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PubMed1994

["Revolution psychoses" in 1989 and their catamnesis].

In the submitted paper the author deals in detail with patients hospitalized in two large Moravian sanatoria on account of psychotic disorders in the development of which events of November 1989 played some part. The author sought in these patients common anamnestic data, analyzed the psychopathological picture of the disease and finally subjected all the patients to a three-year catamnestic follow-up. The results were compared with several publications dealing with the same subject. The author had, however, the advantage of a longer follow-up and more extensive sources of information, whereby she made also use of contact in writing with former patients. The achieved results were processed by statistical methods, compared also in parts of the group classified by age and sex. In the presented paper only the most interesting data are given. The most positive conclusion is the fact that 31.43% of the group had no longer any psychic complaints, 81.63% of the group work (and another 6.06% returned to work after invalidization). With one exception all patients or their doctors evaluate the present situation at least as satisfactory.

Adolescent↗
PubMed1998

Work incapacity from low back pain in the general population.

STUDY DESIGN: A retrospective cohort study. OBJECTIVE: To describe the incidence and duration of low back pain in patients from the general working population in Norway who take at least 2 weeks of compensated absence from work. SUMMARY OF BACKGROUND DATA: There is a growing concern about the proportion and socioeconomic consequences of work absence resulting from low back pain, and exact figures on incidence and duration of work incapacity from low back pain in the general working population are needed. METHODS: Cases were identified from files of the national medical insurance system, covering 90% of all employees in Norway. A total of 89,190 patients with low back pain were identified in 1995 and 1996, based on the International Classification of Primary Care (ICPC codes L02, L03, L84 and L86). Census data were used for the denominators. RESULTS: The estimated overall 1-year incidence was 2.27%. It was significantly higher for women (2.72%) than for men (1.91%). The incidence increased with increasing age. The median (25th-75th percentile) duration of absence for all claimants was 43 days (25th-75th percentile, 23-103). Approximately 35% of claimants returned to work after 1 month, 70% had returned after 3 months, and 85% had returned after 6 months. Thirty percent of all claimants had low back pain with radiation, and the median duration of absence for these was 59 days (25th-75th percentile, 28-152 days) versus 38 days (25th-75th percentile, 21-86 days) for claimants without radiating pain (P < 0.001). CONCLUSION: The results of this study reaffirm the burden of low back pain to society. The data show that the prognosis for the majority of this group of patients with low back pain, even for those with radiating symptoms, is generally good. From 6 to 20 weeks after onset, however, the return-to-work curve declined steeply among the individuals studied. Approximately 42% of those still off work after 6 months had not returned to work after 12 months, and were switched to permanent disability pension or other compensation forms.

Adolescent↗
PubMed2002

Treating work-injured patients in Europe. The Italian experience.

According with to International Labor Office, the European Union gave the directions to improve the life of workers not only by regulating care, but also safety and return to work. Each European country is conforming to this. In Italy, INAIL, an independent body under the control of the Department of Labor and the Ministry of Health, covers the workers for occupational accidents and is funded by an insurance premium, obligatory paid by the employer. INAIL has the medicolegal task of assessment of injuries, supply of prostheses, physical therapy, and various compensation according to the degree of disability and the type of work. The specific treatment of the injured workers is carried out by the SSN, which is in charge of the outpatient treatment and hospitalization; however, INAIL contributes to the costs according to agreements made with each region. Although on one hand the injured worker is fully protected by the regulations, on the other hand, he or she is obliged to abide to the laws of security and to undergo treatment offered. In returning to work, certain factors are taken into account, such as percentage of disability, type of work, and discomfort that disability produces in carrying out work. Should the type or severity of the disability not allow complete return to work, support is given to assess and integrate the reduced working ability of the injured worker with regards to the workplace, even by adapting the latter to solve structural and environmental problems. INAIL, in accordance with the European Council, is committed to the total care of the worker and not only worker meaning "work force." In fact, health care and economic aid are integrated with the safety and rehabilitation of the worker and his or her return to family, social, and working life.

Accidents, Occupational↗
PubMed2001

Care management of work injuries: results of a 1-year pilot outcome assurance program.

A 1-year pilot study was conducted, linking the efforts of a workers' compensation managed care organization with those of an occupational health clinic and emergency department of manage work-related injuries and associated work disability. Sustained (> 90 day), injury-specific return-to-work outcomes, modified by job title, were compared with loosely managed and well-managed benchmarks. The mean return-to-work outcome, measured as lost workdays (LWDs), was 5.11 +/- 21.0 LWDs for 418 workers. These results exceeded benchmarks for both loosely managed care, 14.0 +/- 17.2 LWDs, P < 0.001 (8.9 fewer LWDs/case), and optimally case-managed care, 6.99 +/- 7.64 LWDs, P = 0.044 (1.9 fewer LWDs/case). An estimate of the value of these saved LWDs to the employers-at $200 per workday was $740,400 for the loosely managed benchmarks and $157,000 for the well-managed benchmarks. The Outcome Assurance Program virtually eliminated typical delays in the diagnosis and medical management of these injured workers.

Accidents, Occupational↗
PubMed2004

Returning the chronically unemployed with low back pain to employment.

Much of the research into return to work following rehabilitation for low back pain in the literature reflects work done in those employed. Unemployment is a consequence of chronic low back pain which has considerable health and economic consequences for the individual and society. This paper describes an occupationally orientated rehabilitation programme for long-term unemployed people (mean duration of unemployment 38.9 months). The aim of the project was to identify factors which predict return to work and progress towards employment. Eight six subjects underwent a pain management rehabilitation programme incorporating vocational focussing and advice, subjects were followed up at 6 months to determine work status. At follow-up 38.4% of subjects were employed and another 23% were in voluntary work, or education/training. There were no significant differences on presenting characteristics between those who returned to work and those who did not. Subjects were divided into those who made positive progress (work, education/training or voluntary work) and those who did not (remained unemployed, dropped out of the programme or lost to follow up). Those who failed to make positive progress were characterised by longer duration of unemployment and higher scores on somatic anxiety and depression. A predictive model was able to identify 80% of those who failed to make progress but prediction of those achieving a positive outcome was poor (44% correct prediction). The factors predicting return to work in unemployed people with low back pain differs from the employed, the need for employment skills training and a vocational focus to rehabilitation are highlighted.

Activities of Daily Living↗
PubMed1986

Clinical and social factors in rehabilitation of patients with chronic low back pain.

Physical signs, medical history and social factors were analyzed and evaluated in 52 patients (17 women and 35 men) with chronic low back pain, in order to determine if any factors were predictive for return to work after rehabilitation. Factors discriminating between the working and sick-disabled groups were: Sex (only men returned to full time work), Duration of sick-leave (the older half of the study population exhibited a negative correlation between time on sick-leave and frequency of return to work), Reported need for analgesics (the working group reported less need of analgesics), Pain in the cervical and dorsal areas of the spine as well as in the lumbar region (less frequent in the working group), The patients' attitude to his own ADL-capacity (those who returned to full-time work were more positive), After work fatigue (less frequent in the working group).

Absenteeism↗
PubMed2002

[Fitness for work after vocational rehabilitation organized by the State Social Security Institute of Iceland.].

OBJECTIVE: The evaluation of a vocational rehabilitation programme initiated by the State Social Security Institute in Iceland (SSSI) in 1999 with the aim of reducing disability. MATERIAL AND METHODS: New disability claimants who had been unable to work because of illness for a few months at least were referred by SSSI physicians to a multidisciplinary team for assessment of rehabilitation potentials and an advice on the appropriate type of rehabilitation. The study group included all the 109 individuals who were referred to the team in the year 2000. Data on marital status, number of children and level of education was compared with information about the Icelandic population obtained in a national survey. The outcome of the rehabilitation was assessed in a telephone survey, carried out by the Social Science Research Institute, University of Iceland, 1-2 years after the assessment and by information obtained from the disability register at SSSI. The effectiveness of the rehabilitation programme was evaluated by comparing the study group with a comparable group that had started to receive rehabilitation pension before the SSSI could offer vocational rehabilitation. Their progress was assessed a year and half after they had contacted the SSSI, the same length of time as the study group had been in the in the rehabilitation programme. RESULTS: In the study group there were about twice as many women as men. The mean age was 35 years (range 18-57 years). The main medical reasons for referral to the team were musculosceletal and psychiatric disorders. Those evaluated were more likely to be unmarried or divorced, had more children and a lower educational level than the general Icelandic population. After evaluation 40 individuals were referred to vocational rehabilitation for approximately 2 months in a rehabilitation clinic; 19 were referred to a 6 week personal computer training at a vocational rehabilitation centre and 15 to a longer (usually 18 months) rehabilitation program in the same centre. In all, 46 individuals received other treatment or education. Almost three quarters (72%) of the participants in the telephone survey said that their fitness for work had increased after rehabilitation, but only 47% had returned to work. At the time of the reserach, 23% were students and it is likely that a part of them will return to work when their studies are completed. Between one and two years after the evaluation by the multidisciplinary team 44 out of 109 (40.4%) in the study group received disability pension and a equal number received no social insurance benefits at all. In the comparison group 97 out of 119 (81.5%) received disability pension and 21 (17.7%) received no social insurance benefits at all. CONCLUSIONS: This study shows that vocational rehabilitation organized by the SSSI is effective and can prevent disability. The results of this study are similar to the results of two Swedish studies on the same topic.

English Abstract↗
PubMed2005

Motherhood during residency training: challenges and strategies.

OBJECTIVE: To determine what factors enable or impede women in a Canadian family medicine residency program from combining motherhood with residency training. To determine how policies can support these women, given that in recent decades the number of female family medicine residents has increased. DESIGN: Qualitative study using in-person interviews. SETTING: McMaster University Family Medicine Residency Program. PARTICIPANTS: Twenty-one of 27 family medicine residents taking maternity leave between 1994 and 1999. METHOD: Semistructured interviews. The research team reviewed transcripts of audiotaped interviews for emerging themes; consensus was reached on content and meaning. NVIVO software was used for data analysis. MAIN FINDINGS: Long hours, unpredictable work demands, guilt because absences from work increase workload for colleagues, and residents' high expectations of themselves cause pregnant residents severe stress. This stress continues upon return to work; finding adequate child care is an added stress. Residents report receiving less support from colleagues and supervisors upon return to work; they associate this with no longer being visibly pregnant. Physically demanding training rotations put additional strain on pregnant residents and those newly returned to work. Flexibility in scheduling rotations can help accommodate needs at home. Providing breaks, privacy, and refrigerators at work can help maintain breastfeeding. Allowing residents to remain involved in academic and clinical work during maternity leave helps maintain clinical skills, build new knowledge, and promote peer support. CONCLUSION: Pregnancy during residency training is common and becoming more common. Training programs can successfully enhance the experience of motherhood during residency by providing flexibility at work to facilitate a healthy balance among the competing demands of family, work, and student life.

Adult↗
PubMed1995

The effects of a work hardening program on cardiovascular fitness and muscular strength.

STUDY DESIGN: This study analyzed improvements in cardiovascular fitness and muscular strength after a 6-week work hardening program. OBJECTIVES: The objective of this study was to document fitness gains after a 6-week work hardening program. SUMMARY OF BACKGROUND DATA: Studies expounded on the success of a functional restoration approach in return-to-work rates, but few documented the physical fitness gains of a work hardening program. METHODS: Thirty-one subjects from the Rehability Center in Lubbock, Texas, who were diagnosed with lower back dysfunction, completed the 6-week study. A submaximal cycle ergometer protocol was used to determine patients' cardiovascular fitness levels, and the Arcon Static Strength Testing Device was used to measure static strength. Pre- and post-tests were identical. RESULTS: A paired Student's t test was used to analyze the significance of difference from pre- to post-testing. For cardiovascular fitness there was a 28% improvement, t(29) = 5.56, P < 0.001; there was a 76% improvement for the static arm lift, t(29) = 7.86, P < 0.001; there was a 57% improvement in the static pull, t(29) = 9.53, P < 0.001; and an 89% improvement in the static push, t(29) = 9.08, P < 0.001. CONCLUSIONS: Analyzed data clearly show a marked improvement in cardiovascular and muscular fitness. There was not a difference in fitness levels between those who returned to work and those who did not, which suggests return-to-work rates are not entirely based on level of fitness.

Adult↗
PubMed2004

Factors affecting outcome in tibial plafond fractures.

To determine what fracture- and patient-specific variables affect outcome, 29 patients with 32 tibial plafond fractures were evaluated at a minimum of 2 years from the time of injury (range, 24-129 months; average, 46.5 months). The rank order method was used to assess severity of injury and accuracy of articular reduction on radiographs and agreement among the five surgeons was excellent with intraclass correlation coefficients of 0.93 and 0.94. Outcome was assessed by four independent measures: a radiographic arthrosis score, a subjective ankle score, the Short Form-36 (SF-36), and the patient's ability to return to work. The four outcome measures did not correlate with each other. Radiographic arthrosis was predicted best by severity of injury and accuracy of reduction. However, these variables did not show any significant relationship to the clinical ankle score, the SF-36, or return to work. These outcome measures were more influenced by patient-specific socioeconomic factors. Higher ankle scores were seen in patients with college degrees and lower scores were seen in patients with a work-related injury. The ability to return to work was affected by the patient's level of education. This study highlights the difficulties of predicting patient outcome, after these severe articular fractures.

Adolescent↗
PubMed2006

Recommendations for the U.S. National Occupational Research Agenda: research on cancer survivorship and musculoskeletal disorders and work disability.

Occupational health and safety focuses on health problems in the working population. Disability is a significant problem that results in both functional and financial consequences to the worker and society. A problem becoming more evident in the workplace is cancer. As technological advances improve in the early recognition and treatment of cancer and our working population ages, the number of survivors who face challenges returning to work and maximizing productivity while at work will increase. Research is needed to identify the barriers that affect cancer survivors at work and evaluate innovative interventions to assist these workers in both their return to work and long term success at work. Musculoskeletal disorders continue to be a leading cause of work disability in the US. Limited function, pain, lost work time, emotional distress and financial burden are many of the problems associated with musculoskeletal symptoms and disorders. We presented these areas of research needs for the coming decade at the National Occupational Research Agenda (NORA) town hall meeting. The following is our testimony given on December 5, 2005 in College Park, Maryland.

Persons with Disabilities↗
PubMed2001

Employment status, job characteristics, and work-related health experience of people with a lower limb amputation in The Netherlands.

OBJECTIVES: To describe the occupational situation of people with lower limb amputations in The Netherlands and to compare the health experience of working and nonworking amputee patients with a nonimpaired reference population. DESIGN: Cross-sectional study in which patients completed a questionnaire about their job participation, type of job, workplace adjustments to their limb loss, their position in the company, and a general health questionnaire. SETTING: Orthopedic workshops in The Netherlands with a population of lower limb amputees. PATIENTS: Subjects were recruited from orthopedic workshops in the Netherlands. They ranged in age from 18 to 60 years (mean, 44.5yr) and had a lower limb amputated at least 2 years (mean, 19.6yr) before this study. MAIN OUTCOME MEASURES: A self-report questionnaire, with 1 part concerning patient characteristics and amputation-related factors, and the other concerning job characteristics, vocational handicaps, work adjustments, and working conditions; and a general health questionnaire (RAND-36) to measure health status. RESULTS: Responses were received from 652 of the 687 patients (response rate, 95%) who were sent the questionnaire. Sixty-four percent of the respondents were working at the time of the study (comparable with the employment rate of the general Dutch population), 31% had work experience but were not presently working, and 5% had no work experience. After their amputations, people shifted to less physically demanding work. The mean delay between the amputation and the return to work was 2.3 years. Many people wished their work was better adjusted to the limitations presented by their disability and they mentioned having problems concerning possibilities for promotion. Seventy-eight percent of those who stopped working within 2 years after the amputation said that amputation-related factors played a role in their decision. Thirty-four percent said that they might have worked longer if certain adjustments had been made. The health experience of people who were no longer working was significantly worse than that of the working people with amputations. CONCLUSIONS: Although amputee patients had a relatively good rate of job participation, they reported problems concerning the long delay between amputation and return to work, problems in finding suitable jobs, fewer possibilities for promotion, and problems in obtaining needed workplace modifications. People who had to stop working because of the amputation showed a worse health experience than working people.

Adult↗
PubMed1995

Interdisciplinary treatment of the injured worker with chronic pain: long-term efficacy.

The purpose of this study was two-fold: (1) to determine long-term efficacy of an outpatient interdisciplinary pain treatment and management program for injured workers with chronic pain, and (2) to determine if those referred earlier after injury are more likely to benefit. Ninety-one questionnaires were completed a median of 36 months following program completion. Ninety-three percent of patients reported improvement in pain symptoms at the time of program discharge and 76% reported maintenance or improvement of pain level between discharge and the time of survey. Of those not working at the time of initial evaluation, 74% reported return to work or current involvement in a retraining program. Patients referred < or = 12 months after injury reported greater mean pain improvement and were significantly more likely to return to work. We conclude that the interdisciplinary pain treatment and management approach is effective in treating injured workers with chronic pain and that early referral enhances outcome.

Adult↗
PubMed2000

[Intensified after-care--a method for improving occupational reintegration after myocardial infarct and/or bypass operation].

Occupational reintegration after coronary heart disease of patients who are insured by the German workers pension (Arbeiterrentenversicherung) succeeds in 40-60% of the recorded cases. Patients who were not able to return to work after finishing their regular cardiac rehabilitation took part in a program called "Intensivierte Nachsorge (INA)". INA is an interdisciplinary support program, taking place twice a week for a whole day over a period of six weeks. On the remaining three days patients were either progressively reintegrated into their working place or stayed at home. The results of the INA group were compared to those of a control group. Two years after patients had terminated the cardiac rehabilitation, statistically significant effects could still be found: 70.2% of the INA group had returned to work compared to 52.6% of the control group. This is a difference of 17.6%. After the results had been corrected by considering age differences between the two groups, the control group had a recalculated return to work rate of 57.4%. A significant difference of 12.8% could still be identified with respect to the INA group. Support programs which follow regular cardiac rehabilitation seem to be specially suitable for older patients with highly perceived job strain, because our results showed that these patients had lower return to work rates. 44.2% of the INA group and 21.9% of the control group were progressively reintegrated into their work place. Two years after their regular rehabilitation 36.3% of the INA group patients took part in ambulatory heart groups compared with 10.4% of the control group. It was also found that patients of the INA group showed improvements in activities of daily life. The INA program however does not seem to have an influence on behavioral components such as eating habits, relaxation, and smoking as well as on the psychological status. The physical fitness measured in watt x min at the beginning of the INA program (T1) was 589.46 +/- 255.03 in the control group. This number increased to 598.32 +/- 276.01 six months after regular rehabilitation (T3) and continued to rise to 661.15 +/- 362.01 after two years (T4). In the INA group the numbers were as follows: 658.13 +/- 263.63 at T1, 751.83 +/- 318.15 at T3, and 717.93 +/- 336.76 at T4. The differences between the groups are significant at T1 and T3, whereas at T4 there is no significant difference. It should also be stated that the lipid parameters indicated no differences between the groups except for the triglyceride values which were significantly lower statistically in the INA group than in the control group.

Adult↗
PubMedDate not supplied

Outcomes of nurse (RN) refresher courses in a midwestern city.

Graduates of RN refresher courses offered by three hospitals in a midwestern city from 1981 to 1991 were surveyed (N = 179) to compare the nurses who returned to work (n = 148, 82.7%) with those who did not return to work (n = 26, 14.5%) on demographic and career characteristics, personal responsibilities, and attitudes toward professional nursing (5 nurses [2.8%] did not respond to this item). The non-returning group had fewer mean years of experience prior to leaving nursing, more mean years since last nursing position, and lower mean scores on the Professional Attitude scale used in this study, but the differences were not statistically significant.

Adult↗
PubMedDate not supplied

Relations among sociodemographic, neurologic, clinical, and neuropsychologic variables, and vocational status following mild traumatic brain injury: a follow-up study.

OBJECTIVES: To explore the long-term relations among sociodemographic, neurologic, clinical, and neuropsychologic variables, and vocational status in persons with mild traumatic brain injury (MTBI), and to identify the symptoms that determine whether or not these individuals return to work. DESIGN: Longitudinal quasi-experimental between-groups design. PARTICIPANTS: Eighty-five MTBI subjects aged between 16 and 65 years. SETTING: The emergency ward of the Trois-Rivieres Regional Hospital Centre in Quebec, Canada. MAIN OUTCOME MEASURES: Age, gender, Glasgow Coma Scale score, duration of posttraumatic amnesia, duration of retrograde amnesia, total of symptoms at emergency, time elapsed since the trauma, Paced Auditory Serial Addition Task, Stroop Color Word Test, California Verbal Learning Test, and the number of symptoms at follow-up (12 to 36 months posttrauma). RESULTS: Only the total number of symptoms reported at follow-up was related to vocational status. The majority of individuals had returned to work 1 year or more post-MTBI. Individuals who had not returned to work reported the greatest number of symptoms, which could be linked to their affective status. Six affective symptoms, 5 cognitive symptoms, 6 physical symptoms, and 8 symptoms relating to social and daily life activities differentiated the participants who had returned to work from those who had not. CONCLUSIONS: Patient characteristics, injury severity indicators, and cognitive functions were not associated with vocational status. To better understand post-MTBI vocational status, it is important to focus on subjective complaints that arise following the injury.

Adult↗
PubMed2002

Challenges of the working breastfeeding mother. Workplace solutions.

1. The number of women who breastfeed their infants after returning to work is disappointingly low. Many women stop breastfeeding soon after they return to work because of lack of preparation and support. 2. Continued breastfeeding provides health and psychosocial benefits for both mother and infant. 3. The employer experiences a cost saving benefit by keeping the postpartum employee working and by keeping her infant healthy as a result of breastfeeding. 4. Occupational and environmental health nurses can help bridge the gap between the postpartum employee and her primary health care provider. One strategy is to develop a lactation program for the work setting as described in a stepwise approach.

Breast Feeding↗
PubMed2002

Evaluation of pain and disability in plug repair with the aid of a personal digital assistant.

The purpose of this paper is to illustrate the method of real-time data collection using a hand-held personal digital assistant (PDA) in the operating suite, hospital, and office. The technique for the placement of a round Atrium ProLite self-forming, layered polypropylene plug in 155 hernia repairs is described. The study measured postoperative pain by the number of pills used (6.6) and categorizes patient return to work according to sedentary, manual, and standing with an average return to work time of 15.6 days for unilateral repair and 20.4 days for bilateral repair. Return to normal daily activity was within 22.3 days for unilateral- and 28.5 days for bilateral repair.

Computers, Handheld↗