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PubMedDate not supplied

Women's experiences with combining breast-feeding and employment.

A group of primiparas who combined breast-feeding and employment are described in terms of how they felt about the experience, the difficulties they encountered, factors that affected their total duration of breast-feeding, and patterns of feeding while separated from their infant. These women are contrasted with primiparas who weaned prior to returning to work and those who remained homemakers. Of the 619 women included in the analyses, 499 (80.6%) of the women returned to work or school by 12 months postpartum and 288 (46.5%) continued to breast-feed after returning to work. Women who combined breast-feeding and employment were older, had more years of education, worked fewer hours per week, and more worked in professional jobs than those who weaned prior to returning to work. A number of women who chose to express breast milk only at home thought they would have had problems with having enough time and finding a place to express and to store expressed milk had they tried to express breast milk at work. The overwhelming majority of women who combined breast-feeding and employment felt that it was worth the trouble, that they would recommend it to others, and that they had done something special for their infants that no one else could do. The findings suggest that nursing interventions and workplace accommodations could assist more women to experience the benefits and rewards of continuing to breast-feed after returning to employment.

Adult↗

PubMed1984

Two-year outcome of adult intensive care patients.

Five hundred fifty-eight patients admitted to a general/medical surgical intensive care unit were studied 2 years after hospital discharge to determine whether they were still alive, were able to perform daily activities, and had returned to work. The overall 2-year survivorship (hospital and long-term) was 63.5%. Two-year survival was considerably lower for patients with certain condition or treatment characteristics than for others. This ranged from 14% 2-year survival for patients with 48 or more hours of coma to 82.2% for patients with no condition or treatment characteristics recorded. Once a patient was discharged alive, the 2-year cumulative survival of surgical ICU patients (84.6%) was significantly better than that of medical ICU patients (76.5%). Among ICU survivors responding to a follow-up survey, 85% were able to perform daily activities, but only 66% were working. Of the 44 patients experiencing a change in ability to perform daily activities at time of follow-up compared with pre-ICU admission, functional status of 34 (77%) improved, while 10 (23%) got worse. By comparison, of the 45 patients experiencing a change in working status, only 7 patients (16%) who did not work prior to ICU admission had returned to work, whereas the remaining 38 patients (84%) who worked prior to ICU admission were not working at time of follow-up study.

Activities of Daily Living↗

PubMed1993

Contributors to cardiac invalidism after acute myocardial infarction.

Cardiac invalidism is a term used repeatedly in the literature during the past few decades, but little attention has been given to studying the variables contributing to this phenomenon. Data were collected from 111 patients with first acute myocardial infarction. Patients were visited at home 1 month and 4 months after hospital discharge. Social support, self-esteem, health perceptions, emotional distress, interpersonal dependency, and neuroticism were measured using standardized instruments. Illness severity was determined using the Coronary Prognostic Index, the Specific Activity Survey, and treadmill testing results. Neuroticism and social support were significant predictors of cardiac invalidism 4 months after myocardial infarction. Illness severity was not a significant predictor of cardiac invalidism or return to work. The only significant predictor of return to work was health perception. Patients receiving more support than desired experienced less cardiac invalidism after acute myocardial infarction. Physicians are encouraged not to assume that patients with large infarcts will become cardiac invalids. Psychologic recovery may require more than 4 months for many patients, but positive messages regarding patient health can influence such outcomes. Families and friends should be taught to provide appropriate types and amounts of support. The amount of support typically thought to be adequate may not be sufficient. Patients who initially receive more support than desired experience the best psychologic outcomes. High levels of support need not continue indefinitely.

Adaptation, Psychological↗

PubMed1987

Psychological problems associated with diagnosis and treatment of lymphomas. I: Retrospective study.

Patients treated for Hodgkin's disease and non-Hodgkin's lymphoma have a better prognosis than other patients with cancer so may have a lower prevalence of psychological and social morbidity. Trained interviewers used standardised methods to assess 90 patients at a mean of 32 months after the diagnosis of Hodgkin's disease or non-Hodgkin's lymphoma. Chemotherapy and radiotherapy had commonly caused adverse effects including hair loss, vomiting, nausea, and loss of appetite. Although most patients were free of disease and not receiving treatment at follow up, some still suffered from a lack of energy (31 patients), loss of libido (19), irritability (22), and tiredness (19); 30 patients complained of continued impairment of thinking or disturbance of short term memory. After diagnosis 21 patients had suffered from an anxiety state or depressive illness, or both, while 27 had experienced borderline anxiety or depression, or both. Mood disturbance was positively correlated with adverse effects of treatment, particularly those affecting the gastrointestinal tract. Social adjustment was less affected, but failure to return to work, or a long delay in returning to work, and a persistent lack of interest in leisure activities gave cause for concern. These findings of substantial psychiatric and social morbidity in patients with Hodgkin's disease and non-Hodgkin's lymphoma prompted a prospective study of these patients to determine their nature and duration.

Adolescent↗

PubMed1998

[Release of the carpal tunnel by endoscopy].

GOALS OF THE STUDY: Review of the results of 67 endoscopic carpal tunnel releases and description of the surgical technique. MATERIAL AND METHODS: Between 1994 and 96, 67 endoscopic carpal tunnel release have been performed on 49 patients with a mean age of 58 years. Our mean follow-up is 13 months. RESULTS: 31 patients (65%) reported an excellent result, 14 patients (28.5%) reported an improvement of their symptoms and 3 patients (6.5%) no improvement at all. The mean time for return to work was 4.5 weeks and 40% return after 3 weeks. DISCUSSION: Endoscopic carpal tunnel release is effective in relieving symptoms and is associated with an early return to work and minimal palmar pain. The endoscopic release has advantages over open release but this technique has her own complications.

Adult↗

PubMed1982

Coronary artery bypass patients and work status.

Retrospective surgery data were obtained from 358 coronary artery bypass surgery patients 4-22 months (mean 12.5 months) after surgery. Before surgery, 69% of the subjects were working, 10% were unemployed, and 21% were retired. At follow-up, only 58% were working and 29% were retired. Employment before surgery was the most significant predictor of work status after surgery. Other factors that were positively related to returning to work include higher presurgery income and job classification, higher pre- and postoperative ejection fraction, and subjective improvement in tolerance for physical activity. Factors that were negatively related to returning to work were age, number of chronic medical problems, presence of cardiac symptoms, and receipt of disability compensation. Reported improvement in symptoms was not related to postoperative work status. Job classification, physical demands of the job, and time out of work before surgery were also related to how soon patients returned to work. Participation in an outpatient rehabilitation program was significantly related to postoperative work status for men employed before surgery. Questions were raised regarding the role of outpatient cardiac rehabilitation in altering patient perceptions and maintaining "work habits" that might facilitate work resumption after coronary artery bypass surgery. The results suggest that multiple physical, social and psychological factors interact to influence postoperative work status.

Adult↗

PubMed1993

Microsurgical treatment of lumbar disc herniation: follow-up of 237 patients.

We have reviewed retrospectively the results of 237 consecutive patients who underwent microsurgical discectomy for a virgin lumbar disc herniation. Included were 128 (54%) mean and 109 (46%) women, with the mean age of 42 years. Intra-operatively, protrusion was found in 60 (25%) patients, prolapse in 127 (54%) patients and sequestration in 50 (21%) patients. The median post-operative follow-up time was 2 years. During the observation period, sciatic pain had completely recovered or markedly diminished in 218 (92%) patients, and 187 (79%) patients had returned to work. The mean duration of preoperative sciatica was 3.8 months in those patients who finally returned to work. In contrast, it was as long as 6.3 months in those patients who lost their working capacity as a consequence of low back pain. The patients operated on for a prolapse or a sequestrum recovered better than those who underwent surgery for a protrusion. Of the patients operated on for a protrusion, 68% returned to work, while 76% of those operated on for a sequestrum and 85% of those operated on for a prolapse returned to work during the follow-up. Difference was seen also in the occupational outcome: only 37% of the patients operated on for a protrusion reported to manage their work well, while 47% of those with a prolapse and 58% of those with a sequestrum managed well. Surgical complications were infrequent in this study. Dural tear appeared in 10 (4%) patients and post-operative discitis in 4 (1.7%) patients. Of all patients, 9 (4%) required re-operation for a true recurrent disc.

Activities of Daily Living↗

PubMed2002

Outcomes after injury: a comparison of workplace and nonworkplace injury.

BACKGROUND: Factors affecting recovery from injury are investigated comparing male emergency department patients involved in work-related and non-work-related accidents. METHODS: This was a prospective cohort study of 154 injured employed male emergency department patients recording demographic and accident details, return to work information, and involvement in litigation. Standardized questionnaires measured psychological, physical, and social responses. Evaluations were at admission, and at 6 weeks, 6 months, and 18 months after injury. RESULTS: Work-related injuries were less severe than non-work-related injuries (p = 0.006), and more patients became involved in litigation (p = 0.02) and suffered symptoms of posttraumatic stress disorder (p = 0.04). Psychosocial symptoms increased with nonreturn to work (p < 0.05). Factors predicting return to work include injury severity, blaming others, involvement in litigation, and subsequent physical and social functioning. CONCLUSION: Patients injured at work are more likely to commence litigation and develop symptoms consistent with posttraumatic stress disorder. Nonreturn to work is associated with higher psychosocial morbidity. Return to work is predicted from event and recovery period variables.

Absenteeism↗

PubMed1991

Classification system for factitious syndromes in the hand with implications for treatment.

We evaluated 29 patients with factitious disorders in the hand who received Worker's Compensation benefits. Three types of factitious hand disorders based on physical presentation were self-mutilation and wound manipulation, edema, and finger and hand deformities. Two distinct psychological diagnoses present were factitious disorder with physical symptoms and conversion disorder. The Minnesota Multiphasic Personality Inventory revealed two personality profiles: emotionally dependent and angry and hostile. Behavioral treatment was implemented. The emotionally dependent group responded well, with 80% returning to work. The angry and hostile group had a much poorer response, with 21% returning to work. None of the self-multilating patients returned to work. We recommend a combined evaluation by a physician, a psychologist, and a hand therapist to achieve a definitive diagnosis for these disorders. The identification of psychological profiles assists in ascertaining which patients will be responsive to behavioral treatment.

Accidents, Occupational↗

PubMed1999

Minicholecystectomy: a safe, cost-effective day surgery procedure.

OBJECTIVE: To document effectiveness of minicholecystectomy as a safe, cost-effective day surgery procedure with rapid return to work. DESIGN: Review of medical records. SETTING: Small community hospital. PATIENTS: A total of 1207 patients who underwent minicholecystectomies from January 1, 1986, through December 31, 1997. INTERVENTION: Minicholecystectomy. MAIN OUTCOME MEASURES: Complications, length of hospital stay, cost, and time until return to work. RESULTS: Of the 1207 patients who underwent minicholecystectomy, 74% were admitted for day surgery, 88% of whom were discharged in less than 12 hours, 9.3% in 24 hours or less, and 1.7% in greater than 24 hours; 0.3% were readmitted within 2 weeks. The complication rate was 0.2%; 2 cases required laparotomy, with no common duct injuries. The cost of the procedure was S435; the average time it took working patients to return to work was 11.4 days. CONCLUSIONS: Minicholecystectomy is a safe, inexpensive day surgery method of cholecystectomy with minimal time off work after surgery.

Adolescent↗

PubMed2005

Predictors for work ability and disability in men and women with low-back or neck problems.

In many countries back and neck problems are the most common reason for work incapacity. Numerous studies have looked for reliable predictors of return to work (RTW) or not return to work (NRTW) for those incapacitated, but with few exceptions their predictive and detective ability has been limited. We aimed to perform a comparative study of various commonly used health measures ability to predict RTW or NRTW in a cohort of men and women sick-listed for more than 28 days due to low-back pain (LBP) or neck pain (NP). A cohort of 1,575 men and women sick-listed more than 28 days due to back or neck problems was asked to answer ten different health measures (scales) about various aspects of health status (health related quality of life, pain, back function and depressivity) at four occasions during a 2-year period. A statistical diagnostic test was used to study how well the subject's values on these scales would serve as a predictor for work resumption. There was an improvement from day 28 up until 2 years, reflected by the different scales, more pronounced for LBP than for NP patients and for men with LBP compared with women with LBP. For all separately tested scales EuroQol (EQ-5D) had the highest overall ability to predict RTW or NRTW irrespective of gender, diagnoses or duration of the problems. When RTW or NRTW were predicted in a cohort of sick-listed low-back or neck patients, EQ-5D had outstanding properties in this respect irrespective of gender, diagnosis or elapsed time during this 2-year study.

Activities of Daily Living↗

PubMed1998

Long-term physical, psychological and social consequences of a fracture of the ankle.

The long-term physical, psychological and social outcomes of 68 patients with an ankle fracture were investigated by using a postal questionnaire 6 years after injury. Patients were treated at a level I Trauma Centre between January 1989 and December 1989. Where applicable, the outcomes were compared with the outcomes of severely injured patients who were investigated previously. Physically, the patients were suffering from problems in the extremities and the spine. Surprisingly, half of them (52 per cent) had psychological complaints due to the initial injury. Eighty-nine per cent of the patients returned to work. This result seems to be only slightly better than the return to work in severely injured patients (74 per cent). Those with an ankle fracture needed less time to return to work (3 months versus 13 months in the severely injured patients). Further social changes (marital status, leisure activities) were mostly found in the severely injured patients. Patients with an ankle fracture as well as severely injured patients are affected by long-term consequences. The differences between the two groups are not as pronounced as is generally assumed. Probably, the consequences of lesser injuries are frequently disregarded, whereas severely injured patients are doing better than expected.

Adolescent↗

PubMed1998

[Recovery and duration of work disability after laparoscopic and conventional appendectomy. A prospective randomized study].

To evaluate whether laparoscopic appendectomy shortens the convalescence and the postoperative period until return to work when compared to conventional appendectomy, a prospective randomized trial was performed. The major endpoint of the study was the time until return to work; minor endpoints were postoperative pain, fatigue, operative time and postoperative morbidity. In all, 54 patients with a mean age of 29.5 +/- 10.1 years were randomized to open (n = 28) or laparoscopic appendectomy (n = 26). Age, sex, body mass index (BMI), American Society of Anesthesiology (ASA) rating, job status as well as histologic degree of inflammation of the appendix were comparable in the two groups. Operative time was 59.2 +/- 15.8 min for laparoscopic and 59.8 +/- 24.4 min for conventional appendectomy (P = 0.9). Some 16 laparoscopic appendectomies (62%) were performed by board-certified surgeons, while 23 conventional appendectomies (82%) were performed by residents (P = 0.003). Postoperative morbidity was comparable between the two groups. After laparoscopic appendectomy, pain was rated significantly lower on the first, second and fourth postoperative day when compared to the conventional group. There were no difference in postoperative fatigue between the groups. Time to return to work was 17.0 +/- 6.2 days in the laparoscopic group and 18.2 +/- 6.0 days in the conventional group (p = 0.5). Laparoscopic appendectomy has no advantages in terms of convalescence and time to return to work when compared to open appendectomy and should therefore be limited to selected cases.

Adolescent↗

PubMed1998

Employment after coronary angioplasty or coronary bypass surgery in patients employed at the time of revascularization.

BACKGROUND: Patients who undergo coronary angioplasty have a shorter convalescence than those who undergo coronary bypass surgery. This may improve subsequent employment. OBJECTIVE: To compare employment patterns after coronary angioplasty or surgery. DESIGN: Multicenter, randomized clinical trial. SETTING: Seven tertiary care hospitals. PATIENTS: 409 employed patients with multivessel coronary artery disease. INTERVENTION: Coronary bypass surgery or balloon angioplasty. MEASUREMENTS: Time to return to work and time spent working during 4 years of follow-up. RESULTS: Patients who underwent angioplasty returned to work 6 weeks sooner than patients who underwent coronary bypass surgery (P < 0.001), but long-term employment did not differ significantly (P > 0.2). Long-term employment was significantly lower among patients who were 60 to 64 years of age (P < 0.001), those who worked less than full-time at study entry (P < 0.001), and those who had less formal education (P = 0.005). Patients with only one source of health insurance were more likely to continue working (P = 0.005). CONCLUSIONS: Faster recovery after angioplasty speeds return to work but does not improve long-term employment, which is primarily associated with nonmedical factors.

Age Factors↗

PubMed1988

The long-term work record of post-infarction patients subjected to an informal rehabilitation and secondary prevention programme.

The St Vincent's Cardiac Rehabilitation Programme is based on an out-patient non-institutionalized service with long-term follow-up and home-based exercise programmes. Return to work rates of more than 90% in the 1960s and 1970s were reported but these rates have not been sustained in the past seven years. These secular changes in return to work rates are attributed to recent changes in the social and economic climate in Ireland. Medical, social, demographic, and psychological factors which may influence successful return to work were studied. The previously employed, young patients and those in the higher social groups, patients with less severe attacks and those free from post-infarction angina, reported the best return to work rates. Reasons for failure to return to work could be attributed equally to organic and functional causes. Factors affecting secondary preventive measures, including smoking cessation, desirable dietary and weight changes, and aerobic exercise programmes, were also studied. These changes were best achieved by young patients, white-collar workers, the better educated and urban dwellers. It is concluded that informal out-patient rehabilitation programmes aimed at early return to a normal life, active secondary prevention measures and home-based exercise programmes, are effective and safe in the great majority of patients recovering from myocardial infarction and coronary bypass surgery.

Coronary Artery Bypass↗

PubMed1992

Persons with cancer and their return to the workplace.

Over 5 million persons are living today with a diagnosis of cancer. Maintaining employment after a diagnosis of cancer and even during therapy is a major challenge for an increasing number of individuals. The majority of preretirement persons with cancer who have attempted a return to the workplace have confronted a variety of issues and barriers. Social scientists and legal and health care professionals have attempted to identify particular practices and issues that have affected the return to work experiences of those with a diagnosis of cancer. There has not been a program in nursing research that has systematically tested clinical interventions which effect return-to-work outcomes in persons with cancer. Understanding the return-to-work experience is an essential prerequisite to planning clinical nursing therapeutics and assistance to persons with cancer who consider maintaining their worker role. Environmental and personal factors that influence a successful return to the workplace, plus the human responses manifested in the return experience are reviewed in this article. Clinical implications are drawn for nurses who can facilitate the return-to-work for an individual with cancer through interventions that eliminate or alter barriers to the successful return.

Adaptation, Psychological↗

PubMed1982

The rehabilitation of coronary surgical patients.

Coronary revascularization has been reported to have failed to effectively rehabilitate working-age patients. This study of 565 patients demonstrates that motivation to return to work is strongly influences by age and educational level. Patients under age 55 are more likely to return to work than are patients over that age, but preoperative job classification does not influence rehabilitation. Although preoperative disability was associated with a slightly lower return-to-work rate (90%) than was the case with patients working preoperatively (97%) preoperative retirement was a strongly negative influence on rehabilitation. In this study, 80% of the patients worked to or beyond retirement age, and duration of work was not influenced by preoperative disability. The salary produced by those patients who were rehabilitated by surgery was four and a half times greater than the total cost of care and disability payments for the entire patient population. The factors which seemed to be the most important in effective rehabilitation were the psychological preparation of patients and their families and the attitude toward rehabilitation expressed by physicians and employers.

Adult↗

PubMed1996

Are postoperative activity restrictions necessary after posterior lumbar discectomy? A prospective study of outcomes in 50 consecutive cases.

STUDY DESIGN: A prospective clinical trial was conducted. OBJECTIVES: To determine if removing activity restrictions after surgery and encouraging early return to work would affect clinical outcomes after lumbar discectomy. SUMMARY OF BACKGROUND INFORMATION: Current practice usually recommends several weeks to months of restricted activities after lumbar discectomy. No formal studies have been done to determine the optimal period of restriction, if any, after surgery. METHODS: Fifty consecutive patients undergoing limited open discectomy for herniated lumbar intervertebral disc were prospectively treated with no restrictions at all after surgery and were urged to return to full activities as soon as possible. The patients were followed for a minimum of 2 years. At follow-up evaluation, an independent examiner evaluated each patient. RESULTS: The mean time from surgery to return to work was 1,7 weeks. Eleven of 44 (25%) patients returned to work on the next work day. Ninety-seven percent of patients who were working before surgery returned to their previous work. Forty-three of 44 (97%) patients had returned to full duty by 8 weeks after surgery. At follow-up evaluation (3.8 years), five patients had changed work; three patients increased their work level, and two decreased their work level. No patient changed employment because of back or leg pain. There were three reherniations at the operative level (6%), all occurring more than 1 year after surgery. One patient required reoperation. Back and leg pain scores at follow-up evaluation were very low. CONCLUSION: Lifting of postoperative restrictions after limited discectomy allowed shortened sick leave without increased complications. Postoperative precautions in these patients may not be necessary.

Adult↗