Work Capacity Evaluation Research Articles

Evaluation of myocardial work and exercise capacity in patients recovered from the severe form of COVID-19

BackgroundThe impact of COVID-19 goes beyond its acute form and can lead to the persistence of symptoms and the emergence of systemic disorders, defined as long-term COVID. MethodsWe performed a cross-sectional study that included patients over 18 years of age who recovered from the severe form of COVID-19 at least 60 days after their discharge. Patients and controls were enrolled to undergo transthoracic echocardiography (TTE) using a more sensitive tool, myocardial work, in combination with cardiopulmonary exercise testing (CPET). ResultsA total of 52 patients and 31 controls were enrolled. Significant differences were observed in ejection fraction (LVEF; 62 ± 7 vs. 66 ± 6 %; p = 0.007), global longitudinal strain (LVGLS; −18.7 ± 2.6 vs. −20.4 ± 1.4 %; p = 0.001), myocardial wasted work (GWW; 152 ± 81 vs. 101 ± 54 mmHg; p = 0.003), and myocardial work efficiency (GWE; 93 ± 3 vs. 95 ± 2 %; p = 0.002). We found a significant difference in peak VO2 (24.4 ± 5.4 vs. 33.4 ± 8.8 mL/kg/min; p < 0.001), heart rate (160 ± 14 vs. 176 ± 11 bpm; p < 0.001), ventilation (84.6 ± 22.6 vs. 104.9 ± 27.0 L/min; p < 0.001), OUES% (89 ± 16 vs. 102 ± 22 %; p = 0.002), T ½ (120.3 ± 32 vs. 97.6 ± 27 s; p = 0.002) and HRR at 2 min (−36 ± 11 vs. −43 ± 13 bpm; p = 0.010). ConclusionOur findings revealed an increased wasted work, with lower myocardial efficiency, significantly reduced aerobic exercise capacity, and abnormal heart rate response during recovery, which may be related to previously described late symptoms. The reduction in functional capacity during physical exercise is partly associated with a decrease in resting myocardial work efficiency. These findings strongly indicate the need to determine whether these manifestations persist in the long term and their impact on cardiovascular health and quality of life in COVID-19 survivors.

Can International Classification of Functioning, Disability and Health (ICF) Be Used for Prediction of Work Capacity and Employment Status in Multiple Sclerosis?

Background: Multiple sclerosis (MS) affects many body functions and activities, including work capacity and ability to work. An evaluation of work-related parameters is important to understand the barriers to maintaining the job. The aim of this study was to evaluate if a Comprehensive International Classification of Functioning, Disability and Health (ICF) core set for MS can be used to predict work capacity and employment status. Methods: The cohort included 151 participants with MS (99 female/52 male, mean age 49 years) referred for a work capacity evaluation. Results: 71 (47.0%) were employed and a major part (131, 86.7%) had a work capacity between 20 and 40% with no difference between those who were employed and those who were unemployed. The analysis revealed that age and the following categories explained 68.8% of the work capacity: b770 Gait pattern functions; b730 Muscle power functions; b134 Sleep functions; d845 Acquiring, keeping and terminating a job; and b620 Urination functions. The following categories in 79.5% predicted ability to work: b164 Higher-level cognitive functions; d510 Washing oneself; d630; Preparing meals; and d870 Economic self-sufficiency. Conclusions: Here, we show that different functions/activities predicted work capacity in comparison with employment status in MS. Therefore, ICF should be implemented when assessing work ability.

Comprehensive Physical Work Capacity Evaluations for Korean Farmers Assessed in Healthy Volunteers.

To establish the lower limits of normative values of the physical work capacity for Korean farmers in healthy working individual. We developed a comprehensive set of physical work capacity evaluation items that encompass common farming tasks. These items include measurements of trunk flexion/extension angles, strength (hand grip, trunk flexion/extension, leg/back lifting, and pushing/pulling), and positional tolerances. We calculated the normative values for the items and defined the normal range in 124 healthy volunteers aged 20-79 years. We calculated the intraclass correlation coefficient (ICC) to validate the test-retest reliability of the measurements protocol. The normal values for each measurement item were as follows: trunk flexion and extension angle (65.3°±11.6° and 29.6°±6.6°), dominant hand grip strength (32.2±10.5 kgf), trunk flexion and extension strength (288.4±119.0 N and 297.3±129.9 N), leg and back lifting strength (452.9±233.5 N and 349.2±166.7 N), pushing and pulling strength (214.7±75.1 N and 221.7±63.3 N), and positional tolerance time (squat: 76.8±9.0 seconds, front: 73.8±7.7 seconds, twist: 82.2±8.8 seconds, upward: 71.9±11.3 seconds). Regarding test-retest reliability, all strength measurements demonstrated excellent absolute agreement (ICC, 0.91-0.96). However, positional tolerance showed poor-to-moderate absolute agreement (ICC, 0.37-0.58). We conducted measurements of muscle strength and positional tolerance in healthy participants of various ages, focusing on tasks commonly performed by Korean farmers. The outcomes hold significant value as they offer a pertinent instrument for assessing the appropriateness of workers, thereby carrying implications for rehabilitation objectives, legal evaluations, and work capacity assessments within the agricultural domain.

Instruments and Tools in the Medical Evaluation of Work Capacity

Instruments and Tools in the Medical Evaluation of Work Capacity Abstract. In the event of absence from work due to illness or accident, the attending physician is responsible for confirming the connection between absence from work (or, if applicable, reduced performance) and a health disorder (illness or accident) and subsequently issuing a certificate of incapacity for work. The certificates have the legal status of a deed and must accordingly satisfy certain legal requirements. This article presents suitable tools and instruments for this important medical task.

Der deutsche Work Role Functioning Questionnaire – Zur Evaluation seiner Messeigenschaften

The German Work Role Functioning Questionnaire – on the evaluation of its measurement properties Objectives: Measures to maintain the employability of workers should also take their functional ability into account. The Work Role Functioning Questionnaire (WRFQ), which is available in several languages, is suitable for such an assessment. A validated version in German had been missing until now. The 27-item questionnaire was culturally adapted from the Dutch version of WRFQ 2.0 and used with a heterogeneous sample of employees with the aim of psychometrically validating the overall scale and the four subscales. Methods: After adaptation, members of a commercial online access panel with a wide variety of occupations were recruited (T0: n = 653). Two follow-ups were conducted to assess further psychometric properties (T1: n = 66, T2: n = 95). We examined the 1) structural, 2) convergent and 3) discriminant validity using exploratory factor analysis, 4) floor and ceiling effects, as well as 5) the internal consistency, 6) reproducibility, and 7) responsiveness. Results: Measurement properties were found to be good, with the exception of responsiveness and structural validity. In the exploratory factor analysis, satisfactory replicability was found for three of the four subscales (mental and social demands, physical demands and flexibility demands, but not scheduling and output demands). Conclusions: The WRFQ is aimed at the fit between demands and the individual and thus at the ability to participate. With the development and validation of a German-language version, the scale can be used in practice, e.g. in interventions aimed at secondary prevention to maintain the ability to work, tertiary prevention to support a successful return to work, or the identification of employees with declining functional ability. The limitations of the study (limited representativeness of online access panels and poor replicability of the fourth subscale) require further research. Keywords: work capacity evaluation – Work Role Functioning Questionnaire – survey – psychometric measurement properties

Can fatigue predict the worsening of multiple sclerosis one year later? An explorative study with participants referred to assess their ability to work

BackgroundMultiple sclerosis (MS) is an inflammatory and degenerative disease of the central nervous system and is triggered by several environmental factors in genetically predisposed people. ObjectivesTo explore which evaluation battery items used for evaluation of work capacity at baseline can best predict MS progression at 1 year follow-up. MethodsIn this prospective single-centre study, participants with MS were recruited consecutively when visiting a neurologist for referral for the determination work capacity status at the Disability and Working Capacity Assessment Office. At baseline, a neurologist assessed patients using the following evaluation scales: Fatigue self-assessment, Fatigue Descriptive Scale (FDS), Memory self-assessment, Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), Short Form 36 (SF-36), and the Brief International Classification of Functioning and Disability (ICF) core set for MS. The Expanded Disability Status Scale (EDSS) was evaluated by neurologists at baseline and one year later. An increase in EDSS by 0.5 points after one year was defined as MS progression. ResultsDuring the one year period among 72 participants, 21 fulfilled the criteria for MS progression. In more than 75% of these participants, impairments were found in the following ICF subitems at baseline: “energy and drive functions”, “muscle and power functions”, and “moving around”. Greater impairments were identified in progressing participants. Progressing participants scored higher on the FDS and scored lower on the BICAMS and SF-36. Regression analysis indicated that the FDS sum score predicted MS progression one year later. ConclusionsIncreased fatigue might indicate worsening in MS one year later.

State of the art on the predictors of reduced capacity for work in Brazilian workers

Work Capacity (WC) is a dynamic process that involves an interrelationship between human resources and work and is influenced by various factors, especially the work environment and working conditions, as well as the worker's lifestyle. Thus, a close and complex relationship between health and work is observed, and health is negatively affected when work activities are performed in inappropriate environments, which can precipitate or aggravate the reduction of WC, which represents a measure of functional aging and an indicator of worker health. This study aimed to evaluate the state of the art on the predictors of reduced work capacity in Brazilian workers. This is a narrative literature review study in which articles were searched in the BVS, Scielo, LILACS, PubMed, and Medline databases from July to December 2020, using the descriptors/keywords: work capacity evaluation, working conditions, and work capacity index. A total of 119 studies were identified, and 29 full articles were selected for reading in full and analysis. The factors associated with reduced WC were older age, female gender, high demand at work, long working hours, more than one employment relationship, presence of musculoskeletal disorders, absence of physical activity, tobacco use, and obesity. The identification and adequate management of the factors associated with the reduction of WC are fundamental for the prevention of functional aging in the working class, allowing the execution of prevention and health promotion actions that favor an active and healthy aging, avoiding the reduction or early loss of WC.

Evaluation of profile and work capacity of the post Covid-19 patients at the outpatient clinic for occupational health-related diseases at an University hospital in Brazil: preliminary results

Evaluation of profile and work capacity of the post Covid-19 patients at the outpatient clinic for occupational health-related diseases at an University hospital in Brazil: preliminary results

Evaluation of detonation performance and working capacity of explosives by optimized VLW EOS

Detonation performance is fundamental to the power evaluation of high explosives (HEs). This paper assesses the detonation performance (including detonation velocity D, detonation pressure P, detonation heat Q, specific kinetic energy Ek, detonation products, working capacity, etc.) of HEs by an optimized method. Firstly, “exp-six” intermolecular potential function was used to optimize the theoretical VLW (Virial-Wu) EOS (equation of state), which exhibits a good precision in calculations of detonation performance. Then, the detonation performance of three new HEs (LLM-105, FOX-7, and TKX-50) was calculated and compared with traditional HEs (TATB, HMX, and CL-20). The results indicate that, for D and P, LLM-105, FOX-7, and TKX-50 are superior to TATB, but inferior to HMX and CL-20 except for D of TKX-50. The descending order for Q and Ek is CL-20, HMX, TKX-50, FOX-7, LLM-105, and TATB. By analyzing detonation product components, more gaseous products with a higher proportion of heavy and medium molecules favor better detonation performance. Finally, the JWL (Jones-Wilkins-Lee) EOS was fitted by theoretically acquired isentropic expansion process of detonation products and cylinder test was simulated by the hydrodynamic program LS-DYNA. An increasing sequence of working capacity is TATB, LLM-105, FOX-7, TKX-50, HMX and CL-20.

An instrument for quality assurance in work capacity evaluation: development, evaluation, and inter-rater reliability

BackgroundEmployees insured in pension insurance, who are incapable of working due to ill health, are entitled to a disability pension. To assess whether an individual meets the medical requirements to be considered as disabled, a work capacity evaluation is conducted. However, there are no official guidelines on how to perform an external quality assurance for this evaluation process. Furthermore, the quality of medical reports in the field of insurance medicine can vary substantially, and systematic evaluations are scarce. Reliability studies using peer review have repeatedly shown insufficient ability to distinguish between high, moderate and low quality. Considering literature recommendations, we developed an instrument to examine the quality of medical experts’ reports.MethodsThe peer review manual developed contains six quality domains (formal structure, clarity, transparency, completeness, medical-scientific principles, and efficiency) comprising 22 items. In addition, a superordinate criterion (survey confirmability) rank the overall quality and usefulness of a report. This criterion evaluates problems of inner logic and reasoning. Development of the manual was assisted by experienced physicians in a pre-test. We examined the observable variance in peer judgements and reliability as the most important outcome criteria. To evaluate inter-rater reliability, 20 anonymous experts’ reports detailing the work capacity evaluation were reviewed by 19 trained raters (peers). Percentage agreement and Kendall’s W, a reliability measure of concordance between two or more peers, were calculated. A total of 325 reviews were conducted.ResultsAgreement of peer judgements with respect to the superordinate criterion ranged from 29.2 to 87.5%. Kendall’s W for the quality domain items varied greatly, ranging from 0.09 to 0.88. With respect to the superordinate criterion, Kendall’s W was 0.39, which indicates fair agreement. The results of the percentage agreement revealed systemic peer preferences for certain deficit scale categories.ConclusionThe superordinate criterion was not sufficiently reliable. However, in comparison to other reliability studies, this criterion showed an equivalent reliability value. This report aims to encourage further efforts to improve evaluation instruments. To reduce disagreement between peer judgments, we propose the revision of the peer review instrument and the development and implementation of a standardized rater training to improve reliability.

The reproducibility of psychiatric evaluations of work disability: two reliability and agreement studies

BackgroundExpert psychiatrists conducting work disability evaluations often disagree on work capacity (WC) when assessing the same patient. More structured and standardised evaluations focusing on function could improve agreement. The RELY studies aimed to establish the inter-rater reproducibility (reliability and agreement) of ‘functional evaluations’ in patients with mental disorders applying for disability benefits and to compare the effect of limited versus intensive expert training on reproducibility.MethodsWe performed two multi-centre reproducibility studies on standardised functional WC evaluation (RELY 1 and 2). Trained psychiatrists interviewed 30 and 40 patients respectively and determined WC using the Instrument for Functional Assessment in Psychiatry (IFAP). Three psychiatrists per patient estimated WC from videotaped evaluations. We analysed reliability (intraclass correlation coefficients [ICC]) and agreement (‘standard error of measurement’ [SEM] and proportions of comparisons within prespecified limits) between expert evaluations of WC. Our primary outcome was WC in alternative work (WCalternative.work), 100–0%. Secondary outcomes were WC in last job (WClast.job), 100–0%; patients’ perceived fairness of the evaluation, 10–0, higher is better; usefulness to psychiatrists.ResultsInter-rater reliability for WCalternative.work was fair in RELY 1 (ICC 0.43; 95%CI 0.22–0.60) and RELY 2 (ICC 0.44; 0.25–0.59). Agreement was low in both studies, the ‘standard error of measurement’ for WCalternative.work was 24.6 percentage points (20.9–28.4) and 19.4 (16.9–22.0) respectively. Using a ‘maximum acceptable difference’ of 25 percentage points WCalternative.work between two experts, 61.6% of comparisons in RELY 1, and 73.6% of comparisons in RELY 2 fell within these limits. Post-hoc secondary analysis for RELY 2 versus RELY 1 showed a significant change in SEMalternative.work (− 5.2 percentage points WCalternative.work [95%CI − 9.7 to − 0.6]), and in the proportions on the differences ≤ 25 percentage points WCalternative.work between two experts (p = 0.008). Patients perceived the functional evaluation as fair (RELY 1: mean 8.0; RELY 2: 9.4), psychiatrists as useful.ConclusionsEvidence from non-randomised studies suggests that intensive training in functional evaluation may increase agreement on WC between experts, but fell short to reach stakeholders’ expectations. It did not alter reliability. Isolated efforts in training psychiatrists may not suffice to reach the expected level of agreement. A societal discussion about achievable goals and readiness to consider procedural changes in WC evaluations may deserve considerations.

Higher Number of Night Shifts Associates with Good Perception of Work Capacity and Optimal Lung Function but Correlates with Increased Oxidative Damage and Telomere Attrition.

Sleep deprivation and the consequent circadian clock disruption has become an emergent health question being associated with premature aging and earlier chronic diseases onset. Night-shift work leads to circadian clock misalignment, which is linked to several age-related diseases. However, mechanisms of this association are not well understood. Aim of this study is to explore in night-shift workers early indicators of oxidative stress response and biological aging [oxidized/methylated DNA bases and leukocytes telomere length (LTL)] and late indicators of functional aging [lung function measurements (FEV1 and FVC)] in relation to personal evaluation of work capacity, measured by work ability index (WAI). One hundred fifty-five hospital workers were studied within the framework of a cross-sectional study. We collected physiological, pathological, and occupational history including pack-years, alcohol consumption, physical activity, and night shifts, together with blood and urine samples. Relationships were appraised by univariate and multivariate ordered-logistic regression models. We found that workers with good and excellent WAI present higher FEV1 (p< 0.01) and number of night-work shifts (p<0.05), but they reveal higher urinary levels of 8-oxoGua (p<0.01) and shorter LTL (p<0.05). We confirmed that higher work ability was prevalent among chronological younger workers (p<0.05), who have also a significant reduced number of diseases, particularly chronic (p<0.01) and musculoskeletal diseases (p<0.01). The new findings which stem from our work are that subjects with the highest work ability perception may have more demanding and burdensome tasks; they in fact present the highest number of night-shift work and produce unbalanced oxidative stress response that might induce premature aging.

Development and evaluation of a standardized peer-training in the context of peer review for quality assurance in work capacity evaluation

BackgroundThe German quality assurance programme for evaluating work capacity is based on peer review that evaluates the quality of medical experts’ reports. Low reliability is thought to be due to systematic differences among peers. For this purpose, we developed a curriculum for a standardized peer-training (SPT). This study investigates, whether the SPT increases the inter-rater reliability of social medical physicians participating in a cross-institutional peer review.MethodsForty physicians from 16 regional German Pension Insurances were subjected to SPT. The three-day training course consist of nine educational objectives recorded in a training manual. The SPT is split into a basic module providing basic information about the peer review and an advanced module for small groups of up to 12 peers training peer review using medical reports. Feasibility was tested by assessing selection, comprehensibility and subjective use of contents delivered, the trainers’ delivery and design of training materials. The effectiveness of SPT was determined by evaluating peer concordance using three anonymised medical reports assessed by each peer. Percentage agreement and Fleiss’ kappa (κm) were calculated. Concordance was compared with review results from a previous unstructured, non-standardized peer-training programme (control condition) performed by 19 peers from 12 German Pension Insurances departments. The control condition focused exclusively on the application of peer review in small groups. No specifically training materials, methods and trainer instructions were used.ResultsPeer-training was shown to be feasible. The level of subjective confidence in handling the peer review instrument varied between 70 and 90%. Average percentage agreement for the main outcome criterion was 60.2%, resulting in a κm of 0.39. By comparison, the average percentage concordance was 40.2% and the κm was 0.12 for the control condition.ConclusionConcordance with the main criterion was relevant but not significant (p = 0.2) higher for SPT than for the control condition. Fleiss’ kappa coefficient showed that peer concordance was higher for SPT than randomly expected. Nevertheless, a score of 0.39 for the main criterion indicated only fair inter-rater reliability, considerably lower than the conventional standard of 0.7 for adequate reliability.

Stress-strain state of earth dams with a clay cement-concrete diaphragm

The purpose of this research is to calculate stress-strain state of an earth dam with a "diaphragm wall" along the axis of the dam and coupling "diaphragm wall" with a rock bed. "Diaphragm wall" is a vertical clay cement-concrete diaphragm made of secant piles, which elastic modulus varied during the calculation 60 ÷ 120 MPa. The numeric modeling of the stress-strain state was carried out at the elaboration of structure variants for the earth dam of the Nizhne-Bureyskaya Hydro Power Plant (HPP) height about 40 m. Evaluation and analysis of working capacity of the cement-clay concrete diaphragm were carried out on the basis of computational modeling results, which were obtained using the finite element method (FEM). A specialized computer program was used for this calculation, developed at the Hydraulics and Hydraulic Engineering Department of the Moscow State University of Civil Engineering (MGSU). The modeling was carried out in flat setting. In the modeling were included a staged constructing of the earth dam and staged applying loads. There was considered also two variants of presence of friction between ground and liquid clay cement concrete. At the first variant, friction was taken close to zero at the beginning of the calculation and was increased at following stages, and at the second variant, maximum possible friction was taken at all stages of the calculation. For these two variants of the calculation were modeled two variants of embedding the clay cement-concrete diaphragm into the rock bed - rigid and compliant. In this research are shown all results of the modeling of the stress-strain state of the earth dam: the distribution of stresses in the earth dam and in the "diaphragm wall" and also vertical and horizontal displacements in the diaphragm for all described variants. Conclusions were done as a result of this research about effect of construction variants at results of the calculation. All modeling results were analyzed. Recommendations were given for the structure of impermeable diaphragms.

Sickness absentees’ experiences of a work capacity evaluation

Sickness absentees’ experiences of a work capacity evaluation

International comparison of work capacity evaluation in a social security setting

International comparison of work capacity evaluation in a social security setting

Determinants of Grip Strength in Tunisian Nurses: A Bicentric Study.

BackgroundGrip muscle force has always been used to assess functional limitations in elderly. Its use as a tool to assess work capacity has never been described in the literature.ObjectiveTo describe the patent determinants of grip strength and the usefulness of its measurement in assessing workability index in the healthcare sector.MethodsThis is a cross-sectional study conducted in a sample of 293 healthcare workers representative of 1181 based on a comprehensive questionnaire about socio-professional characteristics and on an 8-item work capacity evaluation (WAI). Besides, Body mass index was measured and muscle strength was assessed by JAMAR hydraulic dynamometer.ResultsHandgrip Strength was stronger in male nurses (p < 0.001), with low perceived physical load (p = 0.0001) and working on a night shift (p = 0.001). It decreased with a greater duration of household work (p < 0.0001) and increased with a greater BMI (p = 0.015) and a better workability index (p < 0.0001). After removal of all the variables that were not independently associated with the muscle strength force, factors accounting for 52.6% of the variance in nurses handgrip strength were gender (p < 0.001), workability index (p < 0.001), duration of household work (p = 0.021), BMI (p = 0.002), perceived physical load (p < 0.001) and work schedule (p = 0.002).ConclusionGrip Strength Test is a useful tool to assess strength and functional capacity at work in healthcare workers. Further longitudinal studies are required to confirm this hypothesis.

Critérios para avaliação de incapacidade laborativa na insuficiência cardíaca

&lt;p&gt;Introdução: A Previdência Social, no Brasil, é uma seguradora social que garante a renda do segurado quando ele perde sua capacidade laborativa. Dentre os benefícios concedidos temos a aposentadoria por invalidez, sendo que para sua concessão o segurado deve passar por perícia médica que comprove sua incapacidade total e permanente. Quatorze por cento das aposentadorias por invalidez concedidas nos últimos três anos ocorreram devido a doenças do aparelho circulatório, sendo que a via final das maiorias destas doenças é a insuficiência cardíaca. Objetivo: Identificar critérios para determinar incapacidade total e permanente em segurados portadores de insuficiência cardíaca congestiva em perícias previdenciárias. Metodologia: Revisão bibliográfica, sem limite de data, realizada de abril a agosto de 2014, utilizando os seguintes descritores: insuficiência cardíaca, seguro por invalidez e aposentadoria, nas seguintes bases de dados: Pubmed/Medline; BVS (Biblioteca Virtual de Saúde); Scopus; Web of Science; e Cochrane. A legislação previdenciária foi pesquisada. Resultados: Insuficiência cardíaca pode ser considerada incapacitante para mobilidade, tarefas complexas e tarefas de autocuidado, além de cursar com incapacidade cognitiva moderada ou severa. Insuficiência cardíaca como complicação pós-infarto é forte indicador para aposentadoria precoce, tendo como fator prognóstico positivo para retorno ao trabalho idade menor que 60 anos, fração de ejeção maior que 35%, ausência de financiamento durante o afastamento, ausência de ataques de ansiedade e trabalho com baixa exigência física. Discussão: O Grau III ou IV da insuficiência cardíaca, segundo NYHA e a Previdência Social, cursa com incapacidade que, se permanente, dará direito à aposentadoria por invalidez. Exames complementares não devem ser usados de forma isolada. Idade maior que 60 anos, sexo feminino e alta carga de trabalho são fatores de mau prognóstico. Conclusão: Para a avaliação de capacidade laborativa na insuficiência cardíaca devem ser levados em consideração os achados clínicos, a fração de ejeção, a cognição do examinado, a exigência física do trabalho e as condições de retorno a este, a idade do periciando e a classificação funcional utilizada pela NYHA ou da Previdência Social.&lt;/p&gt;

Attitudes towards evaluation of psychiatric disability claims: a survey of Swiss stakeholders.

In Switzerland, evaluation of work capacity in individuals with mental disorders has come under criticism. We surveyed stakeholders about their concerns and expectations of the current claim process. We conducted a nationwide online survey among five stakeholder groups. We asked 37 questions addressing the claim process and the evaluation of work capacity, the maximum acceptable disagreement in judgments on work capacity, and its documentation. Response rate among 704 stakeholders (95 plaintiff lawyers, 285 treating psychiatrists, 129 expert psychiatrists evaluating work capacity, 64 social judges, 131 insurers) varied between 71% and 29%. Of the lawyers, 92% were dissatisfied with the current claim process, as were psychiatrists (73%) and experts (64%), whereas the majority of judges (72%) and insurers (81%) were satisfied. Stakeholders agreed in their concerns, such as the lack of a transparent relationship between the experts' findings and their conclusions regarding work capacity, medical evaluations inappropriately addressing legal issues, and the experts' delay in finalising the report. Findings mirror the characteristics that stakeholders consider important for an optimal work capacity evaluation. For a scenario where two experts evaluate the same claimant, stakeholders considered an inter-rater difference of 10%‒20% in work capacity at maximum acceptable. Plaintiff lawyers, treating psychiatrists and experts perceive major problems in work capacity evaluation of psychiatric claims whereas judges and insurers see the process more positively. Efforts to improve the process should include clarifying the basis on which judgments are made, restricting judgments to areas of expertise, and ensuring prompt submission of evaluations.

A Systematic Review Assessing the Impact of Chronic Hepatitis C on Health-Related Quality of Life and Patient-Reported Outcomes

Introduction: Chronic Hepatitis (CH-C) and its treatment negatively impacts health-related quality of life (HRQL) and other patient-reported outcomes (PROs). We performed a systematic review to assess the impact of CH-C and its treatments on HRQL. Methods: Databases (Ovid MEDLINE, PubMed, CINAHL,PsycInfo, Social Sciences Citation Index, Social Sciences Abstracts, Social Work Abstracts, and Academic Search Complete) were searched for 2004-May 2014 using a combination of MEsh, thesaurus terms, and relevant text words: hepatitis C, chronic hepatitis C, quality of life, fatigue, work productivity, absenteeism, return to work, work, work capacity evaluation, and employment. After exclusion criteria (studies not in English or patients coinfected with HIV and/or hep B and/or having an active malignancy), 439 articles were obtained. Further exclusion criteria (use of non-validated HRQL questionnaires and/or data not published in a peer review journal) were applied by 2 data collectors. Each article was assessed for quality and results were summarized. Results: After exclusion criteria, 73 articles remained (61 HRQL, 20 fatigue, and 3 work productivity questionnaires). The most common HCV treatment was interferon alpha-2b (IFN) with ribivarin (RBV) (41%). The most common questionnaires were: SF-36 and CLDQ-HCV (HRQL), multidimensional fatigue inventory, and WPAI. Baseline scores were obtained in 59% of the studies, while 45% of the studies measured scores during treatment (range:1-48 weeks). Post-treatment follow-up scores were obtained in 42% (24 weeks post treatment). Baseline, HRQL impairment was noted in CH-C patients (mean differences from population norm PCS score: -3 to -13 [p values 0.05-0.010] and MCS score: -4 to -10 [p≤0.05]), with further impairment during treatment to reach its lowest point after 4-8 weeks of treatment (PCS score: -5.5 to - 6.9 and MCS score:-3.9 to -6.8 for MCS [p <0.05]). At 24 weeks post treatment, SVR increased baseline scores for PCS 3.6 to 4.2 and 1.2 to 2.0 for MCS (p<0.05). Work productivity/absenteeism worsened during treatment and returned to baseline 12 weeks after treatment. Baseline predictors of HRQL were fatigue, depression, anxiety, disease stigma, and sleep difficulties. Furthermore, cirrhosis was associated with a marked decrease in scores. Treatment with regimens that contained RBV but not IFN produced minimal decline in HRQL during treatment while IFN-free, RBV-free regimens showed improvement of HRQL scores during treatment. Finally, achievement of sustained virologic response (SVR) was associated with an increase in HRQL scores. Conclusion: HCV has a negative impact on HRQL. IFN/RBV containing regimens worsen this impairment. IFN- and RBV-free regimens result in improving HRQL scores during treatment. SVR is consistently associated with improvement of HRQL scores post treatment.