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

Prevalence and Factors Associated With Occupational Noise-Induced Hearing Loss Among Palm Oil Mill Workers in Selangor, Malaysia

Introduction Occupational noise-induced hearing loss (NIHL) continues to be a significant public health issue globally, with Malaysia being no exception. In Malaysia, the majority of NIHL cases are reported from the manufacturing sector, with Selangor among the states with the highest number of confirmed cases. This study aimed to assess the prevalence of and factors associated with occupational NIHL among palm oil mill workers in Selangor, Malaysia. Methods A cross-sectional study was conducted to analyze the data from the data collection form, noise risk assessment reports, and audiometric test results done between 2021 and 2022 with a comparable baseline audiometric test. Results A total of 143 participants from three palm oil mills joined this study. The prevalence of NIHL was 42.7% (n = 61). Following the logistic regression model, NIHL was significantly associated with a duration of employment of 10 years and above, a history of occupational noise exposure at the previous workplace, and the use of personal hearing protectors at the current workplace with an adjusted OR of 2.41 (95% CI (1.14, 5.07)), 5.89 (95% CI (2.38, 14.53)), and 0.36 (95% CI (0.16, 0.83)), respectively. Conclusion The prevalence of NIHL among the study participants was high, and the associated factors are modifiable factors that can be prevented with a comprehensive hearing conservation program in the palm oil mills.

Sickness absence and disability pension after road traffic accidents, a nationwide register-based study comparing different road user groups with matched references

Background

Being injured in a road traffic accident may affect individuals' functional ability and in turn lead to sickness absence (SA) and disability pension (DP). Knowledge regarding long-term consequences in terms of SA and DP following a road traffic accident is lacking, especially comparing different groups of road users and compared to the general population. The aim was to estimate excess diagnosis-specific SA and DP among individuals of different road user groups injured in a road traffic accident compared to matched references without such injury.

Methods

A nationwide register-based study, including all working individuals aged 20-59 years and living in Sweden who in 2015 had in- or specialized outpatient healthcare after a new traffic-related injury (n = 20 177) and population-based matched references (matched on: sex, age, level of education, country of birth, living in cities) without any traffic-related injury during 2014-2015 (n = 100 885). Diagnosis-specific (injury and other diagnoses) SA and DP were assessed during 5 years: 1 year before and 4 years following the accident. Mean SA and DP net days/year for each road user group and mean differences of (excess) SA and DP net days/year compared with their matched references were calculated with independent t-tests with bootstrapped 95% confidence intervals (CIs).

Results

A third of all injured road users were bicyclists, 31% were car occupants, 16% were pedestrians (including fall accidents), and 19% were other and unspecified accidents. Pedestrians and other road users were the groups with the highest mean number of SA days during the first year following the accident (51 and 49 days/year respectively). The matched references had between 8 and 13 SA days/year throughout the study period. The excess SA days/year were elevated for all road user groups all five studied years. Excess SA due to injury diagnoses was 15-35 days/year during the first year following the accident. Excess SA due to diagnoses other than injuries were about eight days/year during the whole study period for pedestrians and car occupants and about zero for the bicyclists. The excess DP was low, although it increased every year after the accident for pedestrians and car occupants; for bicyclists no excess DP was seen.

Conclusion

Higher levels of SA due to injury diagnoses were seen among all road user groups during the first year after the accident compared to their references. Pedestrians and car occupants had more excess SA due to other diagnoses and more excess DP four years after the accident than bicyclists and other road users.

The Influence of Personality and Demographic Characteristics on Aggressive Driving Behaviors in Eastern Chinese Drivers

Purpose

Road safety research is important due to the large number of road traffic fatalities globally. This study investigated the influences of age, driving experience and other covariates on aggressive driving behavior.

Methods

A cross-sectional survey was conducted in Yixing City, Wuxi City, Jiangsu Province, China. Regression analysis was applied to explore the influences of age and driving experience and their interactions with other covariates on aggressive driving behavior. Two analyses methodologies were used to assess the simple effect of the interactions. Firstly, the Jamovi automatic analysis classification program was used to calculate the simple slope test. Second, the SPSS macro program was also used to calculate the simple slope test also.

Results

A total of 570 drivers (247 males, 282 females) participated in the survey. A negative correlation was found between age and aggressive driving behaviors, and a positive correlation was found between neuroticism and aggressive driving behaviors in the multiple regression analysis. Significant associations were also found between age, driving experience, and depression, as well as age, driving experience, and neuroticism. Simple slope tests showed that depressive symptoms could increase aggressive behaviors in the elderly and experienced drivers. When experiencing neuroticism, individuals with higher driving experience were more aggressive in driving than shorter experienced drivers.

Conclusion

Age and neuroticism influenced aggressive driving behaviors. Veteran drivers could be aggressive drivers when experiencing depressive symptoms or neuroticism. Mobile intervention could be sent to the potentially risky drivers, which would be safe and broadly feasible to prevent aggressive driving behavior in the background of COVID-19.

Sickness absence and disability pension among injured car occupants, and associations with injury and car safety factors: A prospective cohort study

OBJECTIVE

Knowledge regarding sickness absence (SA) and disability pension (DP) following a road traffic injury, is lacking. The aim of this study was to investigate SA and DP among injured car occupants before and after a crash, accounting for permanent medical impairment (PMI). Further, to explore associations between injured body region, car model year of introduction (MYI), and European New Car Assessment Programme (Euro NCAP) safety rating and number of SA/DP days in year two and four following the crash date.

METHODS

A longitudinal cohort study including 63,358 individuals injured when aged 17-62, in crashes occurring 2001-2013 and involving a car insured by the Folksam Insurance Group. Mean numbers of SA/DP net days per year were calculated, in total and by injury diagnosis category, for all, for those with SA or DP with the same diagnosis as the initial injury, and for those with and those without injuries resulting in PMI. Logistic regressions were performed to calculate odds ratios with 95% confidence intervals for having 90-180 or ≥181 combined SA/DP days, respectively, among those with injury diagnoses, in year two and four after the crash. Associations with injured body region, car model introduction year, and Euro NCAP star ratings, was investigated, with adjustments made for sociodemographics.

RESULTS

The mean number of SA/DP days/year was higher in the years following the crash (56-50 days) compared to the year prior (41). In year one and two the increase in days was mainly with SA due to injury diagnoses and musculoskeletal diagnoses, and in year three and four, with DP due to injury diagnoses, musculoskeletal diagnoses, and mental diagnoses, respectively. Individuals whose injuries resulted in PMI had more future SA/DP days compared to those without PMI. Individuals with injuries to the torso/back and with multiple injuries were more likely to have > 180 SA/DP days both year two (2.9 and 2.2 times, respectively) and year four (2.0 and 1.6 times), compared to individuals with head injuries. Injured occupants in Euro NCAP 2-3-star rated cars as well as in untested cars, were more likely to have > 180 days in year four (1.4 and 2.0 times, respectively), compared to 4-5 stars.

CONCLUSION

Higher levels of SA/DP remained throughout the four years following the crash, with substantial differences between those with PMI and those with no PMI. Low overall car safety level, injuries to the torso/back, and multiple injuries were associated with high SA/DP.

Associated factors from loss productivity among people involved in road traffic accident: a prospective study

OBJECTIVE

To study associated factors with loss productivity in people involved road traffic accidents (RTA).

METHODS

The population based cohort study was conducted in Jequié, Brazil between 2013 to 2015. The instrument for interview was used in people involved in RTA and interview in four months. Individuals, occupational, health conditions, injury and support variables were used for bivariate and multivariate analysis.

RESULTS

The cumulative incidence was loss productivity was 61.1% and density incidence of 7.45 cases/100 person-month. Multivariate analysis showed association for injury (IDR = 4.23; 95%CI = 2.90 - 6.17) and vehicle used with work instrument (IDR = 2.80; 95%CI = 1.62 - 4.85).

CONCLUSION

Public policies are needed to ensure traffic safety in order to minimize the effects of RTA about productivity and to carry news studies to expand knowledge about loss productivity.

Productivity costs among people involved in traffic accidents

This paper aimed to characterize the productivity costs of people involved in traffic accidents (TA) in a medium-sized municipality. A longitudinal household-based study was conducted from 2013 to 2015. During this period, individuals with TA were interviewed, and followed-up and costs of productivity were calculated. The measured and estimated values were considered for the calculation of the gross and per capita values and facilitated the establishment of costs of lost productivity (days off work) and costs of return to productivity (health professionals, medication, transportation, auxiliary devices and vehicle repair). It was shown that the costs of loss were more significant against the costs of return. Among the items that underpin the return to productivity, higher costs were observed in men, young adults, drivers, users of two-wheeled vehicles, people with public employment relationships, intermediate age groups and fracture-type injuries. It is necessary to evaluate and target the stages of recovery of those involved to minimize the social burden generated by these events.

Feasibility of a Hybrid Web-Based and In-Person Self-management Intervention Aimed at Preventing Acute to Chronic Pain Transition After Major Lower Extremity Trauma (iPACT-E-Trauma): A Pilot Randomized Controlled Trial

Objective 1) To assess the feasibility of research methods to test a self-management intervention aimed at preventing acute to chronic pain transition in patients with major lower extremity trauma (iPACT-E-Trauma) and 2) to evaluate its potential effects at three and six months postinjury. Design A pilot randomized controlled trial (RCT) with two parallel groups. Setting A supraregional level 1 trauma center. Methods Fifty-six adult patients were randomized. Participants received the intervention or an educational pamphlet. Several parameters were evaluated to determine the feasibility of the research methods. The potential efficacy of iPACT-E-Trauma was evaluated with measures of pain intensity and pain interference with activities. Results More than 80% of eligible patients agreed to participate, and an attrition rate of ≤18% was found. Less than 40% of screened patients were eligible, and obtaining baseline data took 48 hours postadmission on average. Mean scores of mild pain intensity and pain interference with daily activities (<4/10) on average were obtained in both groups at three and six months postinjury. Between 20% and 30% of participants reported moderate to high mean scores (≥4/10) on these outcomes at the two follow-up time measures. The experimental group perceived greater considerable improvement in pain (60% in the experimental group vs 46% in the control group) at three months postinjury. Low mean scores of pain catastrophizing (Pain Catastrophizing Scale score < 30) and anxiety and depression (Hospital Anxiety and Depression Scale scores ≤ 10) were obtained through the end of the study. Conclusions Some challenges that need to be addressed in a future RCT include the small proportion of screened patients who were eligible and the selection of appropriate tools to measure the development of chronic pain. Studies will need to be conducted with patients presenting more serious injuries and psychological vulnerability or using a stepped screening approach.

Work absence following road traffic crash in Victoria, Australia: A population-based study

INTRODUCTION

Road traffic crash (RTC) burden is typically reported using hospitalisations or fatalities, yet alternative measures such as work absence provide further insight into RTC impacts. This study aimed to quantify work absence due to compensable RTCs in Victoria, and to determine the characteristics associated with prolonged work absence.

METHODS

In Victoria, Australia, two systems provide income support whilst unable to work, among other benefits, to those injured during RTCs either at work (workers' compensation: WC) or elsewhere (RTC compensation). Administrative data of accepted claims between July 1 2003 and June 30, 2013 were included from working age people (15-65 years) if at least one day of income support was paid. Total time (in weeks) on income support, and hence absent from work, was calculated for each person and for each predictor (age group, sex, compensation system, length of hospital stay, injury type and road user type). Cox regression was used to determine the likelihood of prolonged work absence by predictor, presented as hazard ratios (HR) with 95% confidence intervals.

RESULTS

For 36,640 injured people, 1,121,863 weeks were compensated (median 10 weeks). Median work absence was shortest among those involved in a train/tram crash (2.9 weeks, HR:0.57[0.51-0.64]) and those with contusions/abrasions (3.7 weeks, HR:0.66[0.64,0.69]). Median work absence was longest among those with spinal cord injury (115.9 weeks, HR:1.56[1.26,1.92]) or severe acquired brain injury (129.6 weeks, HR:1.60[1.44,1.77]). Work absence likelihood increased with length of hospital stay. Median work absence was similar between compensation systems (WC: 10.1 weeks, RTC: 10.0 weeks) yet likelihood of greater work absence was higher in the RTC compensation system (HR:1.12[1.08,1.17]).

CONCLUSIONS

Work absence is both a measureable and important metric for assessing the impact of RTC injury in those working at the time of injury. Work absence was at least ten weeks for more than half of all injured persons, reinforcing need for road safety, injury prevention, and return to work services. Furthermore, this study identified those most at risk of prolonged work absence, providing the opportunity to target specific individuals to develop strategies to reduce work absence, such as occupation-specific rehabilitation or graduated return to work.

Sickness absence, disability pension and permanent medical impairment among 64 000 injured car occupants of working ages: A two-year prospective cohort study

OBJECTIVE

There is a lack of knowledge regarding sickness absence (SA) and disability pension (DP) as consequences of road traffic injuries, and on the association between DP and permanent medical impairment (PMI). Therefore, the aim of this study was to investigate SA, DP, and PMI among injured passenger car occupants two years after a crash, and how they are associated, accounting for sociodemographics, crash-related factors, and previous SA/DP.

METHODS

This prospective cohort study included 64 007 injured car occupants aged 17-62 years at the time of a crash occurring in 2001-2013, involving a car insured at Folksam Insurance Group in Sweden. Information on sociodemographics, crash-related factors, SA (in SA spells >14 days) and DP status at inclusion and at two-year follow-up, and PMI assessed by the insurance company was used. PMI grades were categorized as 1-4, 5-9, 10-19, or >19%. Logistic regression was performed to calculate odds ratios (OR) with 95% confidence intervals (CI) for DP at follow-up and for PMI, respectively.

RESULTS

At the time of the crash 13% were already on SA or DP. At follow-up two years after the crash, 6% among those not already on SA/DP at the time of the crash were on SA and 2% on DP. Furthermore, 8% of the total cohort had a determined PMI. Among those not already on DP at the crash, 3% with no PMI had DP at follow-up. This proportion was higher the higher PMI grade. Among individuals without already ongoing DP at the crash date, 10% of those with a PMI 1-4 ha d DP, compared to 76% among PMI ≥ 20. Already ongoing SA at the time of the crash (OR = 39.16, 95% CI 34.89-43.95) and PMI grade (PMI ≥ 5 OR = 27.44, 95% CI 23.88-31.52, reference group PMI 0) were found to be associated with DP at two years after crash. The factor most strongly associated with PMI was the model year of the car. The older the car, the higher the risk of PMI (Model year ≤ 1990 OR = 3.36, 95% CI 2.67-4.23, reference group model year 2006-2010). An association with the same direction was also found between the model year of the car and DP at follow-up.

CONCLUSIONS

The association between PMI grade and DP status at follow-up among occupants not on DP at the crash date indicates that both could be used to measure long-term consequences of road traffic injury. In this cohort, already ongoing SA at the crash date was associated with DP at the two-year follow-up, emphasizing the importance of accounting for this factor in future research.

A discrete mixture regression for modeling the duration of non-hospitalization medical leave of motor accident victims

Studies analyzing the temporary repercussions of motor vehicle accidents are scarcer than those analyzing permanent injuries or mortality. A regression model to evaluate the risk factors affecting the duration of temporary disability after injury in such an accident is constructed using a motor insurance dataset. The length of non-hospitalization medical leave, measured in days, following a motor accident is used here as a measure of the severity of temporary disability. The probability function of the number of days of sick leave presents spikes in multiples of five (working week), seven (calendar week) and thirty (month), etc. To account for this, a regression model based on finite mixtures of multiple discrete distributions is proposed to fit the data properly. The model provides a very good fit when the multiples for the working week, week, fortnight and month are taken into account. Victim characteristics of gender and age and accident characteristics of the road user type, vehicle class and the severity of permanent injuries were found to be significant when accounting for the duration of temporary disability.

A Hybrid Web-Based and In-Person Self-Management Intervention Aimed at Preventing Acute to Chronic Pain Transition After Major Lower Extremity Trauma: Feasibility and Acceptability of iPACT-E-Trauma

Background

A transition from acute to chronic pain frequently occurs after major lower extremity trauma. While the risk factors for developing chronic pain in this population have been extensively studied, research findings on interventions aiming to prevent chronic pain in the trauma context are scarce. Therefore, we developed a hybrid, Web-based and in-person, self-management intervention to prevent acute to chronic pain transition after major lower extremity trauma (iPACT-E-Trauma).

Objective

This study aimed to assess the feasibility and acceptability of iPACT-E-Trauma.

Methods

Using a descriptive design, the intervention was initiated at a supra-regional level-1 trauma center. Twenty-eight patients ≥18 years old with major lower extremity trauma, presenting with moderate to high pain intensity 24 hours post-injury were recruited. Feasibility assessment was two-fold: 1) whether the intervention components could be provided as planned to ≥80% of participants and 2) whether ≥80% of participants could complete the intervention. The rates for both these variables were calculated. The E-Health Acceptability Questionnaire and the Treatment Acceptability and Preference Questionnaire were used to assess acceptability. Mean scores were computed to determine the intervention’s acceptability.

Results

More than 80% of participants received the session components relevant to their condition. However, the Web pages for session 2, on the analgesics prescribed, were accessed by 71% of participants. Most sessions were delivered according to the established timeline for ≥80% of participants. Session 3 and in-person coaching meetings had to be provider earlier for ≥35% of participants. Session duration was 30 minutes or less on average, as initially planned. More than 80% of participants attended sessions and <20% did not apply self-management behaviors relevant to their condition, with the exception of deep breathing relaxation exercises which was not applied by 40% of them. Web and in-person sessions were assessed as very acceptable (mean scores ≥3 on a 0 to 4 descriptive scale) across nearly all acceptability attributes.

Conclusions

Findings showed that the iPACT-E-Trauma intervention is feasible and was perceived as highly acceptable by participants. Further tailoring iPACT-E-Trauma to patient needs, providing more training time for relaxation techniques, and modifying the Web platform to improve its convenience could enhance the feasibility and acceptability of the intervention.

Trial Registration

International Standard Randomized Controlled Trial Number (ISRCTN): 91987302; http://www.controlled-trials.com/ISRCTN91987302 (Archived by WebCite at http://www.webcitation.org/6ynibjPHa)

Vocational rehabilitation for enhancing return-to-work in workers with traumatic upper limb injuries

BACKGROUND

Traumatic upper limb injury is a leading cause of work-related disability. After return-to-work (RTW), many survivors of injuries are able to regain a quality of life (QoL) comparable with the normal population. Since RTW plays an important role in economic productivity and regaining health-related QoL, enhancing RTW in workers with traumatic limb injuries is the primary goal of rehabilitation. Vocational rehabilitation has been commonly employed in the field of occupational safety and health to increase the number of injured people returning to the labour market, prevent illness, increase well-being, and reduce disability.

OBJECTIVES

To assess the effects of vocational rehabilitation programmes for enhancing RTW in workers with traumatic upper limb injuries.

SEARCH METHODS

This is an update of a Cochrane review previously published in 2013. We updated our searches of the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 9), MEDLINE (to 30 August 2017), EMBASE (to 3 September 2017), CINAHL (to 6 September 2017), and PsycINFO (to 6 September 2017), and we handsearched the references lists of relevant review articles.

SELECTION CRITERIA

We aimed to include all randomised controlled trials (RCTs) comparing vocational rehabilitation with an alternative (control) intervention such as standard rehabilitation, a limited form of the vocational rehabilitation intervention (such as advice on RTW, referral information, or liaison with employer), or waiting-list controls.

DATA COLLECTION AND ANALYSIS

Two authors independently inspected abstracts, and we obtained full papers when necessary. When the two authors disagreed about the inclusion of a study, we resolved disagreements by discussion. A third author arbitrated when necessary.

MAIN RESULTS

Our updated search identified 466 citations. Based on assessments of their titles and abstracts, we decided to evaluate the full texts of five records; however, none met our inclusion criteria.

AUTHORS' CONCLUSIONS

There is currently no high-quality evidence to support or refute the efficacy of vocational rehabilitation for enhancing RTW in workers with traumatic upper limb injuries. Since injured people in occupational settings frequently receive vocational rehabilitation with the aim of decreasing work disability, enhancing RTW, increasing productivity, and containing the welfare cost, further high-quality RCTs assessing the efficacy of vocational rehabilitation for workers with traumatic upper limb injury are needed to fill this gap in knowledge.

Acute to chronic pain transition in extremity trauma: A narrative review for future preventive interventions (part 1)

BACKGROUND

Several studies have been conducted over the last decade that describe the issue of pain and prognostic factors of acute to chronic pain transition post extremity trauma (ET). However, no thorough interventions to prevent chronic pain development in ET patients have yet been proposed.

OBJECTIVES

This first part of a series of two articles aimed to provide a comprehensive analysis of literature on the epidemiology of pain post-ET, the impact of persistent pain on ET patients and the relevant biological transformations involved in acute to chronic pain transition. The second article will focus on risk and protective factors relating to chronic pain that could potentially assist in the development of preventive interventions.

METHODS

A narrative review of the literature was undertaken. Databases were searched to identify relevant studies and seminal works on the topics of interest.

RESULTS

The review revealed that acute pain converts to chronic pain in up to 86% of ET patients. Analysis of study findings also indicated that chronic pain interferes with activities of daily living and capacity to work. Weak associations between chronic pain and anxiety as well as depression have been demonstrated. Anxiety and depression have been identified as important predictors of chronic pain post-ET. Neuro-immunological transformations, genetics and an emotional shift in the brain circuitry involved in nociception have been shown to contribute to the transition towards chronic pain.

CONCLUSIONS

This narrative review supports the view that acute to chronic pain transition is a prevalent and significant issue post-ET. It also provides information about patients who present a higher risk of chronic pain and features that should be integrated in preventive interventions as well as methodological considerations pertaining to the evaluation of such interventions.

Acute to chronic pain transition in extremity trauma: A narrative review for future preventive interventions (part 2)

BACKGROUND

The first part of this series of 2 articles revealed that chronic pain is an important issue post extremity trauma (ET) involving permanent biological transformations. Interventions aimed at preventing chronic pain in ET patients are therefore required.

OBJECTIVE

To conduct a comprehensive analysis of literature on risk and protective factors for chronic pain post-ET to guide the development of relevant preventive interventions.

METHODS

A narrative review of the literature was undertaken. Databases were searched to identify studies on chronic pain prognostic factors in ET patients.

RESULTS

Demographic, injury-related and psychological factors were shown to either contribute to or limit acute to chronic pain transition. High-intensity acute pain hasconsistently been identified as an important chronic pain risk factor. Other significant documented risk factors include: female gender, older age, less than college education, lower limb injury, symptoms of anxiety and depression and pain catastrophizing. Pain self-efficacy and pain acceptance have been shown to protect individuals against chronic pain.

CONCLUSIONS

This narrative review highlights factors placing ET patients at higher risk of chronic pain or protecting them against this problem. Determining how these factors could be addressed in preventive interventions is the next step before undertaking their development.

Copula-based regression modeling of bivariate severity of temporary disability and permanent motor injuries

The analysis of factors influencing the severity of the personal injuries suffered by victims of motor accidents is an issue of major interest. Yet, most of the extant literature has tended to address this question by focusing on either the severity of temporary disability or the severity of permanent injury. In this paper, a bivariate copula-based regression model for temporary disability and permanent injury severities is introduced for the joint analysis of the relationship with the set of factors that might influence both categories of injury. Using a motor insurance database with 21,361 observations, the copula-based regression model is shown to give a better performance than that of a model based on the assumption of independence. The inclusion of the dependence structure in the analysis has a higher impact on the variance estimates of the injury severities than it does on the point estimates. By taking into account the dependence between temporary and permanent severities a more extensive factor analysis can be conducted. We illustrate that the conditional distribution functions of injury severities may be estimated, thus, providing decision makers with valuable information.

A threshold regression model to predict return to work after traumatic limb injury

OBJECTIVE

The study aims to examine the severity of initial impairment and recovery rate of return-to-work (RTW) predictors among workers with traumatic limb injury.

METHODS

This 2-year prospective cohort study recruited 1124 workers with traumatic limb injury during the first 2 weeks of hospital admission. Baseline data were obtained by questionnaire and chart review. Patient follow-up occurred at 1, 3, 6, 12, 18, and 24 months post injury. The primary outcome was the time of first RTW. The impact of potential predictors on initial impairment and rate of recovery towards RTW was estimated by threshold regression (TR).

RESULTS

A total of 846 (75.27%) participants returned to work during the follow-up period. Our model revealed that the initial impairment level in elderly workers and lower limb injuries were 33% and 35% greater than their counterparts, respectively. Workers with >12 years of education, part-time job, and moderate and higher self-efficacy were less impaired at initial injury compared with their counterparts. In terms of the rate of recovery leading to RTW, workers with older age, part-time jobs, lower limbs, or combined injuries had a significantly slower recovery rate, while workers with 9-12 years of education and >12 years of education had a significantly faster recovery rate.

CONCLUSIONS

Our study provides researchers and clinicians with evidence to understand the baseline impairment and rate of recovery towards RTW by explaining the predictors of RTW among workers with traumatic limb injuries.

Validation of a Chinese version of the Frenchay Activities Index in patients with traumatic limb injury

PURPOSE

The Frenchay Activities Index (FAI) is a frequently used measure that assesses instrumental activities of daily living (IADL). However, the measurement properties of the FAI are largely unknown for patients with traumatic limb injuries. The purpose of this study was to examine the measurement properties of a Chinese version of the FAI, including score distribution, internal consistency, construct validity, predictive validity, and responsiveness in patients with traumatic limb injuries.

METHODS

We performed a secondary data analysis, primarily using non-parametric item response theory, on a data set. The FAI and the World Health Organization Quality of Life Assessment (WHOQOL-BREF) were administered via telephone interview to a cohort of patients at 3, 6, and 12 months after injury. Totals of 342 patients' data (at 3 months after injury), 1,010 patients' data (6 months), and 987 patients' data (12 months) were available for analysis.

RESULTS

After the deletion of 5 items (i.e., travel outings, gardening, household/car maintenance, reading books, and gainful work), the 10-item revised FAI (R-FAI) formed a unidimensional construct. The R-FAI exhibited a unidimensional construct at each of the 3 time points. The R-FAI had sufficient score distribution, internal consistency, predictive validity, and responsiveness in patients with limb injuries.

CONCLUSIONS

Our results support the conclusion that the R-FAI has satisfactory measurement properties. The R-FAI is useful for assessing IADL in patients with limb injuries.

Return to work following unintentional injury: a prospective follow-up study

OBJECTIVE

The aim of this study was to predict time off work following unintentional injuries due to accidents leading to hospital admission.

DESIGN

Prospective 6-month follow-up study.

SETTING

Department of Trauma Surgery of a University Hospital.

PARTICIPANTS

Consecutively recruited victims of unintentional injuries (n=221) hospitalised for a minimum of 32 h including two consecutive nights. All the participants were aged 18-65 years and were able to participate in an assessment within 30 days of the accident.

MAIN OUTCOME MEASURES

Interview-assessed number of days off work during the 6 months immediately following the accident.

RESULTS

The patients' subjective appraisals of (1) accident severity and (2) their ability to cope with the resulting injury and its job-related consequences predicted time off work following the accident beyond the impact of the objective severity of their injury and the type of accident involved.

CONCLUSIONS

The patients' subjective appraisals of the accident severity and of their ability to cope with its consequences are highly relevant for return to work after accidents. Extending the findings from previous studies on severely injured and otherwise preselected accident victims, this seems to apply to the whole spectrum of patients hospitalised with unintentional injuries.

Vocational rehabilitation for enhancing return-to-work in workers with traumatic upper limb injuries

BACKGROUND

Traumatic upper limb injury is a leading cause of work-related disability. After return-to-work (RTW), many survivors of injuries are able to regain a quality of life (QoL) comparable with the normal population. Since RTW plays an important role in economic productivity and regaining health-related QoL, enhancing RTW in workers with traumatic limb injuries is the primary goal of rehabilitation. Vocational rehabilitation has been adapted in the field of occupational safety and health to enhance the number of injured people returning to the labour market, prevent illness, increase well-being, and reduce disability.

OBJECTIVES

To assess the effects of vocational rehabilitation programs in enhancing RTW of workers with traumatic upper limb injuries.

SEARCH METHODS

We searched OSH UPDATE databases (CISDOC, HSELINE, International Bibliographic, NIOSHTIC, NIOSHTIC-2, RILOSH) (up to 10 December 2012), the Cochrane Central Register of Controlled Trials (CENTRAL) (2012, Issue 11), MEDLINE through PubMed (up to 15 November 2012), EMBASE (up to 28 November 2012), CINAHL (up to 5 May 2013), PsycINFO (up to 7 December 2012), and handsearched the reference lists of relevant review articles.

SELECTION CRITERIA

We aimed to include all randomised controlled trials (RCTs) comparing vocational rehabilitation with an alternative (control) intervention such as standard rehabilitation, an incomplete form of the vocational rehabilitation intervention (such as with limited advice on RTW, referral information, or liaison with employer), or waiting-list controls.

DATA COLLECTION AND ANALYSIS

Two authors independently inspected abstracts and we obtained full papers when necessary. When the two authors disagreed about the inclusion of a study, we resolved disagreements by discussion. A third author arbitrated when necessary.

MAIN RESULTS

Our search identified 332 citations. Based on assessments of their titles and abstracts, we decided to evaluate the full texts of 15 citations. In the end, none of these 15 citations met our inclusion criteria.

AUTHORS' CONCLUSIONS

There is currently no high-level evidence to support or refute the efficacy of vocational rehabilitation in enhancing RTW in workers with traumatic upper limb injuries. Since vocational rehabilitation has frequently been provided to injured people in occupational settings with the aim of decreasing work disability, enhancing RTW, increasing productivity, and containing the welfare cost, further high-quality RCTs assessing the efficacy of vocational rehabilitation for workers with traumatic upper limb injury are needed to fill this gap in knowledge.

Work disability after road traffic injury in a mixed population with and without hospitalisation

BACKGROUND

Studies addressing work disability after road traffic injury are generally aimed at seriously injured hospital patients, and less is known about the disability burden associated with injuries not requiring hospitalisation. The aim of this study was to describe the distribution and determinants of work disability outcomes for patients with musculoskeletal and orthopaedic traffic injuries, including those not sufficiently severe to require hospitalisation.

METHODS

Persons injured in road traffic accidents in 2005-2007 claiming compensation via the Transport Accident Commission (Victoria, Australia) were included if they had compensated time off work, and their most serious injury was musculoskeletal or orthopaedic (n=5970). Work disability outcomes were determined from income compensation payments over 17 months following the accident. Logistic regression models were used relating demographic and injury characteristics to work disability.

RESULTS

Of the injuries, 59% required hospitalisation; 15% required hospitalisation of >1 week. Long-term work disability was common with 32% of injuries resulting in work disability ≥6 months after the accident. The duration of work disability increased markedly with length of hospital stay. Those with no hospital stay accounted for 27% of all work disability days; those with ≤7 days in hospital (including no hospital stay) accounted for 71%. Female sex, age ≥35 years and early opioid prescriptions were also risk factors for work disability ≥6 months after the accident.

CONCLUSION

The majority of work disability days were among patients with one week or less in hospital. Because (short) hospitalisation was relatively common after traffic accidents, the relative work disability burden of non-hospitalised injury is not as great as in a mixed injury aetiology population.

The association of social functioning, social relationships and the receipt of compensation with time to return to work following unintentional injuries to Victorian workers

PURPOSE

Understanding individual factors associated with return to work (RTW) post-injury is an important goal of compensation systems research. The aim of the present study was to determine factors associated with time to return to work following acute unintentional injuries.

METHODS

A prospective cohort study was conducted in Victoria, Australia. The cohort comprised 133 persons who were employed at the time they were admitted to one of three study hospitals. Baseline health status data was obtained retrospectively at one-week post-injury and participants were further surveyed at 1, 6, 12, 26 and 52 weeks post-injury to measure recovery. Multivariate Cox proportional hazards regression analysis was used to examine the association between potential prognostic factors and time to RTW during the 12 month study.

RESULTS

At the end of 12 months follow-up, 81.2% of the study cohort had returned to work. Older age, increased injury severity, self reported symptomatic pain and poor mental health at 1 week post-injury were associated with extended time to RTW. A significant statistical interaction between the receipt of compensation and high social functioning as measured by the SF-36 or strong social relationships as measured by the Assessment of Quality of Life was associated with earlier RTW. Participants reporting strong social relationships and high social functioning at 1 week post-injury and entitled to injury compensation returned to work 2.05 and 3.66 times earlier respectively, than similar participants with no entitlement to compensation.

CONCLUSIONS

Both injury-related and psychosocial factors were associated with the duration of time to RTW following acute unintentional injuries. This study replicated previously reported findings on social functioning and compensation from an independent acute trauma sample. Programs or policies to improve social functioning early post-injury may provide opportunities to improve the duration of time to RTW following injury.

The long-term prediction of return to work following serious accidental injuries: a follow up study

BACKGROUND

Considerable indirect costs are incurred by time taken off work following accidental injuries. The aim of this study was to predict return to work following serious accidental injuries.

METHOD

121 severely injured patients were included in the study. Complete follow-up data were available for 85 patients. Two weeks post trauma (T1), patients rated their appraisal of the injury severity and their ability to cope with the injury and its job-related consequences. Time off work was assessed at one (T2) and three years (T3) post accident. The main outcome was the number of days of sick leave taken due to the accidental injury.

RESULTS

The patients' appraisals a) of the injury severity and b) of their coping abilities regarding the accidental injury and its job-related consequences were significant predictors of the number of sick-leave days taken. Injury severity (ISS), type of accident, age and gender did not contribute significantly to the prediction.

CONCLUSIONS

Return to work in the long term is best predicted by the patients' own appraisal of both their injury severity and the ability to cope with the accidental injury.

FTY720 Improves Survival After Transient Ischemia and Reperfusion of the Hind Limbs

BACKGROUND

Ischemia and reperfusion (I/R) damage involves adhesion and transmigration of lymphocytes and neutrophils. FTY720 is an immunosuppressive agent that reduces the number of neutrophils and monocytes in peripheral blood as well as tissue lymphocyte infiltration. This study investigated the effect of FTY720 during hind limb I/R.

METHODS

Male C57/BL6 mice underwent temporary ligation of the infrarenal aorta for 4 hours. After 48 hours of reperfusion, animals were killed by exsanguination. Tissue myeloperoxidase content reflecting neutrophil infiltration and reverse transcription polymerase chain reaction analysis of local cytokine transcription in lung, liver, and kidney were performed.

RESULTS

After I/R, treatment with FTY720 improved survival and prevented upregulation of pro- and anti-inflammatory cytokines in evaluated organs, whereas no changes were detected in myeloperoxidase content after treatment with FTY720.

CONCLUSIONS

Whereas neutrophil infiltration was not affected by treatment with FTY720, other immunocompetent or intrinsic cells appear to be involved in changes of cytokine production in different organs.