Littérature scientifique sur le sujet « Personal injuries – Germany »

Abstract Violence in the workplace is a widespread problem. In Germany, approximately 11,000 occupational injuries resulting from violence are registered every year. Particularly affected by violence are people working in healthcare and social welfare. To avoid violence, technical, organisational and personal protective measures are needed. The training of de-escalation officers in the areas affected can be helpful. For victims of psychological and physical violence in the workplace psychotherapeutic support is offered by accidence insurrances.

Early in his career Edward Bouverie Pusey paid visits to Germany, as a result of which he wrote a book, revealing the influence of both Hegel and Schleiermacher, on the development of German theology. Then came some form of personal crisis, as a result of which he repudiated the book, seeking out second hand copies in order to destroy them, and in his will requiring that it never be republished. The event was tragic not merely for Pusey's personal life, but because it can be taken as symbolic of the fate of English theology since then. As one commentator remarks, it was an attempt to answer modernism by ignoring it. ‘If modernism could not be defeated by intellect, it must be defeated by piety.’ As Stephen Sykes has pointed out, for nationalistic reasons – for it is the nationalist tendency of some tractarianism which is here the point – a breach between the different European traditions was opened and has meant that English systematic theology, never very strong, has suffered injuries from which it has not yet recovered.

SummaryEvery year in Germany nearly 3000 cases of child abuse were reported. When children are presented at emergency units with suspicious injuries and bruises a detailed documentation an evaluation is necessary after emergency treatment. As differential diagnosis inherited or acquired bleeding disorders should be excluded. In addition to a detailed evaluation of personal and family history and a physical evaluation different coagulation test to exclude defects of primary and secondary hemostasis should be performed. Clinician must know the limitations of these tests and keep in mind that an abnormal coagulation test does not exclude child abuse. Coagulation defects may be the consequence of child abuse and neglect or the two conditions may coexist.

From its beginning, mankind suffered injuries through falling, fire, drowning and human aggression [1]. Although the frequency and the kinetics modifiy over millennia, trauma continues to represent an important cause of morbidity and mortality even in the modern society [1]. Significant progresses in the trauma surgery were due to military conflicts, which next to social sufferance came with important steps in injuries’ management, further applied in civilian hospitals. The foundation of modern trauma systems was started by Dominique Jean Larrey (1766-1842) during the Napoleonic Rin military campaign from 1792. The wounded who remained on the battlefield till the end of the battle to receive medical care, usually more than 24 hours, from that moment were transported during the conflict with flying ambulances to mobile hospitals. Starting with the First World War, through the usage of antiseptics, blood transfusions, and fracture management, the mortality decreased from 39% in the Crimean War (1853–1856) to 10%. One of the most preeminent figures of the Second World War was Michael DeBakey, who created the Mobile Army Surgical Hospitals (MASH), concept very similar to the Larrey’s unit. In 1941, in England, Birmingham Accident Hospital was opened, specially designed for injured people, this being the first trauma center worldwide. During the Golf War (1990–1991) the MASH were used for the last time, being replaced by Forward Surgical Teams, very mobile units satisfying the necessities of the nowadays infantry [1]. Nowadays, trauma meets the pandemic criteria, everyday 16,000 people worldwide are dying, injuries representing one of the first five causes of mortality for all the age groups below 60 [2]. A recent 12-month analysis of trauma pattern in the Emergency Hospital of Bucharest revealed 141 patients, 72.3% males, with a mean age of 43.52 ± 19 years, and a mean New Injury Severity Score (NISS) of 27.58 ± 11.32 [3]. The etiology was traffic related in 101 (71.6%), falls in 28 (19.9%) and crushing in 7 (5%) cases. The overall mortality was as high as 30%, for patients with a mean NISS of 37.63 [3]. At the scene, early recognition of severe injuries and a high index of suspicion according to trauma kinetics may allow a correct triage of patients [4]. A functional trauma system should continuously evaluate the rate of over- and under-triage [5]. The over-triage represents the transfer to a very severe patient to a center without necessary resources, while under-triage means a low injured patient referred to a highly specialized center. If under-triage generates preventable deaths, the over-triage comes with a high financial and personal burden for the already overloaded tertiary centers [5]. To maximize the chance for survival, the major trauma patients should be transported as rapid as possible to a trauma center [6]. The initial resuscitation of trauma patients was divided into two time intervals: ten platinum minutes and golden hour [6]. During the ten platinum minutes the airways should be managed, the exsanguinating bleeding should be stopped, and the critical patients should be transported from the scene. During the golden hour all the life-threatening lesions should be addressed, but unfortunately many patients spend this time in the prehospital setting [6]. These time intervals came from Trunkey’s concept of trimodal distribution of mortality secondary to trauma, proposed in 1983 [7]. This trimodal distribution of mortality remains a milestone in the trauma education and research, and is still actual for development but inconsistent for efficient trauma systems [8]. The concept of patients’ management in the prehospital setting covered a continuous interval, with two extremities: stay and play/treat then transfer or scoop and run/ load and go. Stay and play, usually used in Europe, implies airways securing and endotracheal intubation, pleurostomy tube insertion, and intravenous lines with volemic replacement therapy. During scoop and run, used in the Unites States, the patient is immediately transported to a trauma center, addressing the immediate life-threating injuries during transportation. In the emergency department of the corresponding trauma center, the resuscitation of the injured patients should be done by a trauma team, after an orchestrated protocol based on Advanced Trauma Life Support (ATLS). The modern trauma teams include five to ten specialists: general surgeons trained in trauma care, emergency medicine physicians, intensive care physicians, orthopedic surgeons, neurosurgeons, radiologists, interventional radiologists, and nurses. In the specially designed trauma centers, the leader of the trauma team should be the general surgeon, while in the lower level centers this role may be taken over by the emergency physicians. The implementation of a trauma system is a very difficult task, and should be tailored to the needs of the local population. For example, in Europe the majority of injuries are by blunt trauma, while in the United States or South Africa they are secondary to penetrating injuries. In an effort to analyse at a national level the performance of trauma care, we have proposed a national registry of major trauma patients [9]. For this registry we have defined major trauma as a New Injury Severity Score higher than 15. The maintenance of such registry requires significant human and financial resources, while only a permanent audit may decrease the rate of preventable deaths in the Romanian trauma care (Figure 1) [10]. Figure 1 - The website of Romanian Major Trauma Registry (http://www.registrutraume.ro). USA - In the United States of America there are 203 level I centers, 265 level II centers, 205 level III or II centers and only 32 level I or II pediatric centers, according to the 2014 report of National Trauma Databank [11]. USA were the first which recognized trauma as a public health problem, and proceeded to a national strategy for injury prevention, emergency medical care and trauma research. In 1966, the US National Academy of Sciences and the National Research Council noted that ‘’public apathy to the mounting toll from accidents must be transformed into an action program under strong leadership’’ [12]. Considerable national efforts were made in 1970s, when standards of trauma care were released and in 1990s when ‘’The model trauma care system plan’’[13] was generated. The American College of Surgeons introduced the concept of a national trauma registry in 1989. The National Trauma Databank became functional seven years later, in 2006 being registered over 1 million patients from 600 trauma centers [14]. Mortality from unintentional injury in the United States decreased from 55 to 37.7 per 100,000 population, in 1965 and 2004, respectively [15]. Due to this national efforts, 84.1% of all Americans have access within one hour from injury to a dedicated trauma care [16]. Canada - A survey from 2010 revealed that 32 trauma centers across Canada, 16 Level I and 16 Level II, provide definitive trauma care [18]. All these centers have provincial designation, and funding to serve as definitive or referral hospital. Only 18 (56%) centers were accredited by an external agency, such as the Trauma Association of Canada. The three busiest centers in Canada had between 798–1103 admissions with an Injury Severity Score over 12 in 2008 [18]. Australia - Australia is an island continent, the fifth largest country in the world, with over 23 million people distributed on this large area, a little less than the United States. With the majority of these citizens concentrated in large urban areas, access to the medical care for the minority of inhabitants distributed through the territory is quite difficult. The widespread citizens cannot be reached by helicopter, restricted to near-urban regions, but with the fixed wing aircraft of the Royal Flying Doctor Service, within two hours [13]. In urban centers, the trauma care is similar to the most developed countries, while for people sparse on large territories the trauma care is far from being managed in the ‘’golden hour’’, often extending to the ‘’Golden day’’ [19]. Germany - One of the most efficient European trauma system is in Germany. Created in 1975 on the basis of the Austrian trauma care, this system allowed an over 50% decreasing of mortality, despite the increased number of injuries. According to the 2014 annual report of the Trauma Register of German Trauma Society (DGU), there are 614 hospitals submitting data, with 34.878 patients registered in 2013 [20]. The total number of cases documented in the Trauma Register DGU is now 159.449, of which 93% were collected since 2002. In the 2014 report, from 26.444 patients with a mean age of 49.5% and a mean ISS of 16.9, the observed mortality was 10% [20]. The United Kingdom - In 1988, a report of the Royal College of Surgeons of England, analyzing major injuries concluded that one third of deaths were preventable [21]. In 2000, a joint report from the Royal College of Surgeons of England and of the British Orthopedic Association was very suggestive entitled "Better Care for the Severely Injured" [22]. Nowadays the Trauma Audit Research network (TARN) is an independent monitor of trauma care in England and Wales [23]. TARN collects data from hospitals for all major trauma patients, defined as those with a hospital stay longer than 72 hours, those who require intensive care, or in-hospital death. A recent analysis of TARN data, looking at the cost of major trauma patients revealed that the total cost of initial hospital inpatient care was £19.770 per patient, of which 62% was attributable to ventilation, intensive care and wards stays, 16% to surgery, and 12% to blood transfusions [24]. Global health care models Countries where is applied Functioning concept Total healthcare costs from GDP Bismarck model Germany Privatized insurance companies (approx. 180 nonprofit sickness funds). Half of the national trauma beds are publicly funded trauma centers; the remaining are non-profit and for-profit private centers. 11.1% Beveridge model United Kingdom Insurance companies are non-existent. All hospitals are nationalized. 9.3% National health insurance Canada, Australia, Taiwan Fusion of Bismarck and Beveridge models. Hospitals are privatized, but the insurance program is single and government-run. 11.2% for Canada The out-of-pocket model India, Pakistan, Cambodia The poorest countries, with undeveloped health care payment systems. Patients are paying for more than 75% of medical costs. 3.9% for India GDP – gross domestic product Table 1 - Global health care models with major consequences on trauma care [17]. Traumas continue to be a major healthcare problem, and no less important than cancer and cardiovascular diseases, and access to dedicated and timely intervention maximizes the patients’ chance for survival and minimizes the long-term morbidities. We should remember that one size does not fit in all trauma care. The Romanian National Trauma Program should tailor its resources to the matched demands of the specific Romanian urban and rural areas.

Abstract Background While the psychosocial risk factors for traumatic injuries have been comprehensively investigated, less is known about psychosocial factors predisposing athletes to overuse injuries. Objective The aim of this review was to systematically identify studies and synthesise data that examined psychosocial risk factors for overuse injuries in athletes. Design Systematic review. Data Sources MEDLINE, Web of Science and PsycINFO databases, supplemented by hand searching of journals and reference lists. Eligibility Criteria for Selecting Studies Quantitative and qualitative studies involving competitive athletes, published prior to July 2021, and reporting the relationship between psychosocial variables and overuse injury as an outcome were reviewed. This was limited to academic peer-reviewed journals in Swedish, English, German, Spanish and French. An assessment of the risk of bias was performed using modified versions of the RoBANS and SBU Quality Assessment Scale for Qualitative Studies. Results Nine quantitative and five qualitative studies evaluating 1061 athletes and 27 psychosocial factors were included for review. Intra-personal factors, inter-personal factors and sociocultural factors were found to be related to the risk of overuse injury when synthesised and reported according to a narrative synthesis approach. Importantly, these psychosocial factors, and the potential mechanisms describing how they might contribute to overuse injury development, appeared to be different compared with those already known for traumatic injuries. Conclusions There is preliminary evidence that overuse injuries are likely to partially result from complex interactions between psychosocial factors. Coaches and supporting staff are encouraged to acknowledge the similarities and differences between traumatic and overuse injury aetiology.

Background and objectives: Electromobility has become increasingly popular. In 2001, Segway personal transporters (Segway) were established for tourists, and e-scooters have been in use since their approval in 2019. The aim of this study was to analyze and compare the types of injuries directly related to the use of Segways and e-scooters, respectively, in a German city and to phrase potential safety advice. Materials and Methods: All patients presenting to our emergency department after Segway incidents were retrospectively analyzed and compared with the prospectively collected cohort of patients following e-scooter incidents. Presented injuries were analyzed by body region and injury severity score (ISS). Epidemiological data were collected. Results: Overall, 171 patients were enrolled. The Segway group included 56 patients (mean age 48 years), and the e-scooter group consisted of 115 patients (mean age 33.9 years). Head injuries (HI) occurred in 34% in the Segway group compared to 52% in the e-scooter group. The ISS was approximately equal for both groups (mean ISS Segway group: 6.9/e-scooter group: 5.6). Conclusions: Since the e-scooter group presented a high number of HI along with a higher likelihood and greater severity of HI, mandatory use of helmets is suggested.

At the 1994 World Congress of Sociology in Bielefeld (Germany), Henry Quarantelli suggested that sociologists studying disasters ought to pay more attention to documents and to historical research. Research done on Canada's worst catastrophe, the 1917 Halifax, Nova Scotia munitions ship explosion—1,963 dead 9,000 injured—shows that there can be scores of documents available about such incidents. These include media accounts, articles in academic journals and professional publications, and books, both nonfiction and fiction, inspired by personal experience. There are also archival records. Material on the Halifax explosion was found in Boston, Washington, D.C., Paris, London, and Oslo as well as in Canadian centers at Charlottetown, Sydney, Truro, St. John's, Ottawa, Toronto, and Halifax. While some documents were easy to locate, others required using contacts and advertising one's interest. Networking led to new live sources (there are still hundreds of survivors from 1917) and to documents in private hands including diaries and letters. The results provide both new insights into historical events and a test of current theories using historical data.

Background Ankle sprains are one of the most frequent sports injuries. With respect to the high prevalence of ankle ligament injuries and patients’ young age, optimizing treatment and rehabilitation is mandatory to prevent future complications such as chronic ankle instability or osteoarthritis. Objective In modern times, an increasing amount of smartphone usage in patient care is evident. Studies investigating mobile health (mHealth)–based rehabilitation programs after ankle sprains are rare. The aim of this study was to expose any issues present in the development process of a medical app as well as associated risks and chances. Methods The development process of the Ankle Joint App was defined in chronological order using a protocol. The app’s quality was evaluated using the (user) German Mobile App Rating Scale (MARS-G) by voluntary foot and ankle surgeons (n=20) and voluntary athletes (n=20). Results A multidisciplinary development team built a hybrid app with a corresponding backend structure. The app’s content provides actual medical literature, training videos, and a log function. Excellent interrater reliability (interrater reliability=0.92; 95% CI 0.86-0.96) was obtained. The mean overall score for the Ankle Joint App was 4.4 (SD 0.5). The mean subjective quality scores were 3.6 (surgeons: SD 0.7) and 3.8 (athletes: SD 0.5). Behavioral change had mean scores of 4.1 (surgeons: SD 0.7) and 4.3 (athletes: SD 0.7). The medical gain value, rated by the surgeons only, was 3.9 (SD 0.6). Conclusions The data obtained demonstrate that mHealth-based rehabilitation programs might be a useful tool for patient education and collection of personal data. The achieved (user) MARS-G scores support a high quality of the tested app. Medical app development with an a priori defined target group and a precisely intended purpose, in a multidisciplinary team, is highly promising. Follow-up studies are required to obtain funded evidence for the ankle joints app’s effects on economical and medical aspects in comparison with established nondigital therapy paths.

The way the law regulates marriage and marital relations stems, at least to a certain extent, from the common beliefs of the society concerning these issues. The same can be said of the law of torts, whose norms arise from the social convictions regarding who and to what extent shall bear certain damages, including the fundamental issue of whether such damages should be subject to compensation at all or should they be incurred by the party at least allegedly injured. This paper aims to present a brief comparative analysis of the admissibility of seeking monetary compensation for marital infidelity in legal systems close to Poland German, Austrian, as well as in common law systems, and then present the possible legal grounds for such claims under Polish law, acquis of case-law and legal academics, namely — the claims related to the infringement of personal rights Article 23, 24 and 448 of the Polish Civil Code. The Polish approach is discussed in the context of a recent landmark Polish Supreme Court decision, where it has been ruled that the abovementioned provisions cannot be construed as to provide monetary relief for non-material damages suffered by betrayed spouses. The authors employ legal comparative and historical methods, supplanted by formal-dogmatic ones, to describe and show the evolution of the law concerning monetary liability for marital infidelity, in light of the statutory law and jurisprudence of Poland. Pieniężne zadośćuczynienie za krzywdę spowodowaną przez niewierność małżeńską — perspektywa komparatystycznaSposób, w jaki prawo reguluje małżeństwo i relacje między małżonkami, jest silnie zakorzeniony w powszechnych osądach moralnych dotyczących tych kwestii. Podobnie rzecz się ma z wynagrodzeniem szkody, w wypadku którego zasadniczą rolę odgrywa społeczne przekonanie co do tego, kto, czy i w jakim stopniu powinien ponosić odpowiedzialność za jej wyrządzenie. Niniejszy artykuł ma na celu ukazanie możliwości dochodzenia pieniężnej rekompensaty za niewierność małżeńską w perspektywie komparatystycznej, analizując pokrótce możliwości istniejące w tym zakresie zarówno w systemach bliskich polskiemu niemiecki, austriacki, jak i w systemach common law. W dalszej kolejności prezentowane są potencjalne prawne podstawy dla tego rodzaju roszczeń w prawie polskim, mając na uwadze tezy doktryny i orzecznictwa, w szczególności na gruncie przepisów o ochronie dóbr osobistych art. 23, 24 i 448 k.c.. Autorzy odnoszą się zwłaszcza do niedawnego wyroku Sądu Najwyższego wyłączającego zastosowanie przepisów o ochronie dóbr osobistych do konstruowania roszczenia o zadośćuczynienie za krzywdę wyrządzoną zdradą małżeńską. Autorzy używają metod komparatystycznej i historycznej, wspartych analizą dogmatyczną, by ukazać ewolucję różnorodność i ewolucję norm dotyczących majątkowej odpowiedzialności za zdradę małżeńską, w szczególności w świetle polskiego prawa i orzecznictwa.

Abstract Background The current paper is part of the EU-funded REHABILAID Project and aims to describe the profile of cyclists sustaining severe injuries in a road traffic incident as well as the healthcare costs associated with their injury, including hospitalization costs and out-of-pocket expenditure. Methods Seven public hospitals were involved; Greece=5, Italy=1 and Germany=1. Both the intensive care units (ICU) and sub-intensive care units (as high-dependency areas) were involved. Participants enrolled during a 12-month period starting from April 2013 and were followed for one year from admission date. The study used widely recommended classifications for injury severity (AIS-Update 2008, MAIS). Information on the injury was retrieved upon patients’ consent, from medical records while interviews were carried out at months 1,6,12 for personal and cost-related information. Health Care Expenditure was assessed through the MUARC’s framework. Diagnosis-related groups (DRGs) were used to estimate hospitalization costs. Results 120 subjects enrolled in the study in total and 14 were cyclists(Greece=1, Germany=3, Italy=10). Most of them were men(n = 9, 64.3%), with a mean age of 55.5 years (SD16.3;min 32-max 84). As for the current incidents, the majority occurred at city roads (n = 10;71.4%), straight roads (n = 9;64.3%) and intersections (n = 3;21.4%). Many were single-vehicle (n = 4;28.6%), lateral (n = 4;28.6%) and front-lateral (n = 3;21.4%). Half of the cyclists sustained an injury of MAIS3+ severity (n = 7;50.0%). A major injury was primarily sustained at the lower extremities (n = 10;71.4%), head (n = 7;50.0%), face (5=35.7%) and upper extremities (n = 5;35.7%). The mean total hospitalization cost was 5815,6(min 209,00-max 20.647,00) and the mean direct costs arising from injury was 4.047,5(min 0,0-max 24.670,00). Conclusions Individual differences need to be taken into account in future injury prevention efforts as well as in attempts to improve healthcare system’s response to road victims. Key messages Systematic collection of data relevant to health condition and economics of the victims is necessary at European level. Personalized rehabilitation plans are necessary to facilitate the recovery process of victims.

Chapter 1 lays the basis for the analyses in subsequent chapters by summarizing the protest groups and types of violence examined in this book. A first section takes a closer look at the protest groups discussed in chapters 2 to 8: the 1960s student movements in the United States and Germany, the new social movements, and the global justice movement protests. It describes involved social movement groups and discusses their claim-making, their membership composition, their stance toward violence, the frequency of such groups clashing with police, as well as police perceptions of them. A second section discusses the definition of violence used in the book. Highlighting different concepts of violence, it argues for a concise definition of physical interpersonal violence—as actions injuring or killing another person. This definition also allows examination of whether other types of actions often labeled “violence,” such as property damage, may foster interpersonal violence.

In German law, liability for damage due to product defects relies on three concepts: traditional contractual liability, traditional tort liability, and objective liability for damage. The paper discusses tortious liability for damage from product defects according to the provisions of the German Civil Code. Namely, by implementing the provisions of Directive 85/374 / EEC into the German legal order, the provisions of the German Civil Code have not been suppressed, but there is a possibility for the injured party to choose the basis of the claim, based on tortious liability, or objective liability for damage. Contractual liability for product defects plays a small role for injured parties in German law. In order to solve the problems that have arisen as a result of the inadequacy of contractual liability, German courts have decided to improve the position of consumers through tortious liability for damage from defective products. Tort liability for damage has become a convenient mechanism for resolving certain problems that have arisen in relation to this liability. Among others, the answer was given to the question of whether inaction, ie omission, can lead to a tort. More importantly, the circle of persons potentially responsible for the damage was concretized.