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Abstract Background Stakeholders from the mental health care sector and the social security sector are often involved in the implementation of vocational rehabilitation (VR) interventions, so-called coordinated or integrated program, as clients need support from both fields. Collaboration of the involved stakeholders from both sectors is therefore important. In this study, a review was performed to provide an overview of the barriers and facilitators for collaboration during the implementation of coordinated or integrated vocational rehabilitation interventions. Methods A systematic review (PROSPERO ID CRD42023404823) was performed in the databases of Medline PubMed (n = 11.511), Web of Science (n = 4821), and PSYCINFO (n = 368). We used the AI-driven tool ASReview to support the screening process, conducted by two researchers independently. A thematic content analysis was performed to analyse the reported barriers and facilitators. Appraisal of the quality of included studies was conducted using Critical Appraisal Skills Programme (CASP). Results We included 105 of the 11,873 identified articles for full text screening, of which 26 were included for final analysis. Six themes of barriers and facilitators were found: attitude and beliefs, engagement and trust, governance and structure, practical issues, professionals involved, and client-centeredness. We found a reporting quality between 8 and 20, based on CASP. Conclusion We found that a positive attitude towards and belief of those involved in collaboration during coordinated of integrated VR interventions can enhance collaboration. Moreover, a negative attitude or lack of trust, most often found among mental health professionals, hindered collaboration. Collaboration between stakeholders from different sectors could be increased by improving positive attitudes and mutual trust and increasing knowledge about each other’s expertise. Also sharing success stories, co-location of professionals, and having a clear governance were found to be a factor in collaborations’ success.

Abstract Background Common mental health problems, such as stress, anxiety and depression, are highly prevalent among workers and often lead to long-term absenteeism and work disability. Effective elements found in previous researched interventions were to explicitly focus on return to work (RTW) and not solely on symptom reduction, to take into account the employees’ cognition towards RTW and to include the workplace environment. Based on these elements, a stepped-care approach was developed. The aim of this paper is to present the study design of a randomized controlled trial (RESTART), evaluating the effectiveness of the stepped-care approach on lasting RTW and the implementation process. Methods RESTART is a randomized controlled trial with a 2 × 2 factorial design and a follow-up of one year. Employees eligible for this study are those who reported sick within 2 to 8 weeks with psychological distress based on a distress screener. Participants will be randomized to a group receiving a tailored e-Health app or usual care, as well as randomized to a group receiving a Participatory Approach (PA; conversational method) in the workplace or usual care. The PA will however only be provided in case of persistent sickness absence at 8 weeks. Measurements take place at baseline, after the e-Health intervention period (3 months), and after the PA intervention period (6 months) and 12 months. Primary outcome is lasting RTW, defined as full RTW in previous or equal work for at least four consecutive weeks. Secondary outcomes are (the severity of) stress-related symptoms, total number of sickness absence days, self-efficacy for RTW and self-reported health. A process evaluation including a realist evaluation will also be conducted. Discussion Early intervention that focuses on RTW, the cognition towards RTW despite symptoms and involves the workplace environment, plays a crucial role in managing sickness absence among employees with psychological distress. If effective, the stepped-care approach is relevant for employees, employers and society as a whole. Trial Registration ISRCTN: 90663076. Registered on 5 October 2023.

BACKGROUND: Evidence suggests that postpartum recovery takes longer than 6 weeks. However, evidence-based recommendations regarding postpartum recovery are lacking. Current research mainly focuses on shortening hospital stay after childbirth, neglecting outpatient recovery. OBJECTIVE: This study aimed to develop multidisciplinary recommendations on convalescence after vaginal and cesarean delivery using a modified Delphi method to improve recovery after childbirth. STUDY DESIGN: Multidisciplinary experts employed in different medical organizations involved in care and guidance of patients during postpartum recovery participated in the study. The panel included 16 experts (5 gynecologists, 2 senior residents, 4 midwives, 2 maternity nurses, 2 general practitioners, and 1 pelvic floor physical therapist) and representatives from medical organizations. Detailed recommendations on convalescence after uncomplicated vaginal delivery and uncomplicated cesarean delivery were developed. In addition, a list with 35 potential affecting factors that could delay recovery was presented to identify circumstances in which the convalescence recommendation should be adapted. Recommendations were based on a literature review and a modified Delphi procedure among 16 experts. Multidisciplinary consensus of at least 67% was achieved on convalescence recommendations for 27 relevant functional activities after childbirth. RESULTS: Multidisciplinary consensus on convalescence recommendations was reached for 26 of 27 functional activities for uncomplicated vaginal and cesarean delivery after 6 Delphi rounds and 2 group discussions. In total, 7 out of 32 affecting factors were deemed as independent factors that may delay recovery and therefore change the convalescence recommendations. The recommendations were deemed feasible by representatives from the same medical organizations as the panel. CONCLUSION: Multidisciplinary consensus on recommendations regarding convalescence after uncomplicated vaginal delivery and uncomplicated cesarean delivery was achieved.

Reliable and robust monitoring tools are crucial to assess the effectiveness of land mitigation techniques (LMTs) in enhancing carbon uptake, enabling informed decision making by policymakers. This study, addressing one of the scientific goals of the EU Horizon 2020 Land Use Based Mitigation for Resilient Climate Pathways (LANDMARC) project, examines the feasibility of using satellite solar-induced fluorescence (SIF) in combination with other satellite data as a monitoring proxy to evaluate the effects of LMTs on carbon uptake. Two distinct cases are explored: (1) instantaneous vegetation destruction caused by a 2019 eucalyptus wildfire in southeast Australia and (2) gradual forest gain resulting from reforestation efforts in northern China in 2007–2012. The cases are monitored using SIF from the TROPOspheric Monitoring Instrument (TROPOMI) and Global Ozone Monitoring Experiment-2A (GOME-2A), respectively. Comparing the temporal variability in SIF across the affected areas and nearby reference areas reveals that vegetation dynamics changed as a consequence of the land-use changes in both cases. Specifically, in the Australia case, TROPOMI demonstrated an immediate reduction in the SIF signal of 0.6 mW m−2 sr−1 nm−1 (−72 %) over the eucalypt forest right after the fire. Exploiting the strong correspondence between TROPOMI SIF and gross primary productivity (GPP) at the nearby representative eddy covariance Tumbarumba site and through the FluxSat product, we estimate that the Australian fire led to a loss in GPP of 130–200 GgC in the first 8 months after the fire. Over the northern Chinese provinces of Gansu, Shaanxi, Sichuan, Chongqing, and Shanxi, we report an increase in GOME-2A summertime SIF of 0.1–0.2 mW m−2 sr−1 nm−1, coinciding with reforestation efforts between 2007 and 2012. This increase in the SIF signal is likely driven by a combination of increasingly favourable natural conditions and by the reforestation effort itself. A multivariate model that takes into account growth factors such as water availability and maximum temperature as well as satellite-derived forest-cover data explains the observed variability in GOME-2A SIF in the Chinese case reasonably well (R2=0.72). The model suggests that increases in both forest cover and soil moisture have led, in step, to the observed increase in vegetation activity over northern China. In that region, for every 100 km2 of additional forest cover, SIF increases by 0.1 mW m−2 sr−1 nm−1 between 2007 and 2012. Our study highlights that the use of satellite-based SIF, together with supporting in situ, modelled, and satellite data, allows us to monitor the impact of LMT implementation on regional carbon uptake as long as the scale of the LMT is of sufficient spatial extent.

ABSTRACT: Whole milk powder (WMP) manufactured in New Zealand in 1907 was sent to the Antarctic continent with the Shackleton-led British Antarctic Expedition from 1907 to 1909. This powder was stored at ambient conditions at Shackleton's Hut at Cape Royds, Antarctica, for over 100 yr before a sample was collected on behalf of Fonterra by the Antarctic Heritage Trust. Having spent most of its existence both dried and in frozen storage, any deleterious reactions within the WMP would have been markedly retarded. The composition and some properties of the roller-dried Shackleton's WMP are reported along with those of 2 modern spray-dried New Zealand WMP. The Shackleton powder was less white and more yellow than the modern WMP and was composed of flakes rather than agglomerated particles, consistent with that expected of a roller-dried powder. Headspace analysis showed lipolytic and oxidative volatile compounds were present in the Shackleton WMP, indicting some deterioration of the milk either before powder manufacture or on storage of the finished product. On a moisture-free basis, the Shackleton WMP had higher protein, higher fat (with a markedly higher free fat level), higher ash, and a lower lactose level than the modern WMP. The lysine level was lower in the Shackleton WMP compared with the spray-dried powders, whereas the fatty acid composition was relatively similar. The sodium level was markedly higher in the Shackleton WMP compared with the spray-dried powder, which is probably due to the addition of an alkaline sodium salt to adjust the pH of the milk before roller drying. Lead, iron, and tin levels were markedly higher in the Shackleton WMP compared with the spray-dried powders, possibly due to the equipment used in powder manufacture and the tin-plated cases used for storage. The proteins in the Shackleton WMP were more lactosylated than in the spray-dried powders. The Shackleton WMP had a higher ratio of κ-casein A to B variants and a higher ratio of β-lactoglobulin B to A variants than the spray-dried powders, whereas the αS1-casein, β-casein, αS2-casein, and α-lactalbumin protein variants were similar in all powders. The total phospholipid content was markedly lower in the Shackleton WMP than the spray-dried powders, primarily due to a lower phosphatidylethanolamine concentration. The molecular species distributions within the phospholipid classes were generally similar in the 3 powders. Claims are sometimes encountered that the milk of today is different from that consumed by previous generations. However, this comparative study has shown that the Shackleton WMP was generally similar to modern WMP. Although differences in some components and properties were observed, these were attributable to the manufacturing equipment and processes used in the pioneering years of WMP manufacture.

Abstract Background People suffering from mental health disorders have lower work participation compared to people without mental challenges. To increase work participation within this group vocational rehabilitation interventions are often offered. Collaboration between the mental health care and social security sectors is needed to enable professionals to perform optimally when carrying out these interventions. Yet, regulatory and financial barriers often hinder sustainable implementation. To overcome these barriers an experimental roadmap for sustainable funding based on a shared savings strategy was piloted in four regions. The aim of the present qualitative study was to gain understanding of the uses of this roadmap and the factors that were important in the experiment’s process. Method The roadmap consisted of five steps based upon insights from shared savings strategies and implementation science knowledge, and was initiated by a national steering board. The roadmap aimed to make sustainable funding agreements (based on shared savings) for the implementation of a vocational rehabilitation intervention. In four regions, stakeholders from the mental health care and social security services sector followed the roadmap. We conducted interviews (n = 16) with involved participants and project leaders of the experiment and collected 54 sets of field notes and documents to evaluate the roadmap process. A thematic analysis was used to analyse the data. Results Regions perceived improved stakeholder collaboration around vocational rehabilitation after they were guided by the roadmap. Three regions made, or intended to make, agreements on collaboration and funding, yet not based on shared savings. Moreover, going through the roadmap took more time than anticipated. Stakeholder collaboration depended on factors like personal and organizational interests and collaboration conditions and values. Financial legislation and politics were regarded as barriers and personal motives were mentioned as a facilitator in this process. Conclusions Our study showed that the roadmap supported stakeholders to establish a more sustainable collaboration, even though no sustainable financial agreements were made yet. Although participants acknowledged the function of financial insights and the need for financial resources, the driver for collaboration was found to be more on improving clients’ perspectives than on solving unfair financial distribution issues. This suggests modifying the focus of the roadmap from financial benefits to improving clients’ perspectives.

PurposeThe focus of SPINE20 is to develop evidence-based policy recommendations for the G20 countries to work with governments to reduce the burden of spine disease, and disability.MethodsOn September 17-18, 2021, SPINE20 held its annual meeting in Rome, Italy. Prior to the meeting, the SPINE20 created six proposed recommendations. These recommendations were uploaded to the SPINE20 website 10 days before the meeting and opened to the public for comments. The recommendations were discussed at the meeting allowing the participants to object and provide comments.ResultsIn total, 27 societies endorsed the following recommendations. SPINE20 calls upon the G20 countries: (1) to expand telehealth for the access to spine care, especially in light of the current situation with COVID-19. (2) To adopt value-based interprofessional spine care as an approach to improve patient outcomes and reduce disability. (3) To facilitate access and invest in the development of a competent rehabilitation workforce to reduce the burden of disability related to spine disorders. (4) To adopt a strategy to promote daily physical activity and exercises among the elderly population to maintain an active and independent life with a healthy spine, particularly after COVID-19 pandemic. (5) To engage in capacity building with emerging countries and underserved communities for the benefit of spine patients. (6) To promote strategies to transfer evidence-based advances into patient benefit through effective implementation processes.ConclusionsSPINE20's initiatives will make governments and decision makers aware of efforts to reduce needless suffering from disabling spine pain through education that can be instituted across the globe.

Abstract Background Common mental disorders (CMD) are highly prevalent among sick-listed precarious workers and often lead to long-term sickness-absence, work disability and unemployment. This study aimed to identify predictors of a longer time until return to work (RTW) and prolonged duration of sickness absence in sick-listed precarious workers with CMD. Methods We conducted a secondary Cox regression analysis using existing data from two Dutch randomized controlled trials and one cohort study among sick-listed precarious workers with CMD (N = 681). Age, gender, baseline employment status, study allocation, severity of psychological symptoms and RTW self-efficacy were evaluated for their predictive value on time until sustainable (≥ 28 days) RTW and duration of sickness absence during 12-month follow-up. In this study, time until sustainable RTW and duration of sickness absence are distinct dependent variables, because they are not mutually exclusive. Results Age above 50 years (HR 0.57, 95% CI 0.39–0.82), severe psychological symptoms (HR 0.64, 95% CI 0.43–0.93), unemployment (HR 0.19 95% CI 0.11–0.33) and loss of employment contract during sickness absence (HR 0.25, 95% CI 0.14–0.47) were predictive of a longer time until RTW. Male gender (HR 0.77, 95% CI 0.62–0.97), severe psychological symptoms (HR 0.64, 95% CI 0.46–0.87), unemployment (HR 0.47, 95% CI 0.27–0.84) and loss of employment contract (HR 0.48, 95% CI 0.26–0.90) predicted a prolonged duration of sickness absence. Conclusions Unemployment at the moment of sick-listing, loss of employment contract during sickness absence, and severe psychological symptoms are predictors of both a longer time until RTW and prolonged duration of sickness absence among sick-listed precarious workers with CMD. This knowledge assists occupational health and mental health professionals in the early identification of workers at risk of long-term sickness absence, enabling them to arrange targeted occupational rehabilitation support and mental health care. Trial registration The included randomized controlled trials were prospectively registered in the Dutch national trial register under NTR4190 (September 27, 2013) and NTR3563 (August 7, 2012).

Abstract Background This study aimed to explore the experiences and needs of (ex-)welfare benefit recipients from a large urban municipality in the Netherlands regarding their welfare-to-work services and their case workers. Methods Quantitative data from a client satisfaction survey that was filled out by 213 people (response rate 11%) who received welfare-to-work services was combined with results from four group interviews with a total of 15 people receiving welfare-to-work services. Verbatim transcripts from the interviews were analysed using inductive thematic analysis. Results The survey results showed that most clients were reasonably satisfied with the welfare-to-work services they received. Four main themes emerged from the interviews: (1) experiences and needs related to the interactions between case workers and benefit recipients; (2) the need for tailored services; (3) the complicating role of the system the case workers operate within; and (4) the existence of differences between case workers regarding how strict they followed the rules and to what extent they connected with their clients on a personal level. Conclusions Our findings show that clients were reasonably satisfied with the welfare-to-work services provided by their municipality but that there is still room for improvement. Case workers should have good social skills to build a trusting relationship with the client, welfare-to-work services should be tailored to the individual, and clear concise information should be given to welfare benefit recipients, especially with regard to what benefit recipients can expect of the municipality and the case workers, given their dual role in supporting (re-)integration to work and monitoring benefit eligibility.

This paper presents the automated plume detection and emission estimation algorithm (APE), developed to detect CO plumes from isolated biomass burning events and to quantify the corresponding CO emission rate. APE uses the CO product of the Tropospheric Monitoring Instrument (TROPOMI) on board the Copernicus Sentinel-5 Precursor (S5P) satellite, launched in 2017, and collocated active fire data from the Visible Infrared Imaging Radiometer Suite (VIIRS), the latter flying 3 min ahead of S5P. After identifying appropriate fire events using VIIRS data, an automated plume detection algorithm based on traditional image processing algorithms selects plumes for further data interpretation. The approach is based on thresholds optimized for data over the United States in September 2020. Subsequently, the CO emission rate is estimated using the cross-sectional flux method, which requires horizontal wind fields at the plume height. Three different plume heights were considered, and the ECMWF Reanalysis v5 (ERA5) data were used to compute emissions. A varying plume height in the downwind direction based on three-dimensional Lagrangian simulation was considered appropriate. APE is verified for observations over Australia and Siberia. For all fire sources identified by VIIRS, only 16 % of the data corresponded to clear-sky TROPOMI CO data with plume signature. Furthermore, the quality filters of APE resulted in emission estimations for 26 % of the TROPOMI CO data with plume signatures. Visual filtering of the APE's output showed a true-positive confidence level of 97.7 %. Finally, we provide an estimate of the emission uncertainties. The greatest contribution of error comes from the uncertainty in Global Fire Assimilation System (GFAS) injection height that leads to emission errors %, followed by systematic errors in the ERA5 wind data. The assumption of constant emission during plume formation and spatial under-sampling of CO column concentration by TROPOMI yields an error of %. The randomized errors from the ensemble ERA5 wind data are found to be less than 20 % for 97 % of the cases.

Objectives To assess the effectiveness, cost-effectiveness and return on investment of individual placement and support (IPS) implemented through a reimbursement strategy on a nationwide scale compared with traditional vocational rehabilitation (TVR) regarding sustainable participation in competitive employment in individuals with severe mental illness receiving sickness or disability benefits.Methods An observational study was conducted using administrative data regarding all Dutch individuals receiving sickness or disability benefits in the period 2012–2019. Exact matching and difference-in-difference fixed-effect estimations were performed to handle the non-randomised nature of the data. The matched sample consisted of 863 IPS and 16 466 TVR participants. The primary effect measure was the proportion of individuals having worked for at least 48 hours per month in competitive employment (ie, for 12 hours or more per week); the proportion of individuals having worked in competitive employment for at least 1 hour per month was also evaluated. Cost-effectiveness and return on investment were assessed from the societal perspective (intervention, sickness/disability benefit and healthcare costs) and payer perspective (sickness/disability benefit costs).Results IPS led to a statistically significant higher probability of being competitively employed for at least 12 hours per week of 3.7% points (95% CI 0.8% to 6.7%) to 7.5% points (95% CI 3.8% to 11.3%) and of being competitively employed for at least 1 hour per month of 4.7% points (95% CI 1.6% to 7.7%) to 8.9% points (95% CI 5.2 to 12.6%) from 6 to 36 months after starting the intervention. From the societal and payer perspective, IPS was—on average—less costly and more effective than TVR and return-on-investment estimates showed that IPS was—on average—cost saving (eg, societal perspective: ∆C: −364 (95% CI −3977 to 3249); ∆E: 0.104 (95% CI 0.046 to 0.164); benefit–cost ratio: 2.1 (95% CI −14.8 to 19.1)), but the uncertainty surrounding these estimates was large.Conclusions IPS implemented through a reimbursement strategy on a nationwide scale is more effective and potentially cost-effective than TVR in people with severe mental illness receiving sickness or disability benefits. Based on these results, the implementation of IPS by a wide scale reimbursement strategy could be promoted to enhance sustainable participation in competitive employment in these individuals. Future economic evaluations should strive for a more robust sample size and a long follow-up period.

Abstract Background The consequences of restrictive measures during the COVID-19 outbreak have potentially been enormous, especially for those in a vulnerable position in the labour market. This study aims to describe the impact of the COVID-19 crisis on work status, working conditions and health among people with (partial) work disabilities—with and in search of work—during the COVID-19 pandemic in the Netherlands. Methods A mixed methods design was used, combining a cross-sectional online survey and ten semi-structured interviews with people with a (partial) work disability. The quantitative data included responses to job-related questions, self-reported health, and demographics. The qualitative data consisted of participants’ perceptions about work, vocational rehabilitation, and health. We used descriptive statistics to summarize the responses, conducted logistic and linear regression and integrated our qualitative findings with the quantitative findings, aiming at complementarity. Results Five hundred and eighty-four participants (response rate 30.2%) completed the online survey. The majority of participants experienced no change in work status: 39 percent remained employed, 45 percent remained unemployed, six percent of respondents lost their job, and ten percent became employed during the COVID-19 crisis. In general, the results showed a deterioration in self-rated health during the COVID-19 outbreak, both for participants at work and in search of work. Participants who lost their job during the COVID-19 crisis reported the highest deterioration in self-rated health. Interview findings revealed that loneliness and social isolation were persistent during the COVID-19 crisis, especially among those in search of work. Additionally, employed participants identified a safe work environment and the possibility to work at the office as important factors for overall health. Conclusions The vast majority of study participants (84.2%) experienced no change in work status during the COVID-19 crisis. Nonetheless, people at work and in search of work encountered barriers to maintaining or (re)gaining employment. People with a (partial) work disability who lost their job during the crisis appeared to be most affected in terms of health. Employment and health protections could be strengthened for persons with (partial) work disabilities in order to build resilience in times of crisis.

Abstract Background With the worldwide rising obesity epidemic and the aging population, it is essential to deliver (cost-)effective care that results in enhanced societal participation among knee arthroplasty patients. The purpose of this study is to describe the development, content, and protocol of our (cost-)effectiveness study that assesses a perioperative integrated care program, including a personalized eHealth app, for knee arthroplasty patients aimed to enhance societal participation post-surgery compared to care as usual. Methods The intervention will be tested in a multicentre randomized controlled trial with eleven participating Dutch medical centers (i.e., hospitals and clinics). Working patients on the waiting-list for a total- or unicompartmental knee arthroplasty with the intention to return to work after surgery will be included. After pre-stratification on medical centre with or without eHealth as usual care, operation procedure (total- or unicompartmental knee arthroplasty) and recovery expectations regarding return to work, randomization will take place at the patient-level. A minimum of 138 patients will be included in both the intervention and control group, 276 in total. The control group will receive usual care. On top of care as usual, patients in the intervention group will receive an intervention consisting of three components: 1) a personalized eHealth intervention called ikHerstel (‘I Recover’) including an activity tracker, 2) goal setting using goal attainment scaling to improve rehabilitation and 3) a referral to a case-manager. Our main outcome is quality of life, based on patient-reported physical functioning (using PROMIS-PF). (Cost-)effectiveness will be assessed from a healthcare and societal perspective. Data collection has been started in 2020 and is expected to finish in 2024. Discussion Improving societal participation for knee arthroplasty is relevant for patients, health care providers, employers and society. This multicentre randomized controlled trial will evaluate the (cost-)effectiveness of a personalized integrated care program for knee arthroplasty patients, consisting of effective intervention components based on previous studies, compared to care as usual. Trial registration Trialsearch.who.int; reference no. NL8525, reference date version 1: 14–04-2020.

Abstract Background Several occupational health disciplines are involved in return to work guidance, implying that good interdisciplinary collaboration is important. A shared conceptual framework and a common language for the assessment of work capacity and guidance in return to work is expected to be at the benefit of appropriate and sustainable employability of sick employees. The International Classification of Functioning, Disability and Health (ICF) can be considered a shared conceptual framework and is also promising in terms of a common language. The purpose of the current study is to reach multidisciplinary consensus among occupational health professionals on the content of an ICF-based instrument for the assessment of work capacity and guidance in return to work. Methods To obtain multidisciplinary consensus we conducted a modified Delphi study among twelve occupational health experts, including four occupational physicians, four insurance physicians and four labour experts. The study included two e-mail rounds and two virtual meetings. In the consecutive rounds the experts assessed ICF items as well as a list of non-ICF-based work-related environmental factors on their relevance for the assessment of the work capacity and guidance in return to work together with their interpretability. Results The four consecutive Delphi rounds resulted in 20 items that are minimally needed for the assessment of the work capacity and return to work possibilities of employees on sick leave. The final list included six items on personal functioning, seven items on social functioning and seven items on physical functioning. Conclusions This set of items forms the core of an ICF-based instrument, which is expected to facilitate interdisciplinary and intradisciplinary communication because of the use of a shared conceptual framework. As such, it should be of help in the guidance in return to work of employees on sick leave and contribute to appropriate and sustainable employability.

Abstract Background For working patients with a lower socioeconomic position, health complaints often result from a combination of problems on multiple life domains. To prevent long-term health complaints and absence from work, it is crucial for general and occupational health professionals to adopt a broad perspective on health and to collaborate when necessary. This study aimed to evaluate how the ‘Grip on Health’ intervention is implemented in general and occupational health practice to address multi-domain problems and to promote interprofessional collaboration. Method A process evaluation was performed among 28 general and occupational health professionals, who were trained and implemented the Grip on Health intervention during a six-month period. The ‘Measurement Instrument for Determinants of Innovations’ was used to evaluate facilitators and barriers for implementing Grip on Health. Data included three group interviews with 17 professionals, a questionnaire and five individual interviews. Results While most health professionals were enthusiastic about the Grip on Health intervention, its implementation was hindered by contextual factors. Barriers in the socio-political context consisted of legal rules and regulations around sickness and disability, professional protocols for interprofessional collaboration, and the Covid-19 pandemic. On the organizational level, lack of consultation time was the main barrier. Facilitators were found on the level of the intervention and the health professional. For instance, professionals described how the intervention supports addressing multi-domain problems and has created awareness of work in each other’s healthcare domain. They recognized the relevance of the intervention for a broad target group and experienced benefits of its use. The intervention period was, nevertheless, too short to determine the outcomes of Grip on Health. Conclusion The Grip on Health intervention can be used to address problems on multiple life domains and to stimulate interprofessional collaboration. Visualizing multi-domain problems appeared especially helpful to guide patients with a lower socioeconomic position, and a joint training of general and occupational health professionals promoted their mutual awareness and familiarity. For a wider implementation, stakeholders on all levels, including the government and professional associations, should reflect on ways to address contextual barriers to promote a broad perspective on health as well as on collaborative work.

The aim of this scoping review was to present an overview of the existing epidemiological evidence in retired male and female elite rugby players regarding the prevalence rates of musculoskeletal, cardiovascular, neurocognitive, psychological and gynaecological health conditions. A systematic search was carried out across MEDLINE (via PubMed), SPORTDiscus (via EBSCOhost), PsycINFO (via EBSCOhost) and EMBASE for musculoskeletal (eg, osteoarthritis), cardiovascular (eg, hypertension), neurocognitive (eg, dementia) and psychological health (eg, disordered eating, alcohol misuse) conditions in retired elite male and female rugby players and gynaecological health conditions (menorrhagia) in retired female rugby players. Primary research studies describing the prevalence rates of health conditions in retired elite male and female rugby players written in English, Dutch or French and with full text available online were included. Five hundred and seventy-three citations were originally identified and 16 studies were ultimately included in our review. No studies on health conditions in retired elite female rugby players were found. Four individual studies showed there was a significant higher prevalence rate of osteoarthritis in retired elite male rugby players compared with control groups. Various neurocognitive health conditions were investigated and showed, among others, a prevalence rate of 57% for mild cognitive disorder. The prevalence of self-reported depression and hazardous alcohol use in retired elite male rugby players was significantly higher than in control groups matched for age and education. Our review found relatively high prevalence rates of musculoskeletal health conditions such as osteoarthritis and psychological health conditions such as depression and hazardous alcohol use in retired elite male rugby players. More research needs to be conducted to understand better the health conditions of retired elite rugby players, especially among retired elite female players.

Summary: Background: Despite the adoption of minimally invasive techniques, recovery after abdominal surgery takes a long time. Electronic health (eHealth) modalities can provide guidance to patients, facilitating early return to normal activities. We aimed to assess the impact of a personalised eHealth programme on patients' return to normal activities after major abdominal surgery. Methods: This single-blind, randomised, placebo-controlled trial was done at 11 teaching hospitals in the Netherlands. Eligible participants were aged 18–75 years who underwent a laparoscopic or open colectomy or hysterectomy. An independent researcher randomly allocated participants (in a 1:1 ratio) to either the intervention or control group by use of computer-based randomisation lists, with stratification by sex, type of surgery, and hospital. Participants in the intervention group had access to a perioperative, personalised eHealth programme consisting of both standard face-to-face care and eHealth, that comprised interactive tools offering goal attainment and a personalised outcome measurement, which managed recovery expectations and provided postoperative guidance tailored to each patient. Patients were provided with an activity tracker and had access to a website and mobile app with an electronic consultation (eConsult) functionality. The control group received standard care and access to a placebo website containing recovery advice provided by the hospital. The primary outcome was the number of days between surgery and personalised return to normal activities, assessed with Kaplan-Meier curves. Intention-to-treat and per-protocol analyses were done with a Cox regression model. This trial is registered with the Netherlands National Trial Register (NTR5686). Findings: Between Feb 11, 2016, and Aug 9, 2017, 355 participants were randomly assigned to the intervention (n=178) or control (n=177) groups. 342 participants were included in the intention-to-treat analysis. The median time until return to normal activities was 52 days (IQR 33–111) in the intervention group, and 65 days (39–152) in the control group (adjusted hazard ratio 1·30 [95% CI 1·03–1·64]; p=0·027). The frequency of postoperative complications did not differ between groups. Interpretation: This eHealth programme, delivering personalised care based on goal attainment scaling, enabled patients to return to their normal activities 13 days earlier than those who received standard care. Funding: ZonMw.

Abstract Background Individual Placement and Support (IPS) is an evidence-based, effective approach to help people with severe mental illness (SMI) obtain and maintain competitive employment. The aim of the present study was to examine employment outcomes and associations with an organizational and a financial factor in people with SMI who participated in Individual Placement and Support using a multifaceted implementation strategy (IPS + MIS). The goal of this strategy was to improve IPS implementation by enhancing collaboration among mental health care and vocational rehabilitation stakeholders, and realizing secured IPS funding. Methods An observational cohort study including 103 participants was conducted, with a 30-month follow-up. Descriptive analyses were used to examine employment outcomes. Multivariable logistic and linear regression analyses were performed to study associations with an organizational and a financial factor: the level of experience of mental health agencies with providing IPS + MIS and the type of IPS funding (i.e. municipality funding (reference group) and the Dutch Social Security Institute: the Institute for Employee Benefits Schemes (UWV) funding). Results Forty-six percent of the participants were competitively employed at any time during the 30-month follow-up; the median number of days until competitive job obtainment and in competitive jobs was 201 and 265, respectively. The majority of all jobs obtained (81%) were categorized as ‘elementary occupations’, ‘clerical support workers’, and ‘service and sales workers’. A higher level of experience of the mental health agencies with providing IPS + MIS was found to be positively associated with job obtainment (OR = 3.83, 95% CI 1.42–10.30, p = 0.01) and the number of days worked in competitive jobs (B = 1.21, 95% CI 0.36–2.07, p = 0.01). UWV funding was found to be negatively associated with job obtainment (OR = 0.30, 95% CI 0.11–0.77, p = 0.01). No association was found for the type of IPS funding and the number of days worked in competitive jobs (B = -0.73, 95% CI -1.48–0.02, p = 0.06). Conclusions This study shows that almost half of the people who participate in IPS + MIS obtain a competitive job within 30 months. The results further suggest that both the level of experience of mental health agencies with providing IPS + MIS, and funding may play a role in employment outcomes.