Unfitness For Work Research Articles

Students or medical professionals: whose knowledge improved after social-medicine training? Results from a quasi-experimental evaluation study

PurposeRehabilitation professionals are faced with judging and describing the social-medicine status of their patients. Rehabilitation professionals must know the core concepts of acute unfitness for work, psychological capacities, and long-term work capacity. Acquiring and applying this knowledge, requires training. The research question is if and to what extent medical professionals and students’ knowledge changes after social medicine training.MethodsThis quasi-experimental study was carried out in the real-life context of social medicine training. Psychology students (n = 42), physicians/psychotherapists (i.e. state-licensed health professionals) (n = 44) and medical assistant professionals (n = 29) were trained. Their social medicine knowledge was measured before and after training by a 10-min expert-approved and content valid knowledge questionnaire. Three free-text questions had to be answered on the essential aspects of present and prognostic work ability and psychological capacities. Answers were rated for correctness by two experts. Paired t tests and variance analysis have been calculated for group comparisons.ResultsAll groups improved their social medicine knowledge from the pre- to the post-test. The students started with the lowest level of knowledge in the pre-test. After training, 69% of the physicians/psychotherapists and 56.8% of the medical assistant professionals, but only 7% of the students, obtained maximum scores for naming psychological capacities.ConclusionsSocial medicine knowledge increased after a training course consisting of eight lessons. The increase was greater for medical assistant professionals and physicians/psychotherapists than for students. Social medicine training must be adjusted to the trainee groups’ knowledge levels.

Allergie aux venins d’hyménoptères : aspects professionnels et médico-légaux

Anyone exercising their professional activity in an outdoor environment can develop IgE hypersensitivity to Hymenoptera venom at the place of work, or during the working hours. The prevalence of professional anaphylaxis and mortality associated with Hymenoptera bites appears to be low, but is nevertheless difficult to assess and probably underestimated. Some professions are accepted as risk factors, but preventive measures remain difficult to put in place. Moreover, the impact of an allergy to hymenoptera venoms on professional life is real, and involves the constraint of immunotherapy, work capacity and even the occurrence of post-traumatic stress. Its recognition as a work accident, occupational disease, unfitness for work and incapacity for work may limit the social consequences for patients.

Medical unfitness for work at sea: causes and incidence rate over a 12-year period in France

BackgroundThe purposes of the study were first to determine the incidence rate of medical unfitness for work at sea among French seafarers, second to identify the conditions (diseases or accidents) causing such incapacity so as to set up prevention measures where possible and third to ascertain whether there were any overrepresentations of diseases according to category of unfit seafarers (fishers, merchant seafarers, shellfish farmers and professional sailors).MethodsAn exhaustive, observational, descriptive, retrospective epidemiological and nosological study was carried out based on the medical coding of files stored in the Aesculapius® national database, which registers all medical data regarding seafarers presenting at the French seafarers’ health services. The increasing rate of permanent medical unfitness for work at sea was calculated in relation to the annual number of registered seafarers. A 12-year span was chosen in an attempt to ascertain the different sociodemographic categories associated with incapacity.ResultsIn all, 2392 seafarers were declared unfit for work at sea. This represents a permanent medical unfitness for work at sea incidence rate of below 1% for all French seafarers examined for medical fitness between 2005 and 2016.The average age of the population of unfit seafarers was 48. The average time spent at sea before being declared unfit for work at sea was 15.5 years. Sixty-seven percent of the seafarers declared unfit had been working in the fishing sector.The main reasons for deciding permanent unfitness for work at sea were: rheumatological conditions associated specifically with the spine; injuries relating to accidents or other external causes, mostly affecting the upper limbs; mental and behavioural disorders, including mood disorders and particularly addictions; and diseases of the circulatory system, namely coronopathies. The incidence rate of medical unfitness for work at sea was seen to increase between 2005 and 2016, but a decrease due to the dilution effect was noted in 2015.ConclusionsPermanent unfitness seldom occurs among French professional seafarers. Prevention measures must be focused on musculoskeletal disorders, psychiatric affections and coronary conditions as well as on combatting maritime accidents, especially in the professional fishing sector, where such affections and accidents are overrepresented.

L’inaptitude au travail, dispositif de protection ou de relégation des salariés ?

L’inaptitude au travail concernerait aujourd’hui près d’un million de salariés en France, dont plusieurs dizaines de milliers sont chaque année déclarés totalement inaptes et finalement licenciés. Dispositif de protection de la santé des salariés, l’inaptitude conduit finalement à exclure les plus âgés ou abîmés, parfois à cause de la nature du travail exercé. Alors que les entreprises y sont contraintes par la loi, peu de salariés sont en effet reclassés en interne sur un autre poste, compatible avec leur état de santé. Grâce à l’analyse des parcours de vingt salariés jugés « inaptes », notre enquête vise à comprendre le processus qui conduit une partie d’entre eux vers le chômage et l’exclusion. En fait, le licenciement pour inaptitude vient toujours clore un parcours long et complexe, qui commence par une atteinte à la santé, et qui est ensuite ponctué d’arrêts maladie (longs ou fréquents), engendrant parfois isolement et conflits, mais aussi des retours plus ou moins réussis. Les aménagements et les restrictions apparaissent plus ou moins respectés selon les univers productifs et peuvent conduire ainsi malades et accidentés au licenciement et à une situation éprouvante de chômage et de recherche d’emploi.

Could Resilience Predict the Outcome of Psychiatric Rehabilitation Patients?

Background: Individual resistance to burdens such as stress, adversity, and even disasters is called “resilience”. Whereas most studies of resilience investigate post-traumatic stress disorder, fewer studies treat anxiety and depressiveness in mentally healthy populations. The present pilot study investigates whether resilience lessens the severity of depressive symptoms. Aim was to figure out whether further research is needed on the relation of resilience both to depression and to rehabilitation from it in regard to fitness for work. Design/Setting/Population: A retrospective, non-blind, non-randomized analysis of charts of 503 stationaryinpatient-patients was performed. Patients without age limits who suffered from diseases of the depressive spectrum (F32, F33) and also adjustment disorder (F43.2), dysthymia (F34.1), and neuras-thenia (F48) according to ICD 10 were included. BDI and resilience scale, state of fitness or unfitness for work, were analysed with correlation analysis and descriptive statistics by the SPSS program. Results: Analysis revealed that resilience and depressive symptoms are inversely related. The higher the resilience the lower the BDI score, indicating a lower burden of depressive symptoms. Resilience also seems to influence important outcome factors of rehabilitation such as reintegration in work and remission of depressive symptoms. Patients who either were fit for work at the beginning of rehabilitation or were dismissed as fit for work had higher resilience scores than those who were unfit for work. Conclusion: This pilot study encourages further investigation of the relation of resilience not only to depressive disorders, but also to rehabilitation and social reintegration after depression.

Early predictors of the long-term outcome of low back pain—results of a 22-year prospective cohort study

poor outcome of low back pain in patients seen in general practice is related to the pain history, physical impairment and working conditions, at least in short-term follow-ups. We do not know if these findings hold, seen from the perspective of decades. to show if patients consulting the GP for the first time regarding an episode of low back pain have excess poor outcome 22 years later and, if so, whether the best predictors are data based on the symptoms, clinical signs or work history. The design of the study is a 22-year follow-up of an inception cohort of 78 patients with low back pain. The setting of the study is a single general practice in a suburb of Copenhagen, Denmark. selected predictors were separated into pain characteristics, clinical signs and indicators related to the work history. Outcome measures were the 1-year period prevalence of low back pain, use of painkillers for low back pain, use of health care providers, impairments due to low back pain and unfitness for work caused by low back pain. The influence of the predictors was assessed by relative risks. after 22 years, four out of five patients still experienced low back pain. The perception of poor working conditions correlates with recurrent low back pain, intake of painkillers and limitations to daily life. compared with pain history and clinical findings, the perception of workload is a better predictor of the long-term outcome of low back pain.

„They’ll never come back ...” - Anspruch und Wirklichkeit der beruflichen Reintegration dienstunfähiger Lehrkräfte

The reactivation of teachers with experience of both life and the profession who have become unfit for work is regarded by politicians not only as a suitable measure against the imminent lack of teaching staff, but also as a promising strategy for reducing the cost of health care. The aim of our study was to gather new evidence- based information on the occupational reintegration of teachers who took early retirement and to investigate to what extent official medical reactivation examinations are an effective instrument of tertiary prevention. DATABASE AND METHODS: In a prospective total assessment (the entire state of Bavaria) over the period of 1997 - 1999 all official medical examinations in the public health centres (Gesundheitsamter und Medizinische Untersuchungsstellen der Bezirksregierungen) were evaluated with regard to the reactivation of teachers unfit for work. The analysis included e. g. socio-demographic/occupational factors, the morbidity spectrum, rehabilitation and the assessment of performance. The answers given in a standardised, anonymous questionnaire provided the database. Evaluation was carried out by means of descriptive statistics. Of the 1465 teachers studied, 64 % (n = 939) were women and 36 % (n = 526) were men. The median age was 53 years (range: 31 - 63 years), and the proportion of over 60-year-olds was 5.5 %. 22 % of those who took early retirement were recognised as being severely disabled. In 77 % of cases, examination of unfitness for work was carried out at the order of the authorities. 57 % (n = 835) of the teachers had taken part in at least one medical rehabilitation measure, 13 % (n = 190) in at least one occupational rehabilitation measure. Within the morbidity spectrum, psychic and psychosomatic illnesses (F-ICD10) took first place with a share of 59 % the prevalence in female teachers of such illnesses was significantly higher than that in male teachers (p < 0.05). Among the psychiatric diagnoses, depressive illnesses dominated (share: 35 %). The most frequent somatic diseases were muscular/skeletal disorders (M-ICD10) in 12 % of cases, then cardiovascular disorders (I-ICD10) in 7 % and malignant tumours (C-ICD 10) in 5 % of cases. In 33 % of cases multi-morbidity was found. 93 % (n = 1,360) of the teachers investigated in follow-up examinations were again classified as unfit for work. In only 7 % (n = 105) reactivation was recommended by the physician; the lowest reactivation quotas were found among teachers with psychic illnesses and grammar school teachers. In who teachers that returned to work, compared to those still unfit for work, a lower age and lower prevalence of severe disability, multi-morbidity and psychic disturbances were objectified. Teachers who take early retirement return to the profession only in exceptional cases. The time and expense needed for reactivation examinations should be critically compared with the benefits. The same applies to the quality of the results of intervention and rehabilitation measures for restoring psychological and physical health. In this context problem-oriented disability management appears superfluous.

Burden of illness imposed by severe sepsis in Switzerland.

This study aims to determine the burden of illness imposed by severe sepsis in Switzerland by evaluating the direct and indirect patient-related costs for critically ill patients with severe sepsis. In order to estimate the direct costs a retrospective analysis was undertaken using records from 61 adult patients treated in three intensive care units (ICUs) in three different University hospitals in Switzerland, in 2001. Resource use was determined by a bottom up approach and valued using centre-specific unit costs for medication, nutrition, blood products, disposables and official tariffs for laboratory and microbiology analysis, diagnostic services, and clinical procedures. By adding centre-specific personnel and basic bed (hotel) costs total direct costs in the ICU were calculated. Indirect costs resulting from unfitness for work, early retirement, and premature death were calculated using official Swiss statistics for the years 1998-2000. The mean total direct costs for a severely septic patient are CHF 41,790 (+/- 33,222 CHF) or CHF 3244 (+/- 757 CHF) per day. Nonsurvivors cause significantly higher costs than survivors (CHF 45,956 vs. CHF 37,759, p <0.001). The total intensive care costs in Switzerland due to severe sepsis amount to CHF 146-355 million. Indirect costs were estimated to range from CHF 347 to 844 million (predominantly due to premature death). Consequently the burden of illness of severe sepsis can be estimated to range from CHF 493 to 1199 million per year in Switzerland (1 CHF = 0.662 Euro in 2001). Patients suffering from severe sepsis in Switzerland have a high mortality rate and spend a prolonged time in the ICU, leading to high direct and indirect costs. Particularly productivity losses due to premature death represent a considerable burden to the Swiss society.

Burden of illness imposed by severe sepsis in Switzerland.

This study aims to determine the burden of illness imposed by severe sepsis in Switzerland by evaluating the direct and indirect patient-related costs for critically ill patients with severe sepsis. In order to estimate the direct costs a retrospective analysis was undertaken using records from 61 adult patients treated in three intensive care units (ICUs) in three different University hospitals in Switzerland, in 2001. Resource use was determined by a bottom up approach and valued using centre-specific unit costs for medication, nutrition, blood products, disposables and official tariffs for laboratory and microbiology analysis, diagnostic services, and clinical procedures. By adding centre-specific personnel and basic bed (hotel) costs total direct costs in the ICU were calculated. Indirect costs resulting from unfitness for work, early retirement, and premature death were calculated using official Swiss statistics for the years 1998-2000. The mean total direct costs for a severely septic patient are CHF 41,790 (+/- 33,222 CHF) or CHF 3244 (+/- 757 CHF) per day. Nonsurvivors cause significantly higher costs than survivors (CHF 45,956 vs. CHF 37,759, p <0.001). The total intensive care costs in Switzerland due to severe sepsis amount to CHF 146-355 million. Indirect costs were estimated to range from CHF 347 to 844 million (predominantly due to premature death). Consequently the burden of illness of severe sepsis can be estimated to range from CHF 493 to 1199 million per year in Switzerland (1 CHF = 0.662 Euro in 2001). Patients suffering from severe sepsis in Switzerland have a high mortality rate and spend a prolonged time in the ICU, leading to high direct and indirect costs. Particularly productivity losses due to premature death represent a considerable burden to the Swiss society.

Case Note - BGH 11 November 1997

The decision of the German Federal Supreme Court adds to its jurisprudence on the circumstances in which a tortfeasor can be made liable for psychological damage to the injured party (compare on this point also the case notes published in this journal on the leading decision of the Supreme Court (BGHZ 132, 341 = JZ 1996, 1080 (note Schlosser), ERPL 1998, 249 ff.). For the facts of the case, reference is made to the first paragraph of the attached case comment, which examines the problem from the point of view of English law. In its reasoning, the Supreme Court deals, inter alia, with liability in relation to a nervous condition and with the issues identified in the statements of principle: Statements of principle: a) The answer to the question whether a harmful event can be so minor that under the principles of the Supreme Court decision BGHZ| 132, 341 ff. liability for psychological harm can be excluded depends on the primary injury suffered by the injured party. b) If the unfitness for work asserted by the injured party arises from a psychological inability to deal with the harmful event, the tortfeasor may be obliged to compensate for the length and amount of any loss of income that may come into consideration, if the prognosis is that serious risks to the development of the injured party's future career because of the aforementioned psychological difficulties exist with a sufficient probability to statisfy §287 of the German Code of Civil Procedure.

Social Class and Social Observation in Edwardian England

In 1887 Charles Booth addressed the Royal Statistical Society on the condition and occupations of the inhabitants of the Tower Hamlets, after which Leone Levi, a well-known statistician of the hard school, posed a testing question:‘Who was a poor man? … The author [Andrew Mearns, writer of The Bitter Cry of Outcast London] had not mentioned the causes of poverty … His own impression was that poverty proper in the district which had been described was more frequently produced by vice, extravagance and waste, or by unfitness for work, the result in many cases of immoral habits, than by real want of employment or low wages.’

Daily Variations in Sickness Absence

Probabilistic models describe the relationship between the day of the week on which spells of sickness absence begin and their subsequent duration, particular attention being paid to the tendency for employees to delay the return to work until after the weekend. Also, the pattern of absence inception by day of the week is studied in relation to the null hypothesis of an even distribution over the whole week for the inception of “unfitness for work”. The absence experience of a population of day workers on a five‐day week is used as illustration.