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2.
Psychother Psychosom Med Psychol ; 74(7): 265-275, 2024 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-38492566

RESUMO

OBJECTIVE: The post-COVID consultation (PCC) is offered as part of a comprehensive range of treatment services provided by the statutory accident insurance for post-COVID patients to determine individual recommendations for further care. The aim of the study was to record the main symptoms and the associated restrictions on social and occupational participation in order to derive consequences for outpatient rehabilitation. METHOD: In addition to a medical examination and a psychological consil, numerous assessments were carried out to evaluate the biopsychosocial state of health. 373 female (82.2%) and 81 male patients aged between 40 and 60 years from the professions of health and care services, education and pedagogy participated in the PCC since April 2021. RESULTS: Nearly all patients (98.2%) reported fatigue as a cardinal symptom of their post-COVID complaints, in combination with subjectively experienced limitations in brain functioning in over 73% of cases. The duration of the symptomatology persisted for an average of 14-15 months in both female and male insured persons. Thus, over 85% of the total sample can be classified as cases of chronic fatigue (Fatigue Scale). The severity of fatigue also proportionally affects quality of life (SF-36), feelings of anxiety and depression (HADS), psychological resilience (RS-13), and motor parameters such as maximum grip strength and endurance capacity. 54.3% of the patients also received a suspected mental diagnosis and 38.1% a recommendation for further neuropsychological diagnostics. CONCLUSION: For further treatment of the leading symptom of chronic fatigue, a multimodal and interdisciplinary outpatient rehabilitation is recommended, which should be oriented towards the treatment of the diagnosis of chronic fatigue syndrome (ME/CFS) and thus in particular towards a psychoeducational and rather than a curative therapeutic approach, and should consider aftercare strategies. Confirmed mental disorders and neuropsychological deficits are to be treated in addition.


Assuntos
COVID-19 , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , COVID-19/psicologia , Qualidade de Vida , Síndrome de Fadiga Crônica/reabilitação , Síndrome de Fadiga Crônica/psicologia , Síndrome de Fadiga Crônica/terapia , Seguro de Acidentes , Alemanha , Assistência Ambulatorial , SARS-CoV-2 , Encaminhamento e Consulta
3.
Contact Dermatitis ; 90(3): 291-298, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38043569

RESUMO

BACKGROUND: Due to limited availability of commercial test preparations, patch testing patient's own material (POM) is of great importance to diagnose occupational allergic contact dermatitis. OBJECTIVES: To assess the quality of performance and documentation of patch testing with POM in patients with suspected occupational skin diseases (OSD) in Germany. METHODS: Retrospective-prospective analysis of protocols of patch tests with POM was conducted between 2013 and 2021 in patients with suspected OSD and submitted to statutory accident insurance institutions. Assessments were done by predefined criteria. RESULTS: Three thousand and four patch tests with POM from 460 patients were included. A full description of the POM was provided in 73.3% of all tests. The test concentration, test vehicle and pH value were documented in 74.3%, 70.5% and 42.2% of tests, for which the respective parameters were considered relevant. One hundred and sixty-one positive reactions to POM were documented. In 72%, sufficient patch testing with commercial test substances was conducted to investigate the positive reaction. In 30.4%, consecutive patch testing of all ingredients of the POM was done. CONCLUSIONS: The results not only show considerable shortcomings mainly in documentation but also to some extent performance of patch tests with POM in patients with suspected OSD in Germany.


Assuntos
Dermatite Alérgica de Contato , Dermatite Ocupacional , Humanos , Testes do Emplastro/métodos , Dermatite Alérgica de Contato/diagnóstico , Dermatite Alérgica de Contato/etiologia , Estudos Retrospectivos , Seguro de Acidentes , Dermatite Ocupacional/diagnóstico , Dermatite Ocupacional/etiologia , Alemanha , Alérgenos
4.
Orthopadie (Heidelb) ; 53(1): 56-68, 2024 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-37917189

RESUMO

Private accident insurance complements the offer provided by statutory accident insurance in Germany. Private accident insurance can be taken out on a voluntary basis with private insurance companies. The amount of compensation paid in the event of accidents is subject to the dismemberment schedule (Gliedertaxe) and the permanent impairment of the physical or mental capacity, which is to be determined by a medical practitioner. The essay describes the development of the medical recommendations for assessing disability from the origins of private accident insurance in the 19th century to the present. It also considers individual scientific articles from medial personalities and the importance of accident surgery and orthopaedic specialist societies for the development of relevant assessment criteria and disability tables (Invaliditätstabellen) of private accident insurance.


Assuntos
Avaliação da Deficiência , Seguro de Acidentes , Prova Pericial , Acidentes , Alemanha
5.
Rehabilitation (Stuttg) ; 62(5): 308-318, 2023 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-37848041

RESUMO

Changes in the employment market and improvements in the current prosthetic treatment have encouraged German Statutory Health Insurance e. V. (DGUV) to re-examine the standard values for reduced earning capacity after work related accidents. The new standard values for reduced earning capacity came into force on 01.11.2019. The present article summarises the consensus paper of the group of independent experts.


Assuntos
Seguro de Acidentes , Programas Nacionais de Saúde , Humanos , Alemanha , Renda , Emprego
6.
Unfallchirurgie (Heidelb) ; 126(9): 736-746, 2023 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-37405507

RESUMO

The following article is an element of a 4-part series on the presentation and discussion of new design recommendations for disability compensation in the private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the design recommendations for the upper and lower extremities have already been published in Die Unfallchirurgie (formerly Der Unfallchirurg) on 17 February, 18 July and 18 November 2022 [2-4]. The topic of the fourth and final part published here is the assessment recommendations for disability outside the compensation scheme.


Assuntos
Avaliação da Deficiência , Seguro de Acidentes , Acidentes , Consenso , Humanos
7.
Chirurgie (Heidelb) ; 94(8): 703-713, 2023 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-37266705

RESUMO

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic resulted in many infections with the virus and sickness due to coronavirus disease 2019 (COVID-19). Therefore, there was a dramatic increase in the number of reported and recognized occupational diseases (Berufskrankheit, BK) and occupational accidents (Arbeitsunfall, AU) at the German Social Accident Insurance Institutions (BG) and accident insurance funds (Unfallkassen).The publication aims to show the differences between BK and AU and to review the current data on occupational diseases. It deals with the definitions of BK and AU, the differences in the conditions for recognition as BK or AU. Furthermore, the claims for benefits are presented. Finally, statistical key figures of the BK according to No. 3101 and the AU are presented.Results (key points)- According to § 7 SGB VII, AU and BK are insured events of the statutory accident insurance.- In surgery, like specifically in the rest of the healthcare system, the relevance of the SARS-CoV­2 infection with post-COVID in personnel for occupational medical prevention and as a case to be recognized by the statutory accident insurance (BK or AU) becomes clear.- Relevant for the recognition are the duration and the intensity of the contact (local proximity) and the SARS-CoV­2 occupational health and safety rule of 20 August 2020 essentially recognizes a contact duration of at least 15 min at a spatial distance of less than 1.5-2 m (further aspects: more intensive shorter contacts, number of verifiably infected persons in the closer activity environment or the usual personal contacts, spatial situation, work route, special constellations).- No case numbers can be elicited for the detailed presentation of the surgery setting.- There are still immense problems and challenges in the assessment of COVID-19 consequences or post-COVID as occupational disease, as numerous uncertainty factors, such as insufficiently secured knowledge about the further long-term course over the years or the widely varied symptom spectrum complicates the medical assessment of the consequences of this disease.Conclusion: the SARS-CoV­2 pandemic is a special challenge for surgery with intensive patient contact and for the entire healthcare system. This caused long-lasting changes and the adequate health care as well as insurance law processing of the (case-specific) consequences might still require considerable efforts and resources.


Assuntos
COVID-19 , Doenças Profissionais , Cirurgiões , Humanos , COVID-19/epidemiologia , COVID-19/complicações , Acidentes de Trabalho/prevenção & controle , Seguro de Acidentes , SARS-CoV-2 , Doenças Profissionais/diagnóstico , Doenças Profissionais/etiologia
8.
Dermatologie (Heidelb) ; 74(6): 393-401, 2023 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-37219622

RESUMO

Since January 1, 2021, recognition of occupational hand eczema as an occupational disease (OD) No. 5101 has been made significantly easier by eliminating the obligation to cease and desist work in the eczema-eliciting job. As a result of this change in OD law, an occupational disease can now also be recognized if the patient continues the (eczema-eliciting) work. This results in a significantly higher liability for accident insurance companies to enable high-quality care for affected patients by the dermatologist-and this, if necessary, in the long term until retirement. The number of recognized OD No. 5101 cases has already increased tenfold (around 4000 cases per year). Work-related hand eczema must be treated as quickly as possible in order to avoid a protracted course of the disease and job loss. Accordingly, those affected should be reported quickly to the accident insurance (dermatologist's report and/or OD notification). After the notification, in addition to the granting of outpatient treatment, the reporting dermatologist has an extensive range of preventive measures available (including skin protection seminars and inpatient treatment). In addition, there are no prescription fees and even basic skin care can be prescribed ("basic therapy"). The extra-budgetary care of hand eczema as a recognized occupational disease is associated with many advantages for the dermatologist's practice and the patient.


Assuntos
Dermatite Ocupacional , Eczema , Humanos , Seguro de Acidentes , Dermatite Ocupacional/diagnóstico , Eczema/epidemiologia , Qualidade da Assistência à Saúde , Registros
9.
Injury ; 54(8): 110848, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-37258403

RESUMO

INTRODUCTION: Pelvic and acetabular fractures can result from work-related accidents and frequently require lengthy medical treatments. Consequently, high medical costs as well as delayed or absent return to work can be the consequence. Therefore, we aimed to study the socioeconomic consequences of work-related pelvic and acetabular fractures. MATERIALS AND METHODS: This retrospective study investigated work-related pelvic and acetabular fractures recorded in the German Social Accident Insurance in 2011 and 2017, in terms of age, sex, type of accident, duration of incapacity to work, reductions in earning capacity, costs for outpatient and inpatient treatment and costs for pension and severance pay. RESULTS: Among a total of 606 injuries in 2011 and 619 injuries in 2017, male patients and patients between 40 and 65 years were predominantly affected. Acetabular fractures caused higher rates of long absence from work of 6-12 months (2011: 24.7% vs. 9.5-16.9%; 2017: 26.1% vs. 6.1-11.0%) and >12 months (2011: 15.8% vs. 9.8-10.2%; 2017: 13.3% vs. 1.9-8.2%) as well as more cases with a reduction in earning capacity of at least 20% (2011: 61 vs. ≤27 cases; 2017: 39 vs. ≤12 cases) compared to pelvic ring fractures. The total costs for pelvic ring and acetabular fractures in the German social accident insurances amounted € 18,726,630 and € 9637,189 in the periods 2011-2020 and 2017-2020, respectively. The average costs per case for treatment and rehabilitation until 2020 was € 19,079 for injuries from 2011 and € 13,629 for injuries from 2017. Acetabular fractures were found to be the most cost-intensive injuries compared to anterior, posterior or complex pelvic ring fractures. CONCLUSIONS: Work-related pelvic and especially acetabular fractures have a considerable socioeconomic impact in the German Social Accident Insurance. Measures to prevent work-related accidents and to improve treatment of pelvic injuries can help to reduce their socioeconomic burden.


Assuntos
Fraturas Ósseas , Fraturas do Quadril , Ossos Pélvicos , Fraturas da Coluna Vertebral , Humanos , Masculino , Seguro de Acidentes , Acetábulo/lesões , Estudos Retrospectivos , Fraturas do Quadril/complicações , Fraturas Ósseas/etiologia , Fraturas da Coluna Vertebral/complicações , Ossos Pélvicos/lesões , Acidentes , Fatores Socioeconômicos
10.
Unfallchirurgie (Heidelb) ; 126(5): 351-365, 2023 May.
Artigo em Alemão | MEDLINE | ID: mdl-37072502

RESUMO

The evaluation of permanent dysfunction after injuries to the musculoskeletal system is one of the core activities of a trauma surgeon and orthopedists. Based on the knowledge of the injury and an accurate description of the dysfunction, the medical expert then makes a proposal regarding the amount of the reduction in earning capacity (Minderung der Erwerbsfähigkeit, MdE). The amount is based on the MdE tables, which have been derived from a decade-long harmonization and coordination between administrative authorities, courts and the medical profession. They have been published in the fundamental guidelines for evaluation. Individual recommendations are subject to change; however, the benchmark figures for amputations have not changed significantly since the introduction of the statutory accident insurance in 1884, although the treatment with prostheses has continuously improved. The benchmark for the MdE is the labor market which becomes unavailable to the insured person due to the dysfunction. In the Social Code for Employment Accident Insurance (Sozialgesetzbuch für die Unfallversicherung, SGB VII), the reduction in earning capacity is defined and the amount "… is based on the extent to which job opportunities are available as a result of the impairment of the physical and mental capacity across the entire area of the working life". The article traces the history of this central instrument for measuring the sequelae of accidents. In this context it is shown that the MdE values did not in fact arise concurrently with the introduction of statutory accident insurance at the end of the nineteenth century but date back to the millennia-old principle of the law of talion (ius talionis). This is the basic form of material civil liability law, according to which the injuring party must compensate the injured party in the case of a culpable impairment of health for the resulting material loss. Here the loss of earnings, the impairment of the capacity to work or, in other words, the reduction in earning capacity is of paramount importance. In the middle of the nineteenth century, private accident insurers developed dismemberment schedules based on the principle of ius talionis. These dismemberment schedules were adopted by the professional organizations after 1884. The highest competent instance for social security matters, which was the Imperial Insurance Office (Reichsversicherungsamt), redefined the dismemberment schedules: the values for the dismemberment schedules then became the benchmark for the reduction of capacity to work (Erwerbsminderung, EM) and subsequently the reduction in earning capacity (MdE). The fact that the MdE values have remained stable over more than 100 years support the view that they not only grant legal certainty but are also regarded as appropriate and fair by both the persons affected and society.


Assuntos
Prova Pericial , Seguro de Acidentes , Humanos , Acidentes , Emprego , Causalidade
11.
Urologie ; 62(3): 229-240, 2023 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-36867214

RESUMO

BACKGROUND: Previous assessment guidelines from standard sources for urologic expert opinions show considerable differences in the recommended percentages for the assessment of reduction of earning capacity (MdE) for accident sequelae in the neuro-urological specialty. OBJECTIVES: To develop a "revised and standardized version of the MdE assessments of neuro-urological accident sequelae (in tabular form) as a guideline/manual" for expert opinions in the legal area of the German and Austrian Statutory Accident Insurance ( www.dguv.de , www.auva.at ). MATERIALS AND METHODS: A working group of neuro-urologists from spinal cord injury centers of different BG ("Berufsgenossenschaft") clinics was formed within the working group Neuro-Urology of DMGP (German-speaking Medical Society for Paraplegiology; www.dmgp.de ). Between January 2017 and September 2022, a total of 7 working meetings and 2 video conferences were held. The consensus of the developed documents was reached by formal consensus finding in a nominal group process and in a final consensus conference. RESULTS: The necessary bases for a targeted, legally sound diagnosis of accident consequences in the neuro-urological field were elaborated and, based on the experience of many years of expert opinion activity, a "matrix" for a uniform, graduated assessment of the level of reduction of earning capacity in the (neuro-)urological field in the case of confirmed neuro-urological accident consequences was created. CONCLUSION: In the interest of equal treatment of all insured persons, it is of great importance to make a uniform and comprehensible assessment of the amount of the MdE on the basis of "table values" that reflect the available empirical values.


Assuntos
Traumatismos da Medula Espinal , Urologia , Humanos , Prova Pericial , Seguro de Acidentes , Traumatismos da Medula Espinal/complicações , Acidentes
12.
Unfallchirurgie (Heidelb) ; 126(6): 468-476, 2023 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-36917224

RESUMO

BACKGROUND: In Germany around 1 Million working and commuting accidents per year are officially registered. Since several years this number is constantly at this high level, only just since the appearance of the actual Covid pandemia significantly lower because of lockdowns and increase of homeoffice workplaces. OBJECTIVE: To ensure the professional care of psychotraumatic sequelae of work-related injuries, in 2012 new regulations were introduced by the DGUV, the national umbrella organization of the German statutory health insurances. This healthcare reform (named "Psychotherapeutenverfahren", verbally translated: psychotherapists' procedure) is looked at 10 years later. Is the new regulation accepted by the surgeons' community? What case constellations can be observed? MATERIAL AND METHODS: The use of this new instrument among trauma surgeons was evaluated by national data for the complete years 2013-2021. Additionally, we include regional data and case reports from a multidisciplinary medical facility including trauma surgery and psychiatry, located in Güstrow (Northeast Germany). RESULTS: Nationwide the percentage of psychotherapy amongst the regular treatment has doubled between 2013 and 2021 from 0.47 to 0.96%. DISCUSSION: Looking at the first 10 years of its clinical implementation, the new German psychotherapy regulation is apparently well accepted by the accident insurance consultants. As data from population based studies are not available, the actual percentage of psychological sequelae of accidents in this cases is not known yet. So there is further need of research and training in this interdisciplinary field to ensure appropriate treatment of victims of work-related accidents. The integration of psychotraumatological facts in the educational agendas of accident insurance consultants has already started.


Assuntos
COVID-19 , Seguro de Acidentes , Humanos , Consultores , Controle de Doenças Transmissíveis , Psicoterapia
13.
Rehabilitation (Stuttg) ; 62(1): 48-59, 2023 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-36780928

RESUMO

It is one objective of German Social Accident Insurance (DGUV) to restore the health and performance of insured persons after an accident "using all appropriate methods". Because of the legal requirements, possible rehabilitation may greatly differ from that provided by sickness or pension insurance. This article provides an overview of the available treatments after accidents at work and the rehabilitation phase in which they may be used.


Assuntos
Seguro de Acidentes , Programas Nacionais de Saúde , Humanos , Pacientes Internados , Pacientes Ambulatoriais , Alemanha , Acidentes
14.
Z Orthop Unfall ; 161(5): 491-499, 2023 Oct.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-35196737

RESUMO

OBJECTIVE: To analyse the results after tibial plateau fractures with a focus on socioeconomic consequences. METHODS: On the basis of the data from the rehabilitation documentation of the German Statutory Accident Insurance (DGUV) on tibial plateau fractures (Code 83), a retrospective anonymised evaluation of the injuries which occurred in 2010 and 2016 was carried out. The registry data allowed subdivision into 3 groups: Medial, lateral and bicondylar tibial plateau fractures. The data have been analysed with regard to the following parameters: age, gender, treatment, time of return to work (AU), costs per case, total costs, workers compensation (MdE) and total payments. RESULTS: The analysis includes 1046 isolated tibial plateau fractures for 2010 and 1072 for 2016. In 2016, 798 fractures could be assigned to the medial, lateral or bicondylar fracture groups. In 551 cases, both condyles were involved. In another 221 cases, the lateral plateau and in 26 the medial plateau was injured. There were 476 (59.7%) men and 322 (40.4%) women. The mean age was 43.4 (SD ± 16.7) years with a peak of 180 cases in the 55-60 year subgroup and 98 aged 15-20 years. The mean age of the cases with isolated lateral plateau involvement was 48.1 (SD ± 13.8) and was 47.5 (SD ± 16.6) in those with medial plateau fractures and 41.4 (SD ± 17.2) years in the subgroup with bicondylar patterns. The mean time of return to work was 39.4 (SD ± 25.3) weeks for the bicondylar tibial plateau fractures, 28.1 (SD ± 27.2) weeks for the medial and 24.5 (SD ± 22.8) weeks for the lateral groups. For the 2016 group, the mean costs were 5212 € for outpatient, 10358 € for inpatient and 7622 € for rehab costs per case (total costs over three years of 4247443 € for outpatient and 7506508 € for acute inpatient treatment). The highest costs per case were caused by the inpatient acute treatment of bicondylar tibial plateau fractures, at a mean of 22292 €. 17.6% of the 2016 casualty group resulted in compensation of at least 20%. The treatment costs for the 2010 group over 9 years (2010-2019) amounted to 4190855 € for outpatient treatments and € 9565313 for inpatient treatments. In addition, compensations of 8632448 € and lump-sum payments of 483289 € were paid from 2010 to 2019. Over a period of 9 years, 456 (66%) of 692 patients needed another in patient follow-up treatment. A total of 51% (n = 353) needed these treatments within the first year. CONCLUSION: Tibial plateau fractures, in particular bicondylar tibial plateau fractures, show long-term, cost-intensive healing processes with reduced occupational capacity. Tibial plateau fractures are of economic importance in the statutory accident insurance in the long term. Preventive measures, optimal care and rehabilitation are therefore essential, together with innovative research to improve clinical outcomes.


Assuntos
Fraturas da Tíbia , Fraturas do Planalto Tibial , Masculino , Humanos , Feminino , Adulto , Estudos Retrospectivos , Seguro de Acidentes , Fraturas da Tíbia/epidemiologia , Fraturas da Tíbia/cirurgia , Tíbia , Fixação Interna de Fraturas/métodos
15.
Unfallchirurgie (Heidelb) ; 126(1): 77-86, 2023 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-36520200

RESUMO

The following article is an element of a 4-part series on the presentation and discussion of new assessment recommendations for disability compensation in the private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the assessment recommendations of the upper extremities have already been published in Die Unfallchirurgie (previously Der Unfallchirurg) on 17 February and 31 August 2022 [2, 3]. The topic of the third part published here is the assessment recommendations for disability in the lower extremities within the compensation scheme.


Assuntos
Pessoas com Deficiência , Seguro de Acidentes , Humanos , Avaliação da Deficiência , Consenso , Prova Pericial
17.
Urologie ; 61(11): 1179-1185, 2022 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-36280644

RESUMO

Tumors of the urinary tract are among the most common types of occupational cancer. A significant proportion of about 5-15% may be of occupational etiology. Suspicion of an occupational genesis is subject to mandatory reporting. However, epidemiological analyses show that the number of reports received by accident insurance companies and employers' liability insurance associations is significantly lower than expected. Finally, the economic and administrative effort in surveying a patient's occupational history hinders adequate reporting. By routinely and systematically using a structured questionnaire as part of clinical routine in our hospital, a significantly improved detection of justified suspected cases (from about 4.8% to about 67% of the theoretically expected value) has been achieved since about 2006. In addition to improved medical care and adequate compensation for recognition as an occupational disease, disease-related care is subject to extra-budgetary remuneration in Germany (UV-GOÄ).


Assuntos
Doenças Profissionais , Neoplasias Urológicas , Humanos , Incidência , Doenças Profissionais/diagnóstico , Seguro de Acidentes , Seguro de Responsabilidade Civil , Neoplasias Urológicas/diagnóstico
18.
Unfallchirurgie (Heidelb) ; 125(10): 825-836, 2022 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-36045263

RESUMO

The following article is one component of a four-part series on the presentation and discussion of new assessment recommendations for disability compensation in private accident insurance. The introduction to the topic and the associated basics as well as the concept of the new draft of the assessment recommendations have already been published in the Der Unfallchirurg on 17 February 2022. The topic of the second part published here is the assessment recommendations for disability of the upper extremities within the compensation scheme.


Assuntos
Pessoas com Deficiência , Seguro de Acidentes , Avaliação da Deficiência , Prova Pericial , Humanos , Extremidade Superior
19.
HNO ; 70(10): 718-723, 2022 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-35471552

RESUMO

Expert assessment of traumatic damage in the head and neck area by the adjuster broadly comprises two main questions: does a causal relationship between the complaint and the specific insured event exist, and what is the extent of the damage? A relationship is probable if the trauma is quantitively and qualitatively suitable to have caused the existent damage. A particularly difficult scenario is represented by cases lacking pre-accident findings or when the claimant claims that pre-existing hearing loss or tinnitus has been worsened by the event or that the accident was the cause of the impairment. It must also be taken into account that claimants frequently relate their complaints to an insured event due to causal thinking. Comprehensive tables are available for evaluation of the extent of the damage in otorhinolaryngology. In statutory accident insurance, the health damage is "considerable" if it leads to a reduced earning capacity of at least 10%. In private accident insurance, physical damage is financially regulated at below 10% invalidity, e.g., 2-3%, although this is hardly possible to calculate using conventional tables. These and other difficulties are discussed in the article based on examples.


Assuntos
Perda Auditiva , Zumbido , Avaliação da Deficiência , Prova Pericial , Perda Auditiva/complicações , Humanos , Seguro de Acidentes , Zumbido/diagnóstico , Zumbido/etiologia
20.
Artigo em Inglês | MEDLINE | ID: mdl-35270710

RESUMO

BACKGROUND: There is limited research on the heterogeneity of worker suicides. We compared differences in workers' suicides by clustering suicide deaths. METHODS: From 2010 to 2017, 353 suicide deaths were claimed in the Industrial Accident Compensation Insurance; variables were coded using a standardized methodology. A two-step cluster analysis classified the clusters based on demographic and employment conditions. Details of the suicide, clinical variables, personal stresses, and work-related stresses were compared using the chi-square test and one-way analysis of variance. RESULTS: We identified five clusters and they differed particularly in work-related stress. "Responsibility-burdened type" experienced excessive responsibility as managers; "role-changed type" experienced a sudden and unpredictable role change as clerks or sales workers; "risk-exposed type" experienced physical risk factors at work (working alone, outdoors, and in shifts) as machine operating and assembling workers, or craft and related trades workers; "job-insecurity type" experienced unstable employment (irregular, nonpermanent) as elementary or service workers; "workplace-violence type" was mainly unmarried women who lived alone, and experienced interpersonal conflict and violence as professionals and related workers. There were no differences between clusters in clinical variables (except problem drinking) and personal stresses. CONCLUSION: Interventions to alleviate work-related stress in worker clusters are needed to prevent suicide in workers.


Assuntos
Estresse Ocupacional , Suicídio , Acidentes de Trabalho , Feminino , Humanos , Seguro de Acidentes , Estresse Ocupacional/epidemiologia , República da Coreia/epidemiologia , Indenização aos Trabalhadores
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