Made by DATEXIS (Data Science and Text-based Information Systems) at Beuth University of Applied Sciences Berlin
Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
Funded by The Federal Ministry for Economic Affairs and Energy; Grant: 01MD19013D, Smart-MD Project, Digital Technologies
An occupational injury is bodily damage resulting from working. The most common organs involved are the spine, hands, the head, lungs, eyes, skeleton, and skin. Occupational injuries can result from exposure to occupational hazards (physical, chemical, biological, or psychosocial), such as temperature, noise, insect or animal bites, blood-borne pathogens, aerosols, hazardous chemicals, radiation, and occupational burnout.
While many prevention methods are set in place, injuries may still occur due to poor ergonomics, manual handling of heavy loads, misuse or failure of equipment, exposure to general hazards, and inadequate safety training.
As in the United Kingdom, slips, trips and falls are common and account for 20-40% of disabling occupational injuries. Often these accidents result in a back injury that can persist to a permanent disability. In the United States, a high risk of back injuries occurs in the health care industry. 25% of reported injuries in health care workers in the state of Pennsylvania are for back pain. Among nurses, the prevalence of lower back pain may be as high as 72% mostly as a result of transferring patients. Fortunately, some of these injuries can be prevented with the availability of patient lifts, improved worker training, and allocation of more time to perform work procedures. Another common type of injury is carpal tunnel syndrome associated with overuse of the hands and wrists. Studies on a cohort of newly hired workers have thus far identified forceful gripping, repetitive lifting of > 1 kg, and using vibrating power tools as high risk work activities.
Additionally, noise exposure in the workplace can cause hearing loss, which accounted for 14% of reported occupational illnesses in 2007. Many initiatives have been created to prevent this common workplace injury. For example, the Buy Quiet program encourages employers to purchase tools and machines that produce less noise and the Safe-In-Sound Award was created to recognize companies and program that excel in the area of hearing loss prevention.
Accidental injection or needlestick injuries are a common injury that plague agriculture workers and veterinarians. The majority of these injuries are located to the hands or legs, and can result in mild to severe reactions, including possible hospitalization. Due to the wide variety of biologics used in animal agriculture, needlestick injuries can result in bacterial or fungal infections, lacerations, local inflammation, vaccine/antibiotic reactions, amputations, miscarriage, and death. Due to daily human-animal interactions, livestock related injuries are also a prevalent injury of agriculture workers, and are responsible for the majoriy of nonfatal worker injuries on dairy farms. Additionally, approximately 30 people die of cattle and horse-related deaths in the United States annually.
In 2007, the World Health Organization estimated annual global needlestick injuries at 2 million per year, and another investigation estimated 3.5 million injuries yearly. The European Biosafety Network estimated 1 million needlestick injuries annually in Europe. The US Occupational Safety and Health Administration (OSHA) estimates 5.6 million workers in the healthcare industry are at risk of occupational exposure to blood-borne diseases via percutaneous injury. The US Centers for Disease Control and Prevention (CDC) estimates more than 600,000 needlestick injuries occur among healthcare workers in the US annually.
Among healthcare workers, nurses and physicians appear especially at risk; those who work in an operating room environment are at the highest risk. An investigation among American surgeons indicates that almost every surgeon experienced at least one such injury during their training. More than half of needlestick injuries that occur during surgery happen while surgeons are sewing the muscle or fascia. Within the medical field, specialties differ in regard to the risk of needlestick injury: surgery, anesthesia, otorhinolaryngology (ENT), internal medicine, and dermatology have high risk, whereas radiology and pediatrics have relatively low rates of injury.
In the United States, approximately half of all needlestick injuries affecting health care workers are not reported, citing the long reporting process and its interference with work as their reason for not reporting an incident. The availability of hotlines, witnesses, and response teams can increase the percentage of reports. Physicians are particularly likely to leave a needlestick unreported, citing worries about loss of respect or a low risk perception. Low risk perception can be caused by poor knowledge about risk, or an incorrect estimate of a particular patient's risk. Surveillance systems to track needlestick injuries include the National Surveillance System for Healthcare Workers (NaSH), a voluntary system in the northeastern United States, and the Exposure Prevention Information Network (EPINet), a recording and tracking system that also gathers data.
Needlestick injuries are a common event in the healthcare environment. When drawing blood, administering an intramuscular or intravenous drug, or performing any procedure involving sharps, accidents can occur and facilitate the transmission of blood-borne diseases. Injuries also commonly occur during needle recapping or via improper disposal of devices into an overfilled or poorly located sharps container. Lack of access to appropriate personal protective equipment, or alternatively, employee failure to use provided equipment, increases the risk of occupational needlestick injuries. Needlestick injuries may also occur when needles are exchanged between personnel, loaded into a needle driver, or when sutures are tied off while still connected to the needle. Needlestick injuries are more common during night shifts and for less experienced people; fatigue, high workload, shift work, high pressure, or high perception of risk can all increase the chances of a needlestick injury. During surgery, a surgical needle or other sharp instrument may inadvertently penetrate the glove and skin of operating room personnel; scalpel injuries tend to be larger than a needlestick. Generally, needlestick injuries cause only minor visible trauma or bleeding; however, even in the absence of bleeding the risk of viral infection remains.
The World Health Organization (WHO) developed the International Classification of External Causes of Injury (ICECI). Under this system, injuries are classified by
- mechanism of injury;
- objects/substances producing injury;
- place of occurrence;
- activity when injured;
- the role of human intent;
and additional modules. These codes allow the identification of distributions of injuries in specific populations and case identification for more detailed research on causes and preventive efforts.
The United States Bureau of Labor Statistics developed the Occupational Injury and Illness Classification System (OIICS). Under this system injuries are classified by
- nature,
- part of body affected,
- source and secondary source, and
- event or exposure.
The OIICS was first published in 1992 and has been updated several times since.
The Orchard Sports Injury Classification System (OSICS) is used to classify injuries to enable research into specific sports injuries.
Injury is damage to the body caused by external force. This may be caused by accidents, falls, hits, weapons, and other causes. Major trauma is injury that has the potential to cause prolonged disability or death.
In 2013, 4.8 million people died from injuries, up from 4.3 million in 1990. More than 30% of these deaths were transport-related injuries. In 2013, 367,000 children under the age of five died from injuries, down from 766,000 in 1990. Injuries are the cause of 9% of all deaths, and are the sixth-leading cause of death in the world.
Heat-related illnesses from occupational heat stress have several risk factors. Some of these factors include high temperatures, humidity, radiant heat sources, limited air movement, metabolic heat from physical exertion of energy, not drinking enough fluids, personal protective equipment and clothing, physical condition and health problems, medications, pregnancy, lack of acclimatization, advanced age, having a previous heat-related illness and others.
TBI is a leading cause of death and disability around the globe and presents a major worldwide social, economic, and health problem. It is the number one cause of coma, it plays the leading role in disability due to trauma, and is the leading cause of brain damage in children and young adults. In Europe it is responsible for more years of disability than any other cause. It also plays a significant role in half of trauma deaths.
Findings on the frequency of each level of severity vary based on the definitions and methods used in studies. A World Health Organization study estimated that between 70 and 90% of head injuries that receive treatment are mild, and a US study found that moderate and severe injuries each account for 10% of TBIs, with the rest mild.
The incidence of TBI varies by age, gender, region and other factors. Findings of incidence and prevalence in epidemiological studies vary based on such factors as which grades of severity are included, whether deaths are included, whether the study is restricted to hospitalized people, and the study's location. The annual incidence of mild TBI is difficult to determine but may be 100–600 people per 100,000.
In the US, the case fatality rate is estimated to be 21% by 30 days after TBI. A study on Iraq War soldiers found that severe TBI carries a mortality of 30–50%. Deaths have declined due to improved treatments and systems for managing trauma in societies wealthy enough to provide modern emergency and neurosurgical services. The fraction of those who die after being hospitalized with TBI fell from almost half in the 1970s to about a quarter at the beginning of the 21st century. This decline in mortality has led to a concomitant increase in the number of people living with disabilities that result from TBI.
Biological, clinical, and demographic factors contribute to the likelihood that an injury will be fatal. In addition, outcome depends heavily on the cause of head injury. In the US, patients with fall-related TBIs have an 89% survival rate, while only 9% of patients with firearm-related TBIs survive. In the US, firearms are the most common cause of fatal TBI, followed by vehicle accidents and then falls. Of deaths from firearms, 75% are considered to be suicides.
The incidence of TBI is increasing globally, due largely to an increase in motor vehicle use in low- and middle-income countries. In developing countries, automobile use has increased faster than safety infrastructure could be introduced. In contrast, vehicle safety laws have decreased rates of TBI in high-income countries, which have seen decreases in traffic-related TBI since the 1970s. Each year in the United States, about two million people suffer a TBI, approximately 675,000 injuries are seen in the emergency department, and about 500,000 patients are hospitalized. The yearly incidence of TBI is estimated at 180–250 per 100,000 people in the US, 281 per 100,000 in France, 361 per 100,000 in South Africa, 322 per 100,000 in Australia, and 430 per 100,000 in England. In the European Union the yearly aggregate incidence of TBI hospitalizations and fatalities is estimated at 235 per 100,000.
People vary in their tendency to get MSDs. Gender is a factor with a higher rate in women than men. Obesity is also a factor, with overweight individuals having a higher risk of some MSDs, specifically lower back.
Common causes of head injury are motor vehicle traffic collisions, home and occupational accidents, falls, and assaults. Wilson's disease has also been indicative of head injury. According to the United States CDC, 32% of traumatic brain injuries (another, more specific, term for head injuries) are caused by falls, 10% by assaults, 16.5% by being struck or against something, 17% by motor vehicle accidents, 21% by other/unknown ways. In addition, the highest rate of injury is among children ages 0–14 and adults age 65 and older.
Occupational heat stress is the net load to which a worker is exposed from the combined contributions of metabolic heat, environmental factors, and clothing worn which results in an increase in heat storage in the body. Heat stress can result in heat-related illnesses, such as heat stroke, hyperthermia, heat exhaustion, heat cramps or heat rashes. Although heat exhaustion is less severe, hyperthermia is a medical emergency and requires emergency treatment, which if not provided can even lead to death.
Heat stress causes illness but also may account for an increase in workplace accidents, and a decrease in worker productivity. Worker injuries attributable to heat include those caused by: sweaty palms, fogged-up safety glasses, and dizziness. Burns may also occur as a result of accidental contact with hot surfaces or steam. In United States, occupational heat stress in becoming more significant as the average temperatures increase but remains overlooked. There are few studies and regulations regarding heat exposure of workers.
There is a growing consensus that psychosocial factors are another cause of some MSDs. Some theories for this causal relationship found by many researchers include increased muscle tension, increased blood and fluid pressure, reduction of growth functions, pain sensitivity reduction, pupil dilation, body remaining at heightened state of sensitivity. Although research findings are inconsistent at this stage, some of the workplace stressors found to be associated with MSDs in the workplace include high job demands, low social support, and overall job strain. Researchers have consistently identified causal relationships between job dissatisfaction and MSDs. For example, improving job satisfaction can reduce 17-69 per cent of work-related back disorders and improving job control can reduce 37-84 per cent of work-related wrist disorders.
In children with uncomplicated minor head injuries the risk of intra cranial bleeding over the next year is rare at 2 cases per 1 million. In some cases transient neurological disturbances may occur, lasting minutes to hours. Malignant post traumatic cerebral swelling can develop unexpectedly in stable patients after an injury, as can post traumatic seizures. Recovery in children with neurologic deficits will vary. Children with neurologic deficits who improve daily are more likely to recover, while those who are vegetative for months are less likely to improve. Most patients without deficits have full recovery. However, persons who sustain head trauma resulting in unconsciousness for an hour or more have twice the risk of developing Alzheimer's disease later in life.
Head injury may be associated with a neck injury. Bruises on the back or neck, neck pain, or pain radiating to the arms are signs of cervical spine injury and merit spinal immobilization via application of a cervical collar and possibly a long board.If the neurological exam is normal this is reassuring. Reassessment is needed if there is a worsening headache, seizure, one sided weakness, or has persistent vomiting.
To combat overuse of Head CT Scans yielding negative intracranial hemorrhage, which unnecessarily expose patients to radiation and increase time in the hospital and cost of the visit, multiple clinical decision support rules have been developed to help clinicians weigh the option to scan a patient with a head injury. Among these are the Canadian Head CT rule, the PECARN Head Injury/Trauma Algorithm, and the New Orleans/Charity Head Injury/Trauma Rule all help clinicians make these decisions using easily obtained information and noninvasive practices.
Workers in certain fields are at risk of repetitive strains. Most occupational injuries are musculoskeletal disorders, and many of these are caused by cumulative trauma rather than a single event. Miners and poultry workers, for example, must make repeated motions which can cause tendon, muscular, and skeletal injuries.
As many as 50–70% of people who survive traffic accidents have facial trauma. In most developed countries, violence from other people has replaced vehicle collisions as the main cause of maxillofacial trauma; however in many developing countries traffic accidents remain the major cause. Increased use of seat belts and airbags has been credited with a reduction in the incidence of maxillofacial trauma, but fractures of the mandible (the jawbone) are not decreased by these protective measures. The risk of maxillofacial trauma is decreased by a factor of two with use of motorcycle helmets. A decline in facial bone fractures due to vehicle accidents is thought to be due to seat belt and drunk driving laws, strictly enforced speed limits and use of airbags. In vehicle accidents, drivers and front seat passengers are at highest risk for facial trauma.
Facial fractures are distributed in a fairly normal curve by age, with a peak incidence occurring between ages 20 and 40, and children under 12 suffering only 5–10% of all facial fractures. Most facial trauma in children involves lacerations and soft tissue injuries. There are several reasons for the lower incidence of facial fractures in children: the face is smaller in relation to the rest of the head, children are less often in some situations associated with facial fractures such as occupational and motor vehicle hazards, there is a lower proportion of cortical bone to cancellous bone in children's faces, poorly developed sinuses make the bones stronger, and fat pads provide protection for the facial bones.
Head and brain injuries are commonly associated with facial trauma, particularly that of the upper face; brain injury occurs in 15–48% of people with maxillofacial trauma. Coexisting injuries can affect treatment of facial trauma; for example they may be emergent and need to be treated before facial injuries. People with trauma above the level of the collar bones are considered to be at high risk for cervical spine injuries (spinal injuries in the neck) and special precautions must be taken to avoid movement of the spine, which could worsen a spinal injury.
Injury mechanisms such as falls, assaults, sports injuries, and vehicle crashes are common causes of facial trauma in children as well as adults. Blunt assaults, blows from fists or objects, are a common cause of facial injury. Facial trauma can also result from wartime injuries such as gunshots and blasts.
Animal attacks and work-related injuries such as industrial accidents are other causes. Vehicular trauma is one of the leading causes of facial injuries. Trauma commonly occurs when the face strikes a part of the vehicle's interior, such as the steering wheel. In addition, airbags can cause corneal abrasions and lacerations (cuts) to the face when they deploy.
The site and type of brachial plexus injury determine the prognosis. Avulsion and rupture injuries require timely surgical intervention for any chance of recovery. For milder injuries involving buildup of scar tissue and for neurapraxia, the potential for improvement varies, but there is a fair prognosis for spontaneous recovery, with a 90–100% return of function.
Brachial plexus injury is found in both children and adults, but there is a difference between children and adults with BPI.
There is a lack of comprehensive statistics about the epidemiology of frostbite. In the United States, frostbite is more common in northern states. In Finland, annual incidence was 2.5 per 100,000 among civilians, compared with 3.2 per 100,000 in Montreal. Research suggests that men aged 30–49 are at highest risk, possibly due to occupational or recreational exposures to cold.
Occupational skin diseases are ranked among the top five occupational diseases in many countries.
Occupational skin diseases and conditions are generally caused by chemicals and having wet hands for long periods while at work. Eczema is by far the most common, but urticaria, sunburn and skin cancer are also of concern.
Contact dermatitis due to irritation is inflammation of the skin which results from a contact with an irritant. It has been observed that this type of dermatitis does not require prior sensitization of the immune system. There have been studies to support that past or present atopic dermatitis is a risk factor for this type of dermatitis. Common irritants include detergents, acids, alkalies, oils, organic solvents and reducing agents.
The acute form of this dermatitis develops on exposure of the skin to a strong irritant or caustic chemical. This exposure can occur as a result of accident at a workplace. The irritant reaction starts to increase in its intensity within minutes to hours of exposure to the irritant and reaches its peak quickly. After the reaction has reached its peak level, it starts to heal. This process is known as decrescendo phenomenon. The most frequent potent irritants leading to this type of dermatitis are acids and alkaline solutions. The symptoms include redness and swelling of the skin along with the formation of blisters.
The chronic form occurs as a result of repeated exposure of the skin to weak irritants over long periods of time.
Clinical manifestations of the contact dermatitis are also modified by external factors such as environmental factors (mechanical pressure, temperature, and humidity) and predisposing characteristics of the individual (age, sex, ethnic origin, preexisting skin disease, atopic skin diathesis, and anatomic region exposed.
Another occupational skin disease is Glove related hand urticaria. It has been reported as an occupational problem among the health care workers. This type of hand urticaria is believed to be caused by repeated wearing and removal of the gloves. The reaction is caused by the latex or the nitrile present in the gloves.
High-risk occupations include:
- Hairdressing
- Catering
- Healthcare
- Printing
- Metal machining
- Motor vehicle repair
- Construction
Occupational lung diseases include asbestosis among asbestos miners and those who work with friable asbestos insulation, as well as black lung (coalworker's pneumoconiosis) among coal miners, silicosis among miners and quarrying and tunnel operators and byssinosis among workers in parts of the cotton textile industry.
Occupational asthma has a vast number of occupations at risk.
Bad indoor air quality may predispose for diseases in the lungs as well as in other parts of the body.
Repetitive strain injury (RSI) and associative trauma orders are umbrella terms used to refer to several discrete conditions that can be associated with repetitive tasks, forceful exertions, vibrations, mechanical compression, or sustained/awkward positions. Examples of conditions that may sometimes be attributed to such causes include edema, tendinosis (or less often tendinitis), carpal tunnel syndrome, cubital tunnel syndrome, De Quervain syndrome, thoracic outlet syndrome, intersection syndrome, golfer's elbow (medial epicondylitis), tennis elbow (lateral epicondylitis), trigger finger (so-called stenosing tenosynovitis), radial tunnel syndrome, ulnar tunnel syndrome, and focal dystonia.
Since the 1970s there has been a worldwide increase in RSIs of the arms, hands, neck, and shoulder attributed to the widespread use of typewriters/computers in the workplace that require long periods of repetitive motions in a fixed posture.
The Control of Vibration at Work Regulations 2005, created under the Health and Safety at Work etc. Act 1974. is the legislation in the UK that governs exposure to vibration and assists with preventing HAVS occurring.
Good practice in industrial health and safety management requires that worker vibration exposure is assessed in terms of acceleration amplitude and duration. Using a tool that vibrates slightly for a long time can be as damaging as using a heavily vibrating tool for a short time. The duration of use of the tool is measured as trigger time, the period when the worker actually has their finger on the trigger to make the tool run, and is typically quoted in hours per day. Vibration amplitude is quoted in metres per second squared, and is measured by an accelerometer on the tool or given by the manufacturer. Amplitudes can vary significantly with tool design, condition and style of use, even for the same type of tool.
In the UK, Health and Safety Executive gives the example of a hammer drill which can vary from 6m/s² to 25m/s². HSE publishes a list of typically observed vibration levels for various tools, and graphs of how long each day a worker can be exposed to particular vibration levels. This makes managing the risk relatively straightforward. Tools are given an Exposure Action Value (EAV, the time which a tool can be used before action needs to be taken to reduce vibration exposure) and an Exposure Limit Value (ELV, the time after which a tool may not be used).
In the United States, the National Institute for Occupational Safety and Health published a similar database where values for sound power and vibrations for commonly found tools from large commercial vendors in the United States were surveyed. Further testing is underway for more and newer tools.
The effect of legislation in various countries on worker vibration limits has been to oblige equipment providers to develop better-designed, better-maintained tools, and for employers to train workers appropriately. It also drives tool designers to innovate to reduce vibration. Some examples are the easily manipulated mechanical arm (EMMA) and the suspension mechanism designed into chainsaws.
Pharmaceutical injuries can occur when a person is injured by a dangerous, defective or contaminated medication. Many pharmaceutical toxic injury cases are mass tort cases, as most medications are consumed by thousands of people. The cases are often litigated against drug manufacturers and distributors, and potentially against prescribing physicians. When prosecuted against drug manufacturers and distributors, pharmaceutical toxic tort cases differ from medical malpractice suits in that pharmaceutical toxic tort cases are essentially product liability cases, the defective product being the drug.