[Work and vocational integration of psychosomatic patients--utilization and indications for a workload tryout program]

The effect of a professional workload test was assessed in a longitudinal study with 80 patients psychosomatic rehabilitation during and following their. In a second study indication criteria were tested with 358 consecutive patients. Participants in the workload program show an improvement of their work ability and job performance according to self-appraisal, superior appraisal and medical assessment. Work ability was still maintained 7 months after treatment. Patients with lasting work disability and unemployment not only show negative work-related attitudes, but also elevated psychological symptoms and a reduced quality of life. The program participants show high levels of psychological strain but also a stronger disposition to change the professional situation. Negative work-related and psychological consequences of lasting disability and unemployment deserve more attention in inpatient psychosomatic treatment.

Changing pattern of brain hemorrhage during 12 years of computed axial tomography

BACKGROUND AND PURPOSE

We examined whether the pattern of cerebral hemorrhage changed after the introduction of computed tomography.

METHODS

Using a prospective data base we analyzed the case-fatality ratio, early mortality, and the incidences of hypertension and anticoagulant medication in 488 consecutive cases with supratentorial hemorrhage between 1978 and 1989. Blood pressure at admission of all patients for the years 1978-1979 and 1988-1989 and the Mathew and activities of daily living scores for the years 1978-1979, 1982-1983, and 1988-1989 were assessed retrospectively.

RESULTS

The case-fatality ratio decreased from 49% in the period 1978-1981 to 31% in 1986-1989 (p = 0.006); early mortality (day 1-4) decreased from 28% to 12% (p = 0.0017). The incidence of hypertension decreased from 78% in the period 1978-1981 to 64% in 1986-1989 (p = 0.01). Systolic and diastolic blood pressure at admission sank (p = 0.09). The decrease of the case-fatality ratio correlated best with a less severe initial disturbance of consciousness (p less than 0.01) and with a higher Mathew score (p = 0.038). The activities of daily living score remained unchanged.

CONCLUSIONS

The case-fatality ratio and early mortality decreased after the introduction of computed tomography. This was basically due to a decreased incidence of comatose and stuporous patients with severe neurological deficit paralleled by a decrease of mean systolic and diastolic blood pressure values at admission.