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PubMed2006

Changes in patient drawings of the heart identify slow recovery after myocardial infarction.

OBJECTIVE: The objective of this study was to investigate how changes in heart attack patients' drawings of their heart over the recovery period relate to psychological and functional recovery. METHODS: Sixty-nine inpatients admitted for acute myocardial infarction at the coronary care unit at a metropolitan hospital completed questionnaires at discharge, including a drawing of what they thought had happened to their heart after their heart attack. Fifty-six patients returned follow-up questionnaires at 3 and 6 months, including heart drawings, cardiac anxiety, time to return to work, changes in exercise frequency, and healthcare use. RESULTS: Increases in the size of the heart drawn at the 3-month follow-up relative to discharge were related to slower return to work (r = 0.48, p < .01), higher cardiac anxiety (r = 0.35, p < .05), and more phone calls to health services (r = 0.37, p < .05) as well as increases in worry about another myocardial infarction (r = 0.39, p < .01), increased activity restriction (r = 0.34, p < .05), higher use of alternative medicines (r = 0.40, p < .05), and less frequent exercise (r = -0.39, p < .05) relative to before the myocardial infarction. CONCLUSIONS: Drawings of the heart may be useful in identifying patients who have experienced heart attacks who are likely to develop greater heart-focused anxiety, complaints of ill health, and higher use of health care. Increases in the size of the patient's drawing of the heart may reflect increases in the extent to which their heart condition plays on their mind and directs their daily activities.

Activities of Daily Living↗
PubMed2005

[The state and results of countermeasures for mental health at a certain apparel company].

We speculated that there would be more occupational stress in an apparel company than in other areas of business, because employees work long hours and under poor conditions. We investigated 66 employees of an apparel company who visited an occupational physician to consult about their mental health. There were 561 male and 387 female employees in that company. The employees who had visited an occupational physician had worked long every day under poor conditions, and they had been required to be more artistic than other employees in that company. Female employees visited occupational physicians more than males. Apparel companies, use a system of "specialty store retailer of Private-label Apparel (SPA)", and several sections make special trademark "brands". These sections compete with each other. Employees must plan, design, make patterns, and sew new dresses in a 7-day cycle. They are extremely busy and this therefore creates stress. We came to the conclusion that many apparel companies were stressful workplaces. It is important that a psychiatrist examines employees who occupational physicians have diagnosed as unhealthy. Frequent consultation with occupational physicians is as important as a psychiatrists examination. Managers must manage absence, efficiency, and written correspondence of all employees. These are useful signs of mental disorder. When employees return to work after sick leave, rehabilitation in the workplace after absence is useful. The employee should work for only two hours a day at first. Working hours are then extended gradually. The employee can then return to work easily if this rehabilitation program is followed.

Clothing↗
PubMed1999

Impairment of hand function and loss of earning capacity after occupational hand injury: prospective cohort study.

OBJECTIVE: To examine the loss of earning capacity and permanent impairment of a cohort of male patients who had experienced finger amputation due to occupational injury. DESIGN: Prospective cohort study. SETTING: University teaching hospital, Hong Kong. PATIENTS: Twenty-eight male patients aged 26 to 55 years who presented with work-related finger amputations in their dominant right hand from 1990 through 1991. MAIN OUTCOME MEASURES: Type and extent of amputation, and hand function before and after (mean, 11 months; range, 8-6 months) the patients' return to work. Assessment results were compared with patients' percentage loss of earning capacity as calculated using the scale described in the Employees' Compensation Ordinance of Hong Kong. RESULTS: Patients with injuries that corresponded to a loss of earning capacity of 12% or greater had a significant impairment in their hand function (P<0.05); the hand function of this group after their return to work significantly improved (P<0.05). There were no significant differences between the loss of earning capacity scores as calculated by the Hong Kong, American Medical Association, or Indian Medical Association scales. CONCLUSION: Patients whose loss of earning capacity of 12% or greater are likely to have significant long-term impairments of hand function. Thus, a more intensive rehabilitation programme should be provided to this group.

Journal Article↗
PubMed2002

Misinterpretation of regional sensory loss in an injured worker: a case report.

Regional patterns of motor or sensory loss are considered indicators of a behavioral component to the complaints of an injured worker. This assumption may lead to a discounting of signs and symptoms with premature return to work and discharge from care. We present the case of a 25-year-old airline baggage handler with an 8-month history of unresolved neck and shoulder complaints who had been returned to work after a lack of objective findings on physical examination. On physiatric evaluation, his unusual pattern of insensitivity to pinprick led to prompt magnetic resonance imaging that revealed a focus of increased intramedullary signal at C6 consistent with a syrinx. This case report shows the importance of a detailed neuromuscular examination coupled with appropriate diagnostic imaging in the assessment of individuals with regional sensory or motor loss so as not to miss more serious spinal cord pathology.

Adult↗
PubMed2002

Impact of case manager training on worksite accommodations in workers' compensation claimants with upper extremity disorders.

Management of the return-to-work process in claimants with work-related upper extremity disorders often poses challenges to the health care provider, claimant, and employer. Modifying workplace ergonomic risk factors as a component of the workplace accommodation process may improve return-to-work outcomes by reducing recurrent pain and discomfort. The present study is a case-control evaluation of the effects of a 2-day training program for nurse case managers that was designed to facilitate the implementation of workplace accommodations within a workers' compensation health care delivery system. After the training, 101 claimants with compensable upper extremity disorders were randomly assigned to case managers with and without training. Overall, 208 accommodations were recommended and 155 of these were implemented (75%). Claimants of trained nurses received 1.5 times as many recommendations for accommodations as claimants managed by nurses not trained in the process, and 1.4 times as many accommodations were implemented, although no differences were found between the two groups in implementation rates. Trained nurses were more likely to recommend accommodations addressing workstation layout, computer-related improvements, furnishings, accessories, and lifting/carrying aids, whereas the untrained nurses were more likely to suggest light duty and lifting restrictions. This study indicates that the training was associated with a change in the practice behavior of case managers regarding the workplace accommodation process. More research is needed to identify barriers to implementation and develop more effective approaches to facilitate worksite accommodations in disabled workers with carpal tunnel syndrome and other persistent upper extremity disorders.

Adult↗
PubMed1993

Restoration of occupational capacity in post-cardiac patients.

Employees returning to work after injury and illness have typically been offered an 'all or nothing' approach to rehabilitation. Dr Bruce Davies questions this attitude and argues for improved policies to facilitate a more effective return to work for post-cardiac patients.

Exercise Therapy↗
PubMed1996

Total extraperitoneal laparoscopic hernia repair: a modified technique associated with few complications and a low early recurrence rate.

Laparoscopic hernia repairs have been demonstrated to be safe and effective, with less postoperative pain and earlier return to work than with open repairs. Modifications of the laparoscopic technique are evolving that attempt to reduce the overall complication rate while maintaining an effective repair. From January 1994 through July 1995, 67 inguinal hernias on 40 patients were repaired using the total extraperitoneal approach at UCLA Medical Center. Of the 67 hernias, four (6%) were pantaloon, 16 (24%) were indirect, and the remainder (70%) were direct. Three patients of 40 (7.5%) had complications that included seromas (two patients) and urinary retention (one patient). The early recurrence rate is zero, with a mean follow-up period of 6 months. The average time taken off from work was 2 days, with a range of zero to 10 days. Total extraperitoneal laparoscopic hernia repair is a modified technique associated with low early recurrence and few complications. In addition, earlier return to work results in less patient inconvenience, greater productivity, and reduction in medical disability expenses.

Adult↗
PubMed2001

Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases.

OBJECT: In this report the author presents surgery-related outcomes after application of a new technique. A posterior microendoscopic laminoforaminotomy was used for the surgical treatment of unilateral cervical radiculopathy secondary to intervertebral disc herniations and/or spondylotic foraminal stenosis. The results of this procedure are compared with those achieved using traditional laminoforaminotomy and anterior cervical discectomy with or without fusion. METHODS: One hundred consecutive patients who experienced unilateral cervical radicular syndromes, which were refractory to conservative therapy, and in whom imaging studies had confirmed lateral canal or foraminal compression, underwent surgical treatment. An endoscopy-assisted posterior laminoforaminotomy was performed using a microendoscopic visualization system for removal of herniated disc and foraminal decompression while the patient was in the sitting position. Excellent or good results were obtained in 97 patients. who returned to their preoperative employment and baseline level of physical activity. One patient returned to work but was unable to perform at baseline level; two patients returned to prior sedentary work but continued to have some activity-related pain and paresthesias. Two patients reported experiencing intermittent paresthesias or numbness, but this did not limit their activities. There were two cases of dural punctures, one case of superficial wound infection, and no deaths. CONCLUSIONS: The microendoscopic posterior laminoforaminotomy is an effective alternative for the treatment of unilateral cervical radiculopathy secondary to lateral or foraminal disc herniations or spondylosis. In this group of patients, it is preferable because it does not require the sacrifice of a cervical motion segment, has a low incidence of complications, and is associated with a much quicker return to unrestricted full activity than that obtained with other techniques.

Adult↗
PubMed2002

Lumbar microdiscectomy: a historical perspective and current technical considerations.

A historical review is presented of the original descriptions of lumbar discectomy, focusing on the evolution toward a less invasive surgical approach following the introduction of the operating microscope. From the initial work in Europe by Yasargil and Caspar to the popularization of microdiscectomy by Williams and Wilson in the United States, this procedure has successfully reduced operative time, surgical morbidity, and incision size while allowing patients to return to work faster. Emphasis is placed on the importance of a careful preoperative clinical and radiographic evaluation by identifying factors that may help in the prediction of a successful surgical outcome. A modification of the lumbar microdiscectomy technique is described including patient positioning in the lateral position as well as minimal disc space and nerve root manipulation. In their experience performing more than 3000 microdiscectomies, the authors have produced good-to-excellent clinical results in nearly 90% of patients, with the majority returning to work within 1 month. The complication rate of dural tears, discitis, or root injury has been less than 2%, with a reoperation rate of 5%. The authors believe that lumbar microdiscectomy remains the gold standard with which all other discectomy techniques must be compared.

Diskectomy↗
PubMedDate not supplied

The intensity of work recovery in low back pain.

The intensity of work recovery in LBP has been studied using the National Health Register. Nine hundred forty men, 40-47 years old, were selected randomly from the census register of the city of Göteborg, Sweden. Sickness absence data were obtained from the Health Register, in which all sickness absence from age 16 is recorded. The rate of return to work decreases as expected with an increase in absence period. Different rates were found for different diagnoses, however, with low return intensities in patients with sciatica compared with those with back pain, ie, return to work was slower in patients with sciatica. Men with manual work had a significantly longer average sickness absence than white-collar workers. The intensity of work recovery was lower in blue-collar workers during the first 20 days of absence, while the reverse was true after 20 days of sickness absence, ie, the white-collar workers who were absent more than 20 days had a slower rate of recovery than blue-collar workers who had been absent for 20 days. Data as presented here can be used to study the effect of intervention (for example, manual therapy) on the natural course of work recovery. It also can be used, as above, to study differences in sickness absence patterns between different diagnoses and work groups.

Absenteeism↗
PubMed1984

Transcutaneous electrical nerve stimulation: its role in the control of chronic pain.

An assessment was made of the effectiveness of long-term transcutaneous electrical nerve stimulation (TENS) in the treatment of chronic posttraumatic pain. Compensation Board files showed that 846 patients received TENS from 1975 to 1979, with more than 70% having intractable back pain. Of this group using TENS, 44.6% were free of disability, and an additional 36.2% were capable of modified work. Questionnaire responses were obtained from 563 of 637 patients receiving TENS in 1978 or 1979. At the six-month follow-up, most respondents (472, 83.8%) reported continuing benefit from TENS, including a reduction of pain (418, 74.2%), less need for medication (322, 57.2%), and improved sleep patterns (331, 58.8%). Only 13.6% of those who had returned to work reported no benefit from TENS, while 18.4% of those still unemployed reported no benefit. Among those who had returned to work (264 cases, 46.9% of respondents), benefit was reported equally by those with back injuries and by those with other injuries. The responses observed in this trial seem larger and more long-lasting than could be obtained by a placebo effect, and further attempts at a controlled trial may be warranted. However, there are major practical difficulties to such an investigation, and the resulting controversy could reduce the therapeutic effectiveness of TENS in conditions where alternative treatments are either ineffective or undesirable.

Back Pain↗
PubMed2005

Prophylactic Diclectin reduces the incidence of postoperative vomiting.

BACKGROUND: Diclectin(R) (DCL) is an effective antiemetic used for relief of nausea and vomiting in pregnancy. It is unknown whether DCL is effective in the prevention of postoperative nausea and vomiting (PONV). METHODS: We conducted a randomized, stratified, double-blind placebo-controlled trial to examine the incidence of PONV in women undergoing elective laparoscopic tubal ligation in the day surgery setting. DCL (doxylamine succinate 10 mg and pyridoxine hydrochloride 10 mg) was administered orally the night before surgery, the morning of surgery, and upon hospital discharge. RESULTS: We enrolled 146 women in the trial, 127 of whom were included in the effectiveness analysis and 102 of whom were included in the efficacy analysis. We did not detect a difference in the incidence of nausea and vomiting in the first six hours postoperatively after adjusting for additional antiemetics administered. Patients receiving DCL as compared with placebo were significantly less likely to experience vomiting six to 24 hr postoperatively [5/59 (8.5%) vs 14/55 (25.4%), P < 0.017]. Treated patients tended to return to work earlier than those who received placebo (1.74 vs 3.7 days P = NS). CONCLUSION: Perioperative oral DCL reduces the incidence of postoperative vomiting in women undergoing elective laparoscopic tubal ligation, and may accelerate return to work.

Adult↗
PubMed2005

New devices for inguinal hernia repair in elderly patients.

A recent meta-analysis concluded that there was a lower incidence of recurrences after mesh hernioplasty, as opposed to non-mesh open methods. Inguinal mesh and plug hernioplasties have been performed using prostheses of different sizes and shapes, either sutured or not to the tissues. However, hernia repair using mesh is sometimes associated with postoperative pain, more or less severe and/or persistent. As a consequence it may interfere with the time required to return to work and to normal daily activities. Finally, concerning the postoperative complications and recurrences, the data presented in our study confirm the very low rate for both aspects; then, as regards the time to return to work, our good results are similar to those of other studies available in literature. In conclusion the tension-free hernia repair described, based upon the use of Prolene 3D patch, is a safe operation, simple to be acquired, it can be performed on an outpatient basis, with a low complication rate, a low level of pain, and an excellent quality of life thereafter. The new device seems to satisfy all requisites of a feasible, reliable and effective system for repairing primary inguinal hernia, at low cost, high patient comfort, and with low risk of recurrences.

Adult↗
PubMed1993

Heart transplantation in Lincoln, Nebraska: the Nebraska Heart Transplant Program experience.

The results of the Nebraska Heart Transplant Program are presented. Survival at one and four years, cost, waiting time and return to work rates are reported and compared to known standards. Survival is 91 percent at one year and 76 percent at four years after transplant. These data as well as costs, waiting time and return to work compare favorably with published and reported data. We conclude the results of the Nebraska Heart Transplant Program by all parameters evaluated are excellent. Referral of patients to distant programs causes needles inconvenience and higher patient costs, and is not justified.

Adolescent↗
PubMed2006

Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey.

BACKGROUND: In recent years, the creation of supportive environments for encouraging mothers to breastfeed their children has emerged as a key health issue for women and children. The provision of lactation rooms and breast pumping breaks have helped mothers to continue breastfeeding after returning to work, but their effectiveness is uncertain. The aim of this study was to assess the effects of worksite breastfeeding-friendly policies and work-related factors on the behaviour of working mothers. METHODS: This study was conducted at a large Taiwanese semiconductor manufacturer in August-September 2003. Questionnaires were used to collect data on female employees' breastfeeding behaviour, child rearing and work status when raising their most recently born child. A total of 998 valid questionnaires were collected, giving a response rate of 75.3%. RESULTS: The results showed that 66.9% of survey respondents breastfed initially during their maternity leave, which averaged 56 days. Despite the provision of lactation rooms and breast pumping breaks, only 10.6% mothers continued to breastfeed after returning to work, primarily office workers and those who were aware of their company's breastfeeding-friendly policies. CONCLUSION: In conclusion, breastfeeding-friendly policies can significantly affect breastfeeding behaviour. However, an unfavourable working environment, especially for fab workers, can make it difficult to implement breastfeeding measures. With health professionals emphasizing that the importance of breastfeeding for infant health, and as only females can perform lactation, it is vital that women's work "productive role" and family "reproductive role" be respected and accommodated by society.

Adult↗
PubMed1999

Cost effectiveness evaluation of ADCON-L adhesion control gel in lumbar surgery.

Patients, physicians and third-party payers are becoming increasingly concerned with the economic burden resulting from advances in health care. Many economic health studies have focused on patients with sciatica and low back pain. An Economic Survey was conducted on lumbar discectomy patients who had been enrolled at least 12 months prior in a prospective randomized controlled clinical study of the adhesion control device ADCON-L. The survey measured patient satisfaction, return to work, additional medical treatment and medications after surgery. In addition, the duration of any re-operations from patients in the clinical study was analyzed. The results of the Economic Survey and re-operation time analysis show significant advantages for lumbar discectomy patients who received ADCON-L compared to control patients who did not. Patients who received ADCON-L not only had less scarring and less back pain than control patients but also were more satisfied with their surgeries and were able to return to work more often, as originally planned (p = 0.02). In addition, ADCON-L patients returned to their original jobs an average of 3.6 days sooner, changed jobs 50% less often, did not seek additional medical treatment as often, and took 20% less pain medication than did control patients (p = 0.01). In addition, patients receiving ADCON-L who required subsequent re-operation at the same lumbar space (e.g., reherniation) had a significantly shorter duration of secondary surgery (56.6 min vs. 130 min, p = 0.001) compared to patients who did not receive ADCON-L at the first surgery. Overall, ADCON-L patients demonstrated significant clinical and economic advantages over control patients. If all lumbar surgical patients in the US were to receive ADCON-L, annual savings to the health care system would exceed one half billion dollars.

Cell Adhesion↗
PubMed1993

Fractures of the os calcis: improved results with internal fixation.

A prospective study of 24 patients with displaced intra-articular fractures of the os calcis was performed to compare operative with non-operative treatment. Twelve patients were treated by internal fixation followed by early mobilization, and 12 were managed non-operatively. The patients were assessed 15 months later using eight parameters. Of the 12 patients who were treated by internal fixation, eight had returned to work. Walking distance was significantly longer (4 km) in this group and only one patient needed a change in shoe size. Of the 12 patients who were managed non-operatively, only three had returned to work and eight had a change in shoe size, while the average walking distance without pain was only 1 km. The mean range of subtalar movement was 24 degrees in the operated group but only 12 degrees in the other group (P < 0.05). Radiological follow-up demonstrated partial or full restoration of Böhler's angle in the patients who underwent internal fixation. We recommend plating of displaced intraarticular os calcis fractures through a lateral approach in patients under 40 years of age.

Adult↗
PubMed1987

Vocational rehabilitation with the industrially injured worker.

The field of vocational rehabilitation has broadened beyond the traditional federal-state model into the private sector primarily through funding by the insurance industry via workers' compensation coverage. Most disabilities encountered by private vocational rehabilitationists are musculoskeletal injuries resulting from traumatic industrial accidents rather than congenital disabilities most often seen by the state's Department of Vocational Rehabilitation. In many cases reduction in physical tolerances, extremity use, and/or chronic pain results in the industrially injured worker not being released by the attending physician for return to work in the previous occupation. To be effective, private vocational rehabilitationists working with the industrially injured worker must have a working knowledge of residual tolerances associated with various disabilities, as well as knowledge of legal parameters of the vocational workers' compensation law for each state worked in. In addition, the ability to communicate effectively with attending physicians, attorneys, claims examiners, occupational and physical therapists, and rehabilitation nurses is concomitant with successful positive movement in the vocational rehabilitation process. As with federal and state vocational rehabilitation counselors, the ability to assess transferability of past work skills and current aptitudes is paramount in determining transferability of work skills to alternate occupations. Finally, growing networking between rehabilitation nurses, therapists, physicians, and vocational rehabilitationists is needed to improve the injured worker's ability to maximize his or her physical tolerances in viewing return to work in a position as close as possible to that performed at the time of injury.

Accidents, Occupational↗