Multimorbidity and quality of life after blast-related injury among US military personnel: a cluster analysis of retrospective data.

BACKGROUND: Blast injury emerged as a primary source of morbidity among US military personnel during the recent conflicts in Iraq and Afghanistan, and led to an array of adverse health outcomes. Multimorbidity, or the presence of two or more medical conditions in an individual, can complicate treatment strategies. To date, there is minimal research on the impact of multimorbidity on long-term patient-reported outcomes. We aimed to define multimorbidity patterns in a population of blast-injured military personnel, and to examine these patterns in relation to long-term quality of life (QOL). METHODS: A total of 1972 US military personnel who sustained a blast-related injury during military operations in Iraq and Afghanistan were identified from clinical records. Electronic health databases were used to identify medical diagnoses within the first year postinjury, and QOL was measured with a web-based assessment. Hierarchical cluster analysis methods using Ward's minimum variance were employed to identify clusters with related medical diagnosis categories. Duncan's multiple range test was used to group clusters into domains by QOL. RESULTS: Five distinct clusters were identified and grouped into three QOL domains. The lowest QOL domain contained one cluster with a clinical triad reflecting musculoskeletal pain, concussion, and mental health morbidity. The middle QOL domain had two clusters, one with concussion/anxiety predominating and the other with polytrauma. The highest QOL domain had two clusters with little multimorbidity aside from musculoskeletal pain. CONCLUSIONS: The present study described blast-related injury profiles with varying QOL levels that may indicate the need for integrated health services. Implications exist for current multidisciplinary care of wounded active duty and veteran service members, and future research should determine whether multimorbidity denotes distinct post-blast injury syndromes.

Injuries and Exposure to Time Lobstering in Northeast US Inshore Lobster Fleet.

Objectives: The study objective was to estimate a denominator of exposure to inshore lobstering in Full-Time Equivalents (FTEs), to count incident injury data from a sample cohort of this population, to use this count to calculate rates for incident injuries, and to use official counts of fatalities to estimate a fatality rate.Methods: Captains were randomly selected from those licensed to fish in Maine and Massachusetts. Data on work exposure and injuries that occurred on the boat were collected using a survey that was administered once per season via phone or face-to-face interview with the captain. Data included self-reports of the number of weeks worked during the season, average crew size, number of trips per week, and average trip length in hours. In addition, this survey captured relevant information (body segment affected, type of injury, and whether treatment was received) on all acute injuries occurring during the season. Only data on acute injuries were collected, and defined as having newly occurred within the last 3 months. Counts of fatalities were obtained from an official surveillance database at the National Institute for Occupational Health and Safety.Results: The total occupational exposure reported for the cohort was over 2 million man-hours over 4 years, resulting in an average annual FTE of 5,847. The fatality rate averaged over 4 years was 21/100,000 FTE. The incidence rates for all injuries (51.0/100 FTE) and injuries receiving treatment (17.5/100 FTE) were much higher than those reported in other studies of fishing that used US Coast Guard data. Lobstermen presented with all categories of injuries, sprains being the most frequent (7.8/100 FTE) and amputations the least (0.2/100 FTE). Wrist/hand injuries on the right side occurred most frequently of all body locations (3.6/100 FTE).Conclusion: Non-fatal injuries occur at high rates in lobstering. The impact of interventions aimed at exposure to risk for sprains and cuts has potential to affect the most lobstermen. Fatality rate appears to have been unchanging since the year 2000.

Resilience Among Caregivers of Injured Service Members: Finding the Strengths in Caregiving.

OBJECTIVE: To examine the relationships between caregiver resilience and a comprehensive set of sociodemographic and health-related quality of life (HRQOL) predictors among both caregivers and injured service members. DESIGN: Cross-sectional analysis of an observational cohort. SETTING: Community dwelling. PARTICIPANTS: Caregivers (n=87) who provide instrumental or emotional support to injured service members (n=73)(N=160). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The Connor-Davidson Resilience Scale 25-item version. RESULTS: Higher caregiver resilience scores were related to lower depressive symptom severity, greater health responsibility, physical activity, nutrition, spiritual growth, interpersonal relations, stress management, and problem-solving orientation. A multivariable regression model showed that spiritual growth and aspects of problem-solving orientation were significantly related to resilience. CONCLUSIONS: Results highlight the relationships between resilience and spirituality, problem-solving orientation, and aspects of HRQOL among caregivers of injured service members. These findings have important implications for caregiver behavioral health programs designed to promote resilience and draw upon caregiver strengths when taking on a caregiver role. Approaches that include a more integrative medicine or strengths-based emphasis may be particularly beneficial when working with families of injured military.

Scoping review of claimants' experiences within Australian workers' compensation systems.

Objective The aim of this scoping review was to map the literature on the lived experiences of injured workers in Australia in order to better understand the factors that inhibit the transition back to work and improved health. The ultimate aim of the study was to identify areas for further research into workers' compensation systems and practices that are associated with improved occupational rehabilitation outcomes. Methods PubMed, ProQuest, Embase and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched for eligible articles published in English in peer-reviewed journals from 2001 to 2017. Narrative data synthesis was used to analyse the data collected from included articles. Results Twelve articles examining injured workers' experiences within Australian workers' compensation systems were identified. Injured workers reported similar experiences across states and territories in Australia. Four common themes and three subthemes were noted, namely: (1) relationships and interactions; (2) injured workers' perceptions (subthemes: mental health effects, social effects and financial effects); (3) the workers' compensation process; and (4) independent medical evaluations. Conclusions There are common difficulties that injured workers experience within Australian workers' compensation systems that are reported to impede rehabilitation and return to work. A less harmful, more cooperative approach to worker rehabilitation and compensation is needed. What is known about the topic? Different workers' compensation systems exist throughout Australia. Little is known about injured workers' perceptions of their experiences within these systems in Australia and whether these experiences are similar or different across systems. What does this paper add? This scoping review synthesises available evidence showing that injured workers report negative experiences of workers' compensation systems, and that this experience is similar across the different systems. This review also identified a clear need for future research on workers' compensation systems in order to promote evidence-based approaches to best support the occupational rehabilitation of injured workers. What are the implications for practitioners? Evidence suggests a more holistic, biopsychosocial approach is required by practitioners when facilitating an injured worker's recovery and return to work. This approach is also vital when considering legislative reforms, such as workers' compensation systems, processes and practices.

Sensory coding and cognitive processing of sound in Veterans with blast exposure.

Recent anecdotal reports from VA audiology clinics as well as a few published studies have identified a sub-population of Service Members seeking treatment for problems communicating in everyday, noisy listening environments despite having normal to near-normal hearing thresholds. Because of their increased risk of exposure to dangerous levels of prolonged noise and transient explosive blast events, communication problems in these soldiers could be due to either hearing loss (traditional or "hidden") in the auditory sensory periphery or from blast-induced injury to cortical networks associated with attention. We found that out of the 14 blast-exposed Service Members recruited for this study, 12 had hearing thresholds in the normal to near-normal range. A majority of these participants reported having problems specifically related to failures with selective attention. Envelope following responses (EFRs) measuring neural coding fidelity of the auditory brainstem to suprathreshold sounds were similar between blast-exposed and non-blast controls. Blast-exposed subjects performed substantially worse than non-blast controls in an auditory selective attention task in which listeners classified the melodic contour (rising, falling, or "zig-zagging") of one of three simultaneous, competing tone sequences. Salient pitch and spatial differences made for easy segregation of the three concurrent melodies. Poor performance in the blast-exposed subjects was associated with weaker evoked response potentials (ERPs) in frontal EEG channels, as well as a failure of attention to enhance the neural responses evoked by a sequence when it was the target compared to when it was a distractor. These results suggest that communication problems in these listeners cannot be explained by compromised sensory representations in the auditory periphery, but rather point to lingering blast-induced damage to cortical networks implicated in the control of attention. Because all study participants also suffered from post-traumatic disorder (PTSD), follow-up studies are required to tease apart the contributions of PTSD and blast-induced injury on cognitive performance.

Effects of Modified Hatha Yoga in Industrial Rehabilitation on Physical Fitness and Stress of Injured Workers.

PURPOSE: The purpose of this study was to assess the effects of 8 weeks of modified hatha yoga training on physical fitness and stress level in injured workers. METHODS: Eighteen male and female injured workers, age between 18 and 55 years, participated in this study. They were divided into two groups: an additive hatha yoga training to routine industrial rehabilitation program group (HYG: n = 9) and a control group with no yoga training (CG: n = 9). A modified hatha yoga protocol was designed for this population by two certified yoga instructors, approved by a physical therapist, and conducted for 1 h, three times weekly for 8 weeks. Physical fitness variables including flexibility of lower back and hamstrings, hand grip strength and lung capacity and scores of sensitivity to stress were evaluated at the time of recruitment and after 8 weeks of intervention. RESULTS: The values of all physical fitness variables and stress scores were no significant difference between the two groups at baseline. Significant post-yoga improvements for HYG group were noted in flexibility, hand grip strength, and vital capacity (p < 0.05). In contrast, there was no significant change in the CG group. Stress scores did not change as a result of hatha yoga training. CONCLUSION: An 8-week modified hatha yoga training experience exerted therapeutic effects on physical fitness variables including flexibility of lower back and hamstrings, hand grip strength and vital capacity, but not on stress level in injured workers. These findings indicate that hatha yoga can be a beneficial adjunct to routine physical therapy treatment in industrial rehabilitation programs.

Use of complementary and alternative medicine for work related musculoskeletal disorders associated with job contentment in dental professionals: Indian outlook.

BACKGROUND: High prevalence rates of work-related musculoskeletal disorders (WRMSD) among dentists have been reported. Complementary and alternative medicine (CAM) therapies can be helpful in managing and preventing work-related musculoskeletal disorders. The purpose of this study was to determine if dental professionals are using CAM for work-related musculoskeletal disorders. Who have greater job satisfaction: dentist who uses Complementary and alternative medicine (CAM) or conventional therapy (CT) as a treatment modality for WRMSD. METHOD: Dentists who registered in Uttar Pradesh state, India under Indian Dental Council, Uttar Pradesh branch (n=1134) were surveyed. Data were analyzed using univariate and bivariate analyses and logistic regression. RESULT: A response rate of 53% (n=601) was obtained, revealing that 82% (n=487) of the respondents suffered from work-related musculoskeletal disorders. The use of complementary and alternative medicine or conventional therapy was reported among 80% (n=390) of the dentists with work-related musculoskeletal disorders. Complementary and alternative medicine users reported greater overall health compared to conventional therapy users (P<0.001). Of those with work-related musculoskeletal disorders, 35.5% (n=172) considered a career change for once, and 4.0% (n=19) reported having left dentistry. CONCLUSION: Complementary and alternative medicine therapies may improve quality of life, reduce work disruptions and enhance job satisfaction for dentists who suffer from work-related musculoskeletal disorders. It is important that dentists incorporate complementary and alternative medicine strategies into practice to facilitate musculoskeletal health that will enable longer and healthier careers, increase productivity, provide safer workplace and prevent musculoskeletal disorders.

Job demands, job resources and safety outcomes: The roles of emotional exhaustion and safety compliance.

The aim of this study was to assess the effectiveness of the job demands-resources (JD-R) model in explaining the relationship of job demands and resources with safety outcomes (i.e., workplace injuries and near-misses). We collected self-reported data from 670 crude oil production workers from three sub-companies of a major oilfield company in China. The results of a structural equation analysis indicated that job demands (psychological and physical demands) and job resources (decision latitude, supervisor support and coworker support) could affect emotional exhaustion and safety compliance, and thus influence the occurrence of injuries and near-misses. The implications of the present findings regarding both the JD-R model and occupational safety research were discussed.

[Rehabilitation after occupational accidents in professional dancers: advice with due regard to dance specific aspects]. / Rehabilitation nach Arbeitsunfällen im professionellen Bühnentanz: Empfehlungen unter Berücksichtigung tanzmedizinischer Gesichtspunkte.

The highly specialized occupation of professional dancers is a combination of sport and artistic expression. The exertion is only possible with a fully operative body. Although professional dancers may be compared with elite athletes and acute injuries frequently happen, dancers do not seem to be granted an appropriate therapy after accidents as compared with athletes. Although even minor injuries may potentially endanger the career of a professional dancer, physiotherapeutic or physical treatment methods are applied in every tenth case only. Alternative and holistic concepts such as Pilates or dance-specific re-integration that proved successful in professional dancers, are used in even fewer instances. The aim of this study is to develop a rehabilitation concept for professional dancers focusing on dance-medicine aspects. It has been taken into account that the best physical outcomes are reflected in an optimized, holistic, dance-specific therapy and rehabilitation. Intensifying and exploiting dance-specific methods of treatment can not only reduce costs in the end but can even contribute to reducing the duration of rehabilitation after injuries of dancers. Preconditions for realization of the rehabilitative model are a high qualification of all persons working in the rehabilitative field as well as a marked willingness to cooperate in the various dance fields. Both gender-specific and dance-style particularities are to be taken into account to ensure a successful rehabilitation.