Non-occupational Activities Research Articles

Subjective and Objective Assessment of Recommended Physical Activity in Female Healthcare Professionals

This study aimed to compare subjective and objective measures of physical activity (PA) in healthcare professionals and assess their adherence to recommended guidelines. A convenience sample of 153 female healthcare professionals (51 nurses, 50 medical caregivers, and 52 physiotherapists) from 24 h healthcare facilities in Poland participated in the study. Subjective assessment was done using an expanded version of the International Physical Activity Questionnaire, while objective assessment involved wearing an Actigraph GT3X accelerometer for seven consecutive days. The results showed no significant correlation between subjective and objective measures of moderate-to-vigorous PA in both occupational and non-occupational activities. Objectively measured PA was significantly lower than self-reported PA, with a large effect size observed for both occupational and total PA. Only 44% of participants met the recommended guidelines for aerobic activity based on accelerometer data, while subjective assessment showed a higher percentage (76%) of healthcare professionals meeting the guidelines. These findings highlight the discrepancy between self-reported and objectively measured PA in healthcare professionals. It emphasizes the need for more accurate assessment methods to understand the actual PA levels of this population. Further research should explore factors influencing PA reporting accuracy and develop interventions to promote regular physical activity among healthcare professionals.

Post-Traumatic Stress Disorder among Frontline Nurses during the COVID-19 Pandemic and Its Relationship with Occupational Burnout.

Objective: This study aimed to determine the level of post-traumatic stress disorder (PTSD) among nurses and its relationship with occupational burnout. Method : This online cross-sectional survey was conducted from late November to early January 2020 in six hospitals in Iran. 309 frontline nurses in COVID-19 wards were selected via stratified random sampling and asked to complete a sociodemographic questionnaire, the Impact of Event Scale-revised version (IES-R), and the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) in an anonymous online survey. Data management and analysis were performed in SPSS 25.0 using descriptive and inferential statistics, including Pearson's correlation coefficient, independent samples t-test, ANOVA, and linear regression. Results: The majority of the participants were women (81.6%) with a mean ± SD age of 31.56 ± 6.42 years. The mean ± SD of the total PTSD score was 39.2 ± 16.44 years, indicating severe PTSD among nurses. The mean ± SD of the total occupational burnout score was 82.77 ± 19.38, expressing moderate burnout. The findings also demonstrated a significant moderate correlation between PTSD and occupational burnout (r = 0.363, P < 0.001). Univariate analysis revealed a significant relationship of occupational burnout with PTSD, work experience, number of night shifts per month, and employment status (P < 0.05). However, in multivariate analysis, only PTSD had a positive and significant relationship with occupational burnout (P < 0.001; R2 = 160; β = 0.339) and was a predicting factor for it. Conclusion: We found that both PTSD and burnout are common among nurses. Given the role of PTSD especially as a predictor of burnout and the significant impact of these disorders on occupational and non-occupational activities, immediate and appropriate measures are necessary to monitor and reduce their effects on the nurses who are at the forefront of fighting the pandemic.

Association between night shift work and different categories of non-occupational physical activity in the Shahedieh cohort study

Introduction Shift-work has been associated with physical and mental health problems. This study aimed to explore the association between shift-work and different non-occupational physical activities in Iranian adults enrolled in the Shahedieh cohort study (SCS). Methods The participants were men enrolled in the SCS (2014-2017). Different categories of non-occupational physical activity were quantified by the International Physical Activity Questionnaires and presented (as continuous by the metabolic equivalent of task [MET]), and dichotomous for defining sedentary/non-sedentary behavior based on MET). Shift-work status was asked through a face-to-face interview. The odds of having a sedentary behavior associated with shift-work, and the association between shift-working and daily MET of each category of activity were modeled using adjusted logistic regression and multiple linear regression (presented as odds ratio [OR] and beta respectively, with 95% confidence intervals [CI]). Results are based on the models adjusted for hypothesized confounders. Results Of 5132 men, 13.3% were shift-worker (more educated, and younger than non-shift-workers). Shift-workers had 20% lower odds of sedentary behavior compared to non-shift-workers (OR = 0.80; 95% CI: 0.60-0.98). Shift-working was associated with higher daily MET related to time spent on driving (ß=0.88; 95%CI: 0.75: 1.02), walking (ß=0.45; 95%CI: 0.33: 0.56), and light manual handling (ß=0.06; 95%CI: 0.01: 0.10), but the negative association with heavy sports activities (ß=-0.01; 95%CI: -0.03:-0.00), time spent on house cleaning (ß=-0.03; 95%CI: -0.06:-0.01), watching television (ß=-0.11; 95%CI: -0.20:-0.02), and working with a computer (ß=-0.13; 95%CI: -0.21:-0.06). Conclusion Shift-workers spent more energy on non-occupational activities than non-shift-workers, especially on outdoor activities. It implies the importance of considering shift-working as a possible effect modifier in the studies with hypotheses related to exposures linked to residing in outdoor environments such as the use of greenspace and ambient air pollution. Keywords Shift-Work, Physical Activity, Occupational Health

Which teachers are most at risk for voice disorders? Individual factors predicting vocal acoustic parameters monitored in situ during a workweek.

To identify the factors affecting teachers' vocal acoustic parameters, with the aim of detecting individuals at risk of phonotrauma. The voicing time, voice sound pressure level [SPL] and fundamental frequency [fo] of 87 teachers were measured during one workweek using a voice dosimeter. We retrospectively investigated the impact of 10 factors (gender, age, teaching experience, teaching level, tobacco, gastro-esophageal problems, nonoccupational voice activity, voice education, past voice problems, and biopsychosocial impact of voice problems measured using the Voice Handicap Index [VHI]) on each voice parameter. None of the above factors affected voicing time or SPL. fo depended significantly on gender, teaching level, nonoccupational voice activity and VHI score. Specifically, fo was higher in women (Δ = 69Hz), in individuals without nonoccupational voice activities (Δ = 11Hz), and in individuals with a lower VHI score (increase of 0.7Hz for each additional point). For females, post hoc comparisons revealed a substantial impact of teaching level on fo: university instructors had deeper voices than kindergarten (Δ = 66Hz), elementary (Δ = 52Hz), or secondary teachers (Δ = 41Hz). Since higher fo increases the mechanical stress related to vocal fold vibration, the screening and prevention of phonotrauma should focus primarily on women, particularly those who teach at lower levels, and teachers with more self-rated voice problems. The lower fo of teachers who engage in nonprofessional voice activities may suggest acute inflammation or muscle fatigue due to voice overload.

Life Conditions of Persons With and Without Low-Back Pain

A comparison of life conditions (such as dwelling, health, leisure-time activities, education, occupation, and work characteristics) was made between age- and sex-stratified groups of persons with and without low-back pain (BP). The primary data were collected from a random, geographically standardized 1:1,000 sample of the Swedish population including 2,872 citizens aged 30-59 years. There were no differences with respect to dwelling, height, weight, habits of physical exercise, other non-occupational activities, and frequency of unemployment. In the group of 50-59 year old persons, the males with BP smoked more than those without. In the same age-group of females, and in the younger male groups there were no differences in smoking habits. Physically heavy, monotonous, and repetitive work was more frequent among the subjects with BP. The relative number of highschool-educated was lower among males--in the youngest age group--with BP. The back-healthy persons evaluated their state of health as better and their need of medical care as less than the persons with BP.

Work-Relatedness.

Work-Relatedness.

Construcción y Validación del Cuestionario de Percepción de Riesgos y Beneficios de la Exposición a Reproductores Personales de Música Para Adolescentes

Evidence has been found of an association between participation in risk behaviors and the perception of their risks and benefits. The use of personal music players (PMPs) is one of the most common non-occupational noise activities, especially among the young. The aim of the study was to develop a questionnaire to assess the positive consequences (benefits) perceived by adolescents and the negative consequences (risks) of listening to music on these devices. The construction and validation process occurred in 3 phases: item pool development; establishment of content validity; and estimation of construct validity, criterion-related validity, and internal consistency, with an accidental sample of 694 adolescents from 2 schools of Cordoba, Argentina. The results of the exploratory and confirmatory factor analyses revealed a 2-dimensional factorial structure. Together, both factors correctly classified 64.6% and 74% of adolescents with high and low exposure to music through PMPs. This questionnaire can be used to detect adolescents with risky listening and to develop strategies to promote protective behavior.

Pesticides as risk factors for head and neck cancer: A review

Humans may be exposed to pesticides such as fungicides, herbicides, and insecticides, during occupational and non-occupational activities. Pesticides could be related to cancer development mainly because of their effects on the endocrine and immune systems and their cumulative effect. The present review evaluated in current literature evidence of an association between exposure to pesticides and the occurrence of head and neck cancer (HNC). A literature search for cohort studies was conducted in the PubMed, Web of science, and Cochrane databases. Methodological quality of each study was rated with the Scottish Intercollegiate Guidelines Network (SIGN) checklist. One thousand one hundred and thirty-two studies were identified. Thirty-two were included. Most of the studies found addressed occupational exposure to pesticides and were conducted in Europe and North America. Eleven high-quality studies were found. Most of them found no association between exposure to pesticides and increased risk of HNC. Two studies found some evidence of a positive association between pesticide (malathion and atrazine) exposure and thyroid cancer. The literature review does not support a clear evidence for association between pesticides exposure and HNC. Only limited evidence points to a positive association between exposure to some pesticides and thyroid cancer. Further standardized studies based on appropriate designs are required to clarify the effect of pesticides on the genesis of HNC, considering dose, length of exposure, and type of pesticide.

Backache in Dumper Operators of a Private Iron Ore Mine in Eastern India: A Cross-Sectional Study

Introduction: Occupational back pain is most common symptoms among seated workers, standing workers, truck drivers and so on. Driving frequently involves many risk factors such as prolonged sitting and motor vehicle driving, vibration, tight running schedules, reduced rest breaks, the sedentary nature of job etc. Backache in working individuals is a commonly present complaint. Determining whether a patient's low backache is a consequence of occupational activity can be challenging. Various studies across the world show prevalence of backache as 45-60%. Very few studies were carried out in India amongst heavy vehicle operators regarding backache and the occupational factors associated with it. Objectives: To find the spectrum, epidemiological profile, prevalence of backache and occupational factors associated with it in 50 dumper operators of a private Iron Ore Mine of Eastern India (Jharkhand). Methodology: A cross-sectional study on 50 dumper operators of a private Iron Ore Mine of Eastern India. Results: As per this study prevalence of backache among the dumper operators is 42% and more common in persons above 40 years of age (81%) and working experience more than 15 years (72%). BMI had been established as an important indicator for backache when the study reveals that 72% of the workers have BMI ≥25 (overweight, obese). Average RMDQ (Ronald-Morris Disability Questionnaire) in comparison to workers with and without backache was 5.3 and 3.1 respectively which is almost similar (5.1 and 3.9 respectively) to the study in India by BorleAmod and others in Truck drivers of Nagpur, India. Conclusions: In the present study it was established that backache is a very common problem in dumper operators. It is cumulative trauma disorder. Injury develops gradually over a period of weeks, months, or even years as a result of stress. Other non-occupational activities may also lead to backache like sports and house hold heavy work.

Noise Exposure Questionnaire: A Tool for Quantifying Annual Noise Exposure.

Exposure to both occupational and nonoccupational noise is recognized as a risk factor for noise-induced hearing loss (NIHL). Although audiologists routinely inquire regarding history of noise exposure, there are limited tools available for quantifying this history or for identifying those individuals who are at highest risk for NIHL. Identifying those at highest risk would allow hearing conservation activities to be focused on those individuals. To develop a detailed, task-based questionnaire for quantifying an individual's annual noise exposure (ANE) arising from both occupational and nonoccupational sources (aim 1) and to develop a short screening tool that could be used to identify individuals at high risk of NIHL (aim 2). Review of relevant literature for questionnaire development followed by a cross-sectional descriptive and correlational investigation of the newly developed questionnaire and screening tool. One hundred fourteen college freshmen completed the detailed questionnaire for estimating ANE (aim 1) and answered the potential screening questions (aim 2). An additional 59 adults participated in data collection where the accuracy of the screening tool was evaluated (aim 2). In study aim 1, all participants completed the detailed questionnaire and the potential screening questions. Descriptive statistics were used to quantify participant participation in various noisy activities and their associated ANE estimates. In study aim 2, linear regression techniques were used to identify screening questions that could be used to predict a participant's estimated ANE. Clinical decision theory was then used to assess the accuracy with which the screening tool predicted high and low risk of NIHL in a new group of participants. Responses on the detailed questionnaire indicated that our sample of college freshmen reported high rates of participation in a variety of occupational and nonoccupational activities associated with high sound levels. Although participation rates were high, ANE estimates were below highest-risk levels for many participants because the frequency of participation in these activities was low in many cases. These data illustrate how the Noise Exposure Questionnaire (NEQ) could be used to provide detailed and specific information regarding an individual's exposure to noise. The results of aim 2 suggest that the screening tool, the 1-Minute Noise Screen, can be used to identify those participants with high- and low-risk noise exposure, allowing more in-depth assessment of noise exposure history to be targeted at those most at risk. The NEQ can be used to estimate an individual's ANE and the 1-Minute Noise Screen can be used to identify those participants at highest risk of NIHL. These tools allow audiologists to focus hearing conservation efforts on those individuals who are most in need of those services.

Considering the Relationship between Transformational Leadership and Organizational Commitment with Citizenship Behavior : Case Study : Staff of Branches of Maskan Bank in Guilan Province - Iran

Organizational citizenship behaviors are counted as working behavior of staff of an organization such as helping each other, being conventional a lot and working on holidays, acting in job affairs higher than introduced standards by the organization and tolerating deficiencies in an organization at work or job and being actively involved in nonoccupational and non-duty activities in the organization and are counted as effective factors on success of the organization. Many factors affect presenting organizational citizenship behavior of staff that in this research the relationship between transformational leadership, affective commitment and constant commitment is considered. Therefore the main goal of current research is considering the relationship between transformational leadership and organizational commitment with citizenship behavior of staff of branches of Maskan bank in Guilan province. This research regarding goal is applied one and its research method is descriptive and correlation type. Statistical society of research is all staff of Maskan bank throughout Guilan province that their number is 500 people in the province. Regarding research limited society, sample volume has been chosen as 217 staff of the bank. Sampling method is cluster-random rumpling type. Tools of data collection in this research are standard questionnaire. For data analysis Spss software version 19 was used. The finding has been analyzed through questionnaire by using Kolmogorov-smirnov test, pearson correlation coefficient, multiple linear regression. Result of testing research denotes positive and meaningful relationship of transformational leadership, affective commitment and constant commitment on citizenship behavior of the organization of staff of Maskan bank in Guilan province.

Are daily physical activities risk factors for knee osteoarthritis?

In spite of many epidemiologic studies, there is still insufficient evidence on the effects of daily physical activity on osteoarthritis. The purpose of this study was to evaluate the association between squatting, climbing, kneeling, lifting and carrying weights and knee osteoarthritis. This population-based case control study was the second stage of the World Health Organization - Community Oriented Program for Control of Rheumatic Diseases (WHO-COPCORD), in which 263 cases and 263 controls aged 30-70years were selected from 780 eligible cases and 4373 eligible controls identified in the first-stage survey in Tehran. Demographic and lifestyle data were obtained from all the participants. The selection probability of each case and control and the stabilized weight was estimated using the restricted cubic spline models. Multivariable regression models by inverse probability weighting were used to minimize the effect of the bias resulting from the unequal selection probability. The female sex, age, obesity and history of previous severe knee injury maintained their strong and significant associations with knee osteoarthritis before and after the adjustment. Although walking and squatting were significantly different in the case and control groups in the bivariate analysis, after adjustment and weighting no such association was found between the disease and squatting, kneeling, standing, walking, climbing, carrying and lifting. This study did not show any significant association between knee osteoarthritis and daily occupational and non-occupational activities; nevertheless it does add another piece of information to the literature on the complex role of physical activities in knee osteoarthritis.

Describing Speech Usage in Daily Activities in Typical Adults

"Speech usage" refers to what people want or need to do with their speech to meet communication demands in life roles. The purpose of this study was to contribute to validation of the Levels of Speech Usage scale by providing descriptive data from a sample of adults without communication disorders, comparing this scale to a published Occupational Voice Demands scale and examining predictors of speech usage levels. This is a survey design. Adults aged ≥25 years without reported communication disorders were recruited nationally to complete an online questionnaire. The questionnaire included the Levels of Speech Usage scale, questions about relevant occupational and nonoccupational activities (eg, socializing, hobbies, childcare, and so forth), and demographic information. Participants were also categorized according to Koufman and Isaacson occupational voice demands scale. A total of 276 participants completed the questionnaires. People who worked for pay tended to report higher levels of speech usage than those who do not work for pay. Regression analyses showed employment to be the major contributor to speech usage; however, considerable variance left unaccounted for suggests that determinants of speech usage and the relationship between speech usage, employment, and other life activities are not yet fully defined. The Levels of Speech Usage may be a viable instrument to systematically rate speech usage because it captures both occupational and nonoccupational speech demands. These data from a sample of typical adults may provide a reference to help in interpreting the impact of communication disorders on speech usage patterns.

Positive and cost-effectiveness effect of spa therapy on the resumption of occupational and non-occupational activities in women in breast cancer remission: A French multicentre randomised controlled trial

Purpose of the researchThe main aim was to assess the effects of a spa treatment on the resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission. A cost-effectiveness analysis (CEA) was also performed. Methods and sampleA multicentre randomised controlled trial was carried out between 2008 and 2010 in the University Hospital of Auvergne and two private hospitals in Clermont-Ferrand, France. Eligible patients were women in complete breast cancer remission without contraindication for physical activities or cognitive disorders and a body mass index between 18.5 and 40 kg/m2. The intervention group underwent spa treatment combined with consultation with dietician whereas the control underwent consultations with the dietician only. Of the 181 patients randomised, 92 and 89 were included in the intervention and the control groups, respectively. The CEA involved 90 patients, 42 from the intervention group and 48 from the control group. Key resultsThe main results showed a higher rate of resumption of occupational activities in the intervention group (p = 0.0025) and a positive effect of the intervention on the women's ability to perform occupational activities 12 months after the beginning of the study (p = 0.0014), and on their ability to perform family activities (p = 0.033). The stay in a thermal centre was cost-effective at 12 months. ConclusionsSpa treatment is a cost-effective strategy to improve resumption of occupational and non-occupational activities and the abilities of women in breast cancer remission.

External load and the reaction of the musculoskeletal system – A conceptual model of the interaction

This paper presents a conceptual model of the interaction between the human body and external factors influencing the musculoskeletal system (biomechanical load, vibration and psychosocial factors). The interrelationship of parameters that define each external occupational or non-occupational factor and their combination creates exposure. Exposure influences the human body modelled as a mental system and a musculoskeletal system, and results in responses leading to improved or impaired structures of the musculoskeletal system. The reaction to external factors expressed as a response depends on personal traits. The results of this study are a basis for insights into how external physical and psychosocial risk factors influence the mechanisms responsible for whether body structures improve or are impaired. The model is intended to be filled in with mathematical equations that describe quantitatively phenomena related to processes caused by external load, with consideration of personal traits. This paper discusses ways leading to mathematical formulas, which would explain the phenomena included in the model quantitatively. Relevance to industryThe relevance of this study to industry consists in providing, through the use of the proposed model, after a quantitative verification, safety levels that can result in improved work and workers protect against MSDs. By considering both occupational and non-occupational activities, the model can help to protect workers holistically.

Estimation of permanent noise-induced hearing loss in an urban setting.

The potential burden of noise-induced permanent threshold shift (NIPTS) in U.S. urban settings is not well-characterized. We used ANSI S3.44-1996 to estimate NIPTS for a sample of 4585 individuals from New York City (NYC) and performed a forward stepwise logistic regression analysis to identify predictors of NIPTS >10 dB. The average individual is projected to develop a small NIPTS when averaged across 1000-4000 Hz for 1- to 20-year durations. For some individuals, NIPTS is expected to be substantial (>25 dB). At 4000 Hz, a greater number of individuals are at risk of NIPTS from MP3 players and stereos, but risk for the greatest NIPTS is for those with high occupational and episodic nonoccupational (e.g., power tool use) exposures. Employment sector and time spent listening to MP3 players and stereos and participating in episodic nonoccupational activities associated with excessive noise levels increased the odds of NIPTS >10 dB at 4000 Hz for 20-year durations. Our results indicate that the risk of NIPTS may be substantial for NYC and perhaps other urban settings. Noise exposures from "noisy" occupational and episodic nonoccupational activities and MP3 players and stereos are important risk factors and should be a priority for public health interventions.

Exposures to Transit and Other Sources of Noise among New York City Residents

To evaluate the contributions of common noise sources to total annual noise exposures among urban residents and workers, we estimated exposures associated with five common sources (use of mass transit, occupational and nonoccupational activities, MP3 player and stereo use, and time at home and doing other miscellaneous activities) among a sample of over 4500 individuals in New York City (NYC). We then evaluated the contributions of each source to total noise exposure and also compared our estimated exposures to the recommended 70 dBA annual exposure limit. We found that one in ten transit users had noise exposures in excess of the recommended exposure limit from their transit use alone. When we estimated total annual exposures, 90% of NYC transit users and 87% of nonusers exceeded the recommended limit. MP3 player and stereo use, which represented a small fraction of the total annual hours for each subject on average, was the primary source of exposure among the majority of urban dwellers we evaluated. Our results suggest that the vast majority of urban mass transit riders may be at risk of permanent, irreversible noise-induced hearing loss and that, for many individuals, this risk is driven primarily by exposures other than occupational noise.

Urinary biomarkers of exposure to glycol ethers and chlorinated solvents during pregnancy: determinants of exposure and comparison with indirect methods of exposure assessment

ObjectivesTo describe urine levels of metabolites of glycol ethers and chlorinated solvents in a sample of pregnant women from the general population, to study their occupational and non-occupational determinants and...

Three-dimensional peak and cumulative L4/L5 spine loads and trunk postures during non-occupational tasks

Cumulative low back loading has been shown to be a risk factor for low back pain reporting in the workplace. Evaluation of tasks outside of work might offer insight into why workers continue to have low back pain and may report pain differentially even when doing the same job. This study utilized a video-based 3D posture sampling approach to document joint postures of 18 people over a 2-hour period while performing non-repetitive tasks in and around their own homes. A 3D rigid link segment model was used to calculate reaction forces and moments at L4/L5 and joint models were used to calculate joint forces. Average peak (4.0 kN) and cumulative (9.9 MN·s) compression force estimates indicate significant loads on the low back occur during non-occupational tasks, despite the fact that participants spent most of their time (86.2%) in neutral trunk postures. Cumulative anterior reaction shear force (440 kN·s) was found to be comparable to those documented for a wide variety of occupational tasks, when extrapolated to an 8-hour shift. To our knowledge, this study is the first to include a full complement of 3D low back forces and moments, in conjunction with an assessment of trunk posture, for non-occupational activities. The evidence suggests that considering 3D peak and cumulative low back loading during non-occupational tasks is warranted and may help to explain some of the variability in the reporting of workplace-related low back disorders despite extensive ergonomic intervention.

P03-45 - Psychosocial functioning of schizophrenic patients in post-acute treatment with long-acting injectable risperidone in ambulatory care

IntroductionImprovement of social and occupational functioning is a major goal in the treatment of schizophrenic patients and therefore may improve reintegration of patients and their ability to lead an independent life.MethodsNon-interventional, 52-week study (RIS-SCH-4091) in schizophrenic patients after treatment of exacerbation or first manifestation of schizophrenia (ICD-10 F20.x; duration of disease ≤10 years) with long-acting injectable risperidone (RLAI) in monotherapy. Presented here is the assessment of the treatment based on the Clinical Global Impression (CGI), the Global Assessment of Functioning (GAF), and skills assessing the ability of patients for reintegration as quantified by the short version of the International Classification of Functioning, Disability and Health for Mental Disorders (Mini ICF-APP).ResultsInterim-analysis after 12 months of 75 patients (ITT, m 64%; 32.7±9.1 years; N=88 safety set). Duration of observation was 278.8±119.3 days. GAF total scores improved significantly (24.4±23.7); 76.0% of the patients improved in CGI-C. Mini-ICF-APP total scores improved significantly from 1.96±0.68 to 1.18±0.94 at final observation. All Mini-ICF-APP sub-items improved significantly, particularly within: participation in public roles, non-occupational activities, self maintenance, competency, flexibility, family relations. 119 adverse events (AEs; 28 serious AEs) were reported in 47 patients. Most common AEs at least possibly related to RLAI were lack of effectiveness 8.0%, weight increase 8.0%, psychotic disorder 5.7%, anxiety 3.4%, EPS 3.4%.ConclusionsResults indicate that treatment with RLAI may improve global functioning of patients by reducing typical disorder of functioning, capacity and participation. Treatment with RLAI may help patients to reintegrate into social and occupational environments.