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1.
Unfallchirurg ; 125(5): 417-421, 2022 May.
Artigo em Alemão | MEDLINE | ID: mdl-35347410

RESUMO

The centerpiece of a private accident insurer is the benefit promise in cases of disability, which must be determined by a doctor in due time. The insurer specifies the rates of the compensation scheme for loss or inability to function and the medical expert must then fall back on generally recognized, revised or updated assessment recommendations in order to be able to apply the given framework to the specific, individual situation of the insured person. In four steps (basics, upper and lower extremities [disability within the compensation scheme] and disability outside the compensation scheme) interdisciplinary consensus benchmarks for disability assessment are presented, which should form the basis of a uniform medical assessment of accident-related functional disorders in private accident insurance compensation.


Assuntos
Prova Pericial , Seguro de Acidentes , Acidentes , Avaliação da Deficiência , Humanos
2.
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
3.
Z Orthop Unfall ; 160(4): 435-441, 2022 Aug.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-33851404

RESUMO

BACKGROUND: Telemedicine can provide great benefits for patients, their physicians and other professionals in the health care system. We have asked ourselves whether a similar service could make a sensible contribution to the rehabilitation management of Germany's statutory accident insurance? PATIENTS/MATERIALS AND METHODS: In the present study, consultations of insured persons with their physicians and rehabilitation managers were transmitted via video conference. Patient satisfaction was determined by survey and potential benefits were analysed. RESULTS: The participants of the study were generally very satisfied with the telecounselling. In particular, 96% of their questions to the rehabilitation manager could be cleared up during the sessions. However, roughly a third of those surveyed prefer personal contact with the rehabilitation manager. CONCLUSION: Telecounselling is well received by the insured in the rehabilitation management of occupational insurance associations and offers a useful alternative when, due to lack of resources - such as lack of time or great distance - the rehabilitation plan cannot be prepared locally together with the insured patient. Under the special circumstances of the coronavirus pandemic, it can also contribute to protecting the health of all involved.


Assuntos
Seguro de Acidentes , Telemedicina , Aconselhamento , Humanos , Pandemias , Satisfação do Paciente
5.
Unfallchirurg ; 124(11): 891-901, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34648057

RESUMO

The medical assessment of affections of the apophyses frequently presents the assessor with problems in causality testing and estimation of functional impairment. Apophyses are the insertion of tendons and are therefore at the center of an acting parallelogram of forces. They fuse via an apophyseal plate in the second decade of life. Depending on the age there is a reduced mechanical load-bearing capacity of the apophyseal plates in the last 1-2 years before complete mineralization of the joint. Two types of injury must be distinguished in an expert opinion: apophyseal detachment as a result of repetitive microtrauma in the event of chronic overload and apophyseal avulsion fracture as an acute injury due to sudden maximum muscle tension. While chronic overload leads to exclusion from insurance cover by the statutory accident insurance, apophyseal avulsion fractures fulfil the necessary requirements for acceptance as an insurance case. The apophyseal avulsion fracture is subject to a time-limited force, which directly leads to damage to health and avulsion of the tibial tuberosity including its tension system. The sudden jerky maximum muscle pull leads to an overload of the tension system and avulsion of the apophysis in cases of an age-related vulnerable apophyseal plate. Once the mineralization is complete, this type of fracture no longer occurs. Osgood-Schlatter disease, an insertion tendinosis of the patellar tendon, occurs in around 20% of all sport-active adolescents but it is questionable whether it can be associated with the acute avulsion fracture. Knowledge of the pathogenesis of affections and injuries of the apophysis can provide the assessor with good foundations for the estimation of a causal association.


Assuntos
Traumatismos em Atletas , Fraturas Ósseas , Ligamento Patelar , Adolescente , Causalidade , Humanos , Seguro de Acidentes
6.
Unfallchirurg ; 124(11): 885-890, 2021 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-34609543

RESUMO

The student accident insurance has been part of the German Statutory Accident Insurance (Deutsche Gesetzliche Unfallversicherung, DGUV) for 50 years. In order to assess the reduction in working capacity (Minderung der Erwerbsfähigkeit, MdE) in the event of permanent consequences of accidents and injuries, the recommendation to treat the affected child or adolescent "as an average adult" is currently still valid. The present work deals with the everyday practice of the MdE assessment in children and adolescents and their weaknesses through the transfer of the principles from adulthood. In addition, proposals for the adaptation of the assessment principles for the growth age are drawn up.


Assuntos
Fraturas Ósseas , Seguro de Acidentes , Acidentes , Adolescente , Adulto , Criança , Humanos
7.
PLoS One ; 16(8): e0255695, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34379643

RESUMO

BACKGROUND: Video analysis is one of the most commonly applied methods for analysing football injuries. PURPOSE: The objective of this study was to assess the accuracy of video analysis for recording head injuries in professional football from official matches in the four highest men's professional football leagues in Germany. METHODS: In this cohort study, head injuries detected by means of video analysis of all official matches over one season (2017-18) were compared to head injuries registered with the German statutory accident insurance. RESULTS: Our video analysis yielded 359 head injuries of 287 players. The comparison of head injuries found in our video analysis to those registered with the accident insurance only yielded a match in 23.1% (n = 83), which presents a rather low verification rate. The verification rates varied between the leagues (7.0-30.8%). All injuries documented in the accident insurance registry were found in the video analysis (100%). The types of head injury most often verified by the accident insurance registry (n = 83) were contusion (43.4%), bone fractures (19.3%) and skin lacerations (18.1%). Only 66 of the 359 head injuries (18.4%) resulted in absence from at least one training session and involved a mean time loss of 18.5 days (1-87 days). CONCLUSION: The mismatch between the number of head injuries found in the video analysis and head injuries registered with the accident insurance is an important methodological issue in scientific research. The low verification rate seems to be due to the unclear correlation between injury severity and clinical consequences of head injuries detected by means of video analysis and the failure of football clubs to register minor head injuries with the accident insurance.


Assuntos
Traumatismos em Atletas/epidemiologia , Contusões/epidemiologia , Traumatismos Craniocerebrais/epidemiologia , Futebol Americano/lesões , Seguro de Acidentes , Lacerações/epidemiologia , Sistema de Registros , Fraturas Cranianas/epidemiologia , Futebol/lesões , Adolescente , Adulto , Alemanha/epidemiologia , Humanos , Incidência , Masculino , Estudos Prospectivos , Gravação em Vídeo , Adulto Jovem
8.
Laryngorhinootologie ; 100(9): 698-706, 2021 09.
Artigo em Alemão | MEDLINE | ID: mdl-34461647

RESUMO

Tinnitus as a subjective, individual sensation defies objective proof. In the assessment situation, tinnitus must also be distinguished from physiological or spontaneous hearing sensations.With regard to the new German "Königsteiner Recommendation" and the verdicts of the last few years, against the background of the different concepts of causality in the statutory and private accident insurance, a stringent examination to determine whether there is a sufficiently high probability of an accident-related subjective ear noise is necessary in the assessment. In order to create a comprehensible and comparable basis, the proposal of a plausibility check with the recording of 5 criteria - appropriate event, immediacy, reproducibility on the basis of today's examination methods of tinnitus masking and matching, persistence and fixation and the recording with a non-suggestive question was subjected to a review.The review shows that the requirements for the respective standard of proof can be fulfilled with the given steps of proof. The simple possibility of the presence of ringing in the ears can be systematically led to the probability of the presence by means of the plausibility criteria, which include psychoacoustic procedures, as well as open questions. This creates the prerequisites for a comprehensible causal consideration between the event and the reported tinnitus according to current medical-scientific knowledge.


Assuntos
Zumbido , Humanos , Seguro de Acidentes , Probabilidade , Reprodutibilidade dos Testes , Zumbido/diagnóstico , Zumbido/etiologia
9.
Gesundheitswesen ; 83(10): 867-870, 2021 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-32079033

RESUMO

OBJECTIVES: Video consultations are becoming more and more important for health care providers as they enable new treatment options. Since 2017 video consultations have been used by the public health insurance companies in Germany. However, similar options are lacking in the employer's liability insurance association (BG in Germany) health insurance system. The aim of this article is to present and discuss possible applications of video consultations in the latter system and to evaluate economic advantages. METHODS: Possible applications of video consultations are discussed in the context of feasibility, potential benefits and the existing scale of fees for physicians (in Germany UV-GOÄ). RESULTS: Video consultations can be used for follow-up evaluations as well as preparation for initial medical examinations especially in complex cases and for case conferences. Even though video consultations are not included in the reimbursement system, similar CPT codes (current procedural terminology) already do exist. CONCLUSIONS: Video consultations might help improve the quality and reduce the costs of the public health insurance system. Furthermore, since video consultations can be expected to become more important in the future, they should be included as a standard tool in the employer's liability insurance association insurance system and an adequate reimbursement system be established.


Assuntos
Seguro de Acidentes , Telemedicina , Análise Custo-Benefício , Alemanha , Encaminhamento e Consulta
10.
Disabil Rehabil ; 43(15): 2110-2122, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-31814463

RESUMO

PURPOSE: By using the eligibility determination process of the Swiss accident insurance (Suva) as a case in point, we aimed to examine current challenges and the need for a goal-oriented ICF-based approach in disability evaluation as experienced by different stakeholder groups. MATERIALS AND METHODS: Descriptive qualitative design involving semi-structured expert interviews with five main stakeholder groups of the eligibility determination process (i.e., Suva insurance officers, Suva insurance physicians, treating physicians, lawyers and judges). Interviews were thematically analyzed and their results reflected upon in focus groups with selected interview participants. RESULTS: Forty-three interviews and three focus groups were conducted. Participants pointed to challenges related to standardization, transparency, objectivity, efficiency and contextual factors. An ICF-based standard documenting claimant-job mismatches and their determinants was deemed promising for ensuring comprehensible and valid eligibility decisions, systematic and uniform reporting and a goal-oriented eligibility determination process. Concerns primarily addressed a potential pseudo-accuracy when using the standard for eligibility decisions. CONCLUSIONS: Implementing a goal-oriented ICF-based standard may help to approach current challenges in disability evaluation. Our findings support the development of such a standard for Suva's eligibility determination, but also point at the importance of involving key stakeholders to ensure its applicability and cross-disciplinary acceptance.IMPLICATIONS FOR REHABILITATIONPoor standardization and transparency as well as objectivity and efficiency issues represent key challenges in disability evaluation, as experienced by the different stakeholder groups involved in an eligibility determination process.A standardized ICF-based approach focusing on the documentation of claimant-job mismatches and their determinants is promising for improving transparency, validity and comparability of eligibility decisions.With its focus on claimants' ability to participate at work such an ICF-based standard has the potential to ensure a goal-oriented planning of assessments and interventions in the eligibility determination process.Our study provides specific targets for optimizing eligibility determination in disability evaluation but also for ensuring a customized and effective return to work after sustaining an injury.


Assuntos
Seguro de Acidentes , Médicos , Avaliação da Deficiência , Objetivos , Humanos , Suíça
12.
Unfallchirurg ; 124(1): 48-58, 2021 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-32488320

RESUMO

BACKGROUND: Accident insurance consultants (D-physicians) are qualified specialists with particular expertise in occupational medicine. Within the medical treatment procedure of the German Statutory Accident Insurance (DGUV), D­physicians must make a report on the medical care after occupational accidents. This nationwide evaluation aimed to systematically measure the quality of documentation of these medical reports. Peer review is a common method to ensure process quality. MATERIAL AND METHODS: For each included D­physician 30 reports of more severe cases from 2017 were randomly selected. The reports were anonymized and randomly assigned to a peer reviewer. Peer reviewers used a web-based checklist with nine rating categories and dichotomous response format (deficiency/no deficiency). To evaluate overall quality each report was rated with an overall grade from 1 (very good) to 6 (insufficient). RESULTS: A total of 30,384 reports were evaluated by 82 peer reviewers. One third of the reports contained no deficiencies. Most deficiencies were found in the category on information about the accident. The mean overall grade for each D­physician was 2.6 and ranged from 1.5 (best) to 4.1 (worst). All evaluated D­physicians were given an individual quality report which described the main findings. CONCLUSION: The first nationwide peer review of the DGUV proved to be a practical and valid quality assurance procedure to evaluate the medical reports of D­physicians. The quality of the reports was in general good. The DGUV plans to repeat the peer review process taking further groups of D­physicians into consideration.


Assuntos
Seguro de Acidentes , Medicina do Trabalho , Acidentes de Trabalho , Consultores , Alemanha , Humanos , Revisão por Pares
13.
Unfallchirurg ; 123(12): 988-998, 2020 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-33108480

RESUMO

If an accident results in a functional disorder that persists and permanently restricts physical and/or mental capacity, this is referred to as a disability. In private accident insurance it is the task of the medical expert to assess this disability by examining the medical findings and produce an assessment taking account of the literature and comparing against generally acknowledged guidance values. The priority dismemberment disability rating schedule initially provides loss values. For the "next lowest" disability levels for arthrodesis of extremity joints, the assessment recommendations are based on a functionally favorable position although this functionally favorable position is not more precisely defined.In this article the authors have defined these functionally favorable positions based on the information available in the literature. In particular, the operatively favorable settings for arthrodesis of the affected joint that are stated in the literature on trauma and orthopedic surgery were consulted. Of course, the functional perspective has been especially emphasized.A difficulty in achieving this was that the literature on arthrodesis is now almost only of historical value due to modern endoprosthetics. The knowledge gained was checked against medical experience and is expounded here.


Assuntos
Prova Pericial , Seguro de Acidentes , Acidentes , Artrodese , Avaliação da Deficiência
14.
Klin Monbl Augenheilkd ; 237(9): 1045-1059, 2020 Sep.
Artigo em Inglês, Alemão | MEDLINE | ID: mdl-32967029

RESUMO

The ophthalmologic assessment of causal relationships is subject to formal guidelines, depending on the legal field (social law in the statutory accident insurance, civil law in the private accident insurance). After determining all objective and subjective findings of the individual case with complete recording of the medical facts, the ophthalmologist has the task of making a summarizing assessment of the existing cause-and-effect relationship. With regard to the distinction between retinal damage caused by an accident or retinal disease not caused by an accident, it is necessary to weigh up the natural causality according to the state of medical experience on the basis of the criteria strength of association, consistency, specificity, temporal sequence, dose dependence, agreement with previous findings, experimental reliability and analogous consideration. All records of medical findings from the patient's medical history and the individual description of the accident must be included in the expert opinion. In the case of several competing causes (often accident and pre-existing damage), the social law in the statutory accident insurance must present the causal contributions with roughly estimated probabilities. In civil law, valid for the private accident insurance, the existence of partial causality (approx. 25, 50, 75%) must be evaluated.


Assuntos
Avaliação da Deficiência , Doenças Retinianas , Prova Pericial , Humanos , Seguro de Acidentes , Reprodutibilidade dos Testes
16.
Klin Monbl Augenheilkd ; 237(6): 805-823, 2020 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-32303072

RESUMO

The ophthalmological appraisal differs significantly in the different areas of law, so there are some different causalities and standards of proof and, above all, the assessment is very different. For the three important sub-areas of private accident insurance, statutory accident insurance as well as disability law and social compensation law, there are abstract tabular guidelines which form the essential basis for a comparable and thus fair assessment. The basics of the assessment in these fields of law are presented in a comparative way, with particular emphasis on causality.


Assuntos
Prova Pericial , Oftalmologia , Compensação e Reparação , Avaliação da Deficiência , Humanos , Seguro de Acidentes
17.
Artigo em Inglês | MEDLINE | ID: mdl-32121256

RESUMO

Tuberculosis (TB) is the most common cause of fatal infections worldwide. Recent TB figures in Europe indicate that 30 people were infected with tuberculosis each hour in 2017. Healthcare workers are at particular risk of being infected through patient contact. TB is the second most common occupational infectious disease among German healthcare workers. Routine data from the German Social Accident Insurance were used to examine trends in occupational TB diseases. We analyzed annual cross-sectional data for the years 2002 to 2017. The data underwent descriptive analysis. A total of 4653 TB cases were recognized as occupational diseases (OD) in the period under study. In 2002, 60 TB cases were recognized as OD No. 3101, i.e., transmissions from person to person. Since 2013, the level has settled at around 500 recognized cases per year. This is around eight times the number of cases compared to 2002. The following three groups collectively accounted for the largest share of TB cases (88.5%): nurses (including geriatric nurses), other healthcare employees, and physicians. The upward trend in the number of TB cases recognized as occupational diseases is probably due to improvements in diagnostic tests used to diagnose TB infections. TB in health and welfare workers remains an important issue in the health and welfare sector in Germany, partly due to the long latency period between potential exposure to infectious patients or materials and the recognition of the latent tuberculosis infection (LTBI) or active TB as OD.


Assuntos
Pessoal de Saúde , Doenças Profissionais/epidemiologia , Tuberculose/epidemiologia , Estudos Transversais , Análise de Dados , Alemanha/epidemiologia , Humanos , Seguro de Acidentes
18.
Int J Occup Saf Ergon ; 26(1): 181-193, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-29663865

RESUMO

Introduction. Global trends such as digitalization, globalization and demographic change are changing workplaces, and accordingly occupational safety and health (OSH) needs. To better prepare for the future and to foster proactive prevention, the German Social Accident Insurance (DGUV) established an OSH risk observatory (RO OSH). Methods. The RO OSH relies on an online survey and calls upon the expertise of labour inspectors. In total, 398 labour inspectors participated in the first RO OSH enquiry. They rated developments with regard to their sector-specific relevance for OSH in the near future. The RO OSH also provides ideas for preventive measures that can be implemented by the German Social Accident Insurance Institutions. Results. Work intensity, demographic aspects and digitalization play a major role for most or all sectors. However, familiar OSH issues such as musculoskeletal strain and noise also continue to be of major importance and require further consideration and specific solutions in prevention. Outlook. For the DGUV, training and consulting have great potential for proactive prevention in these priority areas, e.g., by fostering a prevention culture and supporting companies in (psychosocial) risk assessment (also for mobile work). For instance, concepts for increasing physical activity at sedentary workplaces and data security require continued research.


Assuntos
Doenças Profissionais/prevenção & controle , Traumatismos Ocupacionais/prevenção & controle , Local de Trabalho , Alemanha , Seguro de Acidentes , Medição de Risco , Inquéritos e Questionários
19.
Unfallchirurg ; 123(5): 360-367, 2020 May.
Artigo em Alemão | MEDLINE | ID: mdl-31501974

RESUMO

The development of the numbers of cases involved in accident insurance consultant procedures (DAV), injury type procedures (VAV) and severe injury type procedures (SAV) after the introduction of the new injury type catalogue from 1 July 2018 is presented. Furthermore, possible alterations to organizational aspects, such as operating room times and average duration of hospitalization are presented. A first critical assessment of the modifications in the new catalogue was carried out, particularly with reference to the newly introduced section on complications (section 11). METHODS: A retrospective study of all inpatients treated in the context of the DAV, VAV and SAV procedures at a SAV center from the 2nd and 3rd quarters of 2018 was carried out. The development of the number of cases, the case mix index (CMI), the mean number of operations, the mean time in the operating room and the length of hospitalization were analyzed. Furthermore, an assessment of the SAV cases was carried out with respect to the new developments and with particularly reference to complications. RESULTS: The total number of inpatients in the context of the DAV, VAV, SAV procedures changed only slightly. There was a clear decrease in DAV cases and a relevant increase in SAV cases. The CMI increased by 47%, the number of surgical procedures by 15%, the mean time in the operating room by 36% and the length of hospitalization by 43%. When converted to a daily operating room unit of 7 h (Tagestischeinheit, TTE) the operating room time increased from 89 to 108 TTE and the length of hospitalization increased from 1028 to 1358 days. Of the 111 SAV cases in the 3rd quarter, 52% were assigned to the catalogue number 11 "complications". In comparison to the previous version of the VAV/SAV catalogue, it was now possible to assign all inpatients to a single category. CONCLUSION: The modifications of the VAV in the observational period led to an enormous increase in SAV cases. It remains to be seen whether this development is confirmed in subsequent quarters. The increase in CMI, the number of necessary operations, operating room times and duration of hospitalization showed the necessity of these innovations on structural changes of hospitals involved in the treatment of SAV cases.


Assuntos
Grupos Diagnósticos Relacionados , Seguro de Acidentes , Hospitais , Salas Cirúrgicas , Estudos Retrospectivos
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