Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Traveler's Diarrhea


Related Terms

  • Delhi Belly
  • Grippe
  • Intestinal Flu
  • Montezuma's Revenge
  • Turista

Differential Diagnosis

Specialists

  • Family Physician
  • Gastroenterologist
  • Infectious Disease Internist
  • Internal Medicine Physician

Comorbid Conditions

  • Diabetes
  • Immune system disorders
  • Inflammatory bowel disease

Factors Influencing Duration

The length of disability may be influenced by the age of the individual, the individual's response to treatment, the presence of complications, and underlying medical conditions.

Medical Codes

ICD-9-CM:
009.2 - Ill-defined Intestinal Infections; Infectious Diarrhea, Dysenteric, Epidemic; Infectious Diarrheal Disease NOS
009.3 - Ill-defined Intestinal Infections; Diarrhea of Presumed Infectious Origin

Overview

Traveler's diarrhea is caused by the consumption of contaminated water or foods, including raw fruits and vegetables, unbottled juices, unpasteurized milk, and poorly cooked or improperly refrigerated foods. The contaminants are enteropathogenic bacteria (about 80% of cases), protozoa, or viruses. Individuals from industrialized nations typically encounter the disease while visiting countries where waste disposal, water treatment facilities, sanitation, and hygiene practices are substandard. These areas include parts of Mexico, the Caribbean, Central and South America, Africa, Asia, and the Middle East. The organism most likely to cause the disease and the one associated with about half of reported cases is the Escherichia coli (E. coli) bacteria, followed by Campylobacter jejuni, and species of Shigella and Salmonella. Other causes include Giardia and norovirus (Norwalk virus), rotavirus, and astrovirus.

Infections of the gastrointestinal system cause frequent loose stools (diarrhea), sometimes accompanied by abdominal cramps, bloating, fever, urgency to have a bowel movement, a vague feeling of bodily discomfort (malaise), nausea, and vomiting. Although most cases of traveler's diarrhea are not serious, some infections such as dysentery or cholera can be more severe.

Incidence and Prevalence: Every year 20% to 50% of international travelers contract traveler's diarrhea during a trip to a less-developed nation. Bacteria account for almost 80% of traveler's diarrhea, with protozoa and viruses about equally responsible for other outbreaks. An estimated 10 million people worldwide develop traveler's diarrhea each year ("Traveler's Diarrhea").

Source: Medical Disability Advisor



Causation and Known Risk Factors

The risk for travelers to developing countries is increased by drinking tap water and eating raw fruits and vegetables, seafood, unpasteurized dairy products, or food that has been improperly handled or stored. In industrialized nations, the risk is increased by eating food that has been inadequately cooked or stored at improper temperatures. Children, the elderly, and people with suppressed immune systems, diabetes, or inflammatory bowel disease are at higher risk of experiencing more severe symptoms.

Source: Medical Disability Advisor



Diagnosis

History: The incubation period varies depending on the infectious agent (6 to 48 hours for bacterial and viral pathogens; 1 to 2 weeks for protozoal pathogens). Traveler's diarrhea usually begins abruptly. The individual may complain of frequent loose, watery stools, abdominal cramps, and bloating. Nausea, vomiting, and fever may also be reported. The unformed stools do not usually contain blood or mucus. Headache and muscle pain are also common in infections caused by norovirus (Norwalk virus).

Physical exam: The reported symptoms are usually enough to make a diagnosis if the individual is visiting or has just returned from a trip to an underdeveloped area.

A low-grade fever may be present, and the individual may show signs of dehydration (blood pressure that changes with body position changes [orthostatic blood pressure], thirst, decreased urine output, dry mucous membranes, sunken eyes, decreased skin tension [turgor], headache, and dizziness or lightheadedness) if fluids have not been adequately replaced.

Tests: If the condition persists, especially if blood is present in the stool, a fecal sample may be taken for microscopic analysis (culture) to identify the specific microorganism causing the condition.

Source: Medical Disability Advisor



Treatment

Traveler's diarrhea usually resolves on its own within 5 to 7 days and only requires drinking plenty of clear liquids (rehydration) to prevent dehydration. For mild diarrhea, over-the-counter medications can provide effective short-term relief by reducing fluid loss from the intestines (antimotility agents), but they should not be taken for more than 48 hours and are not recommended for individuals with fever or blood in their stool.

Antibiotics are effective only against bacterial infections and are not usually prescribed unless the infection becomes severe. If antibiotics are prescribed, fluoroquinolones are preferred. Many strains of bacteria are resistant to tetracyclines and other antibiotics commonly used in the past to treat bacterial traveler's diarrhea.

For prolonged or severe diarrhea, specially formulated oral-hydration salts (ORS) are widely available. The individual should continue to eat while experiencing diarrhea but should avoid certain food and liquid irritants such as alcohol, caffeine, raw fruits and vegetables, dairy products, and fatty foods.

Source: Medical Disability Advisor



Prognosis

Traveler's diarrhea is relatively mild. Approximately 80% of cases resolve on their own within 5 to 7 days. The other 20% usually resolve within another week or two. If the condition persists, antibiotic therapy is often successful. Complications such as dehydration or electrolyte imbalance could delay recovery. In rare cases, individuals with weakened immune systems may face severe, prolonged symptoms and possibly death.

Source: Medical Disability Advisor



Complications

Infection with an antibiotic-resistant microorganism is becoming increasingly common. With prolonged diarrhea, dehydration and electrolyte imbalance may occur. Persistent diarrhea can become life threatening for individuals with weakened immune systems.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Strenuous activity may need to be limited until recovery is complete. The individual should also be permitted bathroom breaks, as needed.

Risk: Individuals with traveler's diarrhea should practice good personal hygiene including hand washing after toileting and before handling food both at work and home to prevent disease transmission.

Capacity: Capacity is influenced by the severity and frequency of the diarrhea.

Tolerance: Tolerance of symptoms varies according to the individual, although many individuals choose to work despite discomfort. Individuals with frequent diarrhea may require ready access to bathroom facilities during recovery.

Accommodations: Employers willing to accommodate activities as needed can have employees return to work earlier.

Source: Medical Disability Advisor



Maximum Medical Improvement

30 days.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Was diagnosis of traveler's diarrhea confirmed?
  • Were other causes of diarrhea ruled out?
  • Were appropriate tests conducted to determine the microorganism responsible for the disease?
  • Did individual experience untreated or severe dehydration or electrolyte imbalance?

Regarding treatment:

  • Were dehydration and electrolyte imbalance successfully avoided or controlled? Did individual require intravenous rehydration?
  • Was antibiotic therapy indicated? Did the symptoms resolve following treatment with antibiotics? If not, were repeat culture and sensitivities done to rule out the possibility of antibiotic resistance or secondary infection?
  • Were symptoms severe enough to warrant hospitalization?

Regarding prognosis:

  • Did symptoms resolve in approximately 5 days?
  • Have tests been performed to rule out an antibiotic-resistant organism?
  • Did individual have a compromised immune system that could affect recovery and prognosis?
  • Did individual experience any complications, such as dehydration or electrolyte imbalance, that would prolong recovery?

Source: Medical Disability Advisor



References

Cited

"Travelers Diarrhea." Centers for Disease Control and Prevention. 21 Nov. 2006. U.S. Department of Health and Human Services. 21 Jul. 2015 <http://www.cdc.gov/ncidod/dbmd/diseaseinfo/travelersdiarrhea_g.htm>.

Source: Medical Disability Advisor






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