Previous Professional Activities Research Articles

Analysis of prospects and problems in the development of human resources for the employment of Ukrainian refugees

An influx of workers who have accumulated knowledge in labor markets other than the current one can have particularly large effects on the development of the host country's human resources. Other things being equal, a region with higher fluctuations in the number of highly skilled workers should be in a better position than a region with low mobility. Refugee laws are in constant evolution, reflecting the changing political, economic, and legal environments. This paper examines the situation that has developed in the Czech Republic after the arrival of a large number of refugees from Ukraine, in terms of their opportunities and prospects, as well as their ability to enter the labor market in accordance with their education and previous professional activities. The purpose of this study is to analyse the potential and obstacles to the labor integration of Ukrainian refugees, given the situation of uncertainty and the measures taken by the Czech government and state structures to receive refugees. The article considers the objective and subjective prerequisites for the labor integration of refugees, taking into account their socio-demographic characteristics and subjective intentions for the future.

Female physician and pregnancy- effect of the amended German maternity protection act on female doctors' careers.

In Germany, the 2018 amended Maternity Protection Act frequently leads to fundamental restrictions for female physicians, especially surgeons, and now even also for students impeding the progress of their careers. Our goal was to assess the current situation for pregnant female physicians and students, respectively, and their perspective on this amendment regarding their career path. A nationwide survey was conducted in Germany from December 2020 to February 2021. The questionnaire included 790 female physicians and students who were pregnant after the inception of the amended Act. Those women pregnant after the beginning of the corona pandemic were excluded. The survey revealed that two thirds of female physicians worked a maximum of 50% in their previous professional activity as soon as they reported pregnancy. Amongst medical students this amounted up to 72%. 18% of the female physicians and 17% of the female medical students respectively could not follow the sense of these restrictions. 44% of female medical physicians and 33% of female students felt their career impeded. This led up to 43%amongst female medical doctors and 53% amongst female medical students, respectively, who were concerned to announce their pregnancy. As a consequence, pregnancies were reported at 12weeks in female physicians compared to 19weeks in medical students. Analyses of the current survey revealed that a relevant number of female physicians and medical students felt impeded in their career path through the application of the amended Maternity Act.

PSYCHO-EMOTIONAL STATE AND HEALTH LEVEL OF LAW ENFORCEMENT OFFICERS IN THE PROCESS OF THEIR PROFESSIONAL TRAINING

Aim: To investigate the level of psycho-emotional state and health of newly certified law enforcement officers in the process of their professional training. Materials and Methods: The research involved first-time certified police officers of different categories (n = 104) who studied at the initial professional training courses in 2019. In addition, we investigated the dynamics of police officers’ health indicators during their initial professional training courses and in the process of their service for one year, depending on the type of previous professional activities (2019-2021, n=112). Results: It was found that newly certified police officers of the 3rd category (police officers of a body, establishment, institution) have the worst level of psycho-emotional state and health indicators. Most police officers are characterized by a high level of anxiety and a low to below average level of health. At the end of the research, 58.1% of police officers had a below average level of health, 21.4% had a low level of health, and no police officers of the 3rd category had a high level of health. It is important to note that the level of health of police officers involved in the research has not changed in the course of one year of their service. Conclusions: The negative impact of the new conditions and peculiarities of training and service activities during the initial professional training courses on the psycho-emotional state and health of newly certified police officers has been proved.

Risk factors of long term symptoms and outcomes among patients discharged after covid-19: prospective, multicentre observational study

ObjectiveTo investigate risk factors and subphenotypes associated with long term symptoms and outcomes after hospital admission for covid-19.DesignProspective, multicentre observational study.Setting93 hospitals in France.ParticipantsData from 2187 adults admitted to hospital...

One-Year Sequelae and Quality of Life in Adults with Meningococcal Meningitis: Lessons from the COMBAT Multicentre Prospective Study.

IntroductionCOMBAT is a prospective, multicentre cohort study that enrolled consecutive adults with community-acquired bacterial meningitis (CABM) in 69 participating centres in France between February 2013 and July 2015 and followed them for 1 year.MethodsPatients aged at least 18 years old, hospitalised with CABM were followed during their hospitalisation and then contacted by phone 12 months after enrolment. Here we present the prevalence of sequelae at 12 months in a subgroup of patients with meningococcal meningitis.ResultsFive of the 111 patients with meningococcal meningitis died during initial hospitalisation and two died between discharge and 12 months, leaving 104 patients alive 1 year after enrolment, 71 of whom provided 12-month follow-up data. The median age was 30.0 years and 54.1% of the patients had no identified risk factor for meningitis. More than 30% reported persistent headache, more than 40% were not satisfied with their sleep and 10% had concentration difficulties. Hearing loss was present in about 15% of the patients and more than 30% had depressive symptoms. About 13% of the patients with a previous professional activity had not resumed work. On the SF-12 Health Survey, almost 50% and 30% had physical component or mental component scores lower than the 25th percentile of the score distribution in the French general population. There was a non-significant improvement in the patients’ disability scores from hospital discharge to 12 months (p = 0.16), but about 10% of the patients had residual disability.ConclusionsAlthough most patients in our cohort survive meningococcal meningitis, the long-term burden is substantial and therefore it is important to ensure a prolonged follow-up of survivors and to promote preventive strategies, including vaccination.Trial RegistrationClinicalTrial.Gov identification number NCT01730690.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12325-022-02149-7.

ХИРУРГИЧЕСКАЯ КОРРЕКЦИЯ БОКОВЫХ И ПЕРЕДНЕБОКОВЫХ ГРЫЖ ЖИВОТА

Objective: To improve the results of surgical treatment of primary, postoperative and recurrent hernias of the lateral and anterolateral abdominal wall. Methods: Various types of hernioplasty were performed in 68 patients with lateral and anterolateral hernias of the abdominal wall (LALHAW) aged 24 to 67 years. Primary hernias were diagnosed in 10 patients, postoperative – in 30, recurrent – in 28. There were 16 men and 52 women enrolled on the study. Analysis of the anamnesis and medical records revealed that postoperative hernias (30) arose after the following surgical interventions: nephrectomy (11), nephrolithomy (8), appendectomy (4), cholecystectomy (3), drainage of the retroperitoneal space (2), surgery for hepatic echinococcosis (1) and adrenalectomy (1); 24 patients were admitted with recurrent hernia after traditional hernioplasty, and 4 patients – after combined methods of hernioplasty. Results: Among the total number of patients, traditional hernioplasty was performed in 25 (36.8%) patients, tension-free repair – in 5 (7.4%) and combined repair – in 38 (55.8%) patients. Simultaneous operations were performed in 14 cases, such as nephrolithotomy (3), resection of the ovarian cyst (3) and greater omentum (5), supravaginal amputation of the uterus (3). Surgical site complications developed in 12% of cases after traditional hernioplasty, and in 5.2%. after combined methods of operation. Among 5 patients operated using a tension-free method, seroma occurred in one observation. Recurrent hernia after traditional hernioplasty developed in one patient (4% of cases). Conclusion: Surgical treatment of LALHAW is a complicated problem of herniology, due to the complexity of anatomical architectonics of the anterior abdominal wall and limited plastic resources of the surrounding tissues. Currently, the results of traditional hernioplasty remain disappointing, as there is a trend towards increased recurrence and incidence of surgical site complications after its application. The widespread use of the combined methods of surgical treatment of hernias of this localization, along with reliable reinforcement of the hernia defect, provide the most optimal longterm functional results, allowing the patients resume their previous professional activities. The incidence of recurrent hernias after these operations tends to reduce, contributing to an improvement in the quality of life. Keywords: Lateral abdominal hernia, anterolateral abdominal hernia, recurrent hernia, traditional hernioplasty, tension-free hernioplasty.

Monitoring primary disability of former military personnel by applying to the bureau of medical and social expertise as a basis for choosing measures for the professional rehabilitation of disabled people: a regional aspect

The factors of the formation of primary disability in the former military personnel in the Republic of Dagestan were studied according to the appeal to the bureau of medical and social expertise over 5 years (from 2014 to 2018). The article analyzes gender and age indicators, social affiliation, causes of disability, nosological diseases of military personnel that led to disability, severity by disability group and others. An analysis of the disability indicators of former military personnel in the Republic of Dagestan as a large subject of the North Caucasus Federal District of the Russian Federation is important for organizing measures to continue previous professional activities for persons with limited ability to work. The revealed complex of socio-hygienic and medical-social indicators made it possible to determine the directions of labor and social integration of persons with disabilities from among former military personnel in society. The social indicator established in more than half of disabled people, the place of residence in rural areas, made it possible to recommend self-employment in the agricultural areas of activity (animal husbandry, vegetable growing, fruit and berry processing), in the service sector, and small business, including those related to revival and development of national Dagestan crafts. The state program Accessible Environment (2011-2020-2025) emphasizes the need to take into account the regional characteristics of primary and general disability, the national specifics of the development of territories. In this regard, the results of medical and social analysis allow us to more accurately determine the direction of the organization of labor and social integration of persons with disabilities from among former military personnel in the Republic of Dagestan.

КОМУНІКАТИВНА КОМПЕТЕНТНІСТЬ У ПОЛІТИЧНОМУ ДИСКУРСІ (НА ПРИКЛАДІ ОФІЦІЙНИХ СТОРІНОК НАРОДНИХ ДЕПУТАТІВ У СОЦІАЛЬНІЙ МЕРЕЖІ «ФЕЙСБУК»)

<div><em>The article presents the results of the study of the communicative competence of the politicians on the basis of the analysis of their messages on their official pages of the Facebook social network. The research used the following general scientific methods: descriptive and comparative, as well as analysis, synthesis and generalization. The quantitative content analysis method with qualitative elements was used to distinguish the peculiarities of information messages that provide communication of the deputies of Verkhovna Rada (Ukrainian Parliament) on their official Facebook pages. Information messages have been analyzed by the following three criteria: subject matter, structure and language.</em></div><p> </p><p><em>For the first time the article draws a parallel between communicative competence and the ability to communicate with voters on the official pages of Facebook which is the most popular social network in Ukraine. As it is established, communicative competence in the analyzed cases is caused not by education, but by previous professional activity of a politician. The most successful and high-quality communication was from the current parliamentarian who worked as a journalist in the past. More than half of the messages that provided successful communication consisted of sufficiently structured short text and a video. The topic covers the activity of the parliamentarian in the Verkhovna Rada and in his district. More than half of the messages are spoken in the first person.</em></p><p><em>The findings of the study can be used in teaching such subjects as Political PR and Electronic PR, and may be of interest to politicians and their assistants.</em><em></em></p><p><strong><em>Key words:</em></strong><em> competence and competency, communicative competence, political discourse, official page of the deputy of Verkhovna Rada of Ukraine on the Facebook social network, subject matter and structure of the information message, first-person narrative, correspondence of communication to the level of communicative competence.</em></p>

Job Crafting among Younger and Older Academic Teachers

The subject of the study is job crafting, currently (from the point of view of empirical research) very evolving in the subject literature, but relatively rarely undertaken in Polish conditions. The study is composed of two parts: theoretical one, which discusses the concept of job crafting and cited research results on the phenomenon and factors co-occurring with job crafting, as well as empirical one, including the presentation of mixed-qualitative research results carried out in the group of academic teachers. The research was conducted in a group of 64 and then a group of 36 teachers selected from them, of public and non-public academic teachers in Poland. As a result, it turned out that there is statistically significant differentiation among younger and older representatives of academic teachers, both in terms of frequency and content of behavior job crafting. Older academic teachers more often modify their way of perceiving their work and reflect on their previous professional activity (modification is made at the cognitive level), i.e. they boil down to critical reevaluation of their own assessments and most often positive reflections over their own professional achievements; younger teaching staff more often introduce structural changes related to work with students.

APSI scaphoid hemiarthroplasty – long-term results

ObjectiveThis study is aimed at evaluating the long-term results of proximal scaphoid hemiarthroplasty for post-traumatic avascular necrosis at this institution. MethodsTwelve patients who underwent this procedure were identified, and the mean follow-up time was 6.5 years (range: 5–8 years). All patients were male, with a mean age of 39 years (range: 28–55 years). In eight patients, the non-dominant limb was affected. The procedure was carried out through a dorsal approach and all patients underwent the same rehabilitation protocol. Cases were evaluated regarding complications, pain, range of motion, functional status (Mayo Wrist Score), and disability (QuickDASH Score). ResultsNo immediate post-operative complications, such as infection or dislocation of the implant, were observed. All patients presented with peri-implant osteolysis at follow-up, on a radiograph study. None of the patients was forced to abandon their previous professional activity, although about 50% required some type of adaptation at their workplace. The mean functional capacity was, according to the Mayo Wrist Score, of 67.5 points (range: 50–80), corresponding to a satisfactory degree of function. The QuickDASH disability score presented a mean of 25 (range: 3–47.7). ConclusionThe results of this series are in line with previously published studies about this technique. Hemiarthroplasty with a pyrocarbon implant is a safe technique for the treatment of post-fracture avascular necrosis of the scaphoid proximal pole. This technique allowed for satisfactory functional results at a mean follow-up of 6.5 years.

Hemiartroplastia do escafoide com APSI – resultados funcionais em longo prazo

ObjectiveThis study is aimed at evaluating the long‐term results of proximal scaphoid hemiarthroplasty for post‐traumatic avascular necrosis at this institution. MethodsTwelve patients who underwent this procedure were identified, and the mean follow‐up time was 6.5 years (range: 5 to 8 years). All patients were male, with a mean age of 39 years (range: 28 to 55 years). In eight patients, the non‐dominant limb was affected. The procedure was carried out through a dorsal approach and all patients underwent the same rehabilitation protocol. Cases were evaluated regarding complications, pain, range of motion, functional status (Mayo Wrist Score), and disability (QuickDASH Score). ResultsNo immediate post‐operative complications, such as infection or dislocation of the implant, were observed. All patients presented with peri‐implant osteolysis at follow‐up, on a radiograph study. None of the patients was forced to abandon their previous professional activity, although about 50% required some type of adaptation at their workplace. The mean functional capacity was, according to the Mayo Wrist Score, of 67.5 points (range: 50 to 80), corresponding to a satisfactory degree of function. The QuickDASH disability score presented a mean of 25 (range: 3 to 47.7). ConclusionThe results of this series are in line with previously published studies about this technique. Hemiarthroplasty with a pyrocarbon implant is a safe technique for the treatment of post‐fracture avascular necrosis of the scaphoid proximal pole. This technique allowed for satisfactory functional results at a mean follow‐up of 6.5 years.

Internet Use in Aphasia

Purpose: This article uses an illustrative case example to discuss a means of producing a holistic profile of Internet use for individuals with aphasia. Methods: The authors used the International Classification of Functioning, Disability, and Health as a framework to select novel and existing assessments to explore the Internet use and skills of a 74-year-old retired academic with severe aphasia. Results: Quantitative and qualitative assessment results revealed that language impairment, nonverbal impairment, nonverbal aspects of cognition, and hemiparesis had an impact on the individual's ability to use the Internet independently for many previous professional activities; however, relevant Personal Factors showed him to have strong goals and motivation to continue to use the Internet for email and gaining information about topics such as sports. Consideration of Environmental Factors provided insight into barriers and facilitators to Internet use and into the skills of people providing support. Discussion/conclusions: This approach to profiling Internet use in aphasia may be clinically useful in identifying key factors at work to guide information gathering and decision making with people with aphasia. Implications about SLP preparation and funding policies related to therapeutic priorities also are discussed.

Capitolunate Arthrodesis for Treatment of Scaphoid Nonunion Advanced Collapse (SNAC) Wrist Arthritis

The aim of the study was to evaluate results of capitolunate arthrodesis for the treatment of post traumatic degenerative SNAC wrist disorders. A capitolunate arthrodesis was performed on 12 patients, three women and nine men, of 44years in average (28-66 years). Ten patients were manual workers; dominant side was involved in seven cases with no history of previous operation. Fixation of the arthrodesis was performed with headless compression screws. Patients were reviewed at 37.4months of average follow up (range; 12-47 months). Mayo score equal to 82.8 points. Radiolunate and capitolunate angles were decreased of 6 and 8° respectively at the final follow up radiograph compared to preoperative values. The Ten manual worker patients were able to return to their previous professional activities and the other two patients were retired but they resume their sports and recreational activities. With the advent of headless compression screws the capitolunate arthrodesis gained a higher union rate, short operative time and short rehabilitation period. In the present study the capitolunate arthrodesis allowed restoring a stable functional wrist in the 12 patients reviewed. It is a satisfactory therapeutic alternative to four corners fusion for SNAC wrist with osteoarthritis.

Proximal scaphoid hemiarthroplasty for the treatment of post-fracture avascular necrosis of the proximal pole

Introduction The scaphoid is the most frequently fractured carpal bone. Most of its surface is covered by articular cartilage, which limits the space for the entrance of nutritious vessels. This leads to a precarious irrigation, especially at its proximal pole. A fracture further impairs bloodflow, which may lead to delayed union, nonunion, or even avascular necrosis of the proximal fragment. The proximal scaphoid hemiarthroplasty is one of the techniques available to treat the scaphoid proximal pole osteonecrosis. This part of the bone is substituted by a pyrocarbon implant that aims to maintain proximal carpal row kinematics and prevent carpal collapse, minimizing the risk for symptomatic osteoarthrosis. The goal of our study was to evaluate the long-term results of proximal scaphoid hemiarthroplasty for posttraumatic avascular necrosis of the scaphoid's proximal pole. Materials and methods Twelve patients who underwent this procedure were identified, and the average follow-up time was 6.5 years (range 5–8 years). All patients were male, with a mean age of 39 years (ranging from 28 to 55). In 8 patients the non-dominant limb was the one affected. The procedure was carried out through a dorsal approach and all patients were subjected to the same rehabilitation protocol. Functional results were determined using the QuickDASH and Mayo Wrist Score. Results There were no immediate postoperative complications such as infection or dislocation of the implant. All patients presented with peri-implant osteolysis at follow-up. None of the patients was forced to abandon their previous professional activity, even though 50% required some type of adaptation necessary at their workplace. The average functional capacity was, according to the Mayo Wrist Score, of 67.5 points (range 50–80), corresponding to a “Satisfactory” degree of function. From the application of the QuickDASH resulted an average disability of 25 (range 3–47.7). Discussion All patients mentioned as having the biggest disability with working with, or carrying, heavy objects. The results of this series are in line with previously published studies about this technique. Conclusion Hemiarthroplasty with a pyrocarbon implant is a safe technique for the treatment of post-fracture avascular necrosis of the scaphoid pole. This technique allowed for a satisfactory functional result at a mean follow-up of 6.5 years.

Résultats cliniques et radiologiques à dix ans de recul moyen de l’arthrodèse capito-lunaire. Série monocentrique de 12 patients

The aim of the study was to evaluate long-term results of capitolunate arthrodesis for the treatment of posttraumatic degenerative wrist disorders. A capitolunate arthrodesis was performed on 12 patients, three women and nine men, of 45 years on average (28–66). Ten patients were manual workers. Dominant side was involved in seven cases. Indications were nine scapholunate dissociations (SLAC) and three scaphoid non-unions (SNAC) with degenerative lesions. Fixation of the arthrodesis was performed with K-wires in seven, K-wires and staples in two, and only staples in three. Patients were reviewed at 118 months of average follow-up (72–168). One complete wrist arthrodesis was necessary one year after the capitolunate arthrodesis for an evolutive painful osteoarthritis. For the 11 remaining patients, pain on visual analogic scale (VAS) was 0.5. The flexion/extension arc was decreased of 25° and strength of 6kg compared to preoperative values. DASH score was equal to 33.7 points, Cooney score to 77.2 points and Mayo score to 82.8 points. Radiolunate and capitolunate angles were decreased of 4.9° and 6.2° respectively compared to preoperative values. Some complications occurred: evolutive osteoarthritis between triquetrum and lunate in two, non-union of the arthrodesis in one, and reflex sympathetic dystrophy in two. Nine patients were able to return to their previous professional activities. Capitolunate arthrodesis allowed restoring a pain free and functional wrist in eight out of the 11 patients reviewed. Results were maintained with follow-up. It is a satisfactory therapeutic alternative to four corners fusion for chronic instability of the wrist with osteoarthritis. Level of evidenceIV.

Lexical access speed is significantly correlated with the return to professional activities after awake surgery for low-grade gliomas

Awake surgery with intraoperative brain mapping is highly recommended for patients with diffuse low-grade gliomas in language areas, to maximise the extent of resection while preserving the integrity of functional networks and thus quality of life. The picture-naming test "DO.80" is the gold standard for language assessment before, during, and after surgery. Cognitive functioning is correlated with quality of life, itself linked with return to work. Our objective was to evaluate the significance of measuring naming speed, and its correlation with the return to professional activities. Two complementary studies are reported. In the first retrospective study, eleven patients were examined post-operatively. Five patients were selected because they were not able to resume their professional activities ("no return group 1"). They were compared with a control group of six patients who are working normally after surgery ("return group 1"). The eleven patients performed a global language and neuropsychological assessment, with a post-operative median follow-up of 35 months. In a subsequent prospective study, twelve patients were examined pre-operatively and post-operatively. Six patients who were not able to return to work ("no return group 2") were compared with a control group of six patients who were working normally after the surgery ("return group 2"). The twelve patients performed a pre and post-operative language assessment, with a median follow-up of 9 months. Our results show, for the first time, that naming speed is significantly correlated with a major criterion of quality of life: the return to professional activities. There were no differences between the two groups regarding other measures of cognition. Assessing naming times, and not only naming accuracy, is essential in the management of low-grade glioma patients, before, during, and after surgery, to preserve their quality of life by resuming their previous professional activity. Our results have fundamental implications concerning the comprehension of language processing and its relationship with cognitive functioning.

O perfil dos ingressantes de um programa de educação física para idosos e os motivos da adesão inicial

Numa sociedade em pleno envelhecimento, a Educação Física deverá desempenhar um importante papel. A cada ano, cresce a procura por programas supervisionados, como é o caso do Programa Autonomia para Atividade Física do Idoso - PAAF. Conhecer o idoso é fundamental para orientar as ações pedagógicas e atender suas expectativas. Assim, este trabalho destina-se a conhecer o perfil sócio-demográfico, a atividade física pregressa, verificar a saúde percebida e entender quais foram os motivos de adesão ao programa. Participaram desse estudo 54 pessoas (14 homens e 40 mulheres), com idade acima de 60 anos (66,45 ± 5,176 anos de idade), que ingressaram no PAAF-2002. Foram utilizados questionários, em que foram consideradas as seguintes variáveis: gênero, idade, nível de escolaridade, estado civil; saúde percebida do ingressante; a atividade profissional e a atividade física pregressa e o nível sócio-econômico. Para verificar os motivos da adesão inicial utilizamos tabela tipo Liekert e aplicamos o Índice de Consistência Interna de Liekert. Utilizamos o Coeficiente de Concordância de Kendall (W) e o Teste de Friedman (Xr²), com nível de significância (p = 0,05). A maioria dos alunos tinha entre 60 a 70 anos de idade, pertencia aos níveis sócio-econômico A e B e possuía alto nível de escolaridade. A maioria tinha pelo menos uma doença, porém, a saúde percebida era positiva. Os motivos de adesão relatados foram: aprender fazer exercícios físicos, melhorar condicionamento físico e prevenir problemas de saúde. Já, ocupar o tempo livre e fazer amigos foram motivos considerados menos importantes..

Arbeitsunfähigkeit, Erwerbsunfähigkeit, Invalidität – die Begriffe und ihre rechtliche Bedeutung in der Schweiz

The precise and correct understanding of terms in insurance medicine like incapacity to work, occupational disability and disability by physicians in general praxis and as experts is of great importance for patients. Swiss physicians are first of all requested to presumably judge incapacity to work retrospectively with regard to the previous professional activities and prospectively taking into account alternative activities that can be envisaged after appropriate medical measures. In contrast occupational disability and disability in the legal sense require a permanent and important impairment of the health status ensuing economical losses in the labour market.

Returning to work for individuals with health problems: Experiences in Brazil

Purpose: In 1999, the Federal University of Minas Gerais (UFMG) created the Worker Health Care Service with the purpose to implement health promotion and health protection policies in the workplace. This service supported workers with impairments and resulted from health proposals by a Professional Counseling Outplacement Program. The objectives of this study were to describe the demographic and impairment-related characterics of workers and to evaluate their outcomes.Method: Quantitative and qualitative methods were used for data analyses. First, a questionnaire was developed for collection of quantitative data. Secondly, in-depth interviews evaluated the perceptions of workers, supervisors and workmates concerning the program.Results: Of the 78 workers who attended the Outplacement Program, 65 (83%) were considered effective and capable of working, and 13 (17%) were retired. A sample of 38 workers took part in this study and 21 (76%) developed osteomuscular disease. Most returned to previous professional activities, after concluding the program. However, 27 individuals (71%) returned to work with job restrictions. Important constructs emerged from the interviews performed with workers, their supervisors and colleagues, regarding the lack of routine procedures of university policies, exceeding the tasks required in the work environment, and decreases of the workers' roles in the presence of limiting health conditions. The findings led to a redefinition of the role of individuals involved in the Professional Counseling Outplacement Program.Conclusions: These results may contribute to the development of a new professional rehabilitation policy in educational institutions in Brazil.

Emergency management of type IIIB open tibial fractures

We present our therapeutic strategy for the treatment of type IIIB open tibial fractures. It involves emergency internal stabilisation of the bone by locked intra-medullary nailing when appropriate and skin cover using either a pedicled or free muscle flap. Where there is bone loss, a cancellous iliac graft is performed at the same time. Eighteen cases of type IIIB open tibial fractures treated between 1986 and 1995 were analysed. There were 17 men and 1 woman; the average age was 35 years. Each of the 18 patients underwent wound debridement as a primary emergency procedure with no secondary reoperation. Bone fixation was performed by locked intra-medullary nailing (AO nail, How Medica) 6–10 h after trauma. A primary cancellous iliac bone graft was performed in three cases. Cover was applied immediately after nailing (muscular pedicle flaps in 12 cases, muscular free flaps in 6 cases). Local flap cover led to two failures: both these fractures were followed by postoperative complications. The 6 free muscle flaps were successful. The average time to bone union was 6.5 months (range: 3–18.5 months) according to clinical criteria and 9 months (range: 4–27 months) according to radiological criteria. Out of the 18 fractures, 13 were primarily united (72.2% of cases); 3 involved osteitis and 2 nonunion. Sixteen patients were examined again with a mean follow-up of 4.8 years (range: 1–11 years). Six moderate malunions occurred; none needed surgical reoperation. Ankle motion was normal in 7 cases and reduced to below 50% in 9 cases when compared with the healthy ankle. Thirteen patients resumed their previous professional activities. This surgical strategy reduces bone union time, the number of operations and the time spent in hospital; it improves functional results.