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PubMed2002

[Career wishes and career worries of medical students--results of focus group interviews].

PURPOSE: In addition to a prospective longitudinal study of career determinants in young physicians the aim of the present qualitative study was to gather information on 1. experiences by medical students during their clinical year, 2. their understanding of career, 3. their career desires and worries regarding the compatibility of profession and family, and 4. their wishes of career promotion. METHOD: Twenty-two subjects from the initial sample of 377 students from the three medical schools in the German-speaking part of Switzerland in their senior year agreed to participate in focus groups. The interviews were structured by an interview guideline, the material was tape-recorded, transcribed, paraphrased, and categorised. RESULTS: 1. The experiences during the clinical year mainly brought a gain of practical skills. Female students were disillusioned by the daily routine at the hospital. 2. Career was associated with a poor quality of life. 3. Regarding career wishes male students showed more optimistic attitudes, while female students suppressed their career wishes in prospect of a spouse and/or family. Female and male students had rather traditional ideas about the compatibility of their profession and family. The only acceptable models were the so-called life cycle model (professional work - family phase - return to work for women) or a reduced professional engagement of the woman during the family phase. 4. The majority of the participants wanted some sort of career promotion, female students at the beginning, males rather in a later stage of their career. CONCLUSION: The results of the longitudinal study will show whether the assessments of the subjects in the focus groups will be confirmed during their further career.

Adult↗
PubMed2005

Reintegration after severe brain injury: a retrospective study.

PRIMARY OBJECTIVE: The evaluation of school and work reintegration of patients following severe brain injury and of the relationship between the most common (early and late) prognostic indicators and reintegration itself. RESEARCH DESIGN: A retrospective study on a population of 353 patients consecutively admitted to an intensive rehabilitation unit (S. Cuore Hospital, Negrar, Italy) from 1991-1999. METHODS AND PROCEDURES: Evaluation of school and work outcome in this population up to December 2001 (follow-up from 2-10 years post-trauma). Data collection was made using the EBIS (European Brain Injury Society) protocol. RESULTS: In December 2001, 53% of those previously working had returned to competitive work; 76.5% of students were continuing with their studies or had progressed into work. There was a significant difference between employed and non-employed groups in terms of GCS, post-traumatic amnesia (PTA), in-patient rehabilitation length of stay (LOS) and GOS at 6 and at 12 months post-injury. CONCLUSIONS: The data confirm the predictive value of the indices used regarding work reintegration in TBI patients. Nevertheless, prolonged and intensive rehabilitation programmes can lead to high re-employment rates in patients whose initial prognosis seemed very poor.

Adolescent↗
PubMed2005

Women with fibromyalgia: work and rehabilitation.

PURPOSE: To explore disability in women with fibromyalgia with a focus on their work situation. METHOD: Review of literature on work status of women with fibromyalgia. RESULTS: Major differences exist between studies in reported disability and in the percentages of women working. Limitations caused by pain, fatigue, decreased muscle strength, and endurance influence work capacity. However, 34 - 77% of the women work. Individual adjustments in the work situation are reported. When the women find a level that matches their ability, they continue to work and find satisfaction in their work role. Many factors besides degree of impairment or disability influence whether clients with longstanding pain can remain in their work role or return to work after sickness leave. CONCLUSION: The total life situation, other commitments, type of work tasks, the ability to influence the work situation, and the physical and psychosocial work environment are important factors in determining whether a person can remain in a work role. More knowledge is needed about how to adjust work conditions for people with partial work ability to the benefit of society and the individual.

Adolescent↗
PubMed1987

Physical training and occupational rehabilitation after aortic valve replacement.

Forty-four patients were tested 2, 6 and 12 months after an isolated aortic valve implantation in order to evaluate the influence of training and vocational assistance on physical work capacity and the rate of reemployment. They were randomly allocated to a training group (A) or a control group (B). Training was carried out from the eighth to the twelfth week after operation and the socio-occupational status was evaluated. Training increased physical work capacity, expressed as cumulated work (CW), by 58 per cent (P less than 0.001), decreased the rate-pressure product (RPP) by 13 per cent (P less than 0.001) and the rate of perceived exertion (RPE) by 13 per cent (P less than 0.001) at the highest comparable work load. The CW was 38 per cent higher in the training than the control group after 6 (P less than 0.02) and 37 per cent after 12 months (P less than 0.025). After one year 81 per cent in group A and 65 per cent in group B were working (NS). Reemployment correlated significantly with the CW and inversely with the duration of sick leave prior to operation. Thus, physical training shortly after aortic valve operation rapidly and persistently improves physical work capacity while return to work is less influenced by training and socio vocational assistance.

Adult↗
PubMed1981

Rheumatoid arthritis: returning patients to work.

Fifty-two patients with stable rheumatoid arthritis were followed-up for one year after being referred to the Disablement Resettlement Officer for work counselling. The proportion of patients employed following work counselling initially increased from 35% to 67%, falling to 57% after one year. In addition, 44% of patients "off sick" were re-established at work by job modification. Comparison of patients employed or unemployed one year later indicated that successful employment was related more to social and environmental factors than disability ro financial considerations.

Adolescent↗
PubMed2006

Subjective and objective measures of adaptation and readaptation to night work on an oil rig in the North Sea.

STUDY OBJECTIVES: To study the adaptation and readaptation processes to 1 week of night work (6:30 PM to 6:30 AM) followed by 1 week of day work (6:30 AM to 6:30 PM). DESIGN: Part of a randomized, placebo-controlled, crossover field study. Here, data from the placebo arm are presented. SETTING: Oil rig in the North Sea. Work schedule: 2 weeks on a 12-hour shift, with the first week on the night shift and the second week on the day shift. PARTICIPANTS: Subjects complaining about problems with adjusting to shift work. Seventeen workers completed the study. INTERVENTIONS: N/A. MEASUREMENTS: Subjective and objective measures of sleepiness (Karolinska Sleepiness Scale and simple serial reaction time test) and sleep (diary and actigraphy). RESULTS: Both subjective and objective measures improved gradually during night work. The return to day work after 1 week on the night shift led to a clear increase in subjective sleepiness and worsening of sleep parameters. During the week on the day shift, sleepiness and sleep gradually improved, similar to the improvement seen during night work. The workers indicated that the day shift was worse than the night shift on some of the measures, e.g., sleep length was significantly longer during the night-shift period. CONCLUSIONS: This is one of few studies showing how shift workers in a real-life setting adjust to night work. Both subjective and objective sleepiness and subjective sleep improved across days. The effects were especially pronounced for the subjective data.

Adaptation, Physiological↗
PubMed2002

Percutaneous screw fixation of fractures of the iliac wing and fracture-dislocations of the sacro-iliac joint (OTA Types 61-B2.2 and 61-B2.3, or Young-Burgess "lateral compression type II" pelvic fractures).

A technique for closed reduction and percutaneous screw fixation of fractures of the iliac wing and fracture-dislocations of the sacro-iliac joint is presented. Twenty-seven pelvic fractures were treated with attempted closed reduction followed by percutaneous screw fixation. Closed reduction failed in two patients. In the other twenty-five, closed reduction to within one centimeter of residual displacement was obtained, and was followed by stabilization with percutaneously placed cannulated screws. Complications included dislodgment of a screw from the superior pubic ramus in one patient, and partial cut-out of a screw along the inner cortex of the iliac wing in another. Two patients were lost to follow-up before fracture union occurred. The remaining twenty-three patients were followed-up for an average of twenty-seven months (range, 18-48 months). All of the fractures healed in the twenty-three patients who were not lost to follow-up. All but two of the patients who were working before injury returned to work. All but one of the patients was satisfied with the outcome of their pelvic fracture treatment. Closed reduction and percutaneous screw fixation of fractures of the posterior portion of the iliac wing yields acceptable reductions, with minimal blood loss and limited damage to the surrounding soft tissues.

Adolescent↗
PubMed1997

Operative versus nonoperative treatment of acute Achilles tendon ruptures: a quantitative review.

OBJECTIVE: To determine the optimal treatment of acute Achilles tendon ruptures. DATA SOURCES: A comprehensive search for all of the English articles published between 1959 and 1997. STUDY SELECTION: All of the articles were reviewed independently by at least three of the four authors to decide on eligibility based on predetermined criteria. Disagreements were discussed and then settled, if necessary, by a majority vote. DATA EXTRACTION: Eligible studies were reviewed independently, and data were extracted by using standardized coding forms. Inconsistencies in data extraction were settled by discussion and majority vote. The main outcomes extracted were strength, time to return to work, frequency of return to sports, rerupture rate, and complications. Complications were divided into major, moderate, and minor categories. DATA SYNTHESIS: The overall rerupture rate was 2.8% for operatively treated and 11.7% for nonoperatively treated patients (p < 0.001). The rate of minor and moderate complications in operatively treated patients was 20 times that of nonoperatively treated patients. The difference in rates for major complications was not statistically significant. CONCLUSIONS: Although operative treatment provides a reduced rerupture rate compared with nonoperative treatment, the minor and moderate complication rate of operative treatment is 20 times greater. Treatment should be individualized to the concerns and health of the patient. Future clinical trials are necessary to determine the optimal method of both operative and conservative treatment.

Achilles Tendon↗
PubMed2003

Excision of a bony spike without fixation of the fractured clavicle in a jockey.

Various modalities are available for treatment of a clavicle fracture. Conservative treatment is successful in most cases. Open reduction, when indicated, usually is accompanied by fixation of the fracture. In the case of a jockey with a fractured clavicle, the fracture was complicated by tenting of the skin. The fracture was opened and a bony spike was excised extraperiosteally without doing internal fixation of the fracture to avoid skin necrosis and allow early return to work. The patient returned to his profession 2 weeks after surgery. Radiologic and clinical examinations revealed a satisfactory outcome at the 6-month followup.

Adult↗
PubMedDate not supplied

Effects of social context on psychological responses to survived myocardial infarction.

Persons respond in a diversity of ways to the crisis of acute myocardial infarction (MI). The social contexts of 120 survivors of MI was examined to determine whether this influenced such responses, working on the assumption that MI would represent a greater threat to the livelihoods of certain groups of persons than it would for other groups. The most prominent influence was observed for patients' occupation, where persons in so-called blue collar occupations exhibited significantly more anxiety in response to MI than did persons in white collar occupations. It was argued that this arose from the possibility that the nature of blue collar jobs was physical, and that loss of myocardial tissue might be expected to more markedly interfere with their work efficiency (on returning to work) than it would the efficiency of the more sedentary jobs of white collar workers.

Acute Disease↗
PubMed2004

Outcome of an interdisciplinary pain management program in a rehabilitation clinic.

The Chronic Pain Section at Reykjalundur has 33 beds for patients with various chronic pain problems. About 200 patients are treated annually. For 3 years, 158 patients were enrolled in a random study focusing on increasing the patients' functioning and eliminating analgesic drugs through an interdisciplinary rehabilitation program. Patients answered a questionnaire at admission, before discharge from the clinic and about one year after discharge. The follow-up was done with a mailed questionnaire. The focus was on the patients' functioning rather than absence of pain. The program's duration was 7 weeks. The first 2 weeks were utilized for evaluation, information and education (pain school). Pain relieving drugs were gradually withdrawn but anti-inflammatory drugs were used when indicated. Cognitive behavioral therapy was applied in an increasing number of cases over the 3 year period by specially trained nurses and a psychiatrist. Pain, anxiety and depression were self-evaluated on a numeric rating scale (NRS). About 50% of the patients had a history of pain for more than 5 years. Low back pain was the most common diagnosis (48.1%) and 28.5% had post-traumatic pain. A significant reduction in pain, anxiety and depression was found both at discharge (p < 0.0001) and at follow-up (p < 0.001). Before entering the program, only 18.4% of the patients were able to work whereas 48.1% returned to work after discharge and 59.2% were working at follow-up.

Adolescent↗
PubMed1992

[Favorable prognoses in 24 adult patients with acute leukemia, surviving over five years since 1985].

Since 1985 we have experienced 24 leukemia cases with long-term survival, who were treated with one of three types of postremission therapy. Of them, 20 patients were physically fit for ordinary work and returned to their work as workers or housewives during long-term follow-up period. Two housewives gave birth. We have devised three types of postremission therapy; 1) multidrug combination therapy with gradually longer intermissions (January 1980-March 1983); 2) controlled randomized clinical trial by the Japanese Foundation for the Multidisciplinary Treatment of Cancer, April 1983-March 1985-March 1988). In a group who underwent multidrug combination therapy without prednisolone, 12 of 20 patients who achieved complete remission have shown continued complete remission, as of November 1991, including seven 5-year survivors. These results indicate that improvement of postremission therapy makes it possible for adult patients with acute leukemia to survive 5 years or longer.

Adolescent↗