Bodyworkability

Background:The common standards of disability assessment for long-term care (LTC) insurance are currently absent. The International Classification of Functioning, Disability and Health (ICF) was designed for a better description of health and functioning, which could fill the demand gap for the standards of disability assessment and be a promising tool for the development of LTC insurance system.ObjectivesTo validate a disability assessment scale for disabled elderly individuals based on the ICF for LTC in the Chinese context.MethodsThe present study is a cross-sectional study. A disability assessment tool based on the ICF was developed by referring to other assessment tools and an expert consensus meeting in the initial phase of the study. The developed tool was used to evaluate 1,610 elderly individuals in the LTC institutions. The Cronbach's α coefficient and split-half reliability were applied to test the internal consistency of the tool, while the Interclass correlation coefficients (ICCs) were used to evaluate the interrater reliability (IRR). Factor analysis was performed to verify the construct validity of the tool. The scores from the Medical Outcomes Short Form-12 (SF-12) were correlated with that from the disability assessment tool, to assess the criterion-related validity.ResultsThe Cronbach's α coefficient and split-half reliability of the disability assessment tool were 0.969 and 0.877, respectively. The ICCs of the sum scale was 0.85, and the ICCs of each of the 20 items in the scale ranged from 0.78 to 0.94. The items were divided into three factors through analysis, which is consistent with the structure expectation. The scores of each item and the sum score of the disability assessment scale were negatively correlated with the scores of the physical and psychological fields in SF-12 (p < 0.001). Overall, the data indicated that the tool was characterized by good internal consistency, IRR, construct validity, and criterion-related validity.ConclusionsThe disability assessment tool based on the ICF is a reliable and valid tool for the collection of information on functioning across various LTC settings. The information of disability provided evidence for the distribution of LTC service and guided the development of LTC insurance standards.

BackgroundMusculoskeletal disorders (MSDs), a common type of occupational diseases, have become the main cause of absenteeism and early retirement in the occupational population, as well as a major risk factor for occupational disability. The purpose of this study was to investigate the effects of occupational stress and mental health on MSDs in coal miners in Xinjiang, China, to provide a theoretical basis for reducing the incidence of MSDs in coal miners and improving their physical and mental health.MethodsIn this study, stratified cluster random sampling was used to randomly select six coal mining companies in Xinjiang, and 1675 coal miners were surveyed by questionnaire. The status of occupational stress, mental health and MSDs among coal miners was investigated by means of the Effort–Reward Imbalance questionnaire (ERI), Symptom Checklist-90(SCL-90), and Musculoskeletal disorders scale (MSDs) questionnaire.ResultsThe prevalence of MSDs among coal miners was higher, and there were statistical differences among different sexes, ages, working years, shifts, types of work, educational level and monthly income (P < 0.001). The prevalence of MSDs in different body parts in the occupational stress group and mental disorder group was higher than that in the normal group. The results of multivariate logistic regression analysis showed that females had an increased risk of developing MSDs (OR = 2.23, 95% CI.:1.50,3.33). The risk of MSDs was higher with age < 30 years (30-39 years,OR = 2.39, 95% CI.,1.68,3.40; 40-49 years,OR = 2.15, 95% CI.:1.52,3.04; 50-60 years:OR = 3.25, 95% CI.:2.09,5.07), and the longer the working years, the higher the risk of MSDs (OR = 1.90, 95% CI.:1.38,2.62). The two shifts group (OR = 2.18, 95% CI.:1.59,2.98) had an increased risk of developing MSDs compared with the fixed day shift group. The risk of MSDs was lower in heading drivers (OR = 0.41, 95% CI.:0.29,0.60,) and transport workers (OR = 0.30, 95% CI.:0.20,0.43). The higher the education level, the lower the risk of MSDs (high school: OR = 0.46, 95% CI.:0.34,0.62, junior college and above: OR = 0.12, 95% CI.:0.08,0.17), and the higher the monthly income, the lower the risk of MSDs (OR = 0.50, 95% CI.:0.34,0.74). Occupational stress (OR = 1.32, 95% CI.:1.05,1.67) and mental disorder(OR = 2.94, 95% CI.:2.25,3.84) increased the risk of MSDs. A Bayesian network diagram showed that occupational stress and MSDs have direct effects on mental disorders, and occupational stress can have indirect effects on mental disorders through MSDs.ConclusionOur research shows that MSDs are common among coal miners. Occupational stress and psychological disorders can increase the incidence of MSDs.

For an individual, the functional consequences of an episode of low back pain is a key measure of their clinical status. Self-reported disability measures are commonly used to capture this component of the back pain experience. In non-acute low back pain there is some uncertainty of the validity of this approach. It appears that self-reported assessment of disability and direct measurements of functional status are only moderately related. In this cross-sectional study, we investigated this relationship in a sample of 94 acute low back pain patients. Both self-reported disability and a performance-based assessment of disability were assessed, along with extensive profiling of patient characteristics. Scale consistency of the performance-based assessment was investigated using Cronbach's alpha, the relationship between self-reported and performance-based assessment of disability was investigated using Pearson's correlation. The relationship between clinical profile and each of the disability measures were examined using Pearson's correlations and multivariate linear regression. Our results demonstrate that the battery of tests used are internally reliable (Cronbach's alpha = 0.86). We found only moderate correlations between the two disability measures (r = 0.471, p < 0.001). Self-reported disability was significantly correlated with symptom distribution, medication use, physical well-being, pain intensity, depression, somatic distress and anxiety. The only significant correlations with the performance-based measure were symptom distribution, physical well-being and pain intensity. In the multivariate analyses no psychological measure made a significant unique contribution to the prediction of the performance-based measure, whereas depression made a unique contribution to the prediction of the self-reported measure. Our results suggest that self-reported and performance-based assessments of disability are influenced by different patient characteristics. In particular, it appears self-reported measures of disability are more influenced by the patient's psychological status than performance-based measures of disability.

The widespread introduction of computers into clinical settings has increased the feasibility of conducting comprehensive functional disability assessment. The Functional Status Questionnaire (FSQ) is a brief, self-administered questionnaire designed to facilitate clinical assessment of functional disability. The FSQ items can be scored by computer using a simple algorithm and summarized into disability index scores. These scales have alpha reliability coefficients of .64 to .82 and substantial convergent validity when used with primary care patients. Disability assessment tools like the FSQ can be adapted easily for clinical use by physical therapists.

The prevalence of knee osteoarthritis (OA) among individuals active in the workforce will increase considerably in the next generation and a significant percentage of these individuals are expected to experience work disability because of this disease. The aim of this review was to summarize the existing knowledge on the following: (a) work disability risk factors; (b) reliable and valid work disability assessment tools; and (c) efficient interventions to reduce work disability in individuals with knee OA. An electronic document search using key words and MeSH terms was performed with various databases. Two independent investigators were tasked with the screening of articles and quality assessment. A critical appraisal of what is known was performed and recommendations for clinical practice and future research were formulated. The database search yielded 61 references. One article on risk factors, three related to assessment tools, and two on interventions were retained. Age and previous work absence episodes were found to be risk factors of workplace disability. The Work Limitation Questionnaire, the Work Instability Scale for Rheumatoid Arthritis, and the Workplace Activity Limitations Scale were psychometrically sound for the population studied. Education-based interventions seem to be more effective than conventional interventions in helping individuals with knee OA return to work faster, reduce the number of days absent from work, and improve their overall well-being. This review is the first to summarize the evidence on work disability risk factors, assessment tools, and interventions for this growing population and to show a critical gap in the existing knowledge.

The assessment and measurement of disability and handicap are of particular relevance in rehabilitation, as these are the main foci of therapeutic intervention. The area of handicap is the least developed with few measuring tools to provide an objective assessment of status. The Environmental Status Scale (ESS) is now becoming increasingly utilized to measure handicap. It was used in a study of 50 patients on admission and discharge in a neurorehabilitation unit, to analyse its validity and usefulness as an outcome measure of the rehabilitation process. The results suggest it has limited validity, mixes disability and handicap issues and in some sections has a misleading scoring system. It requires modification to overcome these difficulties.

BackgroundCoal miners differ from other professional population in their exposures to physical and psychosocial hazards in the work environment. In China, the number of coal miners far exceeded millions, but...

Is my blood mine? Some comments on the Convention on Human Rights and Biomedicine.

Labor in State-Socialist Europe, 1945–1989: Contributions to a History of Work

Recent advances in the assessment of disability in schizophrenia have separated the measurement of functional capacity from real-world functional outcomes. The authors examined the similarity of performance-based assessments of everyday functioning, real-world disability, and achievement of milestones in people with schizophrenia in the United States and Sweden. The UCSD Performance-Based Skills Assessment-Brief Version (UPSA-B) and a neuropsychological assessment were administered to schizophrenia patients living in rural areas in Sweden (N=146) and in the New York City area (N=244), and patients' functioning was rated by their case managers. Information from records and case managers was used to determine the frequency of living independently, working, and having ever experienced a stable romantic relationship. Performance on the UPSA-B was essentially identical in the two samples (New York, mean score=13.84; Sweden, mean score=13.30), as were scores on the case manager ratings of everyday activities (New York, mean=49.0; Sweden, mean=48.8). The correlations between UPSA-B score, neuropsychological test performance, and case manager ratings did not differ across the two samples. The proportion of patients who had never had a close relationship and the rate of vocational disability were also nearly identical. However, while 80% of the Swedish patients were living independently, only 46% of the New York patients were. While scores on performance-based measures of everyday living skills were similar in people with schizophrenia across cultures, real-world residential outcomes were very different. These data suggest that cultural and social support systems can lead to divergent real-world outcomes among individuals who show evidence of the same levels of ability and potential.

Background: The assessment of disability is an integral part of the management of patients with schizophrenia. The Indian Disability Evaluation and Assessment Scale (IDEAS) is a government-recommended tool used for the assessment and certification of disability in mental illnesses. The literature on the psychometric properties such as reliability and validity of IDEAS for the assessment of disability in schizophrenia patients is relatively scant. Materials and Methods: This was a cross-sectional, observational, descriptive study done in a tertiary health care center catering the rural patients in central India. A hundred male and female treatment-seeking schizophrenia patients, who were in symptom remission, were purposively included in the study. Apart from sociodemographic profile and severity assessment, the disability levels of the patients were assessed using IDEAS as well as the World Health Organisation Disability Assessment Scale version 2.0 (WHODAS 2.0). Results: The mean age of the patients included in the study was 36.6 (±9.11) years. Among the four disability domains in the IDEAS, maximum disability was seen in the work domain, whereas self-care was the least affected domain. Males had a higher disability in work, whereas in the individuals belonging to joint families and rural backgrounds, self-care was significantly affected. Pearson correlation test implied that IDEAS showed good internal consistency (Cronbach's alpha = 0.892) and concurrent validity with the WHODAS 2.0 in the assessment of disability in the study participants. Conclusion: IDEAS is a reliable and valid instrument for the measurement of disability in severe mental illnesses such as schizophrenia.

Exchanging One Hardship for Another Lesley A. Sharp (bio) In this issue, Moazam and colleagues offer a complex and nuanced study of the postsurgical consequences of kidney vending in Pakistan’s Punjab region, providing a comprehensive response to highly polarized debates over the commercialization of “fresh” body parts. Proponents consider organ sales a legitimate solution to organ scarcity, defending vendors’ rights to make autonomous decisions in a national or global marketplace. Opponents condemn commercialization as unjust and immoral because it preys upon poor, disenfranchised, and desperate people denied access to basic human needs. This study impressively disentangles vending’s clinical, psychological, and social consequences, marking an important paradigmatic shift in biomedical, bioethical, and ethnographic understandings of body commercialization. The study is methodologically sophisticated and interdisciplinary in scope, enriching existing knowledge. As physicians, the team members possess the skill to assess clinical and psychiatric dangers; their ethnographic rigor is also exemplary. Although several important ethnographies expose the detrimental social consequences of kidney vending, a paucity of clinical data remains, especially for impoverished populations. In North American clinical circles, only one post–World War II study (that predates organ transplantation) informs discussions of the benign effects of living with one kidney. Contemporary data on postsurgical morbidity among kidney donors is also scant and often anecdotal. Generally, studies are based in transplant wards most concerned with recipients’ needs, fail to track donors’ postsurgical health beyond a few months, and only involve patients with access to quality health care. This project challenges the relevance of North American assumptions by expanding the field to include impoverished communities in Pakistan. Vendors’ already shaky socioeconomic status and health are dangerously compromised by selling a supposed “redundant” organ. By journeying beyond the hospital and into vendors’ communities, the research generates troubling findings. All vendors endure strenuous manual labor (and certainly suffer from poor nutrition, too); simple nephrological tests reveal evidence of kidney disease or failure. Such clinical dangers are compounded by anxiety, depression, self-loathing, diminished self-worth, and suicidal tendencies. Vendors are marginalized socially, too—considered “half a person” once they’ve lost a kidney. Pronounced fatigue is common, rooted simultaneously in sickness and depression. Vendors and their kin can ill afford such outcomes when their ability to labor is a matter of life and death. Economic survival is often worsened, generating a vicious cycle of inclusion as others are pressured to sell their kidneys, too. Market principles hold that vending alleviates shortages and generates a safe supply of organs, yet scrutiny of the data reveal shocking sociomedical dangers affecting a surprisingly wide range of parties. Several vendors recount tales of recipients’ deaths, from which one might assume that vending attracts middlemen and surgeons who privilege profit over safety and willingly endanger both rural vendors and foreign “medical tourists.” At its worst, vending does not merely shift the burden of ill health from buyers to impoverished vendors; it may devastate a range of households and communities at either end of the buyer/vendor spectrum. Even zamindars, who profit from vending through debt repayments, now fear kidney failure. Vending clearly endangers an extraordinary range of parties. The justifications of commercialization thus rely on faulty premises. Rather than helping to expand the pool of available organs, vendors replace altruistic donors—a finding relevant to both South Asia and North America. Kidney sales also fail to improve vendors’ lives, often driving them deeper into debt because their labor power is diminished. Instead, the sale replaces one kind of hardship with another. Punjabi vendors are locked in a lifetime of debt controlled by zamindars and facilitated by national policies. A contemporary form of enslavement is at work, where more privileged parties can own another’s labor power or purchase their body parts. The frightening truth revealed here is that laboring vendors’ lives are expendable. This in turn drives the slippery slope of embodied “redundancy” wherever organ markets thrive: some vendors now sell sections of their livers, one of their two corneas, sometimes even their lungs or other body parts hoping to acquire just a bit more cash to free themselves temporarily from their insurmountable debt and suffering. [End Page 3] Lesley A. Sharp Lesley A. Sharp is professor of anthropology at...

A disability assessment tool, the Juvenile Arthritis Functional Assessment Scale, was developed for, and validated in, patients with juvenile rheumatoid arthritis (JRA). Standards for this 10-item tool were developed using the scores of 63 normal school children as controls and comparing these results with those of 71 age-matched JRA patients (age 7-16 years). The JRA patients scored statistically significantly higher on the scale, which also demonstrated excellent internal and convergent validity and internal reliability. The test is easily administered in 10 minutes by a physical or occupational therapist in a clinical or office setting. This tool represents the first normalized disability assessment tool developed for JRA patients.

Background: Assessment of exercise tolerance should be an integral part of the follow- up of COVID-19 survivors. Objective: We aimed in this study to investigate the correlation between the 5 Times Sit to Stand Test (5STST) and the 6-Minute Walk Test (6MWT) and to determine their place in assessing exercise tolerance and disability in COVID-19 survivors. Methods: This was a cross-sectional study that included 201 survivors of COVID-19. All patients underwent a detailed medical questionnaire, assessment of disability by the Lawton scale, and sub- -maximal exercise tolerance by 6MWT and 5STST. Our study population was divided into two groups based on the Length of Hospital Stay (LHS) (&lt;10 or ≥10 days). Results: Compared with the group with a LHS &lt; 10 days, the group with prolonged LHS (≥10 days) had a significantly greater mean value of 5STST. In contrast, the mean values of 6-minute Walk Distance (6MWD) and Minimal Oxygen Saturation (MOS) were significantly lower. A significant correlation of 5STST with Lawton score (r = -0.373; p &lt; 0.0001) and 6MWD (r = -0.563; p &lt; 0.0001) was also found. Conclusion: Our results showed that the 5STST was correlated with the 6MWD and Lawton score. Hence, it could be proposed to assess physical capacity and disability, especially in patients who had a prolonged LHS for COVID-19.

Determinants of vocational disability in patients with low back pain.