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Job fitness evaluation for specific jobs is the conclusive step of workers health surveillance. This should include a physical examination and specific tests for the evaluation of organ functions which are the target for risk factors in the working environment. Occupational physicians must assess job fitness following a specific procedure: cooperation with the employer in the process of risk assessment, creating of a medical surveillance protocol related to the existing risks, implementation of medical surveillance, evaluate of etiological diagnosis of workers' illnesses and express the job fitness assessment. Possible patterns of assessment are: no job limitations, some specific temporary or permanent job limitations, temporary or permanent unfitness. The competence of the occupational physician is crucial when addressing specific problems of the workers, such as indvidual hypersusceptibility, particular tasks, illnesses, pregnancy. The occupational physician's competence is also required after fitness evaluation when transferring the worker to a more suitable job when he is deemed unfit for a job at risk and in selecting adequate personal protective equipment. In addition, the physician must perform other duties according to the existing regulations such as informing workers to obtain their consensus and the assurance of maintaining of professional secrecy as regards personal information. The occupational physician is expected to be independent and impartial towards both employer and employees, which is obtained by up-dating professional skills and by acting with care and honesty.
Orthostatic tolerance (OT) and physical performance were tested against the ground simulation of several spaceflight factors. Before and after prolonged isolation and confinement three human subjects were tested by tilting, LBNP, and graded incremental aerobic exercise in the sitting position. Results suggested good OT in all the subjects. However, the pattern of orthostatic reaction was modified depending on the initial functional state of each subject. This was especially distinct in subjects 002 and 003 whose OT was slightly reduced by the experimental conditions. Orthostatic reactions in subject 004 showed greater stability in the baseline data collection period and was not much affected by isolation and confinement. HR variations at rest carried an individual character. On the whole, HR tended downward, particularly in 002. Indices of AP and, to a higher degree, its systolic constituent wandered outside the region of baseline values and even the norm limits in 002 and 004. Maximum variations were documented at the end of the second (003 and 004) and the third (002) months in experiment. ECG parameters in all the operators displayed different patterns of the norm. Diffusive repolarization, especially in the left chest leads, was noted to decline in the experiment. Tolerance of LBNP was qualified as good. Meanwhile, subject 003 developed symptoms of strained functioning of compensatory/adaptive mechanisms responsible for the OT maintenance. Repeated testing by LBNP was found to raise HR. Hence, prolonged simulation of space flight causes some reduction of orthostatic and LBNP tolerance, and degradation of physical performance.
The utilizable sources of energy of the human organism are relatively restricted where by interindividual differences are not substantial, while differences in physical performance are extreme. The capacity to transform chemical energy into mechanical work, sometimes described also as the work capacity of the organism is evaluated by means of mechanical efficiency--ME. In men with varying amounts of training (incl. untrained ones), differing significantly as to the percentage of body fat (3.8-17.2%), assessed by measurement of ten skinfolds, the authors assessed ME on a treadmill. The highest ME values were recorded in trained sportsmen (endurance runners--32.4%), lowest in untrained middle-aged men (16.9%). The authors found a close negative correlation of ME and maximal oxygen consumption per kg body weight and values of body fat percentage. With the increasing percentage of body fat the values of ME decline, the prerequisites for effective transformation of chemical energy of the organism into mechanical work are reduced and the work capacity of the organism declines.
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The authors studied the bioelectroactivity, brain hemodynamics and the state of the nervous-muscular system in 97 patients in the remote period of the vibrational disease. It was established that despite the absence of a contact with vibration most of the patients demonstrated slight general brain changes of an electroactivity in the form of irritation, a disturbance of cerebral hemodynamics. This was expressed in a decrease of blood repletion, an intrahemispheric asymmetry of the blood flux. An analysis of the EMG dopicted a decrease in the general electroactivity and a distrubance in the structure of the EMG. In patients who had a short contact with vibration the above mentioned changes were minimal. The clinico-physiological studies permitted to elaborate the basic principles for the commission of experts in regard to working capacity.
Up to now it has often been the responsibility of physicians to assess whether an insured person qualifies for disability benefits, although the insurance conditions in fact state that the problem is not purely a medical one. Indeed, it is advisable to take advantage of the expertise available in the field of Occupational Studies when assessing elibility for benefits. The spectrum of occupations is subject to constant change. The "classification of Occupations" published by the Federal Employment Agency in Nuremberg lists some 25,000 occupational designations. Further, several thousand agreements are concluded each year between employers and employees' representatives at various levels and these may need to be taken into account when assessing claims for disability benefits. Occupational Studies is a specialist area in its own right, requiring specific training and experience. The assessment of disability claims calls for close cooperation and teamwork: doctors, insurers and occupational consultants must each contribute their own particular skills to the decision-making process. In the final analysis, however, it is the insurer alone who must take responsibility for accepting or rejecting the disability claim. The present paper starts by discussing the term "Occupational Studies" and goes on to explain the tasks of the occupational consultant. Finally, reference is made to descriptions of occupations as well as workplace features and requirements which the medical expert should take into account when assessing and insured's ability to work in a given occupation.
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