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PubMed1981

Effect of early return to work after elective repair of inguinal hernia: Clinical and financial consequences at one year and three years.

Since January, 1976, male patients undergoing elective unilateral inguinal herniorrhaphy have been included in a trial to see whether early return to normal activity is associated with an increased recurrence rate and to investigate economic consequences. By June, 1981, 500 patients had been reviewed at one year. 2 patients had defaulted. The first 200 patients had been examined at one year and three years. Recurrence was assessed independently, and recurrences were found of which the patient was unaware. The acceptable definition of recurrence was need for reoperation or a truss. The overall recurrence rate at one year was 3.9%. At three years no further recurrences were detected in the first 200 patients. There was no difference in the recurrence rate for those in the "early" group with 8 recurrences in a total of 246 patients and 10 recurrences in 245 patients in the control group. the median inactivity period in the "early" group was 48 days, compared with 65 days in the control. This differences of 17 days is significant (p=0.001). The self-employed "early" group returned to work in a median of 31 days. One-third of workers were losing a median of pounds 31 per week (range pounds 3- pounds 200). Patients can return to normal activity sooner after inguinal herniorrhaphy than has been advised without increasing the recurrence rate at one year and three years and with considerable monetary benefit to one-third of workers.

Clinical Trials as Topic↗
PubMedDate not supplied

[Return to work of a pacemaker bearing worker: the relationship between health problems and electromagnetic interferences].

The potential effects of electromagnetic fields is a problem that interest the public opinion, as the modern society expose all people to electromagnetic non ionizing radiations. The problem has a particular and important meaning facing the return to normal life and work conditions of a cardiopatic subject bearing a pacemaker (PM) or implantable cardioverter defibrillator (ICD). Electromagnetic interferences can produce temporary or permanent malfunctions in these devices. Checking for the absence of electromagnetic interferences is necessary considering that correct functioning of these medical devices is essential for the life of the bearer. Precautions normally adopted by these subjects are generally adequate to ensure protection from interferences present in life environment; for occupational environment, there is often lack of adequate information, also due to late involving of the doctor specialist in occupational health. This work intends to study in depth a specific job, a carpentry-workshop with welding activities, starting with a case of a PM bearer who asked a doctor specialist in occupational health to evaluate the problems involved in his return to work. Electric and magnetic fields produced by equipments present in the workshop were measured and compared to data supplied by the literature to evaluate the possibility of interactions in the normally functioning of implanted electronic devices. On the basis of our experience, we have found some criterions for specific risk assessement to adopt for the definition of operative protocols for return to work of PM or ICD carriers, also considering the lack of specific procedures and indications for the doctor specialist in occupational health. The collected information and data from the literature suggest that welding can be a risk for a subject with PM; as observed in experimental conditions, electromagnetic radiations can alter particular sensitive devices and those with uncorrected settings.

Electromagnetic Fields↗
PubMed1980

Return to work after head injury: a review of post-war studies.

The literature on occupational resettlement after head injury is confounded by varying standards of clinical severity and social outcome. A comparison of eleven key studies in the light of the authors' own research yielded a success rate ranging from 50 to 99 per cent, but this was based on superficial evidence. A more searching enquiry is needed, using objective methods and avoiding the technical inadequacies of most previous work. This would be unlikely to challenge the importance of age and length of post-traumatic amnesia as determinants of return to work, but should lead to a better understanding of other factors such as previous occupational status, cognitive deficits and personality changes.

Adult↗
PubMedDate not supplied

The injured worker: assessing "return-to-work" status.

In workers injured on the job, the physical findings tell only part of the story. Physicians must also consider psychologic, economic, social, and legal factors when performing a return-to-work assessment.

Accidents, Occupational↗
PubMed1983

Returning to work: potential problems for mid-career mothers.

Pregnancy is a complex and intense biopsychosocial event. Consequently many mid-career mothers have extreme difficulty when they must leave their infant and return to work. The degree of difficulty can be predicted by assessing a wide range of personal and cultural factors.

Adaptation, Psychological↗
PubMed2003

Returning to work for individuals with health problems: Experiences in Brazil.

PURPOSE: In 1999, the Federal University of Minas Gerais (UFMG) created the Worker Health Care Service with the purpose to implement health promotion and health protection policies in the workplace. This service supported workers with impairments and resulted from health proposals by a Professional Counseling Outplacement Program. The objectives of this study were to describe the demographic and impairment-related characteristics of workers and to evaluate their outcomes. METHOD: Quantitative and qualitative methods were used for data analyses. First, a questionnaire was developed for collection of quantitative data. Secondly, in-depth interviews evaluated the perceptions of workers, supervisors and workmates concerning the program. RESULTS: Of the 78 workers who attended the Outplacement Program, 65 (83%) were considered effective and capable of working, and 13 (17%) were retired. A sample of 38 workers took part in this study and 21 (76%) developed osteomuscular disease. Most returned to previous professional activities, after concluding the program. However, 27 individuals (71%) returned to work with job restrictions. Important constructs emerged from the interviews performed with workers, their supervisors and colleagues, regarding the lack of routine procedures of university policies, exceeding the tasks required in the work environment, and decreases of the workers' roles in the presence of limiting health conditions. The findings led to a redefinition of the role of individuals involved in the Professional Counseling Outplacement Program. CONCLUSIONS: These results may contribute to the development of a new professional rehabilitation policy in educational institutions in Brazil.

Adult↗
PubMed2002

Returning to work after disability.

After a workplace injury or disability, there is a period of hardship and adjustment for the injured party as well as all stakeholders in the workers' compensation process. Ultimately, however, return to work is considered. The author reviews this often challenging exercise from the Canadian perspective and stresses the need for timely intervention, honest communication, the coordination of information and resources--and the need for flexibility. A case study on low back pain is included.

Canada↗
PubMed2003

Management of return-to-work programs for workers with musculoskeletal disorders: a qualitative study in three Canadian provinces.

In this qualitative research project, researchers in three Canadian provinces explored the perceptions of many different actors involved in return-to-work (RTW) programs for injured workers, studying their views on successful RTW strategies and barriers to/facilitators of the RTW process, then analyzing the underlying dynamics driving their different experiences. Each research team recruited actors in a variety of different workplaces and key informants in the RTW system, and used a combination of in-depth, semi-structured interviews and focus groups to collect data, which were coded using an open coding system. Analysis took a social constructionist perspective. The roles and mandates of the different groups of actors (injured workers; other workplace actors; actors outside the workplace), while sometimes complementary, could also differ, leading to tension and conflict. Characteristics of injured workers described as influencing RTW success included personal and sociodemographic factors, beliefs and attitudes, and motivation. Human resources managers and health care professionals tended to attribute workers' motivation to their individual characteristics, whereas injured workers, worker representatives and health and safety managers described workplace culture and the degree to which workers' well-being was considered as having a strong influence on workers' motivation. Some supervisors experienced role conflict when responsible for both production quotas and RTW programs, but difficulties were alleviated by innovations such as consideration of RTW program responsibilities in the determination of production quotas and in performance evaluations. RTW program success seemed related to labor-management relations and top management commitment to Health and Safety. Non-workplace issues included confusion stemming from the compensation system itself, communication difficulties with some treating physicians, and role conflict on the part of physicians wishing to advocate for patients whose problems were non-compensable. Several common themes emerged from the experiences related by the wide range of actors including the importance of trust, respect, communication and labor relations in the failure or success of RTW programs for injured workers.

Accidents, Occupational↗
PubMed1991

The effects of the strain of returning to work on the risk of cardiac death after a first myocardial infarction before the age of 45.

Seventy-nine men who had suffered a myocardial infarction before the age of 45 while they were vocationally active in the greater Stockholm area were followed for five years. Forty-nine survived without cardiac complications and 13 died due to ischaemic heart disease during the period of follow-up. These two contrasting groups were compared with regard to psychosocial risk factors at work before the first myocardial infarction (as reported by the patient when he was interviewed during the weeks after the onset of disease). It was hypothesized that returning to stressful work (high demands and limited possibilities of influencing decisions and developing skills) would be associated with an increased risk of death. All the subjects who died had returned to the work that they had performed prior to the first myocardial infarct. Work performed by these patients was described as having significantly higher psychological demands in relation to the possibility of learning new things and higher demands in relation to variety as well as almost significantly higher demands in relation to influence. Multivariate logistic regression with these factors concerning employment, together with biomedical risk factors recorded at the same time, showed that increasing age, increasing degree of coronary atherosclerosis and number of stenosed coronary arteries, as well as high demands in relation to the possibility of learning new things, were independent predictors of death due to coronary arterial disease. The remaining 17 subjects either survived a re-infarction, or had coronary arterial by-pass surgery during the period of follow-up. This heterogeneous group occupied intermediate positions with regard to psychosocial job factors.

Adult↗
PubMed2004

Modelling return-to-work intervention strategies: a method to help target interventions.

The aim of this study is twofold: 1) to investigate the relationship between the probability of receiving an intervention by the occupational physician and the probability of return-to-work (RTW) of sick workers; 2) to explore the use of simultaneous modelling of the intervention and RTW process. Analyses are performed on population level using data from a major longitudinal survey on work incapacity and RTW in the Netherlands. A bivariate probit model is used to estimate the correlation between the probability of intervention and the probability of RTW A bivariate hazard model is applied to explore the joint distribution of the waiting times for the intervention and RTW The results of this study show that the probability of receiving an intervention from the occupational physician is not correlated with the probability of RTW Neither is the timing of both events correlated. The analyses do not indicate that the intervention by the occupational physician provides incentives for sick workers to RTW quicker.

Adult↗
PubMedDate not supplied

[Psychosomatic disease in female teachers. Social context, contents and perspectives of inpatient treatment with a goal of rehabilitation and return to work].

Despite the considerable consequences, school teachers treated in psychosomatic in-patient settings, have not yet been the subject of investigations. Whether, for whom and which kind of job related treatment can be helpful for teachers returning to work can only be discussed if the specific stress and the social situation of teachers as public officials ("Beamtenstatus") are taken into consideration. On this point of view a systematic evaluation of 63 psychosomatically ill teachers consecutively admitted in a psychosomatic hospital was performed. The average age was 50, suffering mostly from depression or/and tinnitus. Most teachers rated job related stress as influencing their symptomatologies. A program focusing on discrepancies between personal ideals versus real situations in school, problems in social interactions and time management, should be a valuable part of the teachers' psychosomatic inpatient treatment. This approach was affected by a strong desire for early retirement in about half of the teachers.

Age Factors↗
PubMed2005

A clinical return-to-work rule for patients with back pain.

BACKGROUND: Tools for early identification of workers with back pain who are at high risk of adverse occupational outcome would help concentrate clinical attention on the patients who need it most, while helping reduce unnecessary interventions (and costs) among the others. This study was conducted to develop and validate clinical rules to predict the 2-year work disability status of people consulting for nonspecific back pain in primary care settings. METHODS: This was a 2-year prospective cohort study conducted in 7 primary care settings in the Quebec City area. The study enrolled 1007 workers (participation, 68.4% of potential participants expected to be eligible) aged 18-64 years who consulted for nonspecific back pain associated with at least 1 day's absence from work. The majority (86%) completed 5 telephone interviews documenting a large array of variables. Clinical information was abstracted from the medical files. The outcome measure was "return to work in good health" at 2 years, a variable that combined patients' occupational status, functional limitations and recurrences of work absence. Predictive models of 2-year outcome were developed with a recursive partitioning approach on a 40% random sample of our study subjects, then validated on the rest. RESULTS: The best predictive model included 7 baseline variables (patient's recovery expectations, radiating pain, previous back surgery, pain intensity, frequent change of position because of back pain, irritability and bad temper, and difficulty sleeping) and was particularly efficient at identifying patients with no adverse occupational outcome (negative predictive value 78%- 94%). INTERPRETATION: A clinical prediction rule accurately identified a large proportion of workers with back pain consulting in a primary care setting who were at a low risk of an adverse occupational outcome.

Adolescent↗
PubMed1993

Rehabilitation after coronary bypass surgery: coping strategies predict metabolic improvement and return to work.

Thirty-six consecutive male patients who underwent coronary bypass surgery were investigated before and repeatedly up to 5 years after surgery. We followed the patients' physical capacity, dietary and exercise habits, mood, perception of health and return to work. Discriminant analysis identified four variables from the preoperative interview and the psychological tests which correctly classified 22 out of 24 patients into either metabolic responders--who were characterized by favourable changes in their lipoprotein profile, related to a successful clinical outcome--or non-responders. Responders were found to acknowledge subjective, emotional aspects of their situation whereas non-responders minimised their disease. Six preoperative variables successfully predicted the classification of all but one patient into full-time workers or not, one year after surgery. Full-time workers were more frequent among minimizers. The results suggest that whereas minimising of disease is adaptive in a short-term perspective, acknowledgement may be successful in the long run.

Adaptation, Psychological↗