Summary Objectives The study aims to investigate the vocal fatigue symptoms and laryngeal status in relation to vocal activity limitations and vocal participation restrictions. Study Design This is a ...case-control study. Methods Two hundred six teachers were divided into two groups based on the frequency of their self-reported vocal symptoms being more or less than the mean of reported frequency. The study compared odds for activity limitation and participation restriction in relation to frequency of vocal symptoms, number of vocal symptoms recurring weekly, and organic laryngeal changes. Activity limitation and participation restriction were studied using the Voice Activity and Participation Profile questionnaire. Results Increased odds were found for teachers with frequent vocal symptoms and especially those with one or more vocal symptom recurring weekly. Odds were found to be 2.6–8.5 times more likely in teachers with more frequent vocal symptoms. The odds increased dramatically with increase of the number of vocal symptoms recurring weekly. Laryngeal organic changes were found to increase the odds but insignificantly. Conclusions Teachers with frequent vocal symptoms, especially those with vocal symptoms recurring weekly, have increased odds ratio for vocal activity limitation and vocal participation restrictions. High scores or frequent occurrence of self-reported vocal fatigue symptoms must be taken seriously in the evaluation of vocal working ability.
Employment after kidney transplantation is an important marker of health recovery. The study addresses the impact of successful kidney transplantation on socioeconomic factors and employment in a ...Swiss cohort.
Patients who received a kidney allograft at the University Hospital of Basel between 2000 and 2011 were investigated. A standardised survey was used to obtain information on socioeconomic factors 1 year before and after successful transplantation.
A total of 610 patients were contacted; 354 (58%) answered the survey. The median age of respondents was 53.5 (interquartile range 42-61) years at the time of transplantation, 31.2% were females. Overall, 201 out of 282 working-age patients (71.3%) were working 1 year after transplantation: 102 full-time, 55 part-time, 30 patients part-time with additional disability pension, and 14 housework. Seventy-two patients (25.3%) did not work 1 year after transplantation: 63 patients had a full or partial disability pension, and nine patients were unemployed. Thirty out of 282 working-age patients (10.6%) had improved working ability after transplantation. Employment after transplantation was favoured by: living donor transplantation (p <0.0001), pre-emptive transplantation (p <0.0001), dialysis duration ≤1 year (p <0.0001), preserved employment before transplantation (p <0.0001), and higher education (p = 0.003), whereas age above 50 years (p = 0.006), and dialysis duration > 1 year (p <0.0001) had a negative impact.
The employment rate in this Swiss cohort before and after successful kidney transplantation is high compared with the literature. A high number of living donors, of pre-emptive transplantations, and short dialysis vintages contribute to this observation.
To investigate whether a pretreatment multimodal (MM) assessment of patients with chronic muscular pain has an impact on treatment outcome.
The present randomized-controlled study evaluated an MM ...assessment compared with routine multidisciplinary assessment given to a control group. The study population consisted of primary care patients with mixed chronic muscular pain. Variables assessed were: pain intensity, depression, life stress, quality of life (QOL), disability, working ability, and treatment satisfaction. Follow-up was performed at 15 months and 182 patients of 220 (83%) completed the study.
Univariate and multivariate logistic regression showed from baseline to 15 months a significant improvement in QOL as measured by Short-Form 36 in the MM group compared with the control group on the domains of physical function (odds ratio 2.40; 95% confidence interval 1.32-4.37), role physical (2.37; 1.10-5.09), and role emotional (2.05; 1.05-3.96). Working ability improved more significantly in the MM group (46% vs. 35%) and impairment was less (1% vs. 15%) compared with the control group (P=0.016). Satisfaction with the assessment was, on average, higher (P<0.001) in the MM group than in the control group.
Patients who underwent an MM assessment before treatment in comparison with patients receiving routine multidisciplinary assessment improved QOL, working ability, and were also significantly more satisfied. This result indicates that MM pretreatment assessment could be advantageous in the selection of patients for suitable rehabilitation treatment in a primary care setting, and also be used to prepare patients for future rehabilitation.
To investigate the relationship between Hamilton Depression Rating Scale (HAM-D) score and psychiatrists' judgment of working ability in patients with major depressive disorder (MDD) and painful ...physical symptoms.
This was a prospective, observational, 12-week study in patients who received duloxetine or a selective serotonin reuptake inhibitor. Patients were ≥20 years old, resided in Japan, and had at least moderate depression (Quick Inventory of Depressive Symptomatology ≥16) and at least moderate painful physical symptoms (Brief Pain Inventory-Short Form average pain ≥3). The main outcome in this post-hoc analysis was the HAM-D17 cutoff best corresponding with patients' working ability according to the investigator's judgment. Area under the receiver-operator curve was used to determine the time point with the strongest relationship between HAM-D17 and working ability. The optimal HAM-D17 cutoff was determined based on the maximum of sensitivity (true positive rate) minus (1 minus specificity true negative rate). For the evaluation of binary data, a mixed effects model with repeated measures analysis was used.
For the estimation of the HAM-D17 cutoff, the area under the receiver-operator curve was maximal at 12 weeks, when a HAM-D17 score of 6 resulted in the best correspondence with working ability in the combined study population. At 12 weeks, a HAM-D17 score of 6 also resulted in the maximum predictive ability in each of the two treatment groups separately. For predicted working ability at 12 weeks, 52.7% of duloxetine-treated patients achieved the HAM-D17 cutoff of ≤6, whereas 48.5% of SSRIs-treated patients achieved HAM-D17 ≤6 (
=0.477).
In this study of patients with major depressive disorder and painful physical symptoms, a HAM-D17 score ≤6 corresponded best with patients' working ability. This finding is consistent with previous studies showing that a HAM-D17 cutoff of ≤7 may overestimate functional recovery from MDD.
The objective of the present study is to evaluate the effect of hybrid cochlear implantation (hCI) on quality of life (QoL), quality of hearing (QoH), and working performance in adult patients, and ...to compare the long-term results of patients with hCI to those of patients with conventional unilateral cochlear implantation (CI), bilateral CI, and single-sided deafness (SSD) with CI. Sound localization accuracy and speech-in-noise test were also compared between these groups. Eight patients with high-frequency sensorineural hearing loss of unknown etiology were selected in the study. Patients with hCI had better long-term speech perception in noise than uni- or bilateral CI patients, but the difference was not statistically significant. The sound localization accuracy was equal in the hCI, bilateral CI, and SSD patients. QoH was statistically significantly better in bilateral CI patients than in the others. In hCI patients, residual hearing was preserved in all patients after the surgery. During the 3.6-year follow-up, the mean hearing threshold at 125–500 Hz decreased on average by 15 dB HL in the implanted ear. QoL and working performance improved significantly in all CI patients. Hearing outcomes with hCI are comparable to the results of bilateral CI or CI with SSD, but hearing in noise and sound localization are statistically significantly better than with unilateral CI. Interestingly, the impact of CI on QoL, QoH, and working performance was similar in all groups.
Retention in psychical development or mental deficiency is a global deficiency covering the entire personality of an individual: structure, organization, intellectual, affective, psychomotor, ...behavioraladaptive development. Education is one of those issues whose analysis, despite facility appearances and common sense proves ultimately to be of great complexity. Reason for this should be sought in everyday life and the inevitability of its educational implication. Before having quite specific ideas and educational systems, people have practiced physical education and supported its influences. Nowadays, especially in dynamic societies, with a high rate of social mobility, education is no longer a simply means of perpetuating the values of vertical "transmission": from parent to child, from past to present, from adult carriers values to the younger generation in the formation, but also the main instrument through which the society can consciously, traditional or discontinuous self improve, according to the ideals of human and social progress. We witness, therefore, to the appearance of a new relationship between education and society. The society must pay greater attention to the education problems, to support financially the development of research in this field and apply their results in practice. In conclusion, on the educational science largely depends the aspiration to form a new man and a new society, according to social and human high ideals. In this connection, it is necessary to examine also the dynamic of restraint process in development.
Zusammenfassung
Die Nutzung eines Restarbeitsvermögens bei gesundheitlichen Einschränkungen liegt im Interesse der Gesellschaft, der Arbeitgeber, aber auch von Versicherten. Aktuell gibt es in ...Deutschland – wesentlich bedingt durch das Entgeltfortzahlungsgesetz und arbeitsrechtliche Regelungen – nur sehr begrenzte Möglichkeiten eines krankheitsgerechten Arbeitseinsatzes. In der Praxis erfolgt jedoch, insbesondere nach Arbeitsunfällen, durchaus eine Weiterarbeit auf sog. Schonarbeitsplätzen. Die vorliegende Arbeit beschreibt ausgehend von Determinanten der Arbeitsfähigkeit Bedingungen der Etablierung von Schonarbeit als Alternative zum Modell der
Teilarbeitsunfähigkeit
.
A prospective clinical randomized controlled trial.
To determine the long-term effect of a combined exercise and motivational program on the level of disability of patients with chronic and recurrent ...low back pain (LBP).
There is agreement on the importance of exercise during the course of chronic LBP. However, it is well known that long-term adherence with exercises is particularly low.
A total of 93 patients with LBP were randomly assigned to the control group (standard exercise program) or the motivational group (combined exercise and motivational program). Follow-up assessments were performed at 3.5 weeks, 4 months, 12 months, and 5 years. Main outcome measures were disability scores, pain intensity, and working ability. In addition to classic statistics, the sophisticated linear partial credit model was used to test the effects of treatment on disability scores.
In both groups, significant improvements in the disability scores were found at all points of follow-up assessment, however, the cumulative effect of the treatment in the motivational group was more than twice as much as in the control group. This result is in accordance with the increasing divergence in pain intensity between groups between 12 months and 5 years after intervention. A significant, positive long-term effect at the 5-year reassessment in working ability was only seen in the motivational group. All statistically significant results were confirmed by intention-to-treat analyses.
Regarding long-term efficacy, the combined exercise and motivation program was superior to the standard exercise program. Five years after the supervised combined exercise and motivational program, patients had significant improvements in disability, pain intensity, and working ability.
Objective. To investigate how women with SSc and varying degrees of working ability differed regarding disease severity, everyday occupations and well-being. Working ability was operationalized ...according to the degree of sick leave. Methods. Forty-four women of working age with lcSSc were assessed regarding sociodemographic characteristics, disease severity including organ manifestation, perceived physical symptoms, hand function, and satisfaction with everyday occupations, self-rated health and well-being. Results. The subjects formed three groups with regard to reduction in working capacity. Twenty-one women (48%) had no sick leave, 15 women (34%) were on partial sick leave and eight women (18%) were temporarily on full-time sick leave or had a full disability pension. There were no statistically significant differences concerning sociodemographics between the groups. Women without sick leave had less physically demanding jobs (P = 0.026), and the hypothesis that working ability reflects lower disease severity was confirmed regarding dexterity grip force and perceived fatigue and breathlessness (P < 0.05). Greater working ability was associated with better capacity to perform activities of daily life (P < 0.01), greater satisfaction with occupations (P < 0.01), better well-being (P < 0.001) and better health (P < 0.001). Conclusions. Fifty per cent of the women were restricted in their working ability; the lower the working ability, the lower their perceived well-being. This emphasizes the need for further research into the factors that promote working ability and the development of suitable methods to improve working ability.
PDF
