We analyzed the Bureau of Labor Statistics (BLS) fatal and nonfatal injuries and illness data on U.S. workers in the wholesale and retail trade (WRT) sector from 2006 to 2016. The purpose was to ...identify elevated fatal and nonfatal injury and illness rates in WRT subsectors.
To assess the WRT health and economic burden, we retrieved multiple BLS data sets for fatal and nonfatal injury and illness data, affecting more than 20 million employees. We examined yearly changes in incidence rates for lost work-time across event and exposure categories.
In 2016, 553 100 injuries and illnesses and 461 fatalities occurred among WRT workers. WRT has a disproportionately 5% larger burden of nonfatal injuries for its size. From 2006 through 2016, wholesale sector fatality rates (4.9/100 000 FTE) exceeded private industry rates (3.8/100 000 FTE). The largest causal fatal factors were transportation in wholesale and violence in retail. Private industry and WRT experienced a decline in nonfatal injuries and illnesses. Wholesale subsectors with elevated nonfatal rates included durable and nondurable goods, recycling, motor parts, lumber, metal and mineral, grocery, and alcohol merchants. Retail subsectors with elevated rates included motor parts dealers, gasoline stations, nonstores, tire dealers, home and garden centers, supermarkets, meat markets, warehouse clubs, pet stores, and fuel dealers.
Through the identification of safety and health risks, researchers and safety practitioners will be able to develop interventions and focus future efforts in advancing the safety and health of WRT employees.
Traumatic brain injury (TBI) leads to 2.9 million visits to US emergency departments annually and frequently involves a disorder of consciousness (DOC). Early treatment, including withdrawal of ...life-sustaining therapies and rehabilitation, is often predicated on the assumed worse outcome of disrupted consciousness.
To quantify the loss of consciousness, factors associated with recovery, and return to functional independence in a 31-year sample of patients with moderate or severe brain trauma.
This cohort study analyzed patients with TBI who were enrolled in the Traumatic Brain Injury Model Systems National Database, a prospective, multiyear, longitudinal database. Patients were survivors of moderate or severe TBI who were discharged from acute hospitalization and admitted to inpatient rehabilitation from January 4, 1989, to June 19, 2019, at 1 of 23 inpatient rehabilitation centers that participated in the Traumatic Brain Injury Model Systems program. Follow-up for the study was through completion of inpatient rehabilitation.
Traumatic brain injury.
Outcome measures were Glasgow Coma Scale in the emergency department, Disability Rating Scale, posttraumatic amnesia, and Functional Independence Measure. Patient-related data included demographic characteristics, injury cause, and brain computed tomography findings.
The 17 470 patients with TBI analyzed in this study had a median (interquartile range IQR) age at injury of 39 (25-56) years and included 12 854 male individuals (74%). Of these patients, 7547 (57%) experienced initial loss of consciousness, which persisted to rehabilitation in 2058 patients (12%). Those with persisting DOC were younger; had more high-velocity injuries; had intracranial mass effect, intraventricular hemorrhage, and subcortical contusion; and had longer acute care than patients without DOC. Eighty-two percent (n = 1674) of comatose patients recovered consciousness during inpatient rehabilitation. In a multivariable analysis, the factors associated with consciousness recovery were absence of intraventricular hemorrhage (adjusted odds ratio OR, 0.678; 95% CI, 0.532-0.863; P = .002) and intracranial mass effect (adjusted OR, 0.759; 95% CI, 0.595-0.968; P = .03). Functional improvement (change in total functional independence score from admission to discharge) was +43 for patients with DOC and +37 for those without DOC (P = .002), and 803 of 2013 patients with DOC (40%) became partially or fully independent. Younger age, male sex, and absence of intraventricular hemorrhage, intracranial mass effect, and subcortical contusion were associated with better functional outcome. Findings were consistent across the 3 decades of the database.
This study found that DOC occurred initially in most patients with TBI and persisted in some patients after rehabilitation, but most patients with persisting DOC recovered consciousness during rehabilitation. This recovery trajectory may inform acute and rehabilitation treatment decisions and suggests caution is warranted in consideration of withdrawing or withholding care in patients with TBI and DOC.
Prognosis in severe brain injury Stevens, Robert D; Sutter, Raoul
Critical care medicine,
2013-April, Letnik:
41, Številka:
4
Journal Article
Recenzirano
The prediction of neurologic outcome is a fundamental concern in the resuscitation of patients with severe brain injury.
To provide an evidence-based update on neurologic prognosis following ...traumatic brain injury and hypoxic-ischemic encephalopathy after cardiac arrest.
Search of the PubMed database and manual review of bibliographies from selected articles to identify original data relating to prognostic methods and outcome prediction models in patients with neurologic trauma or hypoxic-ischemic encephalopathy.
Articles were scrutinized regarding study design, population evaluated, interventions, outcomes, and limitations. Outcome prediction in severe brain injury is reliant on features of the neurologic examination, anatomical and physiological changes identified with CT and MRI, abnormalities detected with electroencephalography and evoked potentials, and physiological and biochemical derangements at both the brain and systemic levels. Use of such information in univariable association studies generally lacks specificity in classifying neurologic outcome. Furthermore, the accuracy of established prognostic classifiers may be affected by the introduction of outcome-modifying interventions, such as therapeutic hypothermia following cardiac arrest. Although greater specificity may be achieved with scoring systems derived from multivariable models, they generally fail to predict outcome with sufficient accuracy to be meaningful at the single patient level. Discriminative models which integrate knowledge of genetic determinants and biologic processes governing both injury and repair and account for the effects of resuscitative and rehabilitative care are needed.
With the removal of gender restrictions and the changing nature of warfare potentially increasing female soldier exposure to heavy military load carriage, the aim of this research was to determine ...relative risks and patterns of load carriage related injuries in female compared to male soldiers.
The Australian Defence Force Occupational Health, Safety and Compensation Analysis and Reporting workplace injury database was searched to identify all reported load carriage injuries. Using key search terms, the narrative description fields were used as the search medium to identify records of interest. Population estimates of the female: male incident rate ratio (IRR) were calculated with ninety-five percent confidence interval (95% CI) around the population estimate of each IRR determined.
Female soldiers sustained 10% (n = 40) of the 401 reported injuries, with a female to male IRR of 1.02 (95% CI 0.74 to 1.41). The most common site of injury for both genders was the back (F: n = 11, 27%; M: n = 80, 22%), followed by the foot in female soldiers (n = 8, 20%) and the ankle (n = 60, 17%) in male soldiers. Fifteen percent (n = 6) of injuries in female soldiers and 6% (n = 23) of injuries in males were classified as Serious Personal Injuries (SPI) with the lower back the leading site for both genders (F: n = 3, 43%: M: n = 8, 29%). The injury risk ratio of SPI for female compared to male soldiers was 2.40 (95% CI 0.98 to 5.88).
While both genders similarly have the lower back as the leading site of injury while carrying load, female soldiers have more injuries to the foot as the second leading site of injury, as opposed to ankle injuries in males. The typically smaller statures of female soldiers may have predisposed them to their observed higher risk of suffering SPI while carrying loads.
Purpose
Technological advances in recent years have allowed the easy and accurate assessment of knee motion during athletic activities. Subsequently, thousands of studies have been published that ...greatly improved our understanding of the aetiology, surgical reconstruction techniques and prevention of anterior cruciate ligament (ACL) injuries. The purpose of this review is to summarize the evidence from biomechanical studies on ACL-related research.
Methods
High-impact articles that enhanced understanding of ACL injury aetiology, rehabilitation, prevention and adaptations after reconstruction were selected.
Results
The importance of restoring internal tibial rotation after ACL reconstruction has emerged in several studies. Criteria-based, individualized rehabilitation protocols have replaced the traditional time-based protocols. Excessive knee valgus, poor trunk control, excessive quadriceps forces and leg asymmetries have been identified as potential high risk biomechanical factors for ACL tear. Injury prevention programmes have emerged as low cost and effective means of preventing ACL injuries, particularly in female athletes.
Conclusion
As a result of biomechanical research, clinicians have a better understanding of ACL injury aetiology, prevention and rehabilitation. Athletes exhibiting neuromuscular deficits predisposing them to ACL injury can be identified and enrolled into prevention programmes. Clinicians should assess ACL-reconstructed patients for excessive internal tibial rotation that may lead to poor outcomes.
Level of evidence
III.
Rotator cuff weakness and rotation ratio imbalances are possible risk factors for shoulder injury among overhead athletes. In consensus statements, organizations have highlighted the importance of a ...screening examination to identify athletes at risk of injury. The screening should be portable and designed to be feasible in many different environments and contexts.
To evaluate the reliability and validity of the Self-Assessment Corner (SAC) for self-assessing shoulder isometric rotational strength and examining whether performance on 2 physical performance tests was correlated with isometric shoulder rotational strength using the SAC in handball players.
Cross-sectional study.
Sport setting.
A first sample of 42 participants (18 men, 24 women) was recruited to determine the reliability and validity of the SAC. In a second sample of 34 handball players (18 men, 16 women), we examined correlations between physical performance tests and the SAC.
The SAC was used to measure isometric rotational strength with the upper extremity at 90° of abduction in the frontal plane and 90° of external rotation and the elbow flexed to 90° with neutral rotation of the forearm. The SAC findings were compared with those from manual testing. Results from the seated medicine ball throw (SMBT) and closed kinetic chain upper extremity stability test (CKCUEST) were used to establish relationships with the SAC. We calculated intraclass correlation coefficients to determine relative reliability and used standard error of measurement and minimal detectable change to quantify absolute reliability. Relationships among the different strength-testing procedures and with the physical performance tests were determined using the Pearson product moment correlation coefficient (
) or Spearman rank correlation coefficient (
).
We observed good to excellent reliability (intraclass correlation coefficient 2,k range = 0.89 to 0.92). The standard error of measurement varied from 3.45 to 3.48 N. The minimal detectable change with 95% confidence intervals ranged from 8.06 to 8.13 N. Strong correlations were present among strength procedures (
= 0.824,
range = 0.754-0.816). We observed moderate to strong correlations between the CKCUEST findings and rotational strength (
range = 0.570-0.767). Moderate correlations were found between rotational strength and SMBT (
range = 0.573-0.626).
The SAC is a clinically applicable and standardized protocol for self-assessing rotational strength in young healthy adults without pathologic conditions. Performance on the SMBT and CKCUEST may be valuable as a screening tool to further assess shoulder strength.
To estimate the risk of clinically diagnosed knee osteoarthritis (OA) after different types of knee injuries in young adults.
In a longitudinal cohort study based on population-based healthcare data ...from Skåne, Sweden, we included all persons aged 25-34 years in 1998-2007 (n=149 288) with and without diagnoses of knee injuries according to International Classification of Diseases (ICD)-10. We estimated the HR of future diagnosed knee OA in injured and uninjured persons using Cox regression, adjusted for potential confounders. We also explored the impact of type of injury (contusion, fracture, dislocation, meniscal tear, cartilage tear/other injury, collateral ligament tear, cruciate ligament tear and injury to multiple structures) on diagnosed knee OA risk.
We identified 5247 persons (mean (SD) age 29.4 (2.9) years, 67% men) with a knee injury and 142 825 persons (mean (SD) age 30.2 (3.0) years, 45% men) without. We found an adjusted HR of 5.7 (95% CI 5.0 to 6.6) for diagnosed knee OA in injured compared with uninjured persons during the first 11 years of follow-up and 3.4 (95% CI 2.9 to 4.0) during the following 8 years. The corresponding risk difference (RD) after 19 years of follow-up was 8.1% (95% CI 6.7% to 9.4%). Cruciate ligament injury, meniscal tear and fracture of the tibia plateau/patella were associated with greatest increase in risk (RD of 19.6% (95% CI 13.2% to 25.9%), 10.5% (95% CI 6.4% to 14.7%) and 6.6% (95% CI 1.1% to 12.2%), respectively).
In young adults, knee injury increases the risk of future diagnosed knee OA about sixfold with highest risks found after cruciate ligament injury, meniscal tear and intra-articular fracture.
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