Work Assessment due to Disease or Disability on Typical Cases Janko Demšar, Bojan Žibrat, Plavec Valentina, Tomaž Tomažič, Oskar Mittag

Assessing the work capability o Assessing the work capability on 5 typical cases o The cases by Prof. Oskar Mittag from Freiburg o Questionnaire for Slovenian medical assessors forwarded to 220 med. assess. o Assessing the work capability on 5 typical cases o The cases by Prof. Oskar Mittag from Freiburg o Questionnaire for Slovenian medical assessors forwarded to 220 med. assess. The purpose of the inquiry is to compare the assessors' results The purpose of the inquiry is to compare the assessors' results ZPIZ: Pension and Disability Insurance Institute of Slovenia Ocena delazmožnosti

ASSESSORS Questionnaire Sent to 220 assessors Repeating 59 assessors Most experts are: from public sector (76%) from private sector (24%) Questionnaire Sent to 220 assessors Repeating 59 assessors Most experts are: from public sector (76%) from private sector (24%) 27% 73% Izvedenci v javnih zavodih in izvedenci koncesionarji Izvedenci na primarnem in sekundarnem nivoju

ASSESSOR FIELDS Odgovorili so v največjem številu psihiatri Te specialnosti so tudi najbolj zastopane na senatih IK

ASSESSORS’ REGION 5% 24% 3% 8% 34% 7% 8% 3% 7%

1. Traumatic brain injury 32 years Job: roofer. Motorcycle accident (free time) Gross salary: €2,400 Cerebral concussion and bifrontal cerebral haemorrhag Undirected, fluctuating vertigo, insecure gait and dizziness, organic brain syndrome Posttraumatic damage: Insecure gait/dizziness/ vertigo (no work involving standing or walking) Organic brain syndrome (any work involving psychological demands, no time pressure, no new situations…) Traumatska poškodba možganov: 32 letni krovec. gradnja streh, pokrivanje zunanjih sten (družinsko podjetje s 5 zaposlenimi). Kontuzija možganov z zlomom možganskih kosti in bifrontalno možgansko krvavitvijo s posledičnim psihoorganskim sindromom. Po terapiji: vrtoglavice, nesigurno hojo, omotico v stoječem položaju ter posttravmatski psihoorganski sindrom. Pred terapijo: Po odpustu iz bolnišnice 6 tednom hospitalne in 6 tednov ambulantne nevrološke rehabilitacije faze D. Trenutno je v ambulantni oskrbi. Aktivnosti: Zaradi vrtoglavic ne more opravljati dela, ki vključuje stanje ali hojo. Zaradi psihoorganskega sindroma ne dela s psihološkimi obremenitvami (časovni pritisk, prilagoditev na nove situacije, itd). Stališče zavarovanca: Gospod S. se zaradi svojih trenutnih prizadetosti ne čuti več zmožnega za delo – ne za krovska ali katerakoli druga dela. Kdo od vas bi podal I. kategorijo? Kdo bo bil za III. kategorijo KDČ 4 ure? I.cat.? II.4h DJ?

TRAUMATIC BRAIN INJURY II cat. 8h OR: Occupational Reha (New job) III.cat. 8hDJ: Different Job-Full time III.cat. 4hDJ : Different Job-Part time T in prog.: Treatment not compl. I. cat. WInc : Work Incapacitiy (retirement) Other: Other decisions

2. Chronic lumbar pain 47 years Job: assembling /producing working surfaces/counters, Gross salary: €2,500 lifting objects weighting over 20kg same kitchen manufacturer for 30 years employer does not see an alternative occupation Impairment: Chronic low back pain, NO neurology, NO Disc Herniation Lumnar and buttock pain (only lift up to 5kg, changes in position relieve the pain) No Limit ? I.4h DJ? 47 let. izdelava in sestava delovnih površin/ pultov v proizvodnji kuhinjskega pohištva (100 zaposlenih). Kronična bolečina v spodnjem delu hrbta z obrabnimi spremembami hrbtenice, brez znakov diskopatije ali radik.kompresije. Pred terapijo: Ortopedska rehabilitacija pred 2 leti. Aktivnosti: Gospod R. lahko dviguje predmete s tal do delovne površine, in sicer le do 5 kg teže. Občasne spremembe položaja včasih pomagajo pri lajšanju bolečin. Okoljski dejavniki: Po opisu delovnega mesta mora dvigovati bremena nad 20 kg in jih polagati na delovno površino. Delodajalec ga ne more prerazporediti na drugo delovno mesto, deloma tudi zato, ker je podjetje že 3 leta v finančnih težavah. Stališče zavarovanca: Gospod R. bi se rad vrnil na delovno mesto v podjetju, vendar ne ve, kako bi to bilo izvedljivo, saj ni zmožen dvigovanja bremen 20 kg, delodajalec pa ne vidi alternativnih možnosti za zaposlitev. Zavarovanec meni, da so njegove možnosti za drugo delo zaradi trenutne situacije na trgu dela zelo slabe, saj nima nobene uradne kvalifikacije (pripravnik), prav tako je bil celo življenje zaposlen le pri enem delodajalcu.

CHRONIC LUMBAR PAIN Chronic lumbar pain, 47 year old forest worker: 63% believe the patient can work full-time with certain restrictions, while 7% suggest occupational rehabilitation with workplace adaptation. III.cat. 8hDJ: Different Job-Full time III.cat. 4hDJ : Different Job-Part time No Limit: same Job – No limitation Other: Other decisions

3. Breast cancer 65 years Job: cleaning lady at a hospital ward Gross salary: €1,800 (mastectomie+axilla+RT+CT) washing rooms, cleaning floors, making beds same service for the past 6 years employer sees no way to keep Ms. B Impairment: lymph oedema in her right arm (right-handed) paraesthesia in her right arm, fatigue manual activities <4 to 5 hours, NO repetitive work, reduced concentration and reactions Čistilka v bolnišnici - operacija (mastektomija z odstranitvijo aksilarnih limfnih bezgavk) - pooperativna radioterapija -adjuvantna kemoterapija (Tamoxifen Gospa B. ni zmožna opravljati ročne aktivnosti ali lahke, monotone aktivnosti z rokami po več ur skupaj. Po 4 oz. 5 urah dela se izčrpa, kar včasih poslabša njeno zmožnost koncentracije in reagiranja. II for I >55Y

BREAST CANCER III.cat. 4hDJ : Different Job-Part time II.cat.>55Y+I.cat: Work Incapacitiy (retirement) III.cat. 8hDJ: Different Job-Full time Other: Other decisions

4. Coronary Heart Disease 55 years Job: welder working a three-shift sched. Gross salary: €3,500 heavy labour, overhead work ; exposure to steam/gas large shipyard company for the past 30 years employer sees no way to keep Mr. K Impairment: acute heart attack, 3-vessel disease-CABG NYHA II after release (= mild heart failure) reduced cognitive-intellectual capacity light effort while sitting/walking/standing Koronarna srčna bolezen: 30 let varilec ; 3 izmensko delo lahka fizična, pretežno sedča dela obdobno v stoječem položaju/s hojo 8h or 4h DJ? I. cat ?

CORONARY HEART DISEASE III.cat. 4hDJ : DifferentJob-Part time II.cat.>55Y(II-I): Work Incapacitiy (retirement) III.cat. 8hDJ: Different Job-Full time I.cat.: Work Incapacitiy (retirement)

5. Recurr. depressive disorder 47 years Job: police detective for 20Y Gross salary: €3,000 police detective (police department, last 20 years) Ms D.‘s supervisor sees no way to re-instate her to the police force Impairment: (F33.2) Recurrent periods of depression past 2 years; 7W severe depressive, NO psychotic symptoms feeling melancholy, memory problems, anxiety rehabilitation 2 years ago, outpatient psychotherapy, antidepressants have failed, significant mental efforts not possible Ponavljajoča se obdobja depresije brez psihotčnih simptomov: V zadnjih dveh letih je bila 6 mesecev nezmožna za delo, trenutno je nezmožna za delo že 7 tednov 4h SJ? I. cat ?

RECURRENT DEPRESSIVE DISORDER T not compl.: Treatment not completed I.cat: Work Incapacitiy (retirement) III.cat. 4hDJ: Different Job-Part time Other: Other decisions

CONCLUSION In the assessment of these disabilities we observed some discrepancies between experts We conducted a study using these typical 5 examples of prof. Mittag The questionnaire offered the assessors the most expected possibilities: 1.Occupational Rehabilitation 2.Different Job (Full/Part time) 3.Work Incapacity (Retirement) 4.Other III.cat.8h/4h DJ: Different Job-Full/Part time II.cat.>55Y(II-I): Retirement III.cat.8h/4h SJ: Same Job-Full/Part time I.cat:n Retirement (Work Incapacitiy) II.cat.<50Y 4h OR: Occup.Reha (New job) T not compl.: Treatment not completed

CONCLUSION

The analysis shows differences in assessing the working capability in some comparable health problems The analysis shows differences in assessing the working capability in some comparable health problems We acceded to preparing a more universal criteria for all categories and for the whole country We acceded to preparing a more universal criteria for all categories and for the whole country CONCLUSION The study results confirmed the discrepancies in assessing the working capability in some fields of assessment:

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