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PubMed1997

The work incapacity and reintegration study: results of the initial survey conducted in the United States.

The United States and six other countries (Germany, Denmark, Norway, Sweden, Israel, and the Netherlands) are participating in a cross-national study of work incapacity and reintegration under the auspices of the International Social Security Association. The purpose of the study is to identify those medical and nonmedical interventions that are most successful in helping persons disabled due to a back condition return to work. The study involves a baseline survey and two follow-up surveys over approximately 2 years. This article reports on the findings from the baseline survey conducted in the United States. It compares the responses of persons from four study groups (the Social Security Administration's Disability Insurance (DI) beneficiaries and Supplemental Security Income (SSI) recipients, and temporary disability insurance (TDI) recipients from two States--California and New Jersey). The article discusses the potential influence of certain characteristics on the capacity for work reintegration. Study findings suggest that the characteristics of TDI recipients with back disorders may differ in some respects from those of recently entitled DI or SSI beneficiaries with similar impairments, and that there may be some correlation between work resumption and factors such as education occupation, work-related demands, and the presence of other chronic diseases.

Adult↗

PubMedDate not supplied

School reintegration: a rehabilitation goal for spinal cord injured adolescents.

This article describes how the Education for All Handicapped Children Act of 1975, Public Law 94-142, assists in achieving the rehabilitation goal of school reintegration for spinal cord injured (SCI) adolescents. It also describes how subordinate goals are achieved during the inpatient rehabilitation phase. Comments from a survey of 13 SCI adolescents who returned to school demonstrate the need to prepare SCI adolescents for the services to which they are entitled, to acquaint them with ways of resolving possible problems they may encounter, and, when they return for follow-up care, to encourage them to continue in school.

Adolescent↗

PubMed2005

Cardiac risk of coronary patients after reintegration into occupations with heavy physical exertion.

The job related reintegration of patients with coronary artery disease (CAD) is a central part of cardiac rehabilitation. However, specific occupational demands like jobs with heavy physical exertion (> 6 METs) could increase the cardiovascular risk because the relative risk for acute myocardial infarction (MI) and cardiac death is temporarily elevated after vigorous exertion ("hazard period"). Thus, in 2001 any male patient with proven CAD who performed a job with heavy exertion until the occurrence of an index event (MI/ACS, any interventional or surgical revascularization measure) received a questionnaire after an average of 20 months. Complete data were available in 108 from 119 included patients (90.8%), aged 51.8+/-7.8 years. Ejection fraction was 61.5+/-13.1% and the functional capacity at the time of hospital discharge averaged 130.1+/-31.2 W. 75% of the patients had a previous MI and 59.3% underwent bypass surgery. During follow-up the previous job with heavy exertion was performed over a cumulated time of 74 years. The aim of the study was to compare the observed and the expected incidence of MI and cardiac death with and without job performance. The expected ("basal") risk for MI and cardiac death without heavy physical exertion was determined from pooled study results and assumed to be 5.2% per year. The combined risk due to performing an occupation with strenuous exertion can be calculated from time periods with and without working hours and amounts to 11.9%. There could be expected 0.119 . 74=8.8 cardiac events related to the job. In contrast, 5 MIs (4 NSTEMI, 1 STEMI) were observed (6.8%). The relative risk for an expected event compared to the basal risk without heavy exertion was 2.3 (95% CI: 0.7-7.4). The relative risk for the observed cardiac events amounts to 1.3 (95% CI: 0.4-4.8). The lower observed risk is probably due to the high grade of physical fitness in this patient group. In spite of several limitations, our study showed no convincing evidence for increasing the cardiac risk of patients with CAD performing occupations with heavy physical exertion. Because of the importance of this prognostic finding, a representative and prospective study is strongly required.

Coronary Artery Disease↗

PubMed1984

Relationship between a retroviral germ line reintegration and a new mutation at the ashen locus in B10.F mice. Retroviral integration and an ashen mutation.

In a litter of B10.F mice a single mouse was found with a "dilute-like" coat-color mutation. F2 matings were then carried out to establish sufficient numbers of mice carrying this mutation in a homozygous form. The coat-color mutation was found to be allelic to the ashen locus which is closely linked to the dilute locus on chromosome 9. Further analysis of the ashen mice showed they contained an additional ecotropic provirus integrated into their chromosomal DNA. This result initially suggested that retroviral integration was responsible for the mutation. However, backcross studies showed the mutation and provirus were genetically unlinked. The reintegrated provirus was molecularly cloned and transfection studies showed the virus was B tropic in host range. The restriction map of the cloned provirus was found to be similar to previously described B-tropic viruses. The results are discussed in view of the low probability of two rare and unlinked events occurring in a single mouse.

Alleles↗

PubMed1988

Nuclear factor 1 (NF-1) binding sites in the genomes of human oncoviruses: a hypothetic role for reintegrated cellular origins of replication in malignant transformation.

We have found that genomes of human T cell leukemia-lymphoma virus type I (HTLV-I), BK virus (BKV), and a hepatitis B virus (HBV) DNA sequence integrated into DNA of a hepatoma-derived cell line contain binding sites for nuclear factor 1 (NF-1), a cellular protein which binds to adenoviral and putative cellular origins of DNA replication. We suggest that cellular origins of DNA replication acquired by oncoviruses may play a role in malignant transformation after reintegration into the cellular genome by providing new targets for cellular factors initiating DNA replication and by perturbing the temporal order of replication.

Binding Sites↗

PubMed2005

Community reintegration of prisoners with mental illness: a social investment perspective.

Responding effectively and efficiently to the needs of persons with mental illness returning to the community from prison requires identifying their differences in need and placement difficulties upon return and targeting reintegration investments to reflect these differences. This paper has three parts. The first part profiles the male special needs population in New Jersey prisons. These profiles describe behavioral health and criminal justice characteristics of 2715 male inmates with mental health problems, and are used to identify the scope and nature of the public's investment opportunity. The next part describes the costs associated with possible "investments." The special needs population is classified by need and placement difficulty, and then matched to reentry and community-based treatment programs. Costs are estimated for reentry planning and community-based treatment for the first year post-release. The third part recommends an investment strategy and a set of operational changes that might minimize the loss and maximize the return on the public's investment dollar in mental health.

Adult↗

PubMed1997

Reintegration of mobilized titanium implants. An experimental study in rabbit tibia.

The possibility of re-establishing a rigid bone-implant fixation, i.e. osseointegration, after mechanical loosening of titanium implants, was evaluated in the rabbit tibia. Implants were inserted to engage either one (10 mm long, n = 24) or two (16 mm long, n = 24) cortical layers and were allowed to heal for six weeks. A re-entry was then made and 12 test implants in each group subjected to a reverse torque procedure until the integration failed. The remaining nonrotated 24 implants were left as controls. Thereafter all implants were allowed to heal for an additional period of six weeks. At the end of the 12 weeks, the degree of integration was assessed by measuring the removal torque for six test and six control implants in each group of implant lengths. Histomorphometric measurements were also performed on ground sections of the remaining test and control implants. A statistically significant higher removal torque was observed for the monocortical test implants than for the corresponding control implants. No differences were seen for the bicortical implants of either kind, however, no morphological differences could be revealed either, when comparing monocortical and bicortical test and control implants. These results indicate that osseointegrated implants that have been mobilized due to a traumatic disruption of the bone-implant interface, may reintegrate if allowed to heal for an additional period of time.

Animals↗

PubMed1982

Social reintegration of paraplegics and tetraplegics in the Cape Province of the Republic of South Africa.

Rehabilitation of the disabled is a dynamic process which should start from the first day post-injury. Total rehabilitation should include, not only attaining maximum function, but also, satisfaction with life in one's own environment. The obstacles created by able-bodied society, are problems that face the disabled person. The right to participate in, and contribute to, all aspects of economic, social and political life is theirs too, as is the right to make decisions about the future. This should not be overlooked, as decision making sows the seeds of motivation. This in turn dictates the measure of success of social reintegration. Assistance is provided in South Africa by various organisations of central government, provincial and local authorities and private welfare organisations. The Cripple Care Association is a private welfare organisation which provides assistance and acts as a link with other relevant organisations. In the Western Cape the number of successfully rehabilitated persons increases and their presence in the community creates an awareness of their needs. This in turn initiates the process of positive change and action.

Adult↗

PubMed1992

Community reintegration and quality of life following spinal cord injury.

This report contains a brief overview of issues related to community reintegration and quality of life for persons with spinal cord injuries. Current data from the National Spinal Cord Injury Statistical Center are provided on place of residence, employment, education and marital status after rehabilitation discharge. The health policy implications of these data are discussed along with prospects for continued improvement of long term social outcomes and directions for future research.

Employment↗

PubMedDate not supplied

Reintegration after bone marrow transplantation.

OBJECTIVES: This study examines the problems of bone marrow transplantation (BMT) survivors in returning to "normal" life in the community after BMT. MATERIALS AND METHODS: Before being released from The Johns Hopkins Oncology Center, 84 recipients of BMT were interviewed regarding their quality of life and psychosocial adaptation. Survivors were reinterviewed at 6 months, and at 1 year post-BMT, producing considerable qualitative data regarding their problems in living. Eighty-four patients who had received BMT completed qualitative interviews and standardized measures before treatment, before the return home, and at 6 and 12 months post-BMT. The interviews were subjected to a content analysis methodology to establish units and categories to examine the body of material. RESULTS: Content analysis of these interviews from the first year after BMT identified three areas of psychosocial morbidity; 1) physical problems, which included fatigue, appearance, troubles in eating, and physical restrictions; 2) psychological problems, which included fears about the future, sense of loss of control, anxiety, and depression; and 3) community reintegration problems, which included difficulty in returning to former social roles, separation from home, family, and friends, difficulty in resuming social relations, dealing with stigmatization, problems with family and children, and financial and employment difficulties. CONCLUSIONS: Identification of these problems for BMT survivors can be used to guide the development of specific materials and services to prepare recipients of BMTs and their families for life after the transplant. These qualitative results can also be used to direct the development of assessment tools to identify potential patient and family problems.

Activities of Daily Living↗

PubMed2002

["REGRATIO" - A vocational reintegration project for psychiatric patients].

OBJECTIVE: Theoretical background and first results of a vocational rehabilitation program for unemployed persons with chronic psychiatric disabilities will be presented. The aim of the program is job-placement in the regular labour market. METHODS: After a 3-month preparatory period the participants were given the possibility of "training on-the-job" in the areas of social services, catering, and care taking activities in 12-months' rehabilitation reintegration courses in co-operation with a social service centre. In addition, a 6-months aftercare period will be included. RESULTS: More than one third of 34 participants (38 %) were placed in a regular employment. CONCLUSIONS: The results support the importance of vocational rehabilitation programs as a supplementary component of the care system of chronic mentally ill patients.

Adult↗

PubMed2004

["They'll never come back...""--Expectations and reality of occupational reintegration of teachers unfit for service].

AIM OF THE STUDY: The reactivation of teachers with experience of both life and the profession who have become unfit for work is regarded by politicians not only as a suitable measure against the imminent lack of teaching staff, but also as a promising strategy for reducing the cost of health care. The aim of our study was to gather new evidence- based information on the occupational reintegration of teachers who took early retirement and to investigate to what extent official medical reactivation examinations are an effective instrument of tertiary prevention. DATABASE AND METHODS: In a prospective total assessment (the entire state of Bavaria) over the period of 1997 - 1999 all official medical examinations in the public health centres (Gesundheitsamter und Medizinische Untersuchungsstellen der Bezirksregierungen) were evaluated with regard to the reactivation of teachers unfit for work. The analysis included e. g. socio-demographic/occupational factors, the morbidity spectrum, rehabilitation and the assessment of performance. The answers given in a standardised, anonymous questionnaire provided the database. Evaluation was carried out by means of descriptive statistics. RESULTS: Of the 1465 teachers studied, 64 % (n = 939) were women and 36 % (n = 526) were men. The median age was 53 years (range: 31 - 63 years), and the proportion of over 60-year-olds was 5.5 %. 22 % of those who took early retirement were recognised as being severely disabled. In 77 % of cases, examination of unfitness for work was carried out at the order of the authorities. 57 % (n = 835) of the teachers had taken part in at least one medical rehabilitation measure, 13 % (n = 190) in at least one occupational rehabilitation measure. Within the morbidity spectrum, psychic and psychosomatic illnesses (F-ICD10) took first place with a share of 59 % the prevalence in female teachers of such illnesses was significantly higher than that in male teachers (p < 0.05). Among the psychiatric diagnoses, depressive illnesses dominated (share: 35 %). The most frequent somatic diseases were muscular/skeletal disorders (M-ICD10) in 12 % of cases, then cardiovascular disorders (I-ICD10) in 7 % and malignant tumours (C-ICD 10) in 5 % of cases. In 33 % of cases multi-morbidity was found. 93 % (n = 1,360) of the teachers investigated in follow-up examinations were again classified as unfit for work. In only 7 % (n = 105) reactivation was recommended by the physician; the lowest reactivation quotas were found among teachers with psychic illnesses and grammar school teachers. In who teachers that returned to work, compared to those still unfit for work, a lower age and lower prevalence of severe disability, multi-morbidity and psychic disturbances were objectified. CONCLUSIONS: Teachers who take early retirement return to the profession only in exceptional cases. The time and expense needed for reactivation examinations should be critically compared with the benefits. The same applies to the quality of the results of intervention and rehabilitation measures for restoring psychological and physical health. In this context problem-oriented disability management appears superfluous.

Adult↗

PubMed2006

[Patients' satisfaction and social reintegration after breast reconstruction with the DIEP/TRAM flap].

The aim of the study was to evaluate social reintegration and patients' perception after breast reconstruction with the free TRAM/DIEP flap. Between 2004 and 2006, 100 patients with an average age of 48 years with breast cancer, capsular contracture and lymphangioma underwent single or second stage autologous tissue transfer. In 7 patients reconstruction was performed on both sides (altogether 107 flaps). The patients were seen for postoperative evaluation and were asked for their personal acceptance after reconstruction. Postoperatively, no instability of the abdominal wall was seen. 3 patients had a total flap loss, in 2 patients a partial loss was evident, 1 had a hematoma, 2 showed successfully treated thrombosis of the flap vein, and 2 patients suffered from wound healing problems at the flap and 4 patients at the abdomen. Aesthetic results concerning natural feeling and breast symmetry were graded as excellent and patients' satisfaction was high.

Adult↗

PubMedDate not supplied

[Effect of social status on occupational reintegration after lumbar discotomy].

QUESTION: The influence of non somatic factors, especially the social status of the patients' profession on postoperative reintegration following lumbar discectomy is investigated. METHODS: In 511 patients postoperative loss of working time and time till return-to-work after lumbar discectomy were investigated. Patients were interviewed by questionnaire at an average of 7.6 years postoperatively. RESULTS: Patients returned to work at an average of 10.5 weeks after operation. Looking at the social status of the patients we found an average time of 5.4 weeks until return to full work for self employed people. Civil servants took on average 10.2 weeks and regular employees returned to work after 14.0 weeks. The longest time to return to work was seen in workers with 17.2 weeks. Somatic risk factor profile for nucleus pulposus prolaps was identical in the group of self employed and employees. There was a different risk profile in the other two groups. CONCLUSION: We could show a correlation between the length of the return-to-work period and long-term clinical outcome with the social status of the patient. This correlation was most clearly shown in the group of self employed and employees. CLINICAL RELEVANCE: For judgement of the postoperative rehabilitation period, the social status may indicate the pain level and duration of pain that has to be expected.

Absenteeism↗

PubMed2004

Comparison of the Sydney Psychosocial Reintegration Scale (SPRS) with the Community Integration Questionnaire (CIQ): psychometric properties.

PRIMARY OBJECTIVE: This study compared the psychometric properties of two community integration measures used with people with acquired brain injury (ABI) in the community. RESEARCH DESIGN: Questionnaires were mailed-out to people with ABI and nominated proxies. METHODS AND PROCEDURES: Responses were obtained from 96 people with ABI and 121 proxies on the Community Integration Questionnaire (CIQ) and the Sydney Psychosocial Reintegration Scale (SPRS). MAIN OUTCOMES AND RESULTS: Matched client-proxy scores were not significantly different. The SPRS had greater internal consistency and more normal distributions than the CIQ. Correlations between the three pairs of theoretically parallel sub-scales were modest (0.41-0.60). Multi-dimensional scaling did not support the theoretical structure of the sub-scales, but found two dimensions underpinning the measurement of community integration. CONCLUSIONS: Mail-out administration is associated with poor completion rates. The SPRS has sound psychometric properties when compared to the CIQ. Further research investigating the theoretical structure of community integration in ABI is recommended.

Activities of Daily Living↗

PubMed1999

Coping with community reintegration after severe brain injury: a description of stresses and coping strategies.

A basic qualitative approach was used to describe the stresses and coping strategies of 11 adults with severe brain injury during a critical period of reintegrating into a new community. Subjects identified nine problems as stressful. The stresses conform to a theoretical model of community integration, consisting of four factors: social support, independent living, occupation, and a general integration factor. These stresses identified by subjects may be used in the development of a new measure of stress for persons with brain injury. Subjects used eight coping strategies to deal with these stresses. The coping strategies represent a sampling of three major types of coping: problem-focused, perception-focused, and emotion-focused. The findings show that subjects made more use of problem-focused coping strategies than any other type of coping, suggesting that persons with brain injury have awareness of the problems they face and the ability to assert some control over eliminating or managing these problems. The stresses and coping strategies are consistent with existing studies involving persons with brain injury. However, significant differences in some coping strategies reported in this study change how some forms of coping are thought about. The findings delineate the need for professionals to assist persons with brain injury develop more positive, adaptive coping strategies.

Adaptation, Psychological↗

PubMed1990

SV40 DNA amplification and reintegration in surviving hamster cells after 60Co gamma-irradiation.

SV40-transformed Chinese hamster embryo cells were exposed to 60Co gamma-irradiation and the fate of the integrated SV40 sequences was pursued over a period of 20 days following radiation exposure. As shown by colony hybridization, integrated SV40 sequences were amplified in surviving and non-surviving cells. At later times, however, clonal sublines of surviving cells grown for 20-30 cell generations after irradiation had lost most of their amplified SV40 copies but showed altered restriction fragment patterns indicating reintegration of SV40 sequences at new sites of the hamster genome. This suggests that 60Co gamma-irradiation can generate mutations by inducing over-replication of chromosome segments that are then substrates of enzymatic rearrangements.

Animals↗

PubMed2001

Reintegrating women leaving jail into urban communities: a description of a model program.

Women are the fastest-growing population in the criminal justice system, and jails reach more people than any other component of the correctional system. About 1 million women pass through US jails each year. Most return to their communities within a few weeks of arrest, and few receive help for the substance abuse, health, psychological or social problems that contribute to incarceration. We describe a model program, Health Link, designed to assist drug-using jailed women in New York City to return to their communities, reduce drug use and HIV risk behavior, and avoid rearrest. The program operates on four levels: direct services, including case management for individual women in the jail and for 1 year after release; technical assistance, training, and financial support for community service providers that serve ex-offenders; staff support for a network of local service providers that coordinate services and advocate for resources; and policy analysis and advocacy to identify and reduce barriers to successful community reintegration of women released from jail. We describe the characteristics of 386 women enrolled in Health Link in 1997 and 1998; define the elements of this intervention; and assess the lessons we have learned from 10 years of experience working with jailed women.

Adult↗