Clinics in occupational and environmental medicine
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Work-related upper extremity burns often occur. The cause directs the course of action. Thermal burns should be assessed for system alterations, and depth of burn should be determined. ⋯ Some chemical burns, such as those that involve phenols and metal fragments, require specific topical applications before water lavage. Hydrofluoric acid burns can cause life-threatening electrolyte abnormalities with a small, highly concentrated acid burn. The goal with any extremity burn is to provide the patient with a multidisciplinary team approach to achieve a functional, usable extremity.
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Tendinopathy in the upper extremity continues to be a source of morbidity and disability in the working population despite a benign clinical course. Risk factors include high force, repetition, and awkward positions. An understanding of the pertinent anatomy and pathophysiology should help clinicians in the management of these conditions. ⋯ Clinical presentation includes localized pain and tenderness. Most treatment options have yet to undergo evaluation for efficacy in well-designed clinical trials, yet there is a generally favorable response to nonoperative or conservative management. Cases resistant to conservative treatment may require surgical intervention.
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The use of tobacco can be traced back to ancient times. Its popularity grew exponentially during the twentieth century, surging during wartime and with the advent of mass media. The tobacco industry in the United States has been under constant legal pressure during the past 40 years. Despite the well-known and continually increasing morbidity and mortality related to smoking, it continues to be a prominent feature in worldwide culture and health.
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The tobacco control policy tools developed in a few rich countries in the 1970s, 1980s, and 1990s are currently being implemented widely in many poorer countries, thanks in part to the astonishing success of the Framework Convention on Tobacco Control (FCTC). With smoking rates already high in most of the Third World, however, the projections for the twenty-first century are grim: up to 1 billion tobacco-caused deaths, which raises the issue of what more can be done, particularly to help people who already are addicted to nicotine. ⋯ This finding has sparked fierce discussions among anti-tobacco activists about the role of harm reduction in curbing death and disease. This article discusses whether harm reduction is possible with the tobacco industry subject to a largely unregulated environment for tobacco products.
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Workers' compensation reform efforts respond to the competing interests of business, labor and insurers. Early reforms expanded programs in response to inadequate benefits and coverage while in the 1980s and 1990s states responded to increasing costs by tightening fee schedules, limiting physician choice, restricting eligibility,lowering benefits, and integrating managed care into workers' compensation. ⋯ Controlling costs alone, however, cannot solve other problems of workers' compensation. Future reform efforts will need to focus not only on the costs of the system but also its inclusiveness and support of the workers and their families it was intended to protect.