Tesi sul tema "The professional risk"

Risk management is composed of three major elements viz., hazard identification, risk estimation and risk evaluation. The aim of hazard identification and risk estimation is to identify the outcomes from risk, the magnitude of the associated con&quences from risk, and the estimation of the probabilities of these outcomes. Previous work focused on hazard identification and risk estimation and identified the relatively high risks associated with playing professional football. By adhering to the risk management process, the aim of this thesis was to determine the significance of these high risks to football clubs and their players. A theoretical framework was designed to evaluate the influence of player injury on the financial and playing performance of professional football clubs. This framework was also used to assess, through use of cost benefit analysis, the practicalities of investing in suitable injury prevention strategies, to reduce the risks to football clubs and their players. Former professional footballers were surveyed to investigate the long-term medical and socioeconomic consequences associated with the high risks of playing professional football. The results identified the high financial costs associated with player injury on professional football clubs. Although the high risks of player injury have a relatively minor effect on teamperformance of the Premier League clubs, this effect still has a relatively major influence on the financial performance of the club. In contrast, the influence of player injury to teamperformance was relatively major for Division I and Division 2 clubs, but this had a relatively minor effect on financial performance. The application of cost benefit analysis to the investment of specialist personnel to reduce the risks of injury demonstrated that the proposals were practicable for Premier League and Division I clubs only. In addition, it was also demonstrated that the high risks associated with playing professional football have a significant influence on the long-term well-being of foriner players. One-third of former players had been medically diagnosed osteoarthritic in a lower limb joint. The majority of players also perceived that injury had a negative influence on their present and future welfare. The results demonstrate that the consequences associated with the relatively high acute injury risk also have a significant effect on the financial and playing performance of football clubs and the future welfare of their players.

The central issue addressed in this thesis was the validation of a novel risk assessment system designed to meet the security requirements of a high secure forensic hospital. To this end, three research strands investigating the clinical, predictive and preventative utility of the system were pursued. This thesis reports the process of the development, adaptation and implementation of a system based on the HCR-20, called the Structured Clinical Judgement: Risk (SCJ: Risk). The first research strand involved investigation of the processes necessary implement a system of structured professional judgement. The conceptual and operational utility of the system were investigated, and successful implementation of the system within clinical practice was demonstrated by compliance of use by clinical teams. A survey was conducted, investigating the perceptions of clinicians in relation to the clinical utility and usability of the SCJ: Risk. Overall acceptance of the pilot and implementation phase of the system was demonstrated, and the system was perceived to assist clinical teams to structure and document risk-related decisions. The second research strand studied the validity of the SCJ: Risk in predicting intra-institutional behaviour. A prospective investigation of the application of the SCJ: Risk to a forensic population detained in conditions of high security was conducted and this demonstrated variation in the predictive utility of the system. The predictive accuracy of subscale items of the SCJ: Risk, and the individual risk factors comprising the subscales of the system were robust for behaviours relevant to violence and suicide/self-harm. However, prediction of behaviours relevant to escape/abscond, vulnerability to risk from others and subversion of security were not demonstrated. The third research strand involved exploration of the preventative utility of the system, specifically if the identification of a patient as high-risk would minimise the occurrence, or prolong the time to an incident of intra-institutional behaviour. Results illustrated the efficacy of the SCJ: Risk system in the identification of high risk individuals for behaviours relevant to any intra-institutional infraction, violence and self-harm. Patients identified as high-risk displayed a higher prevalence and earlier incidence of relevant intra-institutional behaviour. It is concluded that the system of Structured Clinical Judgement: Risk (as an adaptation of the HCR-20) contributes positively to the overall goals of clarity of risk communication, identification and management of high risk patients within forensic psychiatric practice. However, the extended risk assessment of the SCJ: Risk does not make a significant additional contribution to the parental system on which it is based.

This thesis includes four papers based on three different prospective cohort studies on injury characteristics in men’s professional football. The same general methodology was used in all papers. Time-loss injuries and player individual exposure was registered for match and training separately. The general aim was to investigate potential internal and external risk factors for injury, with a focus on age, playing position, time in professional football, playing surface (artificial turf and natural grass), changes between surfaces and climate; and to evaluate the study methodology. Paper I was based on data collected between 2001 and 2010 from 26 top professional clubs in Europe; the UCL injury study. In total, 6140 injuries and 797 389 hours of exposure were registered. A decreased general injury rate was observed for newcomers compared with established players (hazard ratio (HR), 0.77; 95% CI 0.61-0.99). Using goalkeepers as a reference, all outfield playing positions had significantly higher age-adjusted injury rates. Using players aged ≤ 21 years as a reference, the overall adjusted injury rate increased with age, with a peak injury rate among players aged 29 to 30  years (HR, 1.44; 95% CI, 1.24-1.68). Paper II and Paper III are based on data collected during two consecutive seasons, 2010 and 2011, in the Swedish and Norwegian male first leagues. In total, 2186 injuries and 367 490 hours of football exposure were recorded. No statistically significant differences were found in acute injury rates on artificial turf (AT) compared with natural grass (NG) during match play (rate ratio, 0.98, 99% CI 0.79-1.22) or training (rate ratio 1.14, 99% CI 0.86-1.50) when analysing at the individual player level. However, when analysing at the club level, clubs with AT installed at their home arena had a significantly higher acute training injury rate (rate ratio 1.31, 99% CI 1.04-1.63) and overuse injury rate (rate ratio 1.38, 99% CI 1.14-1.65) compared to clubs with NG installed at their home venue. No association was found between frequent surface shifts and subsequent overuse injury risk (risk ratio 1.01, 95% CI 0.91-1.12). Analyses on the total cohort showed no difference in injury rates between clubs in the two climate zones (total rate ratio 1.01, 95% CI 0.92-1.10). Data included in Paper IV were collected during two consecutive seasons 2008 and 2009. During this period, two Norwegian elite football clubs were concurrently included in two research groups’ surveillance systems. The capture rate for match injuries was similar between the two audits, while the capture rate for training injuries was slightly higher with individual-based exposure recording. The inter-rater agreement in injury variable categorisations was in most aspects very high.

This thesis explores the phenomenon of workforce modernisation through the reconfiguration of professional roles, which represents a policy priority in healthcare systems in the United Kingdom (UK) and globally. Heavily informed by conflict or power accounts of professionalism, the literature presents attempts to reconfigure professional roles as opportunities for the reallocation of professional knowledge and expertise and therefore power and status. Existing work emphasises the strategic, competitive activity of professionals to establish, extend and defend jurisdiction in the face of such change. Utilising an organisational neoinstitutional approach this thesis provides a novel theoretical interpretation of the opportunities and threats that the renegotiation of roles presents to the professional groups involved, adding complexity to the accounts that dominate the literature. The thesis draws upon work that describes the evolving nature and function of professionalism to demonstrate that in the contemporary organisational environment, focussed on accountability and risk management, attempts to reconfigure professional roles are understood not only in terms of the transfer of professional knowledge and expertise but the concurrent transfer of accountability for the management of risk. This represents a more complex commodity potentially associated with professional risk in the event of untoward incidents. Using the case of changes to the roles of consultant psychiatrists in the UK National Health Service (NHS) that propose the redistribution of clinical activity and responsibility from psychiatrists across the wider mental health workforce, the thesis demonstrates that rather than competing for jurisdiction associated with the management of significant risk, professionals carefully renegotiate their roles in a manner that ensures the protection, not just of their clients, but of the professionals involved. In this case, despite institutional work from professionals and managers to create change in established practice, concern with accountability for the management of risk drove adherence to traditional, readily accepted and organisationally sanctioned interprofessional boundaries, limiting the degree of change enacted. These findings have important practical implications for those involved in the management of change as well as theoretical implications for our understandings of professional role reconfiguration attempts and the nature of contemporary professionalism more broadly.

Background: Injuries are common in professional football, especially during matches, and they cause suffering for players, in both the short and the long term. It is therefore important to try to prevent these injuries. One of the most important steps in injury prevention is to fully understand the different risk factors that contribute to these injuries. Aim: The aim of this thesis was therefore to investigate several match-related factors that have been suggested to be important for the risk of sustaining injuries during professional football matches. Methods: The thesis consists of four papers, and all analyses are based on data gathered during a large-scale prospective cohort study that has been running since 2001: the UEFA Elite Club Injury Study. Medical teams from 61 clubs have been involved in this study, and they have prospectively gathered data about football exposure and injuries for their first team players. Associations between the following factors and injuries have been analysed: • Match characteristics in terms of match venue, match result, and competition • Match congestion, both short and long term, and at team and individual player level • Number of completed training sessions between return to sport after an injury and the first match exposure Results: All match characteristics studied were shown to be associated with injury rates, with higher injury rates during home matches compared with away matches, in matches that were lost or drawn compared with matches won, and in domestic league and Champions League matches compared with Europa League and other cup matches. It was also shown that injury rates, muscle injury rates in particular, were higher if the recovery time between matches was short. This association between match congestion and injury rates was shown when match congestion was considered at both team and individual player level. Finally, the odds of injury during the first match exposure after a period of absence due to injury was found to be higher if players had completed few training sessions between return to sport and their first match. Conclusion: There are several match-related risk factors that contribute to the injury rate during professional football matches. A better understanding of these risk factors will help teams to make better estimations of the injury risks to which players are exposed in different situations (e.g. during periods of match congestion and when players return to sport after an injury). Knowledge about risk factors will also offer the possibility of reducing the number of injuries for football teams by addressing them with appropriate measures.

The development of competency in personal and professional skills and values is likely to increase in importance as Clinical Psychologists in-training take on leadership and consultancy roles and work with greater complexity on qualification. However, the literature on how this competency develops and what helps and hinders this within Clinical Psychology training programmes is very limited. An understanding of the experience of Clinical Psychologists’ in-training development of this competency is important to inform teaching and supervisory practice and to promote development of self awareness, professional effectiveness and resilience. Given the lack of literature and the exploratory nature of the research question, a qualitative approach was undertaken which explored Clinical Psychologists’ in-training lived experience of developing personal and professional skills (PPD) through managing risk. A focus on such situations was chosen because managing risk is experienced by many trainees as taking them to the limits of their competence and to often demand interprofessional working. The research explored how the experience of managing such risks and complexity enhanced or diminished PPD learning. A systematic review of the extant literature was conducted and semi-structured qualitative interviews were pursued with ten Clinical Psychologists’ in-training across the UK, from a range of doctoral training programmes. An interpretative phenomenological approach was employed to analyse participants’ accounts. Four themes which interlinked to form a learning cycle: ‘event perception’, ‘managing the professional self’, ‘reflective practice’ and ‘identity’. The emergent themes were interpreted with reference to the literature on PPD in broader populations of health professionals. The findings have a range of implications for training programmes, supervisors, trainees, and for the British Psychological Society/The Committee of Training in Clinical Psychology accreditation criteria which is currently being revised. Implications of the findings for risk management in clinical practice and recommendations for future research are also presented.

This study adopted an interpretive qualitative approach, using narrative inquiry to understand the experiences of early career physical education (PE) teachers who took ‘risks’ during their training year, and who had been teaching in schools. Narrative interviews were conducted with nine PE teachers who had engaged with a Risk-Taking Professional Development Programme (PDP) during their training year and who had been teaching for between two months and five years. Interviews explored the meanings, definitions and influences that participants ascribed to risk taking from their memories of the training year and once they began teaching in schools. The focus of the study emerged because in my role as a PE teacher trainer, I designed the Risk-Taking PDP to challenge trainee PE teachers to reflect critically upon their teaching and pupil learning and, move beyond their comfortable practices. Inspiration was taken from the Office for Standards in Education outstanding descriptor at that time, to ‘Take risks when trying to make teaching interesting, be able to deal with the unexpected and grab the moment’ (Ofsted, 2008, p. 1). The Risk-Taking PDP became a core component of the PE Teacher Training course in one UK Higher Education Institution (HEI) and was delivered to over 100 PE trainee teachers. An interpretive analysis located overlapping and interlocking themes which closely represented illuminative epiphanies (Denzin, 2001). Findings revealed that risk-taking became a central component of teachers’ practice during the training year. It encouraged critical reflection and developed trainee confidence. Epiphanic moments experienced by participants highlighted that adaptation, negotiation and resilience formed over time as crucial aspects of risk-taking. Once qualified and teaching in schools, key influences affected PE teachers’ willingness to take risks. These included; performativity measures, time, pupil behaviour and the influence of the subject community. Risk-taking was found to support personal and professional growth and, when influences in schools were positive, engagement with innovation and creativity continued. This led to further growth and learning for both teachers and pupils. This study provides new knowledge to inform the continuation of the Risk-Taking PDP and offers new insights for PE Initial Teacher Education and Training (ITET) practices. Furthermore, this study reaffirms the views of Clandinin and Connelly (2000) who argue for narrative being a three-dimensional space where temporality, sociality and place (context) influence thinking and learning and also, those of Dewey (1938) where experience and learning is transactional and always in relation to others and the social context. This study proposes a fourth dimension to risk-taking, a visional dimension where teachers visualise an ‘ideal’ situation and, is represented through the abstract conceptualisation of risk-taking holding a four-dimensional metaphorical space. This is represented through a geometrical shape, the Tesseract. This study suggests that the Tesseract Model should be utilised in schools to support early career teacher professional development, build resilience and encourage collaborative engagement in subject communities. Likewise, insights from a methodological approach, of narrative inquiry, that has seen a limited application in the context of PE provides a different and invaluable viewpoint in positioning the researchers’ and participants’ stories centrally.

Introduction: Knee osteoarthritis (KOA) is a common complex disorder. Although previously believed to be degenerative, KOA is in fact a regenerative condition, compensating against insults sustained at the joint. However, a failure of this compensatory repair process, especially in the presence of constitutional and local joint factors, increases the risk of KOA and inevitably leads to joint-failure (Dieppe and Lohmander, 2005, Arden and Nevitt, 2006, Sandell, 2012). Diagnosis of KOA may be made via clinical presentation, imaging, or using clinical algorithms, which may be a combination both in addition to biochemical diagnostic tests (Brandt et al., 2003). Knee pain (KP) is the most common symptom, and in the general population its prevalence is 25% (Peat et al., 2001a). Patients may also experience early morning stiffness of the joint and reduced function. Physician-observed signs include crepitus, restricted movement, and bony and soft tissue swellings (Abhishek and Doherty, 2013). Although considered the gold standard to diagnose KOA, plain film radiography is not without its limitations (Wick et al., 2012). Clinicians, however, favour radiography because it can easily discern two key features of the condition: joint space narrowing (JSN), a surrogate of cartilage loss, and the formation of osteophytes on the joint margin (Roemer et al., 2014). Assessment of radiographs is most commonly undertaken using Kellgren-Lawrence (KL) grade verbal descriptors (Altman et al., 1986a). The prevalence of radiographic KOA (RKOA) may be higher than KP, but there is a discordance between people reporting symptoms and those with structural change (RKOA) (Peat et al., 2001a, Bedson and Croft, 2008). A plethora of constitutional risk factors and joint-specific biomechanical factors increase the risk of KOA, including joint injury and occupation (Suri et al., 2012, Silverwood et al., 2015). One such occupation, which has a greater risk of injury are professional footballers (Drawer and Fuller, 2002) and knee injuries account for 17% of all footballing injuries (Ekstrand et al., 2011). Football is one of the most common team sports worldwide, with over 265 million people worldwide play the game (FIFA, 2007a), and of these, 110,000 are male professional footballers (FIFA, 2007b). Although perceived that that footballers are at great risk of long-term consequences such as KOA, due to their high risk of injury, the current evidence supporting this is limited (Kuijt et al., 2012, Tran et al., 2016). The previous studies observing KOA in footballers are difficult to generalise to the wider football population. This is for a number of reasons, including recruitment of inadequate sample, absence of inappropriate control groups, and differing case definitions, all resulting in a large variation in prevalence of KOA. Thus, there exists a need for a comprehensive study to determine the true prevalence and risk of KOA in retired professional footballers compared to the general population. Aims: (1) To determine the prevalence and risk of KOA (measured as KP, RKOA and requirement for total knee replacement (TKR)) in retired professional footballers compared to the general population; (2) To determine the specific factors (constitutional, biomechanical and football-specific) that are associated with an increased risk of each of these outcomes (KP, RKOA and TKR) within footballers. Methods: The Nottingham University Hospitals NHS Trust and the Nottingham Research Ethics Committee (Refs 14/EM/0045; 14/EM/0015) approved this study, which was registered on the clinicaltrials.gov portal (NCT02098044; NCT02098070). This study design involved carrying out two cross-sectional studies. The Football Study involved distributing 4775 postal questionnaire surveys to retired professional footballers via multiple sources, including football clubs, their former players’ associations and the Professional Footballers Association (PFA). The Knee Pain and Related Health in the Community Study (KPIC) involved distributing 40,500 postal questionnaires, via 12 general practice surgeries, to both men and women in the East Midlands general population. However, only men formed the control group for this study. The inclusion criteria for both the footballers and control participants was the same: men aged 40 and older. The questionnaires, developed based on previously literature, were similar to capture detailed information about KP, undergoing a TKR and putative risk factors for KOA, including knee injuries, surgery and alignment. The questionnaires also gathered information regarding demographics, medical and occupational history, general health and current medication. Following this, footballers and controls who consented had radiographic assessments of both their knees, including weight-bearing semi-flexed posterior-anterior (PA) view using the Rosen template (Rosenberg et al., 1988) and a seated 30° flexion skyline view. A single observer (GSF) scored all the radiographs as a single mixed batch using HIPAX Dicom software. In addition to the KL grades, the Nottingham Line Drawing Atlas (NLDA) was used (Nagaosa et al., 2000) (Wilkinson et al., 2005), which scored composite joint space narrowing (JSN), composite osteophyte, and a combined global score for each knee. Primary outcomes observed were current KP, RKOA (measured using the NLDA) and TKR. Secondary outcomes observed were ever having KP (chronic), physician-diagnosed KOA, RKOA (measured using KL grades) and radiographic CC. Power calculations determined the sample size for the questionnaire survey and the radiographic survey. Categorical variables presented as frequency and percent and compared using a chi-squared test. Continuous variables presented as mean and standard deviation and compared using a t-test. The risk of KOA (measured for each outcome independently) in footballers compared to the controls was determined using a generalised linear model (GLM) with a Poisson distribution, and adjusted for known risk factors (including age, body mass index (BMI) and previous knee injury). The specific risk factors within footballers associated with outcomes of KOA (namely KP, RKOA and TKR) were determined using multivariate logistic regression. Results: 1207 footballers (response rate of 25.3%) and 4085 control men responded to the Football and KPIC studies respectively, which was far lower than studies previously conducted in both populations. Following this, 470 footballers and 500 men consented to undergoing radiographic assessment of their knees. For participants who returned the questionnaire (footballers and controls), characteristics were compared between those who underwent a knee radiograph and those who did not. Age and sustaining a knee injury were the main factors significantly difference in both. Footballers were significantly older (3.9 years) than the controls, but were gender-matched (males-only) and had a similar BMI. Footballers had a significantly greater number of injuries (64.5% v. 23.3%) compared to the controls. They also had significantly more body pain (74.7% v. 69.8%) and therefore took more pain-relief medication (61.9% v. 28.5%). However, footballers suffered from far fewer comorbidities compared to the controls (29.4% v. 45.7%). Footballers had a far greater prevalence of both primary and secondary outcomes. The prevalence of KP was almost twice as great in footballers (52.2%) compared to the controls (26.9%) and this increased prevalence was regardless of age. The peak prevalence of KP also occurred at least ten years earlier in footballers compared to the controls. Although the prevalence of physician-diagnosed KOA was much lower than the prevalence of KP in footballers (28.3%), it was more than double that of the controls (12.2%). Additionally, footballers (11.1%) had almost three times greater prevalence of TKR compared to the controls. Risk factors significantly associated with footballers who had undergone a TKR, included age [OR 1.09, 95% CI 1.07-1.11], being obese [OR 1.77, 95% CI 1.00-3.12] and having gout [OR 3.11, 95% CI 1.96-4.70]. Sustaining a significant knee injury [OR 3.11, 95% CI 1.94-4.99] and receiving an intra-articular knee injection [OR 2.56, 95% CI 1.76-3.73] were also significant risk factors for footballers who underwent a TKR. However, those footballers with a longer duration of playing the game [OR 0.95, 95% CI 0.92-0.98] had a reduced risk of TKR.
Conclusion: These findings show footballers have a greater risk of KOA compared to the general population, reporting up to three times higher prevalence of various outcomes (KP, RKOA, physician-diagnosed KOA and TKR). The age-prevalence of all outcomes of KOA, are greater in footballers compared to the controls. The high prevalence of injuries significantly account the risk of KOA in footballers compared to the controls (even following adjustment of other risk factors). Within footballers, knee injuries, together with subsequent investigations (specifically exploratory and interventional arthroscopy) and management (specifically intra-articular knee injections), were strongly associated with risk of KOA (KP, RKOA and TKR independently). Football’s governing bodies need to set out and implement strategies to reduce or even prevent the risk of serious injury (thus reducing the risk of subsequent investigation). This will reduce the risk of long-term consequences, such as KOA. However, whether the Industrial Injuries Advisory Council considers the risk of KOA in footballers an industrial compensable disease remains a question.

A prospective cohort study of 412 professional rugby union players registered with the English Premiership clubs was conducted during the 2002-2003 season. Injuries were diagnosed and reported by the club medics and the training practices by the club strength and conditioners. A total of 1,090 club injuries (match: 818; training: 260; unidentifiable onset: 12) and 145 international injuries (match: 97; training: 48) were reported. The incidence and risk of club match injuries was 97 injuries and 1,480 days absence per 1,000 player-hours, and the incidence and risk of international match injuries was 218 injuries and 3,076 days absence per 1,000 player-hours. The highest incidence of match injuries occurred to the thigh, however, injuries to the knee were of highest risk. The incidence of club and international training injuries was 3.1 and 6.1 injuries per 1,000 player-hours, respectively. When intrinsic risk factors were assessed, the youngest players (<21 years old) had the highest incidence and a significantly higher risk of injury. Playing position appeared to be the most influential determinate of injury profile, rather than intrinsic anthropometric risk factors alone. The match injury with the second highest incidence and risk was hamstring muscle injuries and a number of risk factors and protective training factors were identified. Results presented from this study have provided the most comprehensive study of injury incidence, aetiology and risk factors in professional rugby union to date. The data provide objective evidence on which to base both preventative interventions to reduce the probability of sustaining an injury and therapeutic interventions to reduce the severity of an injury and thereby reduce the overall risk associated with injuries.

The standing debate regarding how preferences should be defined is still evident in research today. Are they invariant to current endowment as a neoclassical practitioner would proclaim, or reference dependent as a behavioural economist would state? This theoretical discrepancy, regarding how preferences should be defined, when agents are experienced at what they do is found by List (2003) to be non-existing. In recollection of this notation, this thesis investigates how professional agents adopt risk in reference to a point that a neoclassical practitioner would deem irrational. With data on professional golf players on the U.S professional golf tour during 2013-2018, I find evidence that players respond in terms of what risk they adapt to a normatively irrelevant reference point in accordance to what Prospect Theory would predict. Indicating that even experienced agents have reference dependent preference towards risk. To give what the data proclaim a causal interpretation I adopt a quasi-experimental regression kink design. My estimates indicate a causal kink at my artificial threshold but are proven fragile to bandwidth alterations. Even though a causal claim is questionable, a sensitivity analysis finds evidence that my artificial threshold drives the relationship. Supporting the viewpoint that preferences towards risk are reference dependent and that experience does not eradicate the difference between what we do and what we should do.

Abstract Soldiers are at risk of incurable noise-induced hearing loss (NIHL) in military activities. Therefore the prevention of hearing loss is important. The large variation in individual susceptibility to NIHL is well known but the reason for this is not completely understood. The data of this current comprehensive register-based follow-up study consist of the health records, hearing measuring results and occupational history of 1 941 soldiers. The occurrence and degree of hearing losses among soldiers who served between 1965 and 2007 was investigated by comparing groups formed according to year-class and service branch. An association between cardiovascular risk factors and NIHL was also assessed. Furthermore the efficacy of the hearing conservation measures carried out by the Finnish Defence Forces (FDF) and the Finnish Border Guard (FBG) was evaluated. Noise turned out to be the major risk factor of hearing impairment among the investigated soldiers. The occurrence of NIHL (hearing threshold at 3,4 or 6 kHz > 40 dB) was at least around 10 percentages lower among soldiers who started their career in 1990s than in the older year-classes 15 years after the beginning of military career. Concurrently, the decline of the average degree of hearing loss at high tones improved around 20 dB. The occurrence of NIHL was the lowest among pilots, musicians and naval soldiers, and the highest among soldiers in engineering and air defense corps. No clear difference was found between cardiovascular risk factors and NIHL with the exception of hyperglycemia. A clear temporal connection was found between the decline of the occurrence of NIHL among the soldiers and the hearing conservation measures carried out in the late 80s. A review of the four-stage hearing classification used in Finnish occupational health service since the 1970s, as well as the guidelines that rely on them, is needed
Tiivistelmä Melu aiheuttaa sotilaille palautumattoman kuulovaurion riskin, minkä vuoksi meluvammojen ehkäisy on tärkeää. Yksilöiden meluvamma-alttiudessa tiedetään olevan suuria eroja. Syytä tähän ei vielä kovin hyvin tunneta. Tämän laajan rekisteritutkimuksen aineisto koostui 1941 sotilaan terveystarkastustiedoista, kuulontutkimustuloksista ja työhistoriatiedoista. Tutkimuksessa selvitettiin meluvammojen esiintyvyyttä ja vaikeusastetta vuosina 1965−2007 palvelleilla suomalaisilla ammattisotilailla vertailemalla vuosikurssin ja aselajin mukaan valittuja ryhmiä sekä tutkittiin sotilaiden sydän- ja verisuonisairauksien riskitekijöiden ja meluvammojen yhteyttä. Lisäksi tarkasteltiin Suomen puolustusvoimissa ja Rajavartiolaitoksessa toteutettujen kuulonsuojelutoimenpiteiden vaikuttavuutta. Melu osoittautui olevan merkittävin kuulovian riskitekijä tutkitussa aineistossa. Viidentoista palvelusvuoden jälkeen ilmenneiden meluvammojen (kuulokynnys taajuudella 3,4 tai 6 kHz > 40 dB) määrä oli vähintään kymmenen prosenttiyksikköä pienempi sotilailla, jotka aloittivat uransa 1990-luvulla verrattuna vanhempien vuosikurssien sotilaisiin. Samanaikaisesti korkeiden äänien kuuloviat lievenivät noin 20 dB:n verran. Meluvammariski oli pienin lentäjillä, soittajilla ja laivastosotilailla ja suurin pioneereilla ja ilmatorjuntasotilailla. Sydän- ja verisuonisairauksien riskitekijöistä ainoastaan korkea verensokeri näytti selkeästi liittyvän kohonneeseen meluvammariskiin. 1980-luvun lopulla toimeenpantujen kuulonsuojelutoimenpiteiden ja sotilaiden kuulon parantumisen välillä on nähtävissä selkeä ajallinen yhteys. Suomessa 1970-luvulta lähtien käytetyssä neliportaisessa kuuloluokituksessa ja siihen tukeutuvissa käytännöissä ilmeni puutteita, joiden vuoksi suomalaisen työterveyshuollon kuulonhuoltoa koskeva ohjeistus on aiheellista tarkistaa

UK health and safety legislation aims to protect employees from injury at work; professional footballers as employees are therefore covered by this legislation. A risk assessment approach to health and safety issues, as required by the Management of Health and Safety at Work Regulations 1992, has been undertaken to establish the epidemiological and aetiological factors related to injuries in professional football and to identify management and training procedures to reduce the incidence and severity of injuries. Issues of injury frequency and causation during the period 1994 to 1997 were addressed through two routes. First, during the 1994 World Cup Finals, 1996 European Championships, and 1994 to 1997 English league seasons via match analysis. Second, player injuries at four professional football league clubs were recorded by the club physiotherapist. These results provided complementary evidence showing an overall injury rate of 8.5/1000 playing hours, injury rates during training and matches being 3.5/1000 and 27.7/1000 playing hours, respectively. Two thirds of the injuries occurred during competitive match play, the remainder during training, the highest incidences of match and training injuries taking place during the first month of the playing season (P