Disabling backache in France, Switzerland, and the Netherlands: contrasting sociopolitical constraints on clinical judgment
Article Abstract:
The physician has been placed in the position of making important assessments relating to the nature of job-related injuries, their prognosis (outcome), and any residual incapacity. These clinical judgments are always difficult when the injured area is the lower back. The frequency of lower back pain in an adult of working-age is at least one episode in any six-week period, and the situation is further complicated because postural changes can increase the problem. Estimates suggest that without proper intervention, as much as one-third of the labor force would be incapacitated for at least a month per year. In spite of intervention, the rate of occurrence of lower back injury has been on the rise, and with it increased interest in its cost and social consequences. The administrative and clinical responses to claims of disabling backache were examined in France, Switzerland and the Netherlands. The three key questions requiring definition were: when is a backache an injury? when is the patient well? and what, if any, is the extent of residual damage? The Dutch scheme is very liberal and the social support is so great that there is often very little difference in income between working and not working. That nation also avoids differentiating between accident and illness. The Swiss system is efficient, and 95 percent of workers return to work within 2 weeks. However, there are many problems beneath the surface and the recovery rate may be influenced by the Swiss work ethic and by the use of migrant workers (guest workers) who maintain benefits only while their visas are valid; expiration of a visa may drive an individual back to work before benefits terminate. The French have a pervasive social services system, Securite Sociale, which is involved in every patient-physician contact.
Publication Name: Journal of Occupational Medicine
Subject: Health care industry
ISSN: 0096-1736
Year: 1989
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Absence of respiratory effects in subject exposed to low concentrations of TDI and MDI
Article Abstract:
107 workers from a polyurethane plastic manufacturing plant were tested over a 5-year period for respiratory function. Toluene diisocyanate (TDI) diphenyl methane isocyanate (MDI) concentrations were monitored so that accurate data could be maintained on the workers exposure. The research suggests that it is possible to control isocyanates to a degree that eliminates their adverse effects.
Publication Name: Journal of Occupational Medicine
Subject: Health care industry
ISSN: 0096-1736
Year: 1982
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