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[Work capacity--approach and evaluation criteria].

In occupations involving specific risk factors, the employer is required by law to have his candidates/employees physically examined in the course of pre-placement/work, as a measure of health and safety protection. Upon examination, the occupational health physician issues to the employer a statement of the candidate's/employee's suitability for work. Mandatory pre-placement and periodic medical examinations are also required for workers who may affect the health and safety of the public such as workers in public transportation or food processing. This paper looks into the implementation of regulations and actual practice in performing relevant medical examinations. One of the issues described is the determination of a worker's temporary disability. Practicing physician determines a disability and rates the physical impairment. She or he has to translate clinical information into a decision about whether a patient is able to work. This decision is the basis for healthcare compensation and benefits and requires knowledge not only of the illness or injury and the patient, but also of the job tasks and exposure. From the medical standpoint, it may be difficult to determine when a period of temporary disability has ended or if a degree of impairment has remained, and when the temporary partial or total disability has become permanent. The paper discusses the assessment of total or partial permanent disabilities based on the new Pension Insurance Act (1998) and the differences from earlier criteria, summarising the implementation of new regulations for years 2000 and 2001.

Croatia↗

[Organization and procedure of forensic medical expert evaluation of professional working capacity loss].

Sixty-one forensic medical expert conclusions on the loss of professional working capacity are analyzed and typical errors are characterized. The procedure of forensic medical expert evaluation of the degree of loss of professional working capacity in accordance with the Civil Code and Civil Judicial Procedure Code of the Russian Federation and the actual norm-setting documents is described.

Disability Evaluation↗

[Return to work after myocardial infarction: evaluation and decision].

Working capacity after myocardial infarction depends on the physical and cardiovascular status, psychological repercussions and conditions of work. The latter two are much more important than the first two factors. Cardiovascular functional status is readily assessed by the large number of available investigations which leave little unknown. Exercise stress testing during the second week is the most cost-efficient investigation, providing reliable and sufficiently quantifiable data about the possible sequellae of cardiac failure on effort, ischemia and arrhythmias: an idea of the patient's functional capacity and circulatory responses (athletic, hyperkinetic) may also be obtained allowing adjustment of treatment to improve exercise capacity which goes much further than the statistical hope of prolonging survival. However, it would be naive to think that a satisfactory exercise stress test guarantees the patients' capacity to return to work. Psychological and sociological factors are more important by far. The dominant trait of the post-infarction psychological syndrome must be identified (anxiety, depression, negation): the positive and negative influences of the family, social and professional environment must be evaluated. A good knowledge of the patient's working conditions is essential to go against a number of taboos hindering the return to work (stress, stairs, restaurant meals, etc...). Finally, the medico-legal relationship between the infarct and work should not be neglected: the management of myocardial infarction when an occupational disease must respect the legislative and judicial texts which do not always correspond with everyday clinical practice. There is a lack of structures for cardiac function testing for assessing physical aptitude: we suggest that in the context of the proposed hospital reforms, departmental heads should consider setting up such units which would have a specific task respecting the spirit of these reforms. Nevertheless, cardiologists should pay more attention to the convalescent phase of infarction. This is the time when many social catastrophes can be avoided.

Arrhythmias, Cardiac↗

Treatments of depression and the functional capacity to work.

This study evaluated the effects of antidepressants and psychotherapy on work impairment in depressed patients. Original databases from 10 published treatment studies were compiled and analyzed (N = 827). Functional work impairment was common at baseline, manifested by unemployment (11%) or on-the-job performance problems (absenteeism, decreased productivity, interpersonal problems, 44%). Generally, work outcomes were good when treatment was symptomatically effective, but the trajectories of work restoration and symptom remission were different, with work recovery appearing to take considerably longer. Relapse was an important determinant of long-term occupational outcome, particularly for seriously ill patients for whom relapse meant rehospitalization or other profound social disruption. Affective impairment was distinguished from functional impairment, with the former characterizing milder depression and the latter characterizing moderate to severe depression. Some methodological recommendations are discussed.

Absenteeism↗

[Evaluation of the functional state and working capacity of patients with chronic toxoplasmosis].

Operator's main functions were studied in 78 patients with chronic toxoplasmosis during the period of disease aggravation and during the following 6 months. It was revealed that marked disorders in higher nervous activity and psychomotor system are observed in the patients during the period of aggravation, significantly more expressed during disease recurring course. It is reasonable to examine servicemen with chronic toxoplasmosis using psychologic and psychophysiologic methods before treatment and in 6 months after its completion. Without clear tendency towards improvement of professionally significant qualities in 6 months after treatment (level of neurotization, psychopathyzation, comparative number of mistakes in attention test and during reckon in head, delayed memory, positive tapping-test) it is not recommended to use servicemen at the posts having operator's profile and connected with long staying in secluded small collectives.

Adult↗