Reduced Work Capacity Research Articles

Studying the adaptogenic activity of a series of tetrahydropyrido[2,1-b] [1,3,5] thiadiazine derivatives

Introduction. In the modern world people are exposed to the influence of adverse psychological and physical factors, escalating in intensity. The search for new pharmacodynamic effects of [1,3,5]-thiadiazine derivatives designated by significant biological activity of these compounds is an essential issue.Aim. To research adaptogenic activity of tetrahydropyrido[2,1-b][1,3,5]thiadiazine derivatives using a modified Porsolt Forced Swim Test.Materials and methods. Four substances from the group of 3-R-8-aryl-6-oxo-3,4,7,8-tetrahydro-2H,6Hpyrido[2,1-b][1,3,5]thiadiazine-9-carbonitriles were selected for the research. Rats were divided into a control group, 5 reference groups (amitriptyline, caffeine, thiotriazolin, thiocetam, ginseng) and 4 experimental groups according to the number of the studied original tetrahydropyrido[2,1-b][1,3,5] thiadiazine derivatives.Results. Intragastric injection of substance 2 for 5 days in the modified forced swim test (forced swimming with freight) increased work capacity and endurance of the rats by 103.42% as opposed to the initial results. The detected adaptogenic activity of this tetrahydropyrido[2,1-b][1,3,5]thiadiazine derivative six times exceeds adaptogenic activity of ginseng and seven times that of amitriptyline. The rats in the control group were active for a bit longer time. Ginseng raised the time of activity by 17% at day 5. Caffeine essentially reduced work capacity and endurance. Amitriptyline showed adaptogenic activity at day 3 of the research (increase by 10.4%). Thiotriazolin also showed adaptogenic activity on day 3 of the research (increase by 30.17%). Thiocetam increased the time of activity by 78.55%. Substance 4 had adaptogenic activity too; it increased the time of activity in aversive conditions by 58.25%, which three times exceeds this parameter for ginseng and four times for amitriptyline.

Associated Factors of Stunting and Thinness among Rural Adolescent Girls in Telangana, South India

Adolescent girls are the future mothers and their nutritional needs are critical for the wellbeing of a society and future generations. Stunting and thinness are widely prevalent malnutrition problems among adolescent girls and are known risk factor for obstetric complications and associated with the reduced work capacity. In this connection, an attempt is made in this study to explore the prevalence of stunting and thinness among rural adolescent girls in the newly formed Telangana state in India and their associations with socio-demographic factors. It is a cross sectional study carried out in two districts of Telangana state, India during 2012-2014. WHO guidelines were used to compute the prevalence of stunting and thinness and the data was analyzed on SPSS software. A binary logistic regression was used to identify the risk factors of stunting and thinness and the odds ratios were presented along with the 95% confidence intervals. The prevalence of stunting and thinness among adolescent girls in this study area was 33.4% and 20.4% respectively. Absolute height deficit of 6-13 cm was observed during the adolescence period. Age of the respondent, community, standard of living conditions and occupation of the household head were significantly associated with the stunting and age at menarche, literacy status of the girls was associated with the thinness. The prevalence of stunting and thinness was associated with age of the adolescent girls and standard of living, timely introduction of age-specific nutritional education and practices needed for these adolescent girls.

P5383Autologous adipose-derived stromal cell treatment for patients with refractory angina (MyStromalCell Trial) - 3-years follow-up results

Abstract Background Improvements in medical and interventional therapies have transformed ischemic heart disease into a chronic illness for lot of patients. The disease is in progress and by time patients suffer from cardiac symptoms, reduced work capacity and decline in quality of life. Stem cell therapy is investigated as a treatment option for these patients. Purpose In this study, long-term safety and efficacy of autologous intra-myocardial injections of adipose-derived stromal cells (ASCs) were studied in patients with refractory angina. Methods Sixty patients were double-blinded 2:1 randomised to ASC or saline injections and followed for three years. The patients had significant angina due to ≥1 coronary artery stenosis but preserved left ventricular ejection fraction. ASCs were obtained from abdomen, ex vivo culture expanded and VEGF-A165 stimulated before delivery into the ischemic myocardium. Results The cardiac symptoms, CCS and NYHA classification, were significantly reduced in the ASC group during the three years follow-up period (2.5±0.9 to 1.8±1.2, P=0.002 and 2.4±0.6 to 2.2±0.8, P=0.007, respectively). However, no significant change was observed in CCS or NYHA in the placebo group during the follow-up period (2.5±0.8 to 2.1±1.3, P=0.186 and 2.7±0.6 to 2.4±0.8, P=0.314, respectively). Moreover, the number of weekly angina attacks reported was significantly reduced in the ASC group (P=0.017), but not in the placebo group (P=0.425). For patients in the ASC group, the bicycle exercise time (383±30s to 370±44s, P=0.052) and the exercise performance in watt were un-changed (81±6 to 78±10, P=0.123), but the performance in METs was reduced significantly (4.2±0.3 to 4.0±0.4, P=0.027) during the follow-up period. At the same time in the placebo group, there was a significant decline in bicycle exercise time (437±53s to 383±58s, P=0.001), the exercise performance measured in watt (87±12 watt to 80±12 watt, P=0.019) and in METs (4.5±0.4 to 4.1±0.4, P=0.002). In both groups, significant improved quality-of-life, angina stability, angina frequency and physical limitation score was observed but not for overall satisfaction score. Conclusion Patients receiving ASCs had improved cardiac symptoms during the three years follow-up period, which was not the case for patients in the placebo group. Moreover, patients receiving ASCs had unchanged exercise capacity, in opposition to deterioration in the placebo group. Acknowledgement/Funding Arvid Nilssons Foundation; Rigshospitalets Research Foundation; Aase and Ejnar Danielsens Foundation

Impacts of Climate Change on Outdoor Workers and their Safety: Some Research Priorities.

The literature on the potential impacts of climate change on the health of outdoor workers has received limited attention as a whole, and in sub-Saharan African countries in particular. Yet, substantial numbers of workers are experiencing the health effects of elevated temperature, in combination with changes in precipitation patterns, climate extremes and the effects of air pollution, which have a potential impact on their safety and wellbeing. With increased temperatures within urban settlements and frequent heats waves, there has been a sudden rise in the occurrence of heat-related illness leading to higher levels of mortality, as well as other adverse health impacts. This paper discusses the impacts of extreme heat exposure and health concerns among outdoor workers, and the resultant impacts on their productivity and occupational safety in tropical developing countries with a focus on Sub-Saharan Africa, where there is a dearth of such studies. Aside from the direct effects caused by extreme heat exposure, other indirect health hazards associated with increasing heat among this group includes exposures to hazardous chemicals and other vector-borne diseases. In addition, reduced work capacity in heat-exposed jobs will continue to rise and hinder economic and social development in such countries. There is an urgent need for further studies around the health and economic impacts of climate change in the workplace, especially in tropical developing countries, which may guide the implementation of the measures needed to address the problem.

Road to healthcare professional’s burnout: poor empathy and impaired work ability, are they cause or effect?

Introduction: Occupational stress is inevitable, but prolonged and intense can lead to serious health problems. Neglecting this significant aspect of work and inadequate treatment of the first indicators results in the reduced working capacity of healthcare professionals.
 Material and methods: Assessing working conditions of 100 healthcare professionals regarding stress impact on empathy and workability was the primary goal of this study. A survey was conducted to identify differences between work in intensive care units and other clinical departments all related to empathy, workability, and stress perceiving to determine what is a better predictor of workability.
 Results: In the research group “intensive care units”, significantly lower empathy quotients, poorer workability, and different stressors were registered compared to research groups named “other departments”.
 Conclusion: The main conclusion of the study states different dynamics in the working environment of intensive care units compared to other departments that could potentially harm the personal capacity of healthcare professionals.

A study on nutritional status and environmental conditions of school children residing in social welfare hostels in urban area of a South Indian city

Background: Nutrition plays a vital role, as inadequate nutrition during childhood may lead to malnutrition, growth retardation, reduced work capacity and poor mental and social development. The school age period is nutritionally significant so this study aims is to evaluate the present scenario of nutritional status and environmental conditions of schedule caste school children residing in social welfare hostels.Methods: A community-based cross sectional study was taken up in 9 social welfare hostels in urban Vijayawada city. 312 students were studied in a period of one year, from October 2012 to October 2013. Nutritional status of children was assessed by anthropometric measurements viz BMI, Hb levels. Environmental conditions of the hostel were assessed after thorough inspection of all the environmental conditions. Data was analysed using SPSSv20.Results: Prevalence of underweight was more in boys compared to girls with (27.9%) of boys with grade III thiness as compared to (11.50%) of girls and overall prevalence of underweight of 39.1% in boys as compared to 31.1% girls. Overall prevalence of anaemia was found out to be 97.7% with girls 53.5% and 44.2% in boys. Overcrowding is seen in all the hostels studied. All the rooms are adequately ventilated, and lighting was adequate. Sanitation is found to be satisfactory.Conclusions: This study found out that prevalence of anaemia (97.7%) and malnourishment was high in majority of school children in social welfare hostels.

Evoluzione metodologica dell’invalidità civile in Italia: confronto ragionato tra i sistemi valutativi tabellari, di legge e non, che si sono succeduti negli anni

The authors describe the evolution from 1980 to the present of the tables that describe invalidating states, on which the medical-legal judgments of civil disability in Italy are based.The first part of the work briefly describes the main disabilities, grouped by both body system and percentage value range, that can be found in the tables attached to the main documents applied, or applicable, to the sector: those issued alongside the Ministerial Decree n. 282 of 1980, those that accompanied the Ministerial Decree of February 1982 (still in force today) and those proposed by the Italian Institute of Social Security (INPS) in 2012, which have not yet entered into force.The second part of the paper has two aims. On the one hand, it seeks to underline the change in the pre-eminent type of disability featured in the tables: from osteoarticular diseases, which were the most significant type in the 1980 tables, to neoplastic diseases, which are the most prevalent overall in the 2012 tables.On the other hand, the authors highlight that the tables themselves have evolved, moving towards a more precise definition (both clinical and instrumental) of the organ damage causing the reduction in general working capacity. In the 1980 tables, disability was often evaluated empirically rather than based on the use of functional indices or systematic classification. In the 2012 INPS proposed tables, evaluations of the reduction in working capacity are often based on specific functional parameters for the various organs (EF for the heart, FEV1 for the respiratory system, GFR for the urinary system) or on standardized disability evaluation scales (NYHA classes for heart diseases, EDSS or the Hoehn & Yahr classification for neurological disorders, MMSE or CDR for dementia, the Child-Pugh classification for cirrhogenic hepatopathies).

Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio as Marker of Disease Activity in Rheumatoid Arthritis

AbstractBackground: RA is a chronic disease that carries a sub-stantial burden for both the individual and society. The indi-vidual burden results from musculoskeletal deficits, with attendant decline in physical function, quality of life, and cumulative comorbid risk. The socioeconomic burden, aside from major direct medical costs, is a consequence of functional disability, reduced work capacity, and decreased societal participation. Efforts to establish the diagnosis early, initiate treatment promptly, and design novel treatment strategies to control inflammation and reduce or prevent consequent damage are paramount.Aim of Study: Is to evaluate the Neutrophil-Lymphocytic Ratio (NLR) and Platelet-Lymphocyte Ratio (PLR) as markers of disease activity in rheumatoid arthritis.Methods: This study included 50 patients with rheumatoid arthritis divided into three groups; group 1 including 30 patients with clinically active disease, group 2 including 20 patients without clinical activity and group 3 including 20 apparently healthy age and gender matched volunteers as controls. CBC, ESR, CRP, Anti-CCP, RF were done to all participants.Results: The NLR and PLR of RA patients was signifi-cantly higher compared to that of the controls. Furthermore, a significant correlation between NLR and the DAS 28 score was observed.Conclusion: NLR and PLR is a promising markers in the assessment of RA disease activity.

Changes in disability, reduced working ability and rehabilitation benefits in Hungary between 1990 and 2015

In our study, based on the data of the last 25 years, we analyzed the changes in the cash benefits paid to people with reduced working capacity, currently accounting for nearly 30% of the budget of the National Health Insurance Fund of Hungary. The purpose of our study is to compare the statistical data of the past 25 years and the changes in the legal environment. Our research was based on the data series of the National Health Insurance Fund of Hungary and the Hungarian Central Statistical Office as well as on the public finance reports of the State Audit Office of Hungary and the Ministry for National Economy. For the period under review, we analyzed the extent of the cash benefits paid to people with reduced working capacity, the measures taken to reduce these benefits, and the related legal background. In the long term, we examined the relevant dimension of the complex sociological processes in the background as well as the medical evaluation of the changed working ability. In the last 25 years, benefits (annuity, retirement) paid under different denominations (disability, work ability reduction, health impairment, rehabilitation benefit) are still a decisive part of the health insurance budget (HUF 315 billion in 2016). Serious efforts have been made to replace the previously funded system of invalidity pension and annuity system, with the complex medical, occupational, and social rehabilitation, maintenance and improvement of the remaining state of health. The purpose of the measures is essentially to reduce budget expenditures and to improve the utilization of the amount paid on rehabilitation benefits. The sociological changes that occurred during the long period of time regrettably helped to initially increase the number of recipients of invalidity benefits, to stabilize them at a high level and to have a significant burden on the budget. This could not be counterbalanced by the rehabilitation approach of money supply either. Orv Hetil. 2019; 160(Suppl 1): 29-36.

Factors Related to the Fatigue in Workers in the Cargo Unit of Pt. AngkasaPura Logistic Makassar

Fatigue showed different condition to each individual that can lead to loss of efficiency and a reduction in work capacity and endurance. In this work, the fatigue in of workers in the cargo unit of Pt. AngkasaPura Logistic Makassarwas analyzed. This work is an observational analytic with cross sectional study aimed to determine the relationship of age, energy intake, workload, and work attitude with fatigue in workers in cargo unit. The number of samples were 51 people. Questionnaire was utilized for data collection. SPSS program was used for data analysis. The results showed that there was a relationship between age P = 0.004 (p <0.05), the workload of p = 0.004 (p <0.05), energy intake P = 0.004 (P <0.05) and workload of P = 0.000 (P <0.05) with fatigue workers. Based on the result of research that has been done can be concluded that there is relationship between age, workload, energy intake and work attitude with fatigue in cargo unit at the PT. AngkasaPura LogisticMakassar in 2017.

The Assessment of Mental Load of Air Traffic Controllers Based on Psychophysiological Indicators

The article presents a part of a broader study on identifying and monitoring occupational risks, early detection of signs and symptoms of reversible impairment of physical and mental health of staff, decrease in work capacity and the occurrence of deficient, risky behavior in working practices, as a result of intense neuropsychological or physical professional effort. The results of the study aimed at highlighting: professional effort factors experienced by the trial subjects; occupational risk factors that cannot be avoided and which, due to the nature of the workload and the conditions for completing it, can in time lead to reduced work capacity, premature wear and tear, work-related illnesses and risky behaviors in the workplace, with serious consequences for the safety and health of employees and / or other people; measures to prevent and reduce identified work and stress factors, in order to ensure health and safety at work, optimal use of human resources and maintenance of work capacity throughout the professional life. The results can be implemented in the actions taken to ensure occupational health and safety regulations and to monitor employees’ health conditions and their work capacity in accordance with the legislation in force.

Wage subsidies targeted to jobseekers with disabilities: subsequent employment and disability retirement

In many countries, a non-negligible percentage of the working-age population has impairments that also entail reduced work capacity, and disability retirement is increasing. Despite this, studies on the effects of policies aimed at enhancing the labour market inclusion among people with disabilities, such as targeted wage subsidies, are surprisingly few. In an attempt to fill this gap, we have studied how wage subsidies affect future labour market outcomes for jobseekers with disabilities, in terms of employment and disability retirement. By using inverse probability weighting applied to rich Swedish register data, we contrast participants in the wage subsidy program to observably similar non-participants during a 19-year period. We find that participation was associated with both positive and negative labour market outcomes. On the negative side, participants were less likely to have unsubsidised employment. On the positive side, leaving the labour market through the disability insurance program was somewhat less common among participants. Moreover, using a broader employment measure including subsidised jobs, the participants were found to be employed to a larger extent, which could be interpreted either as locking-in effects or as fostering labour market inclusion.

Results from the ITP World IMPACT Survey (I-WISh): Patients with Immune Thrombocytopenia (ITP) Experience Impaired Quality of Life (QoL) Regarding Daily Activities, Social Interactions, Emotional Well-Being and Working Lives

Results from the ITP World IMPACT Survey (I-WISh): Patients with Immune Thrombocytopenia (ITP) Experience Impaired Quality of Life (QoL) Regarding Daily Activities, Social Interactions, Emotional Well-Being and Working Lives

Корекція негативної поведінки у дітей старшого дошкільного та молодшого шкільного віку засобами соціально­педагогічних і реабілітаційних ігор

The article provides with the analysis of psychological and pedagogical literature on correctional opportunities of rehabilitation and social pedagogical games in preventing negative behavior of preschoolers and primary school children. The concepts "game" and "game activity" are characterized; the priority of games incorrecting children's physical development, health and behavior is defined. The author analyzes the existing classifications of games and proves the efficiency of application of two major games categories, i.e. rehabilitation and social pedagogical ones, according to the main directions of correctional activity, namely health-improving and social and educational. The paper explicates the expediency of rehabilitation games usage to correct physical health, speech development disorders, psychophysiological processes of memory, attention, imagination, thinking, prevention of fast fatigue and reduced working capacity, as well as attests the capacity of social and pedagogical games in correction of children's aggression, impulsiveness, uneasiness, dishonesty, indifference, inclination to negative habits; education of diligence, diligence, politeness, responsiveness, truthfulness, goodwill, and humanity.

Women and men in the Australasian College of Physical Scientists and Engineers in Medicine: workforce survey

A survey was designed to determine aspirations, motivations and workplace experiences of both female and male members of the Australasian College of Physical Scientists and Engineers in Medicine (ACPSEM). The survey collected both quantitate and qualitative data, including open ended questions. This paper reports the survey's qualitative results. The research was approved by Ethics at University of South Australia and endorsed by ACPSEM. All 205 women (30% of total membership) and 440 men were invited to complete the survey online. The data for the qualitative analysis were responses to open-ended questions within the survey. 102 women and 150 men completed surveys were received, with 66 surveys analysed, before data saturation was reached. The survey revealed a number of themes that reflect concerns and opportunities identifying the direction for improving work-life balance and gender equity within the medical physics profession in Australasia. Issues around managing challenging workloads and professional development were amplified for women with children and child-rearing responsibilities, directly contributing to a reduction in work capacity and a reorientation of work-life priorities. The survey provides direction for strategies to improve work-life balance and enable equitable engagement in the profession. The first is to identify and develop role models that actively model successful work-life balance and flexibility in gender roles and in professional conduct. The second is to improve the management skills of current and emerging administrators, advocating for improved work conditions for medical physics professionals at an organisation level. Finally, efforts need to be made to establish flexible professional development and career progression opportunities amongst those that are unable to commit to large workloads, which is common for those with child-rearing responsibilities. The realisation of these strategic goals will reduce the identified barriers to full female participation in the workforce, and shift gender-based subcultures within the workplace.

Study on the correlation between work-related musculoskeletal disorders and work ability among nurses at three level general hospital in Xinjiang

Objective: To investigate the correlation between work-related musculoskeletal disorders (WMSDs) and work ability (WA) among nurses in Xinjiang. Methods: A total of 1 873 nursing staff in the Departments of Internal Medicine, Surgery, Emergency and ICU Department, Operating Room and Supply Room of 6 Grade 3 General Hospitals in Xinjiang Beijiang Region were randomly selected by means of random sampling, and revised Nordic National Musculoskeletal Disorders Standard Questionnaire and Work Ability Index Scale were used to evaluate the status of nursing WMSDs and WA. Results: (1) The symptom incidence of work-related musculoskeletal disorders among nursing staff in the past year was 77.42%; The highest symptom incidence in all parts of the body was waist, neck, shoulder and back, and the symptom incidence was 63.59%, 59.80%, 47.78% and 37.32%, respectively; (2) The total score of nursing staff's work ability was (35.91±5.143) ; The proportion of "poor" , "middle" , "good" and "excellent" were 5.23%, 47.41%, 41.43% and 5.93% respectively; (3) The total working capacity of the sick group was (35.11±5.044) , The working ability of the non-diseased group was (38.64±4.507) , The difference between the two groups was statistically significant (t=13.773, P<0.01) ; There was a significant difference in the level of work ability between the two groups (z=-12.335, P<0.01) ; The working ability of "poor" and medium in the injury group was significantly higher than that of the non injury group, while the working ability was "better" and "excellent" than that of the non injury group; (4) The working ability of nursing staff of different age in WMSDs injury group was lower than that in non injury group, the difference was statistically significant (P<0.01) ; There was a negative correlation between the working ability of the injury group and the length of service, that is, with the increase of the length of service, the working ability index decreased (P<0.01) ; There was a positive correlation between the working ability of the non injury group and the length of service, that is, with the increase of the length of service, the work ability index increased gradually, but the correlation was not statistically significant (r=0.063, P=0.195) ; (5) The working ability of nursing staff of different departments in WMSDs injury group was lower than that in non injury group, the difference was statistically significant (P<0.01) . (6) Multiple linear regression analysis showed that the factors influencing the working ability of nursing staff were: past medical history, WMSDs disease, length of service and night shift frequency; Conclusion: The symptom incidence of WMSDs was high among nurses; Work Ability at a moderate level; work-related musculoskeletal disorders is associated with reduced ability of nursing staff; work-related musculoskeletal disorders are associated with reduced working capacity of nursing staff.

Employment status of workers with a diagnosed occupational disease in Croatia: a 10-year trend (2005-2014).

Occupational diseases (ODs) often have a chronic, progressive course, resulting in reduced work capacity and quality of life, prolonged sick leaves, unemployment, early retirements, and disability claims. The aim of this retrospective study was to see how diagnosed ODs affected the employment of 95 Croatian workers between 2005 and 2014. To do that, we reviewed archived data and made a telephone survey. The lowest age at which an OD was diagnosed was 20 years in women and 22 in men, while the shortest duration of work before OD diagnosis was one year for both genders. The most common ODs were overuse syndromes on the arms, carpal tunnel syndrome in particular, diagnosed mostly in textile and office workers. Of the 95 participants, 12 lost their jobs since the OD diagnosis, 46 retired, and 37 continued to work. Significantly more participants became unemployed after OD diagnosis in the period 2010-2014 than 2005-2009 (9 out of 43, 21 %, vs. 3 out of 52, 6 %, P<0.05). Only five participants were included in an occupational rehabilitation programme. Our findings warn against the deterioration in care for workers diagnosed with OD in Croatia.

Performance of the Michigan Hand Outcomes Questionnaire in hand osteoarthritis

To investigate the performance of the Michigan Hand Outcomes Questionnaire (MHQ) in hand osteoarthritis (OA) by evaluating truth, discrimination and feasibility. Symptomatic hand OA patients from the Hand Osteoarthritis in Secondary Care (HOSTAS) cohort completed questionnaires (demographics, MHQ, Australian/Canadian Hand Osteoarthritis Index [AUSCAN], Functional Index for Hand Osteoarthritis [FIHOA] and visual analogue scale [VAS] pain) at baseline (n=383), 1- and 2-year follow-up (n=312, n=293). Anchor questions at follow-up assessed whether pain/function levels were (un)acceptable and had changed compared to baseline. Correlations between MHQ and other pain/function questionnaires were calculated. Validity of unique MHQ domains (work performance, aesthetics, satisfaction), discrimination across disease stages, and responsiveness were assessed by categorizing patients by external anchors (employment, joint deformities, erosions, and anchor questions). Between-group differences were assessed with linear regression, probability plots and comparison of medians. MHQ pain and function subscales correlated moderately-to-good with other instruments (rs 0.63-0.81). Work performance scores were worse in patients with reduced working capacity than in employed patients. Aesthetics scores were worse in patients with more deformities. Patients with unacceptable complaints had worse satisfaction scores. All pain/function instruments discriminated between patients with acceptable vs unacceptable pain/function, while only MHQ activities of daily living (ADL), FIHOA, and MHQ aesthetics could discriminate between erosive and non-erosive disease. MHQ and AUSCAN were most responsive. MHQ has several unique aspects and advantages justifying its use in hand OA, including the unique assessment of work performance, aesthetics, and satisfaction. However, MHQ, AUSCAN and FIHOA appear to measure different aspects of pain and function.

The capacity to work puzzle: a qualitative study of physicians\u2019 assessments for patients with common mental disorders

BackgroundEntitlement to sickness benefits is a legal process requiring health-related reduced work capacity confirmed by a physician via a sickness certificate. However, there is a knowledge gap concerning physicians’ clinical practice of work capacity assessments for patients with common mental disorders (CMD). Physicians claim more knowledge and skills in how to actually do the assessments. The aim of this study was to explore physicians’ tacit knowledge of performing assessments of capacity to work and the need for sickness absence in patients with depression and anxiety disorders.MethodsWe performed a qualitative study with open-ended interviews and a short video vignette of a physician and a patient with depression as stimuli. Participating physicians (n = 24) were specialized in general practice, occupational health or psychiatry and experienced in treating patients with depression and anxiety. Interviews were audio-recorded and transcribed verbatim. Inductive content analysis was used as the analytical tool.ResultsFive categories were identified. Category 1 identified work capacity assessment as doing a jigsaw puzzle without any master model. The physicians both identified and created the pieces of the puzzle, mainly by facilitating strategies to make the patient a better supplier of essential information. The finished puzzle made up a highly individualized comprehensive picture required for adequate assessment. Categories 2–4 identified the particular essential pieces of information the participants used, relating to the patient’s disorder, capacity in the work place and contextual everyday life. For the sickness absence assessment, apart from decreased work capacity, the physicians also took particulars of the work place into account; e.g. could the work place handle an employee with reduced capacity.ConclusionsPhysicians’ tacit knowledge of assessing work capacity and the need for sickness absence for patients with CMD was identified as doing a jigsaw puzzle. The physicians became identifiers and creators of the pieces of the puzzle using a broad palette of essential information. Our findings contribute to the knowledge gap on clinical assessment and can be used as an educational tool. Because they are based on the professions’ tacit knowledge, acceptance of the model can be expected to be high.

Quality of life, performance status, and work capacity after post-endoscopic retrograde cholangiopancreatography pancreatitis

Objectives: This study evaluated the long-term consequences of post-endoscopic retrograde cholangiopancreatography pancreatitis (PEP) on health related quality of life (HRQOL), performance status, and work capacity.Materials and methods: A follow-up study with prospective outcome measurements on patients with previous PEP and matched controls from a Danish cohort of 772 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP). HRQOL was evaluated by the short form 36 health surveys, performance status by the Zubrod score, and work capacity by employment status. Multivariable models were applied to adjust for potential confounders.Results: Twenty-nine cases and 49 controls were included. Twelve (41%), eight (28%), and nine (31%) patients had mild, moderate, and severe PEP, respectively. Mean follow-up time was 4.8 ± 1.7 years. PEP was associated with long-term reduced mental HRQOL (−13.0 role-emotional score points, 95% CI: −25.4; −0.52). An increased Zubrod score representing reduced performance status was present in 12 of the 29 cases (41.4%) and in nine of the 49 controls (18.4%), p = .002. Reduced work capacity was present in 14 of the 29 cases (48.2%) and in 12 of the 49 controls (24.4%), p = .023.Conclusions: This study indicates that PEP has a detrimental effect on long-term HRQOL, performance score, and work capacity.