[Work capacity and evaluation of the employment of invalids with sequelae of leg and spine injuries and with spinal diseases].
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The hemodynamic indices under conditions of growing physical exercise were studied in 15 healthy women and 17 patients operated for the congenital heart disease. The operated women were found to have a restricted ability to increase the stroke volume. The individual choice of the level of everyday domestic and professional activity should be made with special reference to individual hemodynamic reactions upon the physical exercise.
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The main findings from reports published in scientific journals on the criteria and methods used to assess fitness for work were reviewed. Systematic searches were made using internet engine searches (1966-2005) with related keywords. 39 reports were identified, mostly from the US and western Europe. Assessment of fitness for work is defined by most as the evaluation of a worker's capacity to work without risk to their own or others' health and safety. It is mainly assessed at recruitment (pre-offer or post-offer), and when changes of work or health conditions occur. Five main criteria used by occupational doctors to evaluate fitness for work were identified: the determination of worker's capacity and worker's risk in relation to his or her workplace, as well as ethical, economic and legal criteria. Most authors agreed that assessment tools used need to be specific and cost-effective, and probably none gives unequivocal answers. Outcomes from fitness for work assessments range from "fit" to "unfit", with other possible intermediate categories such as "fit subject to work modifications", "fit with restrictions" or "conditionally fit (temporarily, permanently)". Workplace modifications to improve or adjust working conditions must always be considered. There is confusion about the decision-making process to be used to judge about fitness for work. There is very scarce scientific evidence based on empirical data, probably because there are no standard or valid methodologies for all professions and circumstances.
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One of the leading factors affecting the functional state of the red blood system is arterial hypoxemia. Under such conditions signs of polycythemia are known to appear. At the same time, changes in the quality characteristics of the blood develop in patients with congenital heart diseases (tetralogy of Fallot including). Therefore a study of the physical rehabilitation as a total functional index may describe the adaptation of the body to hypoxemia, the variants and stages of its development. For this purpose the red blood parameters were examined (the content of hemoglobin, the erythrocyte count and their diameter) and the tolerance of physical exercises was tested by ergometry. The data were analyzed with due regard of the age of the patients and the reduction of their capacity for work, as compared to the due level. Stage 1 reduction of the capacity for work was found in patients with high red blood parameters. In groups of patients with Stage 2, 3 and especially 4 reduction of working capacity the red blood indices were significantly reduced. A distinct correlation was revealed between the erythrocyte count and their diameter, on the one hand, and the capacity for work, on the other.
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Using the methods of ultrasonic diagnosis such as M-mode echocardiography and sectoral scanning, the cardiac activity of 92 myocardial infarction survivors was studied. Initially, the patients were examined 3-3.5 months after the infarction, then one year later. The findings of the primary examination suggest that factors aggravating the prognosis of the disease and adversely affecting the work fitness of the patients include the detection of the zones of a- and dyskinesia of the myocardium, an enlargement of the cardiac cavities, a decrease in the rate of the circulatory shortening of myocardial fibers, a reduction in the blood stroke volume and in the ejection of the left ventricle. It is concluded to be advisable to use the ultrasonic data for solving questions of medical evaluation of the work fitness of myocardial infarction survivors.
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