Professional reintegration among professionally active Portuguese stroke survivors: a multicentric study.

PURPOSE: To assess professional reintegration, the perceived impact of stroke on work, and the main determinants of return to work (RTW) among stroke survivors. MATERIALS AND METHODS: A cross-sectional study was performed, based on a cohort of stroke survivors. A structured questionnaire was administered to previously working stroke survivors, 18-24 months post-stroke. Data on sociodemographic characteristics, stroke features and their impact on work, access to rehabilitation services during hospital admission and after discharge, social support, and professional reintegration were reported by 553 stroke survivors. RESULTS: On average, 56.6% (95% CI 52.4-60.8) of stroke survivors resumed professional activity, 20 months after stroke. Approximately 90% of survivors who RTW, returned to the same job and same function they performed before stroke. The majority did not receive reintegration support. The main determinants of RTW were lower age, higher socioeconomic status, and better functional status. CONCLUSIONS: Professional reintegration and vocational support after stroke, remained below the international goals for community reintegration of stroke survivors. Future studies should explore the impact of professional and social reintegration on the psychological health and quality of life of stroke survivors and the barriers, challenges, and strategies used to overcome them, to allow for effective professional reintegration policies.

The amount of professionally active people affected by stroke events is rising worldwide, with increasing numbers of survivors with restricted occupational participation.Higher age and lower socioeconomic status appear to be main determinants for no return to work and so, a special attention should be given to this particular group of stroke survivors.Vocational and social support after stroke is highly needed to help in the reintegration of a professionally active life.Social and community support after stroke should be offered as soon as possible after stroke to promote a successful professional reintegration.

[Professional outcome after cancer disease in military population]. / Devenir professionnel après maladie cancéreuse chez des militaires actifs.

INTRODUCTION: The impact of cancer on working ability in the military environment remains a matter of concern. The primary aim of this study was to identify sociodemographic, professional and disease related factors influencing the professional outcome in the military population. METHODS: Descriptive, retrospective study on active military cancer patients treated in the oncology department of the Military Hospital of Tunis between January 2016 and December 2018. Data collection was based on a previously established survey sheet. The professional development was checked by phone calls. RESULTS: Our study included 41 patients. Mean age was 44 years±8.3. The population was predominantly male (56%). Seventy-eight percent of patients were non-commissioned officers. Most frequent primary tumors were breast (44%) and colorectal tumors (22%). The resumption of professional activity concerned 32 patients. Exemptions were granted to 19 patients (60%). Predictive factors identified in univariate statistical analysis associated with return-to-work were the stage of the disease, the performance status of patients at the time of diagnosis (P=0,001) and the need for psychological support (P=0,003). CONCLUSION: Several factors were involved in the resumption of professional activity after cancer disease, especially in the military population. It therefore seems essential to anticipate the return to work in order to overcome the difficulties that may be encountered during the recovery.

The impact of major occupational injuries on professional reintegration. A Portuguese medico-legal contribution.

Occupational injuries represent an enormous economic impact for victims, respective families, involved institutions and all the community due to professional outcomes. Thus, it is of the utmost importance that medico-legal personal injury assessment and the posterior follow-up of these victims, may allow their concrete damage repair, considering the victims' needs fulfilment and professional reintegration, whenever possible. The main objective of this study is to reflect on the role that legal medicine can play in promoting the professional reintegration of victims of major occupational accidents through the analysis of occupational injuries cases considering the medico-legal examinations performed. A retrospective study was conducted using medico-legal major occupational injuries cases (Partial Permanent Disability ≥40%). Data were collected from two medico-legal assessment moments: (a) personal injury assessment homologated by a labour court 4.8 years on average after occupational injury; (b) medico-legal follow-up for needs and/or Partial Permanent Disability adjustments performed 18.9 years on average after occupational injury. The final sample includes 103 cases. The results showed that in major occupational accidents, permanent long-term outcomes were principally associated with neurological (62.1%) and orthopaedic (52.4%) sequelae. Permanent professional damage parameters assigned by the labour court included Partial Permanent Disability (23.3%), Permanent Absolute Disability for Regular Work (41.7%) and Permanent Absolute Disability for Any Work (35%). Three-dimensional methodology is helpful in predicting Partial Permanent Disability and Permanent Absolute Disability for Any Work. However, three-dimensional methodology did not reveal correlations with Permanent Absolute Disability for Regular Work, and currently 65% of the victims who were considered able to work by the labour court are not professionally active. Thus, these major cases deserve a more detailed medico-legal approach based on concrete information about the professional reality of each victim, especially cases with an eventual Permanent Absolute Disability for Regular Work. Medico-legal Injury Assessment must be based on concrete aspects of the victim's professional reality and not only on permanent disability tables. This calls for an articulation between all institutions working with the victim of occupational injuries and legal medicine to promote recovery and the necessary measures to assure professional rehabilitation.

Quality measurement of out-patient neuropsychological therapy after stroke in Germany: definition of indicators and retrospective pilot study.

BACKGROUND: In contrast to the hospital setting, today little work has been directed to the definition, measurement, and improvement of the quality of out-patient medical and therapeutic care. We developed a set of indicators to measure the quality of out-patient neuropsychological therapy after stroke. METHODS: The indicators cover core and interdisciplinary aspects of out-patient neuropsychological work such as mediation of patients into social care in case of need. Selection of the quality-indicators was done together with a consensus group of out-patient therapists and supported by evidence, validity, reliability as well as estimated relevance and variability with the quality of care. The set of indicators was further tested in a retrospective cohort study. Anonymous data of 104 patients were collected from out-patient clinical records of five clinics between November 2017 and April 2018. Associations between process and outcome quality were estimated exploitatively. RESULTS: Results allowed for the identification of areas with greater variability in the quality of process care and indicated that attention training as recommended by current guidelines had the lowest overall rate for meeting the quality-aim (met in 44% of the cases). This was followed by time < 1 month until the start of therapy (63% met) and mediation into social care in case of need (65% met). We further observed that overall quality and involving relatives in the therapy was associated with higher rates of professional reintegration (p-value = 0.03). However, the need for mediation into social care was associated with a reduced chance for successful professional reintegration (p-value = 0.009). CONCLUSION: In conclusion, we describe a first set of quality indicators which cover different aspects of out-patient neuropsychological therapy and sufficient variability with care. First data further suggests that meeting the specified quality aims may indeed have relevant effects on outcomes.

Oficinas profissionalizantes para reinserção de internos de um centro terapêutico de toxicômanos no mercado de trabalho / Professional workshops for reinsertion of internal staff from a drug rehabilitation center in the labor market / Cursos profesionales para la reinserción de internos de un centro terapéutico de toxicómanos en el mercado laboral

Objetivo: desenvolver atividades a fim de facilitar a reinserção social e no mercado de trabalho de dependentes químicos residentes da comunidade terapêutica Fazenda Paraíso, um centro de recuperação de toxicômanose alcoólatras do noroeste do estado do Rio Grande do Sul. Método: trata-se de um estudo de abordagem qualiquantitativa, com caráter descritivo. Quinze internos com idade entre 16 e 49 anos participaram de oficinas com cunho teórico/prático ministradas por docentes e acadêmicos do curso de graduação de Farmácia. Resultados: a maioria dos participantes estava com idade acima dos 30 anos, e 80% tinham somente formação em educação básica. Constatou-se que o emprego é capaz de gerar estabilidade financeira, além de proporcionar dignidade e trazer reconhecimento por parte da sociedade, sendo então importante para o toxicômano. Conclusão: o profissional farmacêutico pode ser um grande aliado na reinserção do dependente químico na sociedade, seja pela ministração de oficinas ou palestras de educação em saúde

Objective: to develop activities that facilitate social and labor market reintegration of drug addicts residing in Fazenda Paraíso, a drug and alcohol rehabilitation center in the northwest of Rio Grande do Sul, Brazil. Methods: this qualitative/quantitative study of descriptive character included 15 interns aged 16 to 49 years who participated in workshops of theoretical/practical nature taught by educators of the Pharmacy graduation course. Results: most participants were over 30 years old, and 80% had only basic education. Employment was shown to allow for financial stability, as well as to provide dignity and recognition by society, and it is considered important for drug addicts. Conclusion: pharmacy professionals can be great allies in the reintegration of drug addicts in society by providing workshops or lectures on health education

Objetivo: desarrollar actividades para facilitar la reinserción social y laboral de los toxicómanos que residen en la comunidad terapêutica Fazenda Paraíso, un centro para la recuperación de toxicómanos y alcohólicos en el noroeste del estado de Rio Grande do Sul. Método: estudio cualitativo y cuantitativo con carácter descriptivo. 15 pasantes de entre 16 y 49 años participaron en talleres teórico-prácticos impartidos por profesores y académicos del curso de graduación de Farmacia. Resultados: la mayoría de los participantes tenían más de 30 años, y el 80% solo tenían la educación básica. Se observó que el empleo es capaz de generar estabilidad financiera, además de proporcionar dignidad y reconocimiento por parte de la sociedad, lo cual es importante para el toxicómano. Conclusión: el profesional farmacéutico puede ayudar en la reintegración del toxicómano en la sociedad, por medio de la impartición de cursos o conferencias sobre la educación para la salud

Mapping European Welfare Models: State of the Art of Strategies for Professional Integration and Reintegration of Persons with Chronic Diseases.

Background: Persons with chronic diseases (PwCDs) often experience work-related problems, and innovative actions to improve their participation in the labor market are needed. In the frame of the European (EU) Pathways Project, the aim of the study is to compare existing strategies (policies, systems, and services) for professional (re-)integration of PwCDs and mental health conditions available at both European and national level between different European welfare models: Scandinavian, Continental, Anglo-Saxon, Mediterranean, and “Post-Communist”. Method: The European strategies were identified by an overview of relevant academic and grey literature searched through Medline and internet searches, while national strategies were explored through questionnaires and in-depth interviews with national relevant stakeholders. Results: The mapping of existing strategies revealed that, both at European and national level, PwCDs are often considered as part of the group of “persons with disabilities” and only in this case they can receive employment support. European countries put in place actions to support greater labor market participation, but these differ from country to country. Conclusion: Strategies targeting “persons with disabilities” do not necessarily address all the needs of persons with chronic diseases. Countries should consider the importance of employment for all to achieve smart, sustainable, and inclusive growth.

Percepção dos usuários a respeito de um serviço de reabilitação profissional / Users' perception of a professional rehabilitation service

Resumo Introdução: a Reabilitação Profissional (RP) é um programa de intervenção estruturado para desenvolver atividades terapêuticas e de profissionalização, buscando a recuperação do potencial laborativo. Objetivo: identificar a percepção e os sentimentos de trabalhadores reabilitados ou em reabilitação a respeito do processo de RP, bem como descrever o perfil de saúde e afastamento desses trabalhadores. Métodos: estudo qualitativo, descritivo, realizado em uma autarquia municipal de saneamento básico com os funcionários participantes do Programa de Reabilitação Profissional (PRP). Foram realizadas onze entrevistas utilizando um instrumento semiestruturado. Para o tratamento dos dados utilizou-se a técnica de análise temática ou categorial. Resultados: identificaram-se nas entrevistas núcleos de sentido que, ao serem agrupados por suas similaridades, permitiram a formação de quatro categorias de análise: Impacto da doença e do afastamento do trabalho; Inefetividade do Programa de Reabilitação Profissional; Percepção quanto ao retorno ao trabalho; e Relacionamento com chefias e colegas. Conclusão: na perspectiva dos participantes, o processo de reabilitação evidencia os impactos da doença e do afastamento do trabalho, e revela a inefetividade do PRP. As dificuldades no retorno ao trabalho e no relacionamento com chefias e colegas foram apontados como fatores que influenciam a readaptação laboral.

Abstract Introduction: Vocational Rehabilitation (VR) is an intervention program structured to develop therapeutic and professionalization activities aiming at recoverying work ability. Objective: to identify the perceptions and feelings of rehabilitated or in rehabilitation workers about the VR process, as well as to describe their health and sick leave profiles. Methods: qualitative and descriptive study carried out with workers of a municipal basic sanitation public service, who had taken part in the Vocational Rehabilitation Program (VRP). Eleven interviews were conducted using a semi-structured instrument. The thematic or categorical analysis technique was used for data treatment. Results: we identified 4 categories of analysis: Disease and sick leave impact; Ineffectiveness of the Vocational Rehabilitation Program; Workers' perception regarding return to work; Relationship with heads and co-workers. Conclusion: in the participants' perspective, the rehabilitation process highlights the disease and sick leave impacts, and disclose the VRP ineffectiveness. Difficulties in returning to work and in the relationship with heads and co-workers were pointed out as factors that influence work rehabilitation.

[Effectiveness of an inpatient multimodal psychiatric-psychotherapeutic program for the treatment of job burnout]. / Einmal Burnout ist nicht immer Burnout: Eine stationäre multimodale Psychotherapie ist eine effektive Burnout-Behandlung.

We studied the clinical course and long-term effects of inpatient treatment in 723 patients with job burnout referred with an ICD-10 F diagnosis and Z73.0 code («overwhelming exhaustion¼) to a Swiss hospital specialized in the treatment of job stress-related disorders. Patients were characterized in terms of age, gender, socioeconomic status. Self-rated psychological measures related to general and burnout-specific symptoms (i. e., emotional exhaustion, depersonalization, and diminished personal accomplishments) were applied before and after a six-week treatment program, as well as at 15 months after hospital discharge in 232 patients. The results show that the multimodal inpatient psychiatric-psychotherapeutic treatment was successful with a sustainable effect on psychological well-being (>90 %), including improvements regarding emotional exhaustion, depersonalization and personal accomplishments as well as professional reintegration in 71 % of cases.

Estratégias Utilizadas pelos Trabalhadores para Enfrentar o Desemprego / Estrategias de Afrontamiento Utilizadas por Trabajadores para Enfrentar el Desempleo / Coping Strategies Used by Workers Facing Unemployment

Este estudo tem como objetivo identificar as estratégias utilizadas pelos trabalhadores para enfrentar a situação de desemprego. Investigaram-se estratégias objetivas de sobrevivência e de reinserção profissional, e subjetivas, relacionadas com o enfrentamento da situação (coping). Participaram 400 trabalhadores desempregados que iam ao Sistema Nacional de Emprego (SINE) de uma cidade do nordeste do Brasil. Aplicou-se um questionário estruturado com perguntas sobre estratégias objetivas e uma escala de enfrentamento. Os dados foram analisados por meio de uma análise fatorial confirmatória. As estratégias de sobrevivência e de reinserção profissional estão baseadas na ativação das redes de amigos e de familiares. Os fatores de enfrentamento predominantes foram a religiosidade e o planejamento. Níveis educativos menores foram preditores de uma maior utilização de estratégias religiosas. Os resultados contribuem para melhorar a compreensão do fenômeno do desemprego no nordeste do Brasil.

Este estudio se propuso identificar las estrategias utilizadas por los trabajadores para afrontar la situación de desempleo. Se investigaron estrategias objetivas de supervivencia y reinserción profesional, y subjetivas, relacionadas con el afrontamiento de la situación (coping). Participaron 400 trabajadores desempleados que acudían al Sistema Nacional de Empleo (SINE) de una ciudad del noreste de Brasil. Se aplicó un cuestionario estructurado con preguntas sobre estrategias objetivas y una escala de afrontamiento. Los datos se analizaron por medio de un análisis factorial confirmatorio. Las estrategias de supervivencia y reinserción profesional están basadas en la activación de las redes de amigos y familiares. Los factores de afrontamiento predominantes fueron la religiosidad y la planificación. Niveles educativos menores fueron predictores de una mayor utilización de estrategias religiosas. Los resultados contribuyen a mejorar la comprensión del fenómeno del desempleo en el noreste de Brasil.

This study aimed to identify the strategies used by workers facing the unemployment situation. The study focused on the objective strategies of survival and professional reintegration and on the subjective strategies related to coping. A total of 400 unemployed workers who came to the National Employment System (SINE) from a northeastern city in Brazil participated. A structured questionnaire with questions about objective strategies and a coping scale was applied. The data were analyzed using confirmatory factor analysis. Strategies of survival and professional reintegration are based on the activation of networks of friends and family members, and the main coping factors are religiosity and planning. Lower educational levels are predictors of greater use of religious strategies. The results contribute to improving the understanding of the phenomenon of unemployment in northeastern Brazil.