[Evaluation of Double Vision - One Way to Look at it]. / Begutachtung von Doppelbildern ­ eine Betrachtungsweise.

For private accident insurance, the article describes double vision zones and how they are used in various disorders of ocular motility with double vision.

[The new medical treatment procedure of the German Statutory Accident Insurance: From the perspective of BG hospitals]. / Die neuen Heilverfahren der DGUV: Aus Sicht der BG Kliniken.

The Hospital Group of the Statutory Accident Insurance (BG hospitals) was affected by the new requirements for severe injury procedures (SAV) in the same manner as all other maximum care hospitals. Simultaneously, the BG clinics were merged to form a centrally organized hospital group. A substantial need for adjustment existed for specialties, such as neurosurgery and visceral surgery at some sites. Needless to say, all trauma victims benefit from the high standards required by the Statutory Accident Insurance regardless of their insurance status. The provision of medical treatment with respect to its implementation into routine practice must be further optimized and additions, e.g. for the occurrence of complications are necessary.

[The new treatment procedure of the German statutory accident insurance: From the perspective of a community hospital]. / Die neuen Heilverfahren der DGUV: Aus der Sicht eines Städtischen Krankenhauses.

The requirements of the German statutory accident insurance (DGUV) for the new treatment procedure were presented on 1 January 2013 in a new catalogue. The implementation of the certification of hospitals for the very severe injury procedure (SAV) by the DGUV should have been completed by 2014. These requirements placed high demands on trauma-oriented hospitals because of the high structural and personnel prerequisites. The background to the new organization was the wish of the DGUV for quality improvement in patient treatment in hospitals for patients with very severe occupational and occupation-related trauma by placement in qualified centers with high case numbers. No increase in income was planned for the hospitals to cope with the necessary improvements in quality. After 2 years of experience with the SAV we can confirm for a community hospital that the structural requirements could be improved (e.g. establishment of departments of neurosurgery, plastic surgery and thoracic surgery) but the high requirements for qualification and attendance of physicians on duty are a continuous problem and are also costly. The numbers of severely injured trauma patients have greatly increased, particularly in 2015. The charges for the complex treatment are not adequately reflected in the German diagnosis-related groups system and no extra flat rate funding per case is explicitly planned in the DRG remuneration catalogue. The invoicing of a center surcharge in addition to the DRG charges has not been introduced.

[New regulations for inpatient treatment of the statutory accident insurance: From the perspective of a university medical center]. / Neuordnung des stationären Heilverfahrens der Gesetzlichen Unfallversicherung: Aus Sicht einer Universitätsklinik.

BACKGROUND: New regulations of the German statutory accident insurance for inpatient treatment have been introduced. The aims of the new regulations are to improve cost-effectiveness and the quality of medical care. The introduction of the injury type catalogue and the severe injuries type procedure (SAV) has led to a concentration of resources. The purpose of these innovations is an increase in the quality of treatment of patients with complex injuries. CONCLUSION: The introduction of the new regulations resulted in a centralization of medical care in order to optimize the quality of treatment of complex injuries from occupational accidents. Hence, the high demands concerning infrastructure and human resources expected of a level one university medical center are taken into account.

[Evaluation of Field of Vision in Private Accident Insurance]. / Gesichtsfeldbewertung in der privaten Unfallversicherung.

A simple new scheme to evaluate defects in field of vision in private accident insurance.

[Implementation of the AWMF guideline for the assessment of mental disorders]. / Umsetzung der AWMF-Leitlinie zur Begutachtung bei psychischen Erkrankungen.

The assessment of mental health for sick pay and disability supplementary insurance (BUZ) has, in comparison to specialties like internal medicine or orthopaedic surgery, a traditionally low selectivity between BU/AF (sick pay) or BU/Non-BU (BUZ). Reliability, validity and objectivity were low. The appraisals were created individually according to the designee's experience and were very inhomogeneous in structure and quality. The publication of the guideline 051-029 in March 2012 provides improved grounds for the assessment of patients. In this article, we describe our experiences for the first twelve months after the implementation of the guideline.

Lesiones no intencionales. Factores de riesgo en seguridad vial y práctica de actividades acuáticas en adolescentes de 13 a 18 años / Unintentional injuries. Risk factors in road traffic safety and aquatic activity in 13 to 18 years old adolescents

Introducción: los accidentes o lesiones no intencionales constituyen un problema de salud pública por su prevalencia, morbimortalidad y elevados costes sanitarios. El conocimiento de los factores de riesgo de los accidentes ha permitido la elaboración de programas eficaces para su prevención y control. Objetivo: conocer la prevalencia de las lesiones no intencionales que han precisado atención médica en el último año y analizar las conductas de riesgo en seguridad vial y actividades acuáticas en los adolescentes de la provincia de Valladolid (España), así como su relación con diversos factores. Material y métodos: se realizó una encuesta a una muestra de 2412 escolares de 13 a 18 años de edad de la provincia de Valladolid durante el año 2012, con preguntas relacionadas con hábitos, comportamientos y conductas relacionadas con la salud. Se presentan los datos sobre accidentabilidad y factores de riesgo en seguridad vial y actividades acuáticas. Resultados: la proporción de adolescentes que han sufrido algún accidente o lesión que requirió asistencia médica en el último año fue del 14%. Como factores de riesgo en la seguridad vial, destaca que el 81,5% refiere no usar el casco cuando monta en bicicleta, el 6% en moto y un 1,2% no se abrocha el cinturón de seguridad cuando va en coche. Detectamos varios factores de riesgo de accidentes en actividades acuáticas. Diversas variables sociodemográficas, económicas y conductas de riesgo se asocian al riesgo de accidentabilidad. Conclusiones: encontramos en nuestro estudio factores de riesgo en la seguridad vial de los adolescentes y en la práctica de actividades acuáticas. Son necesarias medidas legislativas, campañas publicitarias y programas educativos en la escuela y en el medio sanitario, para reducir el riesgo de muerte y lesiones por accidentes en adolescentes (AU)

Introduction: unintentional injuries or accidents signify a public health issue due to their prevalence, morbidity, mortality and high health costs. Accident risk factors’ knowledge has allowed making efficient control and prevention programs. Objective: evaluating the unintentional injuries needing medical assistance during the last year and assessing Valladolid adolescents’ road traffic safety and aquatic activity practice risk behaviors and their relationship with other factors. Material and Methods: a survey with questions related to healthy habits, behaviors and conducts was conducted to a sample of 2412 students of 13 to 18 years old of Valladolid (Spain) during 2012. Data related with the risk of accident rate and risk factors on road traffic safety and aquatic activities. Results: 14% of adolescents have suffered some kind of accident or injury that required medical assistance during the last year. Road traffic safety risk factors were: not using safety helmet when riding a bicycle in 81.5% of adolescents and 6% in the case of riding a motorbike, 1.2% of them do not fasten their seat belt in cars. A few risk factors are noticed in aquatic activities practice. Several sociodemographic and economic variables and risk behaviors are associated with the risk of accident. Conclusions: our study identifies adolescents’ road traffic safety and aquatic activity practice’ risk factors. Legislative measures, publicity spots, educational programs in school and sanitary environment are required in order to reduce the adolescents’ risk of death and injuries in accidents (AU)

Prevención y discapacidad: modelo de gestión participativo / Prevention and disability: participatory management system

A partir del estudio de los accidentes del Grupo AMICA en los años 2006-2009 se determinó que ésta no era homogénea existiendo 2 puntos críticos: - AMICA: la movilización de personas con discapacidad en los centros de alojamiento, suponía más del 50% de los accidentes ocurridos. - SAEMA EMPLEO SL (Centro Especial de Empleo): aumento de la siniestralidad en un 50% entre los años 2006 a 2009. Frente a la reducción producida en el Grupo AMICA. Gerencia propuso desarrollar un plan de actuación específico para cada punto crítico, basado en la colaboración entre trabajadores y empresa, contando con el asesoramiento del ICSST. La aplicación práctica se llevó a cabo creando un grupo de trabajo en cada entidad compuesto por: - 2 delegados de prevención. - 2 técnicos del servicio de prevención. - 2 mandos intermedios. - Dirección técnica de AMICA / SAEMA EMPLEO SL. La dinámica de trabajo se estructuró realizando reuniones periódicas, en las que se analizaban los resultados de las medidas de mejora implantadas y se presentaban nuevas propuestas de actuación. Grupo de trabajo AMICA: a partir de los resultados de la evaluación ergonómica realizada, se decidió actuar sobre la formación de los trabajadores y mejorar las ayudas técnicas disponibles en los centros de trabajo. Grupo de trabajo SAEMA EMPLEO SL: se propuso mejorar la formación e información que reciben los trabajadores y revisar las condiciones de trabajo, actuando sobre las causas más frecuentes y las susceptibles de provocar los accidentes más graves (AU)

From the study of accidents of AMICA's Group in the years 2006 - 2009, it was determined that the accident rate was not homogeneous, there were two critical points: AMICA: moving and handling of disabled people in accommodation centers, was more than 50% of accidents. SAEMA EMPLEO S.L.: the accident rate increased by 50% between the years 2006-2009, against the reduction that took place in AMICA´s Group. Management proposed to develop a specific action plan for each critical point, based on the collaboration between workers and the company, with the advice of the ICASST. The practical application took place by creating a working party on each entity. They were composed of: 2 safety workers. 2 safety technicians of the Preventive Service. 2 senior managers. Technical manager of AMICA / SAEMA EMPLEO SL. Working dynamics was structured by holding regular meetings, where the results of the implemented improvement measures were analysed and new proposals for action were presented. AMICA working party: from the results of the ergonomic assessment, it was decided to act on the training of workers and to improve the technical aids available at the workplace. SAEMA EMPLEO SL working party: the proposal was to improve the training and information that workers receive and to review working conditions, acting on the most frequent accident causes and on the most likely to cause the most serious accidents (AU)

Revisiones de seguridad basadas en la conducta / BBS: behaviour based on safety reviews

Las Revisiones de seguridad basadas en la conducta (BBS: Behaviour based on Safety Reviews) son una herramienta preventiva que ayuda a identificar las conductas inseguras antes de que lleguen a tener lugar cualquier tipo de incidente. Con su práctica diaria en Arcelor Mittal Tailored Blanks Zaragoza se promueve la mejora de la percepción de los riesgos, las conductas seguras y la cultura preventiva de todos los trabajadores. Este es el camino hacia el 0 accidentes por elección; - Percepción del riesgo - Conducta Preventiva - Actitud Proactiva (AU)

Behaviour Based Safety audits system is a preventive tool which helps us to identify unsafe behaviours before the generation of any incident. Thanks to a daily practice at Arcelormittal Tailored Blanks Zaragoza we promote the risk perception improvement, safe behaviours and the preventive culture of all workers. This is the way to 0 accidents... by choice; - Risk perception - Preventive behavior - Proactive approach (AU)

Campaña global para la participación y concienciación en materia de seguridad y salud / Global campaign for participation and raising awareness in health and safety

La campaña global se apoya en el sistema de gestión de FCC y la nueva reorganización del trabajo, que contribuye a mantener y reforzar el objetivo principal de «Accidentes 0». Con este objetivo y a partir de la nueva estructura y gestión, la compañía ha lanzado varias líneas de trabajo y ha realizado nuevas actuaciones dirigidas a fortalecer la integración de la cultura preventiva y mejorar los resultados. El compromiso y la unificación de procesos, la optimización de recursos, la comunicación y el estímulo de los empleados son los pilares fundamentales de esta iniciativa. El objetivo de la campaña es fomentar la cultura preventiva a todos los niveles y favorecer la actitud positiva de los trabajadores hacia la prevención de riesgos laborales (AU)

The global campaign is based on the FCC H&S management system and the new reorganization work, that help to the maintenance and reinforcement of the main objective: «0 Accidents». From the new structure and management, with this objective the company has launched several lines of work and has made new actions aimed to reinforce H&S culture and to improve the results. The commitment and processes unification, adjusting resources, communication and employees incentive are the basic principles of this initiative. The objective of this campaign is the encouraging of H&S culture at all levels and the contributing to the positive attitude from workers to the H&S issues (AU)

[Recommendations for reporting benign asbestos-related findings in chest X-ray and CT to the accident insurances]. / Anzeigekriterien asbestfaserstaubbedingter Erkrankungen gemäss BK-Nr. 4103 BKV.

Asbestos-related diseases still play an important role in occupational medicine. The detection of benign asbestos-related diseases is one condition for the compensation of asbestos-related lung cancer in Germany. Due to the increasing use of computed tomography, asbestos-related diseases are more frequently detected in the early stages. The present article proposes recommendations for the findings which have to be reported as suspicious for being asbestos-related based on a) chest X-rays and b) computed tomography using the International Classification System for Occupational and Environmental Respiratory Diseases (ICOERD).

[Opinions issued by an expert appointed by a court in civil cases from the point of view of the defendant insurance company]. / Opinia bieglego sadowego w procesach cywilnych, z punktu widzenia pozwanego towarzystwa ubezpieczeniowego.

The paper presents and analyses problems which are encountered by an insurance company in connection with the opinions issued by experts appointed by a court in civil cases and concerning the evaluation of the results of accidents or damages in civil liability insurance. Every year, the group of physicians employed by the Office of Medical Services of Insurance at the PZU Zycie SA and PZU SA, issues opinions for about 3000 appeal and complicated cases from all over Poland. In some of the cases, an individual holding an accident insurance policy or an injured person in the case of civil liability insurance disagrees with the findings of the insurance company and brings the case to a civil court. About 7% of the opinions issued by the Office in 2005 were polemics with court experts, concerning their manner of classifying the results of an accident or an event which resulted in damage to an individual. Among the 200 opinions, there are several important and recurring problems, which are presented in the paper. The main doubts concern: 1. insufficient analysis of the circumstances of an event and drawing hasty conclusions about the cause-and-effect relationship, 2. claiming the certain occurrence of a cause-and-effect relationship, despite substantial doubts, 3. absence of analysis of general conditions of insurance, which in voluntary insurance may contain various exemptions and restrictions, 4. insufficient analysis of medical documentation containing information about some deviations before the event, 5. determining by the experts the degree of permanent loss of health despite the absence of functional impairment revealed in an examination, 6. determining permanent results of an accident based solely on unverifiable subjective complaints, 7. deciding about the percentage of permanent detriment to health in most cases on a slightly higher level than was decided by a physician who took such a decision for the insurance agency.

[Retrospective analysis of falls in an inpatient rehabilitation centre for rheumatic and orthopaedic diseases]. / Retrospektive Analyse von Stürzen und deren Ursachen in einem stationären Rehabilitationszentrum für Patienten mit Erkrankungen des Stütz- und Bewegungsapparates.

AIM: To analyse the frequency and circumstances of falls in an inpatient rehabilitation centre. METHODS: In a survey all falls reported to the Austrian accident insurance carrier were analysed and external circumstances of falls were evaluated. The survey covers a period of 64 months (Jan 2000 to April 2005): 10 820 inpatients (234 502 patient days); mean age 52.8 years; 1,252 patients aged >/= 70 years; 47 % male, 53 % female. RESULTS: Of 223 accidents registered, 140 (62.8 %) were falls. Of these, 17 patients had to be referred to a surgical unit for further treatment. In total, 1.29 % of all patients fell during their stay (with report to the accident insurance carrier), 0.16 % suffered major injuries from falls (with referral to surgical unit). Females fell more frequently than males. 39 % of the falls were associated with physical therapy. Most falls occurred in daytime. The location in the centre or the day of week showed no major influence on the frequency of falls. Falls occurred slightly more often in the first part of the three-week inpatient stay. CONCLUSION: The high total number of falls shows that falls are important in an inpatient rehabilitation centre for rheumatic and orthopaedic diseases. The analysis did not reveal any special location inside the rehabilitation centre with an increased risk of falls calling for urgent interventions. The active and activating physical therapies do not seem to increase the number of falls significantly.

Propuestas para baremo de las secuelas psíquicas derivadas de accidente de circulación / Proposals for scale of psychic sequels derived from traffic accidents

El baremo de indemnizaciones de la Ley 34/2.003 de 4 de noviembre de modificación y adaptación de la normativa comunitaria de la legislación de seguros privados incluye, entre otras secuelas derivadas de accidentes de circulación, los denominados "síndromes psiquiátricos". Nuestro trabajo estudia estos síndromes psiquiátricos y encuentra dos grandes defectos. En primer lugar, la catalogación de los mismos parece estar hecha al margen de las clasificaciones nosográficas internacionales (DSM IV y CIE X). En segundo lugar, la valoración cuantitativa a efectos indemnizatorios, solo en raros casos, se basa en criterios de gravedad sintomática y déficit funcional, como si hace al menos el eje V de DSM IV TR. Proponemos, en consecuencia, un nuevo baremo que, por una parte, clasifique las secuelas psíquicas según las categorías diagnósticas de las clasificaciones internacionales y, por otra, conceda valores a efectos indemnizatorios basados en criterios de gravedad sintomática y déficit funcional, como hace, por ejemplo, la Escala de Evaluación de la Actividad Global, EEAG (Global Assessment of Functioning, GAF)

The scale of reimbursement established in Law 34/2003 of 4 November modifying and adopting the community regulations for the legislation of private insurances includes, among other consequences derived from traffic accidents, the so-called "psychiatric syndromes". Our work analyses these psychiatric syndromes and observes two major defects. Firstly, catalogue appears to be made without considering international classifications (DSM IV and ICD X). Secondly, the quantitative assessment for reimbursement purposes is based, in only a very few cases, on criteria of symptomatic seriousness and functional deficit, as is at least, axis V of the DSM IV TR. We propose, therefore, the establishment of a new scale which, on one hand, classifies the psychic consequences according to the diagnostic categories of international classifications and, on the other hand, grants values for reimbursement purposes based on criteria of symptomatic seriousness and functional deficit, as is the case, for example with the Global Assessment of Functioning, (GAF)

Improving prognosis of type 1 diabetes. Mortality, accidents, and impact on insurance.

OBJECTIVE: Individuals with type 1 diabetes applying for insurance (life, health, accident, etc.) may either see their application being declined by the insurance company or find their premiums being substantially higher than the standard premium. During the last 40-50 years, the prognosis of patients with type 1 diabetes has improved dramatically, partly as a consequence of improved metabolic regulation and partly due to introduction of better treatment for late diabetic complications. The aim of the present study was to determine whether the increased premiums paid by diabetic patients for life insurance and accident insurance reflect the true risk of a diabetic individual. RESEARCH DESIGN AND METHODS: Mortality: 3,000 type 1 diabetic patients were followed for 12-51 years. The impact of age, sex, year of diagnosis, and development of nephropathy on excess mortality was analyzed. Accidents: A cohort of nearly 7,000 members of the Danish Diabetes Association participating in group accident insurance was followed for 3 years. The risk and outcome of accidents in the diabetic group was compared with similar risks in a nondiabetic group. RESULTS: Mortality: Over a 40-year period, the median life expectancy of type 1 diabetic patients increased by more than 15 years. The decrease was predominantly explained by a decreasing incidence of nephropathy, so that a simple model for estimating insurance premiums (including age of diagnosis, sex, and presence or absence of diabetic nephropathy) could be established. Accident insurance: Individuals with type 1 diabetes experienced a risk of accidents that was not in excess of that found in two control groups, and the outcome (degree of disability) after the accidents did not differ between the diabetic and the nondiabetic group. CONCLUSIONS: Type 1 diabetic patients still have a mortality in excess of nondiabetic individuals. Life insurance premiums should, however, always reflect the changing prognosis of type 1 diabetes and thus, continuous monitoring and revisions are needed. For accident insurance, we found no increased risk of accidents; thus, diabetic individuals should be offered accident insurance on normal terms.

O trabalhador acidentado na construçäo civil: sua trajetória na busca de seus direitos / The injured worker in the civil engineering industry: their trajectory in searching their rights

Nesta monografia é analisado o trabalhador acidentado na construçäo civil e sua trajetória na busca de seus direitos. Foi preocupaçäo revelar este trabalhador nas condiçöes de trabalho que lhe säo dadas. O cenário é aindústria da construçäo civil, seu papel estratégico na absorçäo dos trabalhadores brasileiros e sua significância enquanto ramo industrial com um dos maiores índices de ocorrência de acidentes do trabalho. Fechando o círculo investigativo e analítico apresenta a legislaçäo acidentária e a morosa tramitaçäo na conquista dos direitos do trabalhador acidentado. Buscou explicitar as relaçöes entre trabalhador acidentado. Buscou-se explicitar as relaçöes entre trabalhador acidentado/condiçöes de trabalho/legislaçäo acidentária, mais que tais elementos por si