability burden is unequally distributed across Australia and strongly influenced by sociodemographic and occupational factors. The findings can guide more efficient allocation of resources for work disability prevention and rehabilitation.

[Lisfranc lesions: clinical-functional repercussion]

OBJECTIVE

Clinical and functional evaluation of patients with Lisfranc lesion without work or sport cause and treated in our center.

MATERIAL AND METHODS

Thirteen patients with Lisfranc lesion without occupational or sports causes were divided into two groups, high-energy and low-energy injuries. Were analyzed the return to work and sports activity prior to the injury and the use of footwear and insoles after the injury. Also were assessed AOFAS and EVA postoperative score and posterior complications after lesion recovery.

RESULTS

High-energy group included 7 patients who underwent surgery on an average of 7.3 days. Of the total of patients, 4 presented post-surgical sequelae. Of these patients, one patient was unable to return to their previous work activity and two patients were unable to practice the usual sports activity. The AOFAS was 79.4 and EVA 2.8. In the low energy group, we found six patients operated on 5.6 days on average. All of them were able to return to their previous work and sports activity. The AOFAS were 84.8 and the EVA 1.6. Statistically significant differences were not observed in any of the variables studied.

CONCLUSION

Patients with Lisfranc injury out of laboral or sports background present good clinical and functional results.

Air Pollution's Impact on the Economic, Social, Medical, and Industrial Injury Environments in China

In this era of rapid economic development, it is inevitable that economic activities eventually cause serious damage to the environment’s air quality, making it the focus of global public health. If the treatment efficiency of medical accidents can be improved, then this can significantly stabilize society and improve production efficiency. Past research has mainly focused on work safety and health issues, seldom discussing economic, social, medical, and environmental pollution issues together, and, most generally, adopted static methods that fail to recognize how air pollution affects the overall economy, society, medical care, and external environment. In order to more deeply understand the changes among social, economic activities, and environmental issues due to air pollution, this study proposes a meta-two-stage undesirable dynamic DDF (Direction Distance Function) that, under an exogenous model, divides the 30 provinces of China into high-income regions and middle-income regions and explores the economic, social, medical, and environmental efficiencies between the two areas to resolve the lack of related static analyses. The empirical results are as follows. (1) The AQI (air quality index) significantly impacts the efficiency of medical injuries in various regions. (2) When the AQI is considered, the medical insurance expenditure efficiency score value of high-income areas is lower than the value without the AQI. (3) When the AQI is considered, the efficiency value of the number of work injury insurance benefits in the middle-income area is lower than the efficiency value without the AQI.

Upper extremity strength: Normative reference data among uninjured employees

BACKGROUND

Extremity strength testing is used to determine the ability of industrial employees to perform a physically demanding occupation safely, evaluate post-injury impairment, and monitor return to function after injury. There is an unmet clinical need for a robust and granular source of normative reference values to serve as a resource for baseline data on upper extremity isometric strength.

OBJECTIVE

Develop normative reference data for upper extremity strength among industrial employees and investigate associations between strength and physical job demands.

METHODS

Upper extremity strength data from 107,102 industrial employees were collected post-hire. In this study, isometric tests for pinch; hand grip; wrist pronation and supination; and flexion of the wrist, elbow, and shoulder strength were retrospectively analyzed in relationship to sex, age, and job level. Associations between strength scores and five levels of work, defined the United States Department of Labor's Dictionary of Occupational Titles by level of physical difficulty (1-5), were determined.

RESULTS

Higher strength scores were positively associated with more physically demanding job levels (P < 0.001), and there was a progressive increase in strength scores with increased physical job demands for both sexes (P = 0.0002). All strength scores differed significantly by decade of age (P < 0.001). All scores except for pinch strength demonstrated a moderate or high positive correlation with job level (r≥0.50).

CONCLUSIONS

The normative reference upper extremity strength data collected in this study for industrial employees may be useful for evaluating rehabilitation and recovery following injury or illness. In order to utilize normalized strength data as a post-injury reference, it is important to consider job level in addition to age and sex, as these variables are highly correlated with baseline upper extremity strength.

Sleep disturbances and disability following work-related injury and illness: Examining longitudinal relationships across three follow-up waves

Despite the high burden of sleep disturbances among the general population, there is limited information on prevalence and impact of poor sleep among injured workers. This study: (a) estimated the prevalence of sleep disturbance following work-related injury; and (b) examined the longitudinal association between sleep disturbances and disability/functioning, accounting for reciprocal relationships and mental illness. Longitudinal survey data were collected from workers' compensation claimants with a time-loss claim in Victoria, Australia (N = 700). Surveys were conducted at baseline, 6 months and 12 months. Sleep disturbance was measured using the Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaire. Disability/functioning was based on self-reported activity limitations, participation restrictions and emotional functioning. Path models examined the association between disability/functioning and sleep. Mean sleep disturbance T-scores were 55.2 (SD 11.4) at 6 months, with 36.4% of the sample having a T-score of 60+. Longitudinal relationships were observed between disability (specifically, emotional functioning) and sleep disturbances across successive follow-up waves. For example, each unit increase in T2 emotional functioning (five-point scale) was associated with a 1.1 unit increase in T3 sleep disturbance (approximately 29-76 scale). Cross-lagged path models found evidence of a reciprocal relationship between disability and sleep, although adjustment for mental illness attenuated the estimates to the null. In conclusion, sleep disturbances are common among workers' compensation claimants with work injuries/illnesses. Given the links between some dimensions of disability, mental health and sleep disturbances, the findings have implications for the development of interventions that target the high prevalence of sleep problems among working populations.

Work-related musculoskeletal injuries in prosthetists and orthotists in Australia

Objective. This study aims to determine the prevalence of work-related musculoskeletal disorders in prosthetists/orthotists working in Australia. Secondary to this, the relationship between work-related hazards and work-related musculoskeletal disorders will be examined. Methods. In 2012, a self-report survey was conducted with the prosthetist/orthotist workforce in Australia (N = 139, 56% response rate). Data on workplace physical and psychosocial hazards, job satisfaction, work-life balance and musculoskeletal discomfort were collected. Predictors of work-related musculoskeletal disorders were assessed using logistic regression analysis. Results. Prevalence of work-related musculoskeletal disorders was 80%. Gender (β = 1.31, p = 0.030), total weekly hours (β = 0.9, p < 0.010) and physical (β = 1.91, p < 0.010) and psychosocial (β = 1.28, p < 0.010) hazards were all associated with reporting of work-related musculoskeletal disorders. Females reported higher levels of work-related musculoskeletal disorder discomfort than males in all body areas. Conclusions. Work-related musculoskeletal disorders prevalence is high in prosthetists/orthotists. This suggests that focus on workplace injury prevention is required. Targeted prevention requires systematic identification and then control of all relevant workplace hazards.

Comparing time off work after work-related mental health conditions across Australian workers' compensation systems: a retrospective cohort study

Workers' compensation claims (WCC) due to mental health conditions (MHC) are the most expensive due to often lengthy periods off work. This retrospective cohort study aims to determine the factors associated with work time loss in Australian workers with accepted WCCs for MHCs, and investigate whether jurisdiction in which a claim is made affects work time loss, using administrative claims data between January 2010 and June 2011. Cox regression analysis showed that worker age, industry, occupation and type of MHC were associated with work time loss. Workers with depressive disorders had longer time loss than those with stress-related conditions. Workers from South Australia, Comcare and Victoria had the longest durations of work time loss, while Australian Capital Territory and Tasmania had shorter durations. Future research should investigate policy variations that could explain the differences in time spent on compensation between jurisdictions.

Insurance workers' and physiotherapists' perceptions of their roles in the management of workers with injuries in the Western Australian workers' compensation system

BACKGROUND

Insurance workers and physiotherapists are important stakeholders in the rehabilitation of workers with an injury and subsequent musculoskeletal pain. Understanding perceptions of roles may facilitate communication between these stakeholders.

OBJECTIVE

Increase knowledge around, (i) the self-perception of and (ii) the external perception of the insurance workers and physiotherapists roles in the management of a worker with an injury in an Australian workers' compensation environment.

METHODS

A cross-sectional study assessed the perceptions of insurance workers and physiotherapists related to the roles of these two professions in managing a worker with an injury via questionnaire. Respondents were also asked about potential communication barriers.

RESULTS

Insurance workers (n = 48) and physiotherapists (n = 80) reported contrasting role perceptions, with their perception of the other profession leaning towards negative attributes. There was greater alignment of their beliefs of roles in the 'ideal' situation. The perception of barriers to communication also differed between the two professions. Effective and efficient communication was identified as a central component of mismatched role perceptions between stakeholders, but recognised as a critical attribute of 'ideal' stakeholder roles.

CONCLUSION

Insurance workers and physiotherapists self-perception of their roles differs from external perceptions. This information highlights the importance of a shared understanding of stakeholder roles in the management of a worker with an injury.

Adult Reconstructive Surgery: A High-Risk Profession for Work-Related Injuries

BACKGROUND

Adult reconstructive surgery is an orthopedic subspecialty characterized by surgical tasks that are physical, repetitive, and require some degree of stamina from the surgeon. This can result strain and/or injury of the surgeon's musculoskeletal system. This study investigates the prevalence of work-related injuries among arthroplasty surgeons.

METHODS

A modified version of the physical discomfort survey was sent to surgeon members of the Hip Society, the International Hip Society, and the Canadian Orthopedic Arthroplasty via email. One hundred and eighty-three surgeons completed the survey.

RESULTS

Overall, 66.1% of the arthroplasty surgeons reported that they had experienced a work-related injury. The most common injuries that occurred were low back pain (28%), lateral epicondylitis of the elbow (14%), shoulder tendonitis (14%), lumbar disc herniation (13%), and wrist arthritis (12%). Overall, 27% of surgeons took time off from work because of the injury. As the number of disorders diagnosed increased, there was a significant increase in the incidence of requiring time off work because of the disorder (P < .001) and also exacerbation of a previously diagnosed disorder (P < .01). Factors that significantly increased the risk of the surgeon requiring time off because of the disorder were age >55 years, practicing for more than >20 years, and performing >100 total hip arthroplasty procedures per year (P < .05). In addition, 31% of the orthopedic surgeons surveyed required surgery for their injury.

CONCLUSION

Although most studies concentrate on the importance of patient safety and thus the quality of the health care system, the surgeon's safety is also considered an integral part of this system's quality. This study highlights a high prevalence of musculoskeletal work-related injuries among arthroplasty surgeons and indicates the need for the identification of preventive measures directed toward improving the operative surgical environment and work ergonomics for the surgeons.

The relationship between worker, occupational and workplace characteristics and whether an injury requires time off work: a matched case-control analysis in Ontario, Canada

BACKGROUND

The objective of this study was to examine individual, occupational, and workplace level factors associated with time loss following a similar injury.

METHODS

Seven thousand three hundred and forty-eight workers' compensation claims that did not require time off work were matched with up to four claims that required time off work on the event, nature, and part of body injured as well as injury year. Conditional logistic regression models examined individual, occupational, and workplace level factors that were associated with the likelihood of not requiring time off work.

RESULTS

Employees from firms with higher premium rates were more likely to report no time loss from work and workers in more physically demanding occupations were less likely to report no time loss from work. We observed no association between age or gender and the probability of a time loss claim submission.

CONCLUSIONS

Our results suggest that insurance costs are an incentive for workplaces to adopt policies and practices that minimize time loss following a work injury.