The health, family, and social impacts of work related injury Ya-chi Chang 1 , Yi-ping Lin 1,2

1. original job & company (n=18) Got the compensation (n=16) original company and modified job (n=5) In process of the paper work (n=3) 31 cases were traced in the 2nd interview Return to wok (n=25) Injured workers were sent to ER of NTUH for treatment Did not apply the compensation (n=5) different job & company (n=1) 31 cases were traced in the 2nd interview Not qualified to apply (n=6) original job but different company (n=1) Civil servant insurance (n=1) Identified by occupational residents in ER Not return to work (n=6) Non work related Injury work related Injury Slight injury, OPD followed Severe injury, admitted for hospitalization Case manager completed the interview in bedside Injured workers, corresponded with the inclusion criteria, were included in the study and had first time interview (n=40) Followed-up at 6 months by telephone interviews. (n=31) An in-depth interview is performed after the case selection (n=1) The health, family, and social impacts of work related injury Ya-chi Chang1, Yi-ping Lin1,2 1National Taiwan University, Taipei, Taiwan, 2National Yang-Ming University, Taipei, Taiwan BACKGROUND AND OBJECTIVE the compensation,six were not qualified to apply, and one worker was in the civil servant insurance ( Figure 2.). Previous studies of occupational injuries in Taiwan focused on the compensated cases. In this study, we actively contact injured workers who were sent to the NTUH. Through the case manager system in the hospital, we interviewed the workers while they were hospitalized, and follow-up six month later to explore the health, family, and social impacts of their injuries Figure 2. Compensation status 1. Physical aspect: Most of the subjects still suffered from activity limitation and physical pain 6 months after their injury. Six subjects had permanent disability; one of them, gotten a severe injury, might lose his working ability for life. Four subjects needed surgery to remove their nails; three went through surgeries forfurther treatment. SUBJECTS AND METHODS This study was conducted in the National Taiwan University Hospital (NTUH), a large urban medical center in Taipei, Taiwan. With the help of occupational medicine residents in the emergency room (ER), we identified 40 injured workerswho were hospitalized in the NTUH between July and December, 2007 (Fig 1).All subjects, aged between 18 and 65, chosen for this study were correspondent with the injury types of the Labor Insurance Act. 2. Occupational aspect: After occupational injuries, workers are more likely to change or lose their jobs. There were 25 subjects have already returned to work; six workers were still absent from work because of medical reasons ( Figure 3.). The mean of absence was 100.8 ± 69.1days (min: 5 days, max: 230). Many workers faced tight relationship with their employers. Some interviews complained of the employers’ ignorance of their laborrights, including forcing them to return to work with unhealed wound, decreasing their wages, and depriving the employee’s legal rights. Table 3. Absent reason of injured worker (n=31) The subjects were interviewed after their admission to the NTUH by semi-structured interview recording. They were followed up by telephone interviews 6 months later. Besides, weinterviewed one of the subjects for the details of her case history to further explore the health, family, and social impacts of injured workers. Figure 3. The statusof returned to work 3. Economic aspect: More than half of the interviewers expressed that they had economic loss. There were 45.2% workers who got their original wages, 32.3% workers only had base pay, and 22.5% of workers had nothing form their salaries.The situation was worse on the workers who didn’t have regular employer. Some people applied for the worker compensation for economic support, but seven interviewers (22.5%) were not qualify to apply. Although workers’ compensation Figure 1. Study design RESULTS Most of the injured subjects were blue color workers. Theirhousehold annual income werefar lower than the average family income in Taiwan . Table 1 and table 2 are the social characteristics and injury data of our study subjects. insurance could help injured workers to deal with the economic impacts, some subjects reported that the complicated applying process had delayed their urgent needs. Table 4. Salary decreased after getting injury (n=31) Table 1. Characteristics of study subjects (n=40) Table 2. Injury data (n=40) 4. Family aspect: Many injured workers faced family crisis because of economic loss. Some families couldn’t even afford their daily expense. 5. Psychological and behavioral aspect: Many interviewers were under pressure. They indicated that wage loses played an important role in their increased mental stress. Job lost, physical limitation, body image changed, and the dispute with the employer were others to cause bad mood. There was one subject who increased his cigarette consumption, on the other hand, two quitted smoking. No one reported drug or alcohol addiction problems. 6. Social aspect: Concerning social welfare application, 11 contacted with the Bureau of Labor Insurance for working compensation; five went to Labor Affairs Bureau for social subsidy; four got medical help via occupational medical center; one turned to the Legal Aid Foundation for legal consultation; one asked the Labor Standards Inspection Office for the work-site inspection; one sought Taiwan Association for Victims of Occupational Injuries for mental support. DISCUSSIONS AND CONCLUSIONS Occupational injured workers not only suffered from physical problems, but also economic loss, weakened labor rights, and family crisis. Although some injured workers tried to apply for social resources, most workers had little understanding of their rights. Establishing case management systems in major hospitals might offer great help to the injured workers. We traced 31 workers 6 months after their hospitalization (interview rate: 77.5%). There were 16 subjects who had gotten compensated, three of them were in the process of the compensationpaper work , five didn’t apply for