Work Disability Research Articles

A pilot randomized controlled trial on motivational interviewing in return to work after work disability

PurposeDoes 15-minute consult using Motivational Interviewing (MI) have a positive effect on (1) time until return to work (RTW) and relapse after work resumption for patients who have been work disabled for longer than 3 months, and (2) can psychological variables (i.e., work-related motivation, work-related psychological needs, quality of life and work ability) explain these results? Methods265 patients were included in a pilot randomized controlled trial, parallel and single blind, with an allocation ratio of 1:1 comparing the consult with MI with the consult as usual group (CAU). There was a 12-month follow up on actual RTW and relapse for both groups. The psychological outcomes were work-related motivation (MAWS), work-related psychological needs (BPNSFS), quality of life (EQ5D5L)) and work ability (WAI). Measurement of these indicators took place at baseline, 1 week after the intervention and 3 months after the intervention. ResultsPatients in the MI group showed faster RTW and had a lower chance of relapse compared to those in the CAU condition. No significant differences were found between MI and CAU for the psychological outcomes. ConclusionsBased on our results, there is some evidence that counseling including MI helps work-disabled patients to RTW faster and experience less relapse. However, much remains unknown about the underlying psychological mechanisms explaining this effect. Suggestions are made for the full RCT.

Recovery expectations can be assessed with single-item measures: findings of a systematic review and meta-analysis on the role of recovery expectations on return-to-work outcomes after musculoskeletal pain conditions.

The objective of this systematic review is to quantify the association between recovery expectations and return-to-work outcomes in adults with musculoskeletal pain conditions. In addition, this review has the second objective to compare the predictive utility of single-item and multi-item recovery expectation scales on return-to-work outcomes. Relevant articles were selected from Embase, PsycINFO, PubMed, Cochrane, and manual searches. Studies that assessed recovery expectations as predictors of return-to-work outcomes in adults with musculoskeletal pain conditions were eligible. Data were extracted on study characteristics, recovery expectations, return-to-work outcomes, and the quantitative association between recovery expectations and return-to-work outcomes. Risk of bias was assessed using the Effective Public Health Practice Project. Odds ratios were pooled to examine the effects of recovery expectations on return-to-work outcomes. Chi-square analyses compared the predictive utility of single-item and multi-item recovery expectation scales on return-to-work outcomes. Thirty studies on a total of 28,741 individuals with musculoskeletal pain conditions were included in this review. The odds of being work disabled at follow-up were twice as high in individuals with low recovery expectations (OR = 2.06 [95% CI 1.20-2.92] P < 0.001). Analyses also revealed no significant differences in the predictive value of validated and nonvalidated single-item measures of recovery expectations on work disability (χ 2 = 1.68, P = 0.19). There is strong evidence that recovery expectations are associated with return-to-work outcomes. The results suggest that single-item measures of recovery expectations can validly be used to predict return-to-work outcomes in individuals with musculoskeletal pain conditions.

How do low-income single-mothers get by when unemployment strikes: Patterns of multiple program participation after transition from employment to unemployment.

Little is known about longitudinal patterns of welfare program participation among single mothers after they transition from employment to unemployment. To better understand how utilization patterns of these welfare programs may change during the 12 months after a job loss, we used the 2008 Survey of Income and Program Participation to examine the patterns of participation in Medicaid, the Supplemental Nutrition Assistance Program, Temporary Assistance for Needy Families, and unemployment insurance among 342 single mothers who transitioned from employment to unemployment during the Great Recession. Using sequence analysis and cluster analysis, this paper identified four distinct patterns of program participation: (a) constantly receiving in-kind benefits; (b) primarily but not solely receiving food stamps; (c) inconsistent unemployment insurance or Medicaid-based benefits; and (d) limited or no benefits. Almost two-fifths of our sample of single mothers received inconsistent, limited, or no benefits. Results of the multinomial regression revealed that race, work disability, poverty, homeownership, and region of residence were significant factors that influenced whether study subjects participated in or had access to social safety net programs. Our findings illustrate the heterogeneity in patterns of multiple program participation among single mothers transitioning from employment to unemployment. Better understanding these varied patterns may inform decisions that increase the accessibility of US social safety net programs for single mothers during periods of personal economic hardship.

Cooperation between Public Primary Health Care and Occupational Health Care Professionals in Work Ability-Related Health Issues.

Work disability creates significant expenses for nations and causes human suffering by limiting patients’ lives. International studies show that to enhance recognition of and support for work disability, cooperation, mutual trust, and information exchange between public primary health care and occupational health care must be strengthened. However, little is known of how health care professionals experience this cooperation. The aim of this study was to understand how professionals experience the cooperation between public primary health care and occupational health services regarding patients’ work ability. Semi-structured interviews were conducted with 29 health care professionals working in five small cities (<10,000 inhabitants) in Finland. Interviews were audio and video recorded, transcribed verbatim, and analyzed through inductive thematic analysis. Three key themes were identified from the interviews: attitudes toward the other health care sector, the exchange of information, and resources for cooperation. Professionals seem to have poor knowledge about the services available and how care is given in the other sector, appearing to lead to weak mutual trust. The public primary health care professionals especially emphasized the benefits of cooperation, but several issues were mentioned as barriers to cooperation. These results can be used when planning effective patient paths and service provisioning models.

Effectiveness of ergonomic interventions on work activity limitations in adults with rheumatoid arthritis: A systematic review.

Rheumatoid arthritis (RA) is one of the leading causes of work disability in the United States. Ergonomic interventions offer an individualized treatment approach, and when used in conjunction with pharmacological treatment interventions, may improve work outcomes and improve the overall quality of life for individuals with RA. To identify the current body of evidence regarding the effectiveness of ergonomic interventions in reducing work activity limitations in adults with RA. A systematic review was conducted to identify articles of ergonomic interventions targeting working adults with RA. The CONsolidated Standards of Reporting Trials (CONSORT) checklist and Non-Pharmacological Treatment (NPT) Extension evaluated the reporting quality of each randomized controlled trial (RCT), and the Grading of Recommendation Assessment, Development, and Evaluation (GRADE) evaluated the quality of the evidence. Six studies were identified and reviewed for the quality of their reporting on evidence related to work activity limitations. Sixty-six percent of the items on the CONSORT checklist were fully reported by all studies and analysis through the GRADE framework demonstrated moderate confidence that the reported effects of ergonomic interventions on work activity limitations in the studies are accurate. This review revealed varied results for the effectiveness of ergonomic interventions on work activity limitations and at-work productivity. The results of this review indicate a need for further investigation. Future studies should focus on reviewing specific ergonomic interventions to determine the dosage needed to see results in reducing work activity limitations for working adults with RA.

Psychotherapy and change in mental health-related work disability: a prospective Finnish population-level register-based study with a quasi-experimental design

BackgroundMental disorders are a major cause of work disability among the working-age population. Psychotherapy has shown to be an effective treatment for mental disorders, but the evidence is mainly based...

Sex-Differences in Pain and Opioid Use Disorder Management: A Cross-Sectional Real-World Study.

(1) Background: It is essential to focus attention on sex-specific factors which are clinically relevant in pain management, especially with regards to opioid use disorder (OUD) risk. The aim of this study was to explore potential sex-differences in chronic non-cancer pain (CNCP) outpatients. (2) Methods: An observational cross-sectional study was conducted under CNCP outpatients with long-term prescribed opioids (n = 806), wherein 137 patients had an OUD diagnosis (cases, 64% females) and 669 did not (controls, 66% females). Socio-demographic, clinical, and pharmacological outcomes were analyzed. (3) Results: Female controls presented an older age and less intensive pain therapy but higher psychotropic prescriptions and emergency department visits compared to male controls. Meanwhile, cases demonstrated a younger age, higher work disability, double morphine equivalent daily dose, and benzodiazepine use compared with controls. Here, female cases showed an 8% greater substance use disorder (OR 2.04 [1.11–3.76]) and 24% lower tramadol use, while male cases presented a 22% higher fentanyl use (OR 2.97 [1.52–5.81]) and reported the highest number of adverse drug reactions (24%, OR 2.40 [1.12–5.16]) compared with controls. (4) Conclusions: An OUD individual risk profile was evidenced with sex-differences to take into consideration to design equal prevention programs.

“I noticed that when I have a good supervisor, it can make a Lot of difference.” A Qualitative Study on Guidance of Employees with a Work Disability to Improve Sustainable Employability

PurposeFor employees with a work disability adequate daily guidance from supervisors is key for sustainable employability. Supervisors often lack expertise to guide this group of employees. Mentorwijs (literal translation: Mentorwise) is a training for supervisors to improve the guidance of employees with a work disability. The aim of this study was to investigate the experiences of employees with a work disability regarding: (1) the guidance from their supervisors (who followed the Mentorwijs training), (2) which differences they notice in the guidance due to the Mentorwijs training, and (3) what kind of aspects they consider important in their guidance to achieve sustainable employability.MethodsA qualitative study was performed with semi-structured (group) interviews among twenty-one employees with a work disability. Thematic analysis was performed to analyze the data.ResultsThemes that followed from the interviews were: (1) work tasks and conditions can facilitate or hinder sustainable employability: (2) relationships among employees and with supervisors can affect sustainable employability; (3) a desire for new opportunities and challenges; and (4) a need for supervisor skills to facilitate sustainable employability, i.e. appreciation, availability of help, dealing with problems, listening, attitude and communication. According to employees, changes were mainly noticed in supervisor skills.ConclusionsEmployees with a work disability were very satisfied with the guidance of supervisors who followed the Mentorwijs training. To improve sustainable employability, training of supervisors should focus more on adequate work conditions, providing employees opportunities to learn new work tasks and improving supervisors’ skills regarding appreciation, attitude and communication.

Exploring mental health disability gaps in the labour market: the UK experience during COVID-19

People with long-term mental health problems that affect their daily activities are a growing proportion of the UK working population and they have a particularly low employment rate. We analyse gaps in labour market outcomes between mental health disabled and non-disabled people during the COVID-19 pandemic in the UK. We also decompose the outcome gaps in order to explore the relative importance of different factors in explaining these gaps. Our results suggest that the employment effects of the pandemic for mental health disabled people may have been temporary. However, they were more likely to be away from work and/or working reduced hours than people without a disability. Workers with mental health disability were over-represented in part-time work and in caring, leisure and other service occupations, which were disproportionately affected by COVID-19 and the economic response. This is important new evidence on the contribution of segmentation and segregation in explaining the labour market position of people with mental health disability. The longer term effects of the pandemic were still not apparent at the end of our analysis period (2021:Q3), but the concentration of disabled workers in cyclically sensitive sectors and part-time work means that they will always be particularly vulnerable to economic downturns.

Impacts of past occupational injury and long-duration compensated work disability on future hospital admissions.

ObjectivesTo investigate changes in the prevalence and nature of hospital admissions towards the end of long-duration workers’ compensation claims (&gt;2 years), and afterwards. To examine differences in hospitalisation when workers’ compensation claims end due to either a 260-week duration limit, or otherwise, and comparisons with hospitalisations of a community comparator. ApproachA retrospective cohort study examined 2475 workers, termed the s39 group, whose workers’ compensation ceased due to a 260-week limit in 2017/2018 under s39(1) of the Workers’ Compensation Act New South Wales 2012 legislative amendments (Australia). Comparator groups were injured workers with long-duration claims whose compensation ceased independently of s39 (termed the injured control group, N=3626) and a community group (N=8485). Workers’ compensation records were linked to national social security payments, and hospital admissions. Outcomes describe the prevalence and diagnostic categories of hospital admissions 12 months before, and after, the cessation of workers’ compensation stopped payments. ResultsMusculoskeletal health conditions were common diagnoses in overnight hospitalisations for injured workers. Single-day hospital care for mental health disorders were more common for injured workers (17% of same-day admissions) than for members of a community control (3% of same-day admissions) across two years. Exiting the workers’ compensation scheme is associated with significantly fewer annual hospital admissions for the injured control group (OR 0.76), but not for the s39 group (OR 1.01). Injured workers with long-duration compensated work disability were admitted to hospital more often than the community comparator group during the year after workers’ compensation stops (s39 group: OR 1.55, injured control group: OR 1.30). Across all study groups, hospital admission was more common for people receiving disability social security benefits and older age groups. ConclusionPolicy change in the New South Wales workers’ compensation system introduced a 260-week limit on compensation, leaving workers with an elevated need for hospital care after their compensation ended. Welfare policies that disrupt key determinants of health require dedicated inter-agency provisions to support the elevated health needs of those affected.

Comparing treatment of proximal phalangeal fractures with intramedullary screws versus plating

PurposePhalangeal fractures are the most common injuries in humans and account for approximately 10% of all fractures. With plate fixation, anatomic reduction is achievable in most cases, but extension lag is seen in up to 67%. Intramedullary headless screw offers treatment of unstable proximal phalangeal fractures using a minimally invasive procedure with very few complications. One of the major disadvantages of this technique is the transarticular screw position, damaging the articular surface and thus preventing very proximal fractures from being treated with a distally inserted screw. In this study, we present a modified approach to the fixation of the proximal phalangeal fractures and compare outcomes with plate osteosynthesis.Materials and methodsTwenty-nine patients with 31 comparable fractures of the proximal phalanx were treated either with a plate (14) or with minimal invasive cannulated compression screw (17). Pain, strength, range of motion (ROM), work disability and QuickDASH score were assessed.ResultsTAM was significantly better in the screw group. The extension lag was worse in the plate group. Plate removal had to be performed in 13 of 14 the cases, while the screw had to be removed in only 3 cases. The average duration of work disability was 9.9 weeks in the plate group, compared to 5.6 weeks in the screw group.ConclusionMinimally invasive screw osteosynthesis not only has the advantage of significantly shorter work disabilities, but also shows remarkably improved postoperative range of motion. In contrast to plate osteosynthesis, removal of the screw is only necessary in exceptional cases. With the antegrade screws position, even difficult fractures close to the base can be treated without destroying any articular surface. In proximal phalanx fractures with both options of plate or single-screw osteosynthesis, we recommend minimal invasive cannulated screw osteosynthesis.

Cost of arterioveinous fistula at the Douala General Hospital: A Cameroon-based cross-sectional study

Background: Cost is a major limiting factor for dialysis in low-income countries. The objective of our study was to determine the economic cost of creating an arteriovenous fistula (AVF) for hemodialysis at the Douala General Hospital (DGH). Material and methods: We conducted a descriptive cross-sectional study including patients undergoing AVF creation at the DGH from January to April 2020. Costs were calculated using a bottom-up approach. The direct cost was composed of the sum of the cost of medical consultation, additional paraclinical tests, drugs, disposables, hotel services, food, transport and medical and nursing care. The indirect cost was calculated as the sum of the costs related to the temporary incapacity to work and the additional expenses of the families. The cost of temporary work incapacity was calculated according to human capital theory. The economic cost was the sum of the direct cost and the indirect cost. The costs were expressed as a mean with standard deviation. The calculated costs were expressed in US Dollars. Statistical significance was considered as p &lt; 0.05. Results: A total of 44 patients were included of which 29/44 (65.9%) were male. The mean age of the study population was 49.1 ± 14.7 years. The median monthly income was $172 and only 6.8% of patients had health insurance. The average direct cost per patient was $327.3 ± $212.7, with hospitalization costs accounting for 59.6% of that cost. The average indirect cost per patient was $64.5 ± $50.3. The largest proportion of these costs was due to lost productivity related to temporary work disability (45.7%). The average economic cost per patient was $391.9 ± $219.5. Direct costs accounted for 83.54% of the economic cost. Re-operation (p = 0.039), age (p &lt; 0.01) and number of hospitalization days (p &lt; 0.01) significantly affected the cost Conclusion: The cost of creating an AVF for hemodialysis was high and represented more than 2 times the median monthly income of patients and was mainly due to hospitalization costs. Therefore, there is a need to implement strategies to reduce the financial burden of arteriovenous fistula creation in our setting.

‘You don’t want to be seen as a burden’ experiences of working with early inflammatory arthritis: a qualitative study

Purpose To describe the impact of early inflammatory arthritis on work participation. Materials and Methods Thirty individuals (24 women) of working age (age 18–69 years) with inflammatory arthritis (<2 years duration) who were in paid employment or fulltime education were interviewed using qualitative description methodology. Data was analysed using thematic analysis. Results Half of participants (n = 15) reported work disability within the first two-years of diagnosis. Five descriptive themes were identified that explained the early impact of IA on participation in paid employment. These themes were: (i) altered capacity for work; (ii) work comes first; (iii) the invisible burden; (iv) the disclosure effect; and (v) a reconstructed work future. Conclusion The scale of early work disability appears to be higher than previously understood. Although early medical intervention has improved disease management, significant work-based restrictions requiring intervention remain. Internalised and invisible work-related anxieties present early in the disease and need to be acknowledged and addressed by healthcare providers. IMPLICATIONS FOR REHABILITATION Early inflammatory arthritis causes significant challenges in work ability, and early work-based participation restrictions are present despite early use of drug therapy. Assessment of the client’s subjective experience, including understanding the invisible burden, is an important aspect in determining the types of work interventions required. Disclosure of diagnosis in the work environment is associated with anxiety and fear, however, disclosure is influential in supporting capacity to retain work participation and should be included in work interventions. Routine healthcare should include early interventions to address work-based restrictions and supporting work retention to avoid work disability.

Depression and Alcohol Use Behaviours among Primary and Secondary School Teachers in Mwanza, Tanzania; A Cross-Sectional Study

Background: Depressive disorders and alcohol use disorders are highly prevalent in the workplace and have an enormously negative impact on work performance, productivity, absenteeism, and disability costs. Little is known about the burden among primary and secondary school teachers in Tanzania. Method: A cross-sectional study was conducted at Mwanza City in the Lake and Western zones of the United Republic of Tanzania aimed at determining the prevalence and factors associated with depression and alcohol use behaviours among teachers where primary and secondary school teachers from both private and public schools were involved. A total of 300 teachers were recruited and interviewed using Patient Health Questionnaire-9 (PHQ-9) and Alcohol Use Disorder Identification Test (AUDIT). A systematic sampling approach was used to select both schools and participants. Results: The mean age of the participants was 36.1 (SD = 8.465), the majority of the participants were from primary and public schools, 60.67% and 55.67%, respectively. Using cut-off points of four and eight for PHQ-9 and AUDIT, respectively, 51% of the participants had symptoms of depression, and 16% had harmful alcohol use. While the male gender, being married, having a low number of children, and degree level of education was statistically less likely to be associated with depression, on the other hand, male gender, age group of 41-50, being married and having a high number of children were statistically more likely to be associated with harmful alcohol use. Limitations: A cross-sectional study was used, which relies on self-report of symptoms which could lead to recall bias. Despite that, the study was done among both public and private primary and secondary school teachers from the largest city in the lake and western zone of Tanzania, which serves a diverse population still, and regional differences could be there. Conclusion: Depression and alcohol use disorders are high among a sample of our teachers in Mwanza Tanzania; further studies are needed to explore and measure the incidence, causal inference and the association between outcomes and risk factors.

Associations of Rheumatoid Arthritis and Depressive Symptoms Over Time: Are There Differences by Education, Race/Ethnicity, and Gender?

To examine associations between changes in rheumatoid arthritis (RA) symptoms and depressive symptoms adjusted for other time-varying characteristics, and to test if these associations differed by education, race/ethnicity, or gender. Data from the 1988-1998 US National Rheumatoid Arthritis Study were analyzed (n=854). Time-varying covariates included year of the study, pain, functional ability, household work disability, parental status, marital status, employment status, and social support. The time-invariant covariates included years since diagnosis, education, race/ethnicity, and gender. Multivariate multilevel-model analyses were used to estimate associations within people over time. Patients with RA experience considerable change in depressive symptoms, pain, functional disability, and household work disability over the study period. Depressive symptoms were driven more by differences between people compared to changes within people over time. Findings show that patients experienced increases in depressive symptoms over the study period. The rate of change in depressive symptoms did not differ by education, race/ethnicity, or gender. Times of worse pain, functional disability, and household disability were associated with worse depressive symptoms. The association of functional disability and depressive symptoms was stronger for men than women. Increases in pain and disability were associated with worse depressive symptoms, adjusted for covariates. It is important to monitor and treat both mental and physical health symptoms. Future research efforts should focus on collecting data reflecting the educational, gender, and racial/ethnic diversity of individuals with RA.

Work-Related Medical Rehabilitation (WMR) Care in Psychosomatic Medicine in Comparison with Other Indications

So far, there is little data on the quality of work-related medical rehabilitation (WMR)-care in the routine, including from a user perspective. The best data are still available for orthopedic rehabilitation. For psychosomatic rehabilitation, a special need for WMR is known due to the long periods of inability to work and the frequent early retirements. It is unclear how precisely and to what extent WMR services are provided in routine care. In 2019, a representative sample (N=34.887) of employed insured persons up to 65 years old, stratified by indication, was surveyed by the German Pension Insurance fund six months after their rehabilitation with the self-assessment tool MBOR-R. In addition, standard data of the rehabilitation provider (RSD) were collected, from which WMR-related therapeutic offer data (KTL) could be taken. Rehabilitants were asked about their return to work as part of the catamnesis. The participation rate in the survey is 29%, complete survey and RSD data are available after exclusion of addiction rehabilitation and post-operative-procedures from a total of 6.128 rehabilitants, of which N=1.460 after psychosomatic rehabilitation. The comparison of indications shows that 37% of the rehabilitation patients need WMR, which is by far the highest rate. WMR care in psychosomatic rehabilitation is still the best developed and most targeted, but still far from the standards required by the pension insurance. More than 50% of the rehabilitants, even after WMR, rate their employment-related treatment offer as too low. These subjective rehabilitation assessments in the MBOR-R questionnaire prove to be a relevant factor for the prognosis of the return to work quotes, in contrast to the documented KTL services, in addition to the need indicators of WMR and the implementation of WMR. The results suggest that in the field of psychosomatic rehabilitation, too, increased efforts should be made in the future to offer and expand basic WMR services for all rehabilitants and core and special services for rehabilitants with poor work ability and an increased risk of permanent work disability (BBPL) in routine care. The scope and design of MBOR measures should also be quality-optimized from the user's perspective in order to achieve the greatest possible effects.Limitations of the results result from the restriction to rehabilitants of the German Federal Pension Insurance, to limited participation rates, Limitations of the interpretability of the therapy documentations and due to the study design with a one-point measurement and remembered pre-values.

Socioeconomic factors and use of psychotherapy in common mental disorders predisposing to disability pension

BackgroundResearch in high-income countries has identified low socioeconomic status as a risk factor for disability pension (DP) due to common mental disorders (CMDs). Psychotherapy is an evidence-based treatment for the majority of CMDs along with medication and it is often targeted to prevent work disability. This study examines socioeconomic differences in the use of rehabilitative psychotherapy in Finland, where citizens have universal health coverage, but psychotherapy is partly dependent on personal finance.MethodsThe study subjects (N = 22,501) were all the Finnish citizens granted a DP due to CMD between 2010 and 2015 and a comparison group (N = 57,732) matched based on age, gender, and hospital district. Socioeconomic differences in psychotherapy use were studied using logistic regression models. Socioeconomic status was defined by education, income, and occupation. Age, gender, and family status were also examined.ResultsA lower level of education, lower occupational status (blue-collar worker), male gender, and older age, were associated with less frequent psychotherapy use, in both groups. Education was the strongest component of socioeconomic status associated with psychotherapy use, but the role of income was not straightforward. Unemployment when approaching DP, but not otherwise, was a risk factor for not receiving rehabilitative psychotherapy. Socioeconomic disparities were not any smaller among CMD patients approaching DP than in the comparison group.ConclusionThis study demonstrates the disparity in the provision of psychotherapy for CMD patients, even on the verge of DP with an acute need for services. This disparity is partly related to a complex interplay of socioeconomic factors and the service system characteristics. Factors predisposing to unequal access to mental health services are presumably diverse and should be studied further.

Postoperative Quality of Life in Patients with Pyogenic Spondylodiscitis.

Pyogenic spondylodiskitis affects a fragile patient population frequently fraught with severe comorbidities. Data on long-term outcomes, especially for patients undergoing surgery, are scarce. The aim of this study was to assess the long-term quality of life after surgical instrumentation. Data of 218 patients who were treated for spondylodiskitis at our institution between January 2008 and July 2017 were reviewed. In-hospital death and mortality rates at 1 year and follow-up were assessed. A survey was conducted using the following questionnaires: Oswestry Disability Index (ODI), Short Form Work Ability Index (SF-WAI), 36-Item Short Form Health Survey (SF-36), and Short Form McGill Pain Questionnaire (SF-MPQ). We investigated the correlation between the assessed variables and clinical data including patient age, comorbidity score at admission, number of operated levels, corpectomy, and length of hospital stay. In-hospital mortality rate was 1.8% and 1-year mortality rate was 5.5%. At the final follow-up (mean 7 ± 6 years), the mortality rate was 45.4%. Seventy-four patients were lost to follow-up or refused to participate in the study. Forty-four patients responded to the survey and had a mean age of 73 years and mean follow-up of 7 ± 2 years. In the ODI questionnaire, disability grades were classified as minimal (23%), moderate (21%), severe (19%), complete (33%), and bed bound (4%). We found a significant correlation between inability to return to work and severe disability on ODI (p < 0.001), as well as a low score on any component of the SF-36 (p < 0.05). Despite low in-hospital and 1-year mortality rates, patients with surgically treated pyogenic spondylodiskitis are prone to long-term limitation in all domains of quality of life, especially in physical health and work ability.

Assessing Relationships between Physically Demanding Work and Late-Life Disability in Italian Nonagenarian Women Living in a Rural Area.

As more and more persons live into their 90s and beyond, investigating causes of disability in the oldest-old population is relevant for public health implications to plan preventive strategies and rehabilitation interventions. A negative association between physically demanding work and midlife physical function has been shown, but there is a paucity of longitudinal studies investigating possible work-related long-term effects in the oldest old. This study investigates the relationship between physically demanding work exposure and late-life physical performances, disability, general health status, and quality of life in a sample of women aged 90 years and over inside the Mugello Study. Sociodemographic data, cognitive and functional status, lifestyle, medical history, drug use, and work history were collected from 236 participants. Farmers had a lower percentage of individuals with preserved independence in basic activities of daily living compared to other occupations. However, in the multivariate analysis, only a higher cognitive function remained associated with functional independence. While confirming the well-known association between cognitive and functional decline in very old age, our results do not support the hypothesis that the negative effects of physical work exposure observed in midlife are relevant to predict disability in nonagenarian women.

Legal and Factual Barriers to the Termination of Employment of a Disabled Employee in the Slovak Republic

In the first part of the article, the authors analyse the legislation of the Slovak Republic relating to the termination of employment of an employee with disabilities. In that regard, in the main part of the article, they point to the fundamental contradiction of the case-law and practice of public authorities in the question of defining a disabled employee as well as in the question of the authority of a public authority which creates fundamental practical barriers for the employer in the intended termination of employment with such an employee. The conclusion goes from practical problems to theoretical considerations of the justifiability of the legislation in question which aims to protect groups of disabled workers at particular risk.