[System analysis of human work activity as a basis for health evaluation].
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Annuities granted because of unfitness for work in general or unfitness to perform particular professional work are being paid in Germany by a state insurance agency. Unfitness for work has to be ascertained in each individual case as has been ruled by jurisdiction of the Highest German Court. It is the task of the medical expert in the course of this procedure to register the clinical status of the applicants and to reach a medical judgment in regard to fitness for work. This judgment does not rely upon the diagnosis or prognosis of a particular disease; a decreased fitness for work because of a particular disease can only be assumed if the disease has led to long-term irreversible deficient organ functions. Annuities for a limited time period may be granted if there is a chance for improvement of health. Problems of finding expert judgement are reported.
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Under study was the state of 215 patients operated upon for acute pancreatitis. Rehabilitation of their working capacity was noted in 84 cases. 73,7% of the patients resumed their former activities, 16,6% of the patients did it 2--10 months later, 4 patients dropped their work due to the family circumstances, 4 patients were recognized to be invalids.
Of 528 patients subjected to radical operations on the stomach for cancer, polyposis and ulcerous disease the dumping-syndrome was revealed in 74 patients. Following resection of the distal gastric portion the latter was observed in 49 cases, after resection of the cardia--in 18, and after gastrectomy--in 7. In most patients with the dumping-syndrome an impairment of basic hepatic functions and motor-evacuative function of the gastric stump was observed. The study of the work capacity in patients with the dumping-syndrome has deomonstrated its reduction in most patients (in 74% of cases). 55 of 74 investigated patients proved to be invalids of the second and third group. The capacity for work was mostly impaired in patients showing the dumping-syndrome of average and severe gravity.
Rheumatic diseases, particularly those affecting the back, cervical spine, and the joints, are widespread in the general population. The general costs, especially those associated with social medical services, show constant increases. Time and effectiveness lost from work due to back problems in the FRG accounted for most of the days off the job because of disability, time spent in the hospital or at a health spa facility. Therefore, the appropriate evaluation of the degree of disability plays an increasingly important role in the area of social benefits. Yet unambiguous and objective physical measurements of the disease and the degree of associated disability are lacking in most cases of rheumatic diseases. More attempts to address the subjective aspects of the disease should be included in such evaluations. For recent years, models of measurement have been developed and tested, which are suited to the multidimensional nature of rheumatic illnesses. It is recommended that these be introduced in routine use for physical evaluations.