Occupational reintegration after severe burn injury: a questionnaire study

Summary Background As a consequence of improved survival rates after burn injury occupational reintegration of burn survivors has gained increasing significance. We aimed to develop a precise patient questionnaire as a tool to evaluate factors contributing to occupational reintegration. Material and methods A questionnaire comprising 20 questions specifically evaluating occupational reintegration was developed under psychological supervision. The single-center questionnaire study was implemented in patients with burn injuries who were admitted to the 6‑bed burn intensive care unit (BICU) of the General Hospital of Vienna, Austria (2004–2013). The questionnaire was sent to burn survivors of working age (18–60 years) with an abbreviated burn severity index (ABSI) of 6 or greater, a total burn surface area (TBSA) of 15% or greater, and a BICU stay of at least 24 h. Results A total of 112 burn survivors met the inclusion criteria and were contacted by mail. Of the 112 patients 11 (10%) decided to participate in the study and 218/220 questions (99%) in 11 patients were answered. Out of 11 patients 7 (64%) reported successful return to work and 4 of 11 (36%) did not resume their occupation. Advanced age, longer BICU and hospital stays, higher TBSA, burn at work, lower education, and problems with esthetic appearance seemed to impair patients’ return to their occupation. Conclusion When implementing the questionnaire, severely burned patients with higher age, lower education, and longer hospital and BICU stay seemed at high risk for failed reintegration in their profession after burn injury.

Wiedereingliederung – und dann? Nachhaltigkeitskonflikte um die Rückkehr an den Arbeitsplatz nach psychischer Erkrankung

Zusammenfassung Bei der Betrachtung betrieblicher Wiedereingliederung wird in der Regel der Prozess des betrieblichen Eingliederungsmanagements (BEM) fokussiert. Unberücksichtigt dabei bleibt häufig, dass Wiedereingliederung auch nachhaltig sein soll. Rückfällen und erneuter Erkrankung Betroffener soll vorgebeugt ­werden. Damit rückt die Zeit nach der Rückkehr an den Arbeitsplatz in den Fokus. Am Beispiel psychischer Erkrankungen wird untersucht, welche potenziell aus Arbeitsunfähigkeit und Rückkehrprozess resultierenden Folgekonflikte die Nachhaltigkeit von BEM bedrohen. Anhand problemzentrierter Interviews mit Betroffenen, KollegInnen sowie Führungskräften wird gezeigt, dass es hierbei um soziale Konflikte geht, die aus konkurrierenden Interessenkonstellationen resultieren. Diese sind zugunsten akzeptierter Lösungen auszutarieren, um den langfristigen Reintegrationserfolg nicht zu gefährden. Abstract: Occupational Reintegration – What Comes Next? Sustainability Conflicts Around Return to Work After Psychic Disorder When it comes to return to the workplace, typically the process of the return itself is focused. However, terms of sustainability are often underexposed. Relapses and newly occurring disorders should be avoided. For this reason, subsequent development at the workplace is important. By taking the example of psychic disorders, this paper examines follow-up conflicts resulting from sick leave and the return-process, which are threatening sustainability demands. Problem-centered interviews with returnees, colleagues, and local leaders show the impact of social conflicts, resulting from competing constellations of interests. To promote sustainable reintegration socially accepted solutions are needed.

Legitime Leiden. Die Rechtfertigung von eingeschränktem Arbeitsvermögen und betrieblichen Reintegrationsmaßnahmen am Beispiel psychisch erkrankter Beschäftigter

Zusammenfassung Die neuere Forschungsliteratur betont die normativen Dimensionen der betrieblichen Wiedereingliederung. Daran anknüpfend untersucht der Artikel am Beispiel psychisch erkrankter Beschäftigter, wann und wie im Prozess der Eingliederung Rechtfertigungsbedarf entsteht und analysiert die Rechtfertigungsmuster, auf die betriebliche Akteure zurückgreifen. Als theoretischer Rahmen dient die Soziologie der Konventionen. Empirisch beruht der Artikel auf qualitativen Interviews mit Beschäftigten, Vorgesetzten, HR- und Eingliederungsverantwortlichen in drei Großunternehmen in der Schweiz. Weiterbeschäftigung und Wiedereingliederung werden vorwiegend über das kooperative Verhalten und die (weiter zu erwartende) Arbeitsleistung der Betroffenen gerechtfertigt. Aus diesen Rechtfertigungslogiken können sich zum Ziel der Rehabilitation konträre Dynamiken und Handlungszwänge ergeben. Abstract: Legitimate Distress: the Justification of Limited Work Capacity and Occupational Rehabilitation – the Case of Employees with Mental Health Issues Recent literature has stressed the normative dimensions of occupational reintegration. This article examines when and how a need for justification arises in the process of reintegration, focusing on mentally ill employees. Drawing on the sociology of conventions, justification patterns used by organizational actors are analysed. Empirically, the article is based on qualitative interviews with employees, supervisors, HR and integration managers in three large companies in Switzerland. The employees’ cooperative behaviour and their (expected) work performance are the most important criteria of justification. These logics of justification can result in dynamics and constraints that are contrary to the goal of rehabilitation.

Programas de Reenganche educativo y condiciones organizativas para su implementación: la importancia de la coordinación curricular

Esta aportación deriva de un proyecto de investigación[1] en el que se analizan programas de reenganche para jóvenes en situación de vulnerabilidad con resultados positivos (aumento del enganche con los aprendizajes y reinserción educativa o socio-laboral). Se centra en aspectos organizativos, en particular, en la coordinación entre el profesorado en dos de los casos analizados en la Región de Murcia (España): Aulas Ocupacionales y Formación Profesional Básica. El texto ofrece algunos resultados sobre las distintas vías de coordinación en el seno de tales programas para su desarrollo en la práctica. Marco Teórico. Se articula sobre dos pilares: 1) procesos de mejora escolar y condiciones organizativas para posibilitarla, 2) influencia del funcionamiento educativo y organizativo del centro escolar en dinámicas de desenganche. Metodología. Diseño de “caso múltiple de múltiples unidades”. Se diseñaron diversos instrumentos de recogida de información. Se comenta únicamente aquella derivada de entrevistas semiestructuradas a profesionales implicados en los citados programas, analizada cualitativamente. Resultados. Los mecanismos y dinámicas de coordinación, en cuanto que condición organizativa, destacan como pilares fundamentales de estos programas, complejos en el discurrir de los mismos y también con algunas limitaciones. Conclusiones. La coherencia y relevancia curricular constituyen uno de los puntos flacos de la coordinación, agudizada por la departamentalización de los Institutos de Educación Secundaria. Su complejidad requiere ámbitos de coordinación más funcionales. [1] Proyecto I+D (2016). "Procesos de reenganche educativo y socio-laboral de adolescentes en situación de vulnerabilidad. Estudio de casos e implicaciones socioeducativas". EDU2016-76306-C2-1-R. This contribution derives from an investigation project where re-engagement programs for young students in situation of vulnerability with positive results (an increase in the engagement of their learning and educational and social-occupational reintegration) are analyzed. It explores organizational aspects, in particular coordination among teachers, in two educational contexts in the Region of Murcia (Spain): Training Centers and Basic Vocational Training Schools. The study reports on the practical development of the coordination processes found within the above-mentioned two contexts. Theoretical Framework: It articulates on two pillars: 1) processes for school improvement and organizational conditions to enable them, 2) influence of specific educational and organizational systems on disengagement dynamics. Methodology: "Multiple-cases of multiple-units" design. Although different instruments for the collection of information were designed, the study reports solely on the semi-structured interviews conducted with the professionals involved. Results: The mechanisms and dynamics of coordination, looked at from an organizational perspective, stand out as complex but fundamental pillars of these programs, whether they present some limitations related to curricular aspects. Conclusions: Coherence and curricular relevance reveal themselves as one of the weakest points of coordination. This is aggravated by the division into departments typical of Secondary High Schools. Their complexity requires more functional coordination scopes.

The psychology of pain-related disability: Implications for intervention

Research over the past two decades a pointed to a number of pain-related psychological variables and mental health conditions that impede recovery following musculoskeletal injury. This chapter briefly reviews evidence suggesting that pain-related psychological variables such as recovery expectancies, self-efficacy, pain catastrophizing, perceived injustice, and fear-avoidance beliefs, depression, and post-traumatic stress disorder (PTSD) play a significant role as determinants of work-disability in individuals with musculoskeletal conditions. Although significant advances have been made with respect to the identification of psychological variables that contribute to prolonged work disability, what has lagged is the development of risk-targeted interventions to promote occupational reintegration. Although numerous clinical trials have shown statistically significant changes in pain-related psychological risk factors, the clinical significance of observed changes has been questioned. The development and evaluation of risk targeted interventions aimed at promoting occupational reintegration in work-disabled individuals will need to be a priority for future research in this area.

Patient-tailored multimodal neurorehabilitation: The Lucerne model

Neurorehabilitation is a rapidly developing subspecialty of neurology due to medical advances and growing knowledge on functional recovery from brain injury such as plasticity and regeneration in the nervous system. Furthermore, progress in modern technologies facilitate new therapeutic concepts. Patient-tailored, flexible multimodal neurorehabilitation is essential in neurological diseases due to the diversity of symptoms. In addition, rehabilitative treatment should be realized from disease onset. To fulfill these goals, the neurocenter of the Cantonal Hospital Lucerne established an uninterrupted treatment chain from the emergency stage to the social and occupational reintegration, which is described in this article with a focus on stroke, Parkinson’s disease, and multiple sclerosis patients.

Impact of overweight, obesity, and post-treatment weight changes on occupational reintegration of breast cancer (BC) survivors.

11562 Background: Overweight and obesity are strongly linked to poorer BC-specific outcomes, quality of life and financial burden in cancer care. Weight loss interventions have the potential to improve such outcomes. Fewer data exist on whether excess weight and post-diagnosis weight changes impact the ability of BC survivors to return to work (RTW). Methods: CANTO (NCT01993498) is a multicenter prospective longitudinal study of 12000 patients (pts) with stage I-III BC that characterizes long-term toxicities of BC treatment. Of 5801 pts enrolled from 2012-2014 (last data lock), we identified 1874 pts who were professionally active at BC diagnosis, ≥5 years (yrs) younger than minimum legal retirement age (62 yrs) and with updated work status 2 yrs after diagnosis. Logistic regression models evaluated the impact of body mass index (BMI) at diagnosis and of weight changes over 2 yrs after diagnosis on odds of non-RTW, adjusting for age, education, income, BC treatment and recreational physical activity (PA). Results: 37% pts were overweight or obese at diagnosis (BMI ≥25 kg/m2): 34% of them gained ≥5% and 16% lost ≥5% weight after diagnosis. Rates of non-RTW at 2 yrs were significantly higher in overweight or obese vs under or normal weight pts (27% vs 18%, p≤.001; adjusted odds ratio 1.37, 95% Confidence Interval [CI] 1.04-1.80, p = .017). Overweight and obese pts who did not RTW experienced higher increments in weight (mean [95% CI]: +3.6% [+2.3, +4.9] vs +1.5% [+0.8, +2.2]) and reported more modest changes in PA (mean [95% CI]: +1.0 [-1.4, +3.5] vs +2.1 [+0.8, +3.3] MET-h/week) vs those who did RTW. Weight changes independently impacted odds of non-RTW in overweight and obese pts (p for interaction weight change*BMI ≤.001): a 5% weight gain was associated with 17% increase in adjusted odds of non-RTW (95% CI 2-35%, p = .024), whereas a loss ≥5% with 60% reduced odds of non-RTW vs weight gain (95% CI 18-82%, p = .013). Conclusions: Excess weight and weight changes are significantly associated with occupational reintegration after BC in overweight and obese pts. Randomized studies testing dedicated weight control interventions should also measure outcomes of social rehabilitation in this large subset of survivors. Clinical trial information: NCT01993498.

Addictology consultations: Experience of the outpatient department of the Razi hospital

IntroductionThe addiction is a social and universal phenomenon. Its coverage is quite recent in Tunisia. It requires a facilitation of the access to healthcare, with broadcasting of the policy of reduction of risks.ObjectivesRaise a current situation of the addicting conducts of our patients.MethodsRetrospective descriptive study, concerned the patients having an addiction in psychoactive substances followed in the external consultation of the hospital Razi between November 2014 and September 2016.ResultsThe average age was 34 ± 10.23 years.Among the patients, 93.7% was of sex male.Almost half immigrated in secret in Europe.Seventy-five percent had criminal record.The most used product was tobacco followed by alcohol, cannabis, benzodiazepines, Trihexyphenidyl and the opiates.The buprenorphin is the most consummate opiate in misuse.Target substances of the request of weaning are respectively: the buprenorphin (58.87%), benzodiazepines (12.63%), the trihexyphenidyl (7.71%), the alcohol (5.61%), the cannabis (5.26%).A pathological personality was raised in 17.5%.A psychiatric comorbidity was found to 8% of the patients.The coverage is made on 3 shutters: biological by the symptomatic treatment of the weaning and the comorbidities, psychological and social by the social and occupational reintegration thanks to non-governmental organizations.ConclusionAddictology is a stigmatized speciality in Tunisia, by the peculiarity of the patients and the slowness of the results. Nevertheless the number of consultants does not stop increasing where from the interest to create more specialized services and structures of rehabilitation.Disclosure of interestThe authors have not supplied their declaration of competing interest.