Increased body mass index: what is the influence on ventilatory muscular strength?

Introduction: Ventilatory muscle strength (VMS) and anatomical/biological factors are important in the functioning and maintenance of body homeostasis. Thus, the study of respiratory mechanics and conditions that can alter them is fundamental. Studies indicate that obesity decreases the Maximum Inspiratory Pressure (MIP) and Maximum Expiratory Pressure (MEP), however, these studies are contradictory in their results. Objective: To verify if there is a difference between the VMS of obese and eutrophic individuals. Methods: Comparative observational study, in which 40 individuals of both sexes were evaluated, divided into two groups: 20 individuals with grade I obesity and 20 eutrophic individuals. Abdominal circumference was considered to be > 102 cm for men and 88 cm for women. Two-way unpaired Student's t-test was applied to compare the Maximum Inspiratory Pressure (MIP) and Maximum Expiratory Pressure (MEP) of the evaluated groups. The BioEstat 5.0 program was used and a p ˂ 0.05 was adopted as significant. Results: The mean MIP for obese and eutrophic individuals was 147 ± 73 vs 145 ± 70 cmH2O, respectively (p = 0.91). For MEP, the mean for the obese and eutrophic group was 133 ± 28 vs 135 ± 27 cmH2O, respectively (p = 0.93). Conclusion: Sedentary individuals with grade I obesity associated with increased waist circumference do not differ in MIP and MEP when compared to eutrophic individuals.Keywords: obesity, work capacity assessment, functional physical performance.

Creating national guidelines for assessing functional and work capacity of recently settled persons

Problem The measurement of functioning in clinical practice should be systematic and comprehensive. However, different versions of the same functioning measure are used e.g. by physicians, psychologists, physiotherapists and occupational therapists. The TOIMIA network of experts aims to harmonize and develop the measuring of functioning in Finland. Description of the problem With increasing immigration to Finland, a specific need for guidelines on how to assess functional and work capacity of recently settled persons was identified. Led by the National Institute for Health and Welfare (mobiTARMO-project, 2017-2020), guidelines for assessing functional and work capacity in the integration phase are in preparation. Results The guidelines on assessing functional and work capacity in the integration phase include four principles: Functional and work capacity assessment should be done with culturally and linguistically appropriate methods.Assessment should be based on shared expertise of the professional and the client.Assessment should be comprehensive, and take into consideration physical, psychological, social and cognitive functional capacity, activities of daily living, and environmental factors.Assessment should be systematic and lead to further actions and necessary services.The national guidelines will be disseminated as free online access material in the Terveysportti health portal to professionals in clinical practice and research. Lessons There are specificities to the cross-cultural assessment of functional and work capacity of recently settled persons. National guidelines can be created through broad collaboration of different organizations, as in the TOIMIA network of experts in Finland. Key messages Jointly agreed principles on how to assess functional and work capacity in the integration phase benefit professionals and clients. National guidelines can be created, disseminated and taken into practice through broad collaboration.

Work capacity assessments – reviewing the what and how of physicians’ clinical practice

Background Although a main task in the sickness certification process, physicians’ clinical practice when assessing work capacity has not been thoroughly described. Increased knowledge on the matter is needed to support a better and more reliable certification process. In this review, we aimed to synthesise existing evidence to provide a clearer description of the work capacity assessment as practiced by physicians. Methods Seven electronic databases were searched systematically for qualitative studies examining what and how physicians do when they assess work capacity. Data was analysed and synthesised using qualitative manifest content analysis. Results Twelve articles were included in the review. Results show that physicians seek to form a knowledge base including understanding the condition, the patient and the patient’s workplace. They consider both medical and non-medical aspects to affect work capacity. Accordingly, to acquire and process the information they use both medical and non-medical skills, methods and resources. Medical competence is an important basis, but not enough. Time, trust, intuition and reasoning are also used to assess the patient’s claims and to translate the findings into a final decision. The depth and focus of the information seeking and processing vary depending on several factors. Conclusions The work capacity assessment is a complex task where physicians rely on their non-medical skills to a higher degree than in ordinary clinical work. These skills are highly relevant but need to be complemented with methods to better understand the patient’s work place, as well as theoretical knowledge regarding the intricate associations between health, work and social security. This would further enhance physicians’ competence and confidence, and promote better experiences and practices of the work capacity assessment. Key messages In the complex task of assessing work capacity physicians rely on their non-medical skills to a higher degree than in ordinary clinical work. A better understanding of the patient’s work situation and the intricate associations between health, work and social security would enhance physicians’ competence and promote better assessments.

Are psychologists and psychiatrists assessing work capacity part of the problem or solution? / Jesu li psiholozi i psihijatri koji ocjenjuju radnu sposobnost dio problema ili rješenja problema?

The aim of this case study was to emphasise the importance of coordination between the members of occupational medicine teams who assess work capacity in persons whose jobs may involve responsibility for other people’s safety and health. We have picked out four cases - three visiting nurses and one applicant for driving and firearms licence extension - where psychiatrists/psychologists and occupational health specialist disagreed in their assessment entirely. These cases illustrate how psychologists and psychiatrists tend to support patients’ wishes to either remain at their workplace or take disability retirement, whereas occupational health specialists take a different, less easy course, relying on the medical condition of the patient, specific job requirements, and broader implications for public safety. It appears that this is not a problem only in Croatia, but in a number of developed countries as well. This problem calls for additional training of all members of a work capacity assessment team.