Advantages of the JobReha discharge letter: an instrument for improving the communication interface in occupational rehabilitation.

PURPOSE: Systematic collaboration between occupational physicians (OPs) and rehabilitation physicians (RPs) can improve occupational rehabilitation processes and outcomes. The JobReha discharge letter (JR-DL) is a key element of JobReha, a multilevel intervention for specific occupational rehabilitation of workers with musculoskeletal disorders. This feasibility study aims to analyse the perceived benefit and acceptance of the JR-DL as an instrument for improving the communication interface between RPs and OPs. METHODS: On the day of discharge from rehabilitation, the rehabilitation physician completed a JR-DL form containing relevant information on the rehabilitation measures undertaken during treatment and recommendations for return to work. The JR-DL was either transmitted to the patient's occupational physician directly or given to the patients to bring to the OP to support the reintegration process. The JR-DL as an instrument for improving the communication interface was evaluated using data from patient questionnaires (n = 250), JR-DLs (n = 247), OP questionnaires (n = 224) and RP questionnaires (n = 232). RESULTS: All rehabilitation physicians sent a JR-DL to the respective occupational physician on the day of discharge. OPs received the reports a median 2 days after discharge. The content quality and relevance of the JR-DL for the reintegration process were rated high to moderate by more than 97.0 % of the OPs; 92.3 % of the patients received a recommendation to return to their previous workplace; 43.3 % returned with minor limitation; and the remaining 31.6 % with a recommendation for individual reintegration; 74.0 % of the workers returned to work within 3 days of discharge. CONCLUSIONS: Use of the JR-DL for the improvement of communication and exchange of relevant information is feasible and supportive for both rehabilitation and occupational physicians. Its positive impact on reintegration and return to work was apparent. Delays in receipt of the JR-DL should be eliminated by appropriate quality assurance measures.

Ambient monitoring and biomonitoring of workers exposed to N-methyl-2-pyrrolidone in an industrial facility.

OBJECTIVES: The exposure of seven workers and three on-site study examiners to N-methyl-2-pyrrolidone (NMP) was studied in an adhesive bonding compound and glue production facility. METHODS: Airborne NMP was analysed by personal and stationary sampling on activated charcoal tubes. NMP and its main metabolites, 5-hydroxy-N-methyl-2-pyrrolidone (5-HNMP) and 2-hydroxy-N-methylsuccinimide (2-HMSI), were analysed in pre-shift and post-shift spot urine samples by gas chromatography-mass spectrometry. The workers were examined with respect to irritation of the eyes, the mucous membranes and the skin, and health complaints before and after the work-shift were recorded. RESULTS: The time-weighted average concentration of NMP in most work areas varied between 0.2 and 3.0 mg/m3. During the manual cleaning of stirring vessels, valves and tools, 8-h TWA exposures of up to 15.5 mg/m3 and single peak exposures of up to 85 mg/m3) were observed. NMP and its metabolites were detected in two pre-shift urine specimens. NMP and 5-HNMP concentrations in post-shift urine samples of five workers and three on-site study examiners were below 125 microg/g creatinine and 15 mg/g creatinine, respectively, while two vessel-cleaning workers showed significantly higher urinary NMP concentrations of 472 and 711 microg/g creatinine and 5-HNMP concentrations of 33.5 and 124 mg/g creatinine. 2-HMSI was detectable in four post-shift samples (range: 1.6-14.7 mg/g creatinine). The vessel cleaner with the highest NMP exposure reported irritation of the eyes, the upper respiratory tract and headaches. CONCLUSIONS: The results of this study indicate a relatively low overall exposure to NMP in the facility. An increased uptake of NMP occurred only during extensive manual vessel cleaning. Health complaints associated with NMP exposure were recorded in one case and might be related to an excessive dermal exposure due to infrequent and inadequate use of personal protective equipment.