[Bicycle ergometry in the expert evaluation of stenocardia patients' work capacity].
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A complex evaluation of energy metabolism, oxygen-transport function of blood and physical work capacity of aquanauts has been performed during three imitation divings at depths of 400, 450 and 500 m in heliox as a breathing medium. These experiments have shown that optimal levels of partial oxygen pressure in artificial chamber environment are 30-33 kPa at 4.1 MPa, 32-35 kPa at 4.6 MPa and 33-34 kPa at 5.1 MPa. It is established that 24-days exposure of aquanautes to 4.6 MPa and 10-days exposure to 5.1 MPa yield no unfavourable changes of the examined organism functions. The activated lipid exchange in combination with stable carbohydrate catabolism, the elevated levels of oxygen consumption and its partial pressure in blood and transient fluctuations of erythropoiesis activity are interpreted as compensatory responses of diverse organisms under the influence of hyperbaric factors.
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BACKGROUND: The aim was to evaluate the working capacity and resting energy expenditure in patients who had undergone restorative proctocolectomy. METHODS: Of 72 patients operated on between April 1990 to September 1998, 51 were eligible and 38 participated in the study. Resting energy was assessed by indirect calorimetry, and working capacity by ergospirometry on an exercise bicycle. RESULTS: The median functional score was 2 (range 0-7). Oxygen uptake during rest was reduced for men compared with predicted values. The corresponding values for women were in keeping with predicted values. The median working capacity was 96 (range 59-102) per cent for women and 91 (range 51-113) per cent for men, compared with reference values of maximum workload based on age, height and sex. There was no correlation between functional score and any other variable measured. CONCLUSION: Patients who have undergone restorative proctocolectomy for ulcerative colitis have normal resting energy expenditure and working capacity.
It has now become possible to study the functional state of the pilots and to appraise their performance capacity by using a complex set of equipment. During the pilot's operation this equipment provides for obtaining electrocardiograms, information on the heart rate, respiration rate, maximum arterial pressure measured on the finger, skin temperature at 4 points, ambient temperature, taking electromyograms, registering dermato-galvanic reactions after Tarkhanov and the rate of the reaction in response to light and sound. In addition to the mentioned data it is also possible to study during off-duty time the electroencephalogram in 2 leads, arterial pressure after Korotkov, dynamogram, critical fusion frequency, as well as data on the coordination of movements and thresholds of audio-sensitivity. The possibilty of using the described apparatus with other electric facilities will enable it to broaden the field of its application, up to an including its utilization in large-scale examinations of the population, occupational examinations and occupational screening.
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An inpatient rehabilitation programme for HIV-infected patients is described. Since the early nineties some 1,200 patients with HIV infection have been treated in our internal and orthopaedic rehabilitation clinic. Beside internal and orthopaedic diagnostics, supporting compliance with antiretroviral therapy, motivating the patients for regular moderate exercises and specific nutritional counselling are major issues of the programme. From the psychological point of view, the patients are offered to aquire relaxation and stress coping techniques, to take part in non-smoking courses and to use individual psychological counselling in case of depression or panic. In addition, all HIV-infected patients are offered individual advice on their disease and necessary changes in lifestyle. Finally, the programme includes social medical evaluation and counselling. As the majority of the patients are still working or are of working age, evaluating the capacity for work and potential introduction of occupational rehabilitation measures are prominent. Almost 70 percent of the HIV-infected patients who had been treated in our clinic over the last few years were fully capable of returning to their previous occupation. Our experiences demonstrate that statements such as rehabilitation of AIDS patients being useless because of its missing prospects of success, are not up-to-date any longer. Since introduction of combination antiretroviral therapy many patients with HIV infection are able to return to their previous occupation if they receive the necessary medical und psychosocial support.
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As part of an investigation to reassess disability which was performed in 579 subjects with an internist's diagnosis, disability was reassessed in 68 males with chronic bronchitis as the main diagnosis. Disability reassessment was carried out by an informal team of physicians consisting of pulmologists and members of a second degree disability board. The aim of the study was to define the differences between disability reevaluation and residual working capacity. In. chronic bronchitics, a complete functional pulmonary test was carried out including measurement of the degree of obstruction, several specific parameters, non-specific bronchial reactivity and an analysis of arterial blood gases. Disability was reassessed in accordance with the following parameters: accurate evaluation, inaccurate evaluation, residual working capacity, uncompleted treatment. The one-way Kruskal-Wallis rank analysis of non-parametric data attributed the following predictors as specific: age, PC20, FEV1, the condition of hyperreactive airways and the degree of airway obstruction. The relevance of functional criteria ar rest, particularly of FEV1, for assessing the loss of working capacity in persons with chronic obstructive bronchitis is emphasized.
Using submaximal exercises, work capacity of 375 aircraft crewmembers, aged 20-49, was investigated. It declined slightly with age. The factors most frequently causing its decrease in healthy and diseased people were identified and methods of its measurement were refined. It was shown that the work load, chronotropic reserve index and cardiac index may give indirect evidence of the coronary blood flow rate, and the inotropic reserve index of the cardiac contractile function. Determination of work capacity of the flight personnel makes it possible to improve the medical supervision, detect at an early stage cardiovascular abnormalities and to substantiate expertise conclusions.
Since 1997 the LVA Baden-Württemberg pension insurance agency has implemented an instrument to measure the outcome quality of in-patient rehabilitation. The objective of this study was to evaluate the prognostic value of various short-term rehabilitation success markers and of variables of the quality assurance program and the rehab-discharge report of the LVA Baden-Württemberg on early retirement by means of a retrospective cohort study. The analysis was based on routinely registered data of patients who underwent in-hospital rehabilitation in a hospital accredited by the LVA Baden-Württemberg between June 1997 and June 1999. Baseline data included information from medical discharge reports and from the quality assurance programme. Follow-up information with regard to disability was collected until July 2000. The prognostic value of the quality assurance programme and of 4 standardized documented items from the medical discharge report was estimated by proportional hazards regression. In this analysis 6,823 patients aged 30-59 years who underwent an in-patient rehab programme between June 1997 and July 1999 in 5 of 6 LVA rehab clinics were included. During follow-up (mean duration: 1.8 years) 908 (13.3%) patients retired because of health-related disability. The variables with the strongest prognostic values were the evaluation of the patient health status by the physician and the patients themselves and the capacity to work. The variables with the highest prognostic value were the evaluation on a 1-6 visual analogue scale; a better assessment by one mark of the health status by physician and patient himself, respectively, was associated with a 53% and 40% reduced risk of disability. Fitness for work at discharge was the most prognostic variable from the discharge report. Patients who were able to work had a 78% reduced risk of disability compared to patients unable to work. Also of prognostic relevance were a positive performance and the duration of the inability to work the year before rehabilitation. The variables of the newly developed quality assurance programme of the LVA clearly demonstrated a prognostic value in terms of risk for subsequent early retirement. It should be considered to include the ability to work at discharge in the programme to further improve its prognostic value.
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Work-related musculoskeletal injuries represent a major source of work disability. While many employers recognize the importance of workplace disability management approaches and are assuming greater responsibility for preventing and minimizing work-related disability, questions about the effectiveness of these interventions exist. The purposes of this article are to: 1) describe the essential components of workplace disability management programs related to musculoskeletal injuries; 2) review the literature on disability management practices based on research evidence by focussing on workplace-based interventions and the role of the workplace; and 3) provide recommendations for disability management in the prevention and reduction of disability, and the rehabilitation of injured workers with musculoskeletal work injuries. The literature suggests that employer participation, a supportive work climate and cooperation between labour and management are crucial factors in facilitating return to work. Given the complexity of the disability management process and the numbers of individuals involved, it is essential that all workplace parties work together to achieve the goal of safe and early return to work.
Capacity to the physical work and functional status were studied during the prolonged (1 year) work in the mountainous conditions (3,600 m above sea level). The fatigue grade and capacity level were proved to depend on individual adaptation to the mountainous conditions.
The effects of the running pulse magnetic field, antianginal drug therapy and their combinations on the physical capacity were compared in 60 patients with Functional Classes I-III stable angina pectoris. Monotherapy with the running pulse magnetic field was found to produce an antianginal effect in patients with Functional Classes I-II angina pectoris, but the efficacy of drug therapy increased when antianginal drugs were used in combination with running pulse magnetic field in patients with severe angina.
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