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Background While it is essential to understand how long is sufficient for return-to-work when designing paid sick-leave systems, little attempt has been done to collect cause-specific information on when and how many of sickness absentees returned to work, became unemployed, or passed away. Methods We studied the first sick-leave episode of ≥30 consecutive days in those ≤55 years of age during 2012-2013 among 11 Japanese private companies (n = 1209), which were followed until 2017. Overall and disease-specific cumulative incidences of return-to-work, resignations, and deaths were estimated using competing risk analysis. Results During the 3.5-year period (follow-up rate: 99.9%), 1014 returned to work, 167 became unemployed, and 27 died. Overall, return-to-work occurred within 1 year in 74.9% of all absentees and in 89.3% of those who successfully returned to work. Resignation occurred within 1 year in 8.7% of all absentees and in 62.9% of all subjects who resigned. According to ICD-10 chapters, the cumulative incidence of return-to-work ranged from 82.1% for mental disorders (F00-F99) to 95.3% for circulatory diseases (I00-I99). The cumulative incidence of return-to-work due to mental disorders ranged from 66.7% in schizophrenia (F20) to 95.8% in bipolar affective disorders (F31). Death was rarely observed except for cases of neoplasms (C00-D48), of which the cumulative incidence of death reached 14.2% by 1.5 years. Conclusions Return-to-work and resignations occurred commonly within 1 year of sick leave among long-term sickness absentees in the Japanese private companies. Our findings may assist occupational physicians and employers in developing effective social protection schemes.

Background Workplace absenteeism increases significantly during influenza epidemics. Sick leave records may facilitate more timely detection of influenza outbreaks, as trends in increased sick leave may precede alerts issued by sentinel surveillance systems by days or weeks. Sick leave data have not been comprehensively evaluated in comparison to traditional surveillance methods. The aim of this paper is to study the performance and the feasibility of using a detection system based on sick leave data to detect influenza outbreaks. Methods Sick leave records were extracted from private French health insurance data, covering on average 209,932 companies per year across a wide range of sizes and sectors. We used linear regression to estimate the weekly number of new sick leave spells between 2016 and 2017 in 12 French regions, adjusting for trend, seasonality and worker leaves on historical data from 2010 to 2015. Outbreaks were detected using a 95%-prediction interval. This method was compared to results from the French Sentinelles network, a gold-standard primary care surveillance system currently in place. Results Using sick leave data, we detected 92% of reported influenza outbreaks between 2016 and 2017, on average 5.88 weeks prior to outbreak peaks. Compared to the existing Sentinelles model, our method had high sensitivity (89%) and positive predictive value (86%), and detected outbreaks on average 2.5 weeks earlier. Conclusion Sick leave surveillance could be a sensitive, specific and timely tool for detection of influenza outbreaks.

BACKGROUND Although previous research has focused on the association between long working hours and several mental health outcomes, little is known about the association in relation to mental health-related sickness absence, which is a measure of productive loss. We aimed to investigate the association between overtime work and the incidence of long-term sickness absence due to mental disorders. METHODS Data came from the Japan Epidemiology Collaboration on Occupational Health Study (J-ECOH). A total of 47,422 subjects were followed-up in the period between April 2012 and March 2017. Information on long-term sickness absence (LTSA) was obtained via a study-specific registry. Baseline information was obtained at an annual health checkup in 2011; overtime working hours were categorized into

Objectives We investigated whether work participation is affected in patients with arthralgia during transition to RA. Arthralgia patients with symptom resolution and early RA patients at diagnosis were used as a reference. Methods Three groups of patients were studied: arthralgia patients converting to RA (n = 114), arthralgia patients with spontaneous symptom resolution (n = 57), and early RA patients (n = 617). Both presenteeism (i.e. working while sick, scale 0–10) and absenteeism (i.e. sick leave) were taken into account. Work ability 1 year prior to clinical arthritis was estimated (in absolute numbers). The course of work restriction over time was studied using linear mixed models (β coefficient; delta per month) within each patient group. Results One-year prior to the development of clinical arthritis, mean presenteeism was 7.0 (95% CI 5.8, 8.1) in patients with arthralgia, indicating 30% loss, and further worsened to 6.1 (95% CI 5.3, 6.6) at RA diagnosis, thus indicating 39% loss. In early RA patients, presenteeism improved over time after DMARD initiation (β 0.052 per month 95% CI 0.042, 0.061, P Conclusion In the months preceding RA, presenteeism was already apparent, and it worsened further during progression to clinical arthritis and diagnosis. This underlines the relevance of the symptomatic pre-RA phase for patients. The observed reversibility in arthralgia patients with symptom resolution may suggest that intervention in pre-RA could improve work participation.

Antoni Sicras-Mainar,1 Juan Carlos Tornero-Tornero,2 Francisco Vargas-Negrín,3 Isabel Lizarraga,4 Aram Sicras-Navarro,1 Javier Rejas-Gutierrez5 1Health Economics and Outcomes Research Department, Atrys Health, Barcelona, Spain; 2Department of Anesthesiology, Hospital Clínico Universitario of Valencia, Valencia, Spain; 3Healthcare Center Dr. Guigou, Canary Islands Health Service, Tenerife, Spain; 4Medical Department, Pfizer, SLU, Alcobendas, Madrid, Spain; 5Health Economics and Outcomes Research Department, Pfizer, SLU, Alcobendas, Madrid, SpainCorrespondence: Antoni Sicras-Mainar, Health Economics and Outcomes Research Department, Atrys Health, C/ Provença 392, bajos, Barcelona, 08025, Spain, Tel +34 934 581 561, Fax +34 93 458 73 03, Email ansicras@atryshealth.comPurpose: To estimate the number of sick leave days and productivity costs in active workers with osteoarthritis (OA) who initiated opioid treatment for moderate/severe chronic pain in clinical practice in Spain.Patients and Methods: This is a secondary analysis of the longitudinal, retrospective OPIOIDS study, using electronic medical records (EMR) of patients aged ≥ 18 years, who started an opioid treatment for moderate/severe chronic OA pain between 2010 and 2015 after treatment failure with ≥ 1 first-line drugs (acetaminophen, metamizole and/or nonsteroidal anti-inflammatory drugs [NSAIDs]). The number of days of sick leave and productivity costs were analyzed during a follow-up period of 36 months.Results: A total of 5089 patients with moderate/severe chronic OA pain, aged 56.8 years (standard deviation [SD]: 4.6) (56.6% were female), were analyzed: 73.3% of them started a treatment with weak opioids and 26.7% of them were treated with strong opioids. At 36 months, adherence was 21.0% (strong opioids: 15.4%; weak opioids: 23.0%; p< 0.001), and 77% of patients had at least one sick leave related with chronic OA pain, with an average of 93 days off work in all working patients (120.5 days in patients with sick leaves). Besides, 16.9% of the study population had sick leave periods that lasted at least 6 months. Pain reduction was modest (− 1.2 points; − 4.0%, p< 0.001). The cost of sick leave was € 2594 patient/year, and factors such as older age (β=0.043), female sex (β=0.036), comorbidities (β=0.035) and strong opioid use (β=0.031) were associated with higher productivity costs (p< 0.05 in all associations).Conclusion: Active workers who started opioid treatment for moderate/severe chronic OA pain showed an increased frequency of sick leave and productivity cost, with a modest effect on pain relief. Older age, female sex, comorbidities, and strong opioids were associated with higher costs for society.Keywords: analgesics, arthritis, disability, sick days, observational study

Supplemental digital content is available in the text., Introduction Avoiding coronavirus disease 2019 (COVID-19) work-related infection in frontline healthcare workers is a major challenge. A massive training program was launched in our university hospital for anesthesia/intensive care unit and operating room staff, aiming at upskilling 2249 healthcare workers for COVID-19 patients' management. We hypothesized that such a massive training was feasible in a 2-week time frame and efficient in avoiding sick leaves. Methods We performed a retrospective observational study. Training focused on personal protective equipment donning/doffing and airway management in a COVID-19 simulated patient. The educational models used were in situ procedural and immersive simulation, peer-teaching, and rapid cycle deliberate practice. Self-learning organization principles were used for trainers' management. Ordinary disease quantity in full-time equivalent in March and April 2020 were compared with the same period in 2017, 2018, and 2019. Results A total of 1668 healthcare workers were trained (74.2% of the target population) in 99 training sessions over 11 days. The median number of learners per session was 16 (interquartile range = 9–25). In the first 5 days, the median number of people trained per weekday was 311 (interquartile range = 124–385). Sick leaves did not increase in March to April 2020 compared with the same period in the 3 preceding years. Conclusions Massive training for COVID-19 patient management in frontline healthcare workers is feasible in a very short time and efficient in limiting the rate of sick leave. This experience could be used in the anticipation of new COVID-19 waves or for rapidly preparing hospital staff for an unexpected major health crisis.

Background: Multiple sclerosis (MS) can impact working life, sickness absence (SA) and disability pension (DP). Different types of occupations involve different demands, which may be associated with trajectories of SA/DP among people with MS (PwMS). Objectives: To explore, among PwMS and references, if SA/DP differ according to type of occupation. Furthermore, to examine how trajectories of SA/DP days are associated with type of occupation among PwMS. Methods: A longitudinal nationwide Swedish register-based cohort study was conducted, including 6100 individuals with prevalent MS and 38,641 matched references from the population. Trajectories of SA/DP were identified with group-based trajectory modelling. Multinomial logistic regressions were estimated for associations between identified trajectories and occupations. Results: Increase of SA/DP over time was observed in all occupational groups, in both PwMS and references, with higher levels of SA/DP among PwMS. The lowest levels of SA/DP were observed among managers. Three trajectory groups of SA/DP were identified: Persistently Low (55.2%), Moderate Increasing (31.9%) and High Increasing (12.8%). Managers and those working in Science & Technology, and Economics, Social & Cultural were more likely to belong to the Persistently Low group. Conclusion: Results suggest that type of occupation plays a role in the level and course of SA/DP.

Objectives Chronic low back pain is an important public health problem, generating high financial and social costs. While most clinical guidelines stress the importance of managing low back pain in primary care, in practice a disproportionate amount of patients with low back pain present to emergency departments. Patients presenting to emergency departments may form a specific group with different factors leading to chronicity. This prospective cohort study aimed to determine the sociodemographic and psychological predictors of persistent low back pain and the length of sick leave due to pain in patients with acute symptoms visiting an emergency department. Methods Patients with a first episode of non-specific acute low back pain in at least three months were qualified for this study. The participants filled a battery of questionnaires, including measures of pain, pain-related disability, depression, anxiety and pain coping strategies. A structured telephone interview was performed after three months with questions regarding pain and the length of sick leave. Results 110 patients participated in the study. 97 patients completed the follow-up, with 70.1% suffering from pain after three months. Lower self-rated health predicted pain after three months. Longer length of sick leave was predicted by lower self-rated health, distraction as a coping strategy and decreased behavioral activity. Conclusion Because of its simplicity, a measurement of self-rated health may be included in future clinical practice for assessing the risk of persistent pain.

Background Multiple sclerosis (MS) is a chronic, demyelinating disease of the central nervous system that results in progressive and irreversible disability. Fatigue is one of the most common MS-related symptoms and is characterized by a persistent lack of energy that impairs daily functioning. The burden of MS-related fatigue is complex and multidimensional, and to our knowledge, no systematic literature review has been conducted on this subject. The purpose of this study was to conduct a systematic literature review on the epidemiology and burden of fatigue in people with multiple sclerosis (pwMS). Methods Systematic searches were conducted in MEDLINE, Embase, and Evidence-Based Medicine Reviews to identify relevant studies of fatigue in pwMS. English-language records published from 2010 to January 2020 that met predefined eligibility criteria were included. We initially selected studies that reported quality of life (QoL) and economic outcomes according to categories of fatigue (e.g., fatigued vs non-fatigued). Studies assessing associations between economic outcomes and fatigue as a continuous measure were later included to supplement the available data. Results The search identified 8147 unique records, 54 of which met the inclusion criteria. Of these, 39 reported epidemiological outcomes, 11 reported QoL, and 9 reported economic outcomes. The supplementary screen for economic studies with fatigue as a continuous measure included an additional 20 records. Fatigue prevalence in pwMS ranged from 36.5 to 78.0%. MS-related fatigue was consistently associated with significantly lower QoL. Results on the economic impact of fatigue were heterogeneous, but most studies reported a significant association between presence or severity of fatigue and employment status, capacity to work, and sick leave. There was a gap in evidence regarding the direct costs of MS-related fatigue and the burden experienced by caregivers of pwMS. Conclusion Fatigue is a prevalent symptom in pwMS and is associated with considerable QoL and economic burden. There are gaps in the evidence related to the direct costs of MS-related fatigue and the burden of fatigue on caregivers. Addressing fatigue over the clinical course of the disease may improve health and economic outcomes for patients with MS.

Background Despite the lack of official COVID-19 statistics, various workplaces and occupations have been at the center of COVID-19 outbreaks. We aimed to compare legal measures and governance established for managing COVID-19 infection risks at workplaces in nine Asia and Pacific countries and to recommend key administrative measures. Methods We collected information on legal measures and governance from both general citizens and workers regarding infection risks such as COVID-19 from industrial hygiene professionals in nine countries (Indonesia, India, Japan, Malaysia, New Zealand, Republic of the Philippines, Republic of Korea, Taiwan, and Thailand) using a structured questionnaire. Results A governmental body overseeing public health and welfare was in charge of containing the spread and occurrence of infectious diseases under an infectious disease control and prevention act or another special act, although the name of the pertinent organizations and legislation vary among countries. Unlike in the case of other traditional hazards, there have been no specific articles or clauses describing the means of mitigating virus risk in the workplace that are legally required of employers, making it difficult to define the responsibilities of the employer. Each country maintains own legal systems regarding access to the duration, administration, and financing of paid sick leave. Many workers may not have access to paid sick leave even if it is legally guaranteed. Conclusion Specific legal measures to manage infectious disease risks, such as providing proper personal protective equipment, education, engineering control measures, and paid sick leave are recommended to be stipulated in Industrial safety and health-related acts.

Objectives: This study aimed to reduce the number of sick leaves due to mental disorders using a problem-solving approach as the primary preventive strategy. Methods: We developed the approach referring to evidence-based public health, community-based participatory research, and competencies of occupational health professionals. We then applied the approach step-by-step to occupational health practices in a manufacturing company. Results: For the problem statement (Step 1) and formulating a hypothesis of cause-and-effect relationships (Step 2), we conducted a case-series study and hypothesized several workplace factors as causes of sick leaves. For empirical analysis (Step 3), we performed a retrospective cohort study. We set a department as the intervention target because of the high prevalence of sick leaves. After finding contextual and translational evidence by searching the scientific literature and assessing scientific evidence (Step 4), we identified stakeholders and weak elements in the occupational health management system. We promoted partnership with the stakeholders by sharing our findings (Step 5). We then developed and prioritized intervention options (Step 6) within the partnership. The employer decided to strengthen those weak elements and address the causes of sick leaves by developing an action plan and implementing interventions (Step 7). The incidence of sick leaves has subsequently decreased in the department. Finally, we evaluated the effectiveness of the problem-solving approach on the system, program, and outcomes (Step 8). Conclusion: This study revealed that a problem-solving approach may be effective in preventing sick leaves due to mental disorders in the workplace by building infrastructure for occupational health practice.

Rationale & Objective: Although patients with chronic kidney disease (CKD) are at risk for work disability and loss of employment, not all experience work disruption. We aimed to describe the barriers to and facilitators of sustained employment experienced by Dutch patients with CKD.Study Design: Qualitative study using semi-structured interviews.Setting & Participants: 27 patients with CKD glomerular filtration rate categories 3b-5 (G3b-G5) from 4 nephrology outpatient clinics in The Netherlands.Analytical Approach: Content analyses with constant comparison of interview data based on the International Classification of Functioning, Disability and Health framework.Results: Participants were 6 patients with CKD G3b-G4, 8 patients receiving maintenance dialysis, and 13 patients with functioning kidney transplants. We identified health-related barriers (symptoms, physical toll of dialysis/transplantation, limited work capacity) and facilitators (few physical symptoms, successful posttransplantation recovery, absence of comorbidities, good physical condition), personal barriers (psychological impact, limited work experience) and facilitators (positive disposition, job satisfaction, work attitude, person-job fit), and environmental barriers and facilitators. Environmental barriers were related to nephrology care (waiting time, use of a hemodialysis catheter) and work context (reorganization, temporary contract, working hours, physical demands); environmental facilitators were related to nephrology care (personalized dialysis, preemptive transplant), work context (large employer, social climate, job requiring mental rather than physical labor, flexible working hours, adjustment of work tasks, reduced hours, remote working, support at work, peritoneal dialysis exchange facility), and support at home. Occupational health services and social security could be barriers or facilitators.Limitations: The study sample of Dutch patients may limit the transferability of these findings to other countries.Conclusions: The wide range of barriers and facilitators in all International Classification of Functioning, Disability and Health components suggests great diversity among patients and their circumstances. These findings underline the importance of personalized nephrology and occupational health care as well as the importance of individually tailored workplace accommodations to promote sustained employment for patients with CKD.

To evaluate work-related issues (WRIs) and their determinants in patients with axial spondyloarthritis (SpA) across Europe.The European Map of Axial Spondyloarthritis is a cross-sectional online survey (2017-2018) of unselected patients with self-reported axial SpA from 13 European countries. Participants were classified as active or inactive members of the labor force according to the International Labor Organization standards. Those employed reported WRIs due to axial SpA in the past 12 months. Sociodemographic characteristics and patient-reported outcomes were compared between patients with and without WRIs. Stepwise regression analysis was conducted to identify independent determinants of WRIs.The sample comprised 2,846 patients with axial SpA, 1,653 were active members of the labor force, 1,450 were employed, and of those employed, 67.7% reported at least 1 WRI. The most frequently reported WRIs were taking sick leave (56.3%), difficulty fulfilling working hours (44.6%), and missing work for doctor's appointments (34.6%). Of the total sample, 74.1% declared that they had faced or would face difficulties finding a job due to axial SpA. Patients with WRIs were more often female, were less likely to be married or in a relationship, and had a higher educational level, poorer patient-reported outcomes, and a greater prevalence of anxiety and depression. Multivariable regression showed that WRIs were associated with a higher Bath Ankylosing Spondylitis Disease Activity Index score (odds ratio [OR] 1.30 [95% confidence interval (95% CI) 1.16-1.45]) and the 12-item General Health Questionnaire score (OR 1.15 [95% CI 1.09-1.22]), and were negatively associated with inflammatory bowel disease (OR 0.58 [95% CI 0.36-0.91]).Approximately two-thirds of employed patients experienced WRIs due to axial SpA. Association between disease activity and psychological distress with WRIs suggests the need to ensure that axial SpA patients receive the required support to cope with their working life.

Background Sickness absenteeism is an area of concern in nursing and is more concerning given the recent impacts of the COVID-19 pandemic on healthcare. This study is one of two meta-analyses that examined sickness absenteeism in nursing. In this study, we examined demographic, lifestyle, and physical health predictors. Methods We reviewed five databases (CINAHL, ProQuest Allied, ProQuest database theses, PsycINFO, and PubMed) for our search. We registered the systematic review (CRD de-identified) and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Additionally, we used the Population/Intervention/Comparison/Outcome Tool to improve our searches. Results: Following quality testing, 17 articles were used for quantitative synthesis. Female employees were at higher risks of sickness absenteeism than their male counterparts (OR = 1.73; 95% CI: 1.33–2.25). Nursing staff who rated their health as poor had a greater likelihood of experiencing sickness absence (OR = 1.38; 95% CI: 1.19-1.60). Also, previous sick leave predicted future leaves (OR = 3.35; 95% CI: 1.37–8.19). Moreover, experiencing musculoskeletal pain (OR = 2.41 95% CI: 1.77–3.27) increased the likelihood of sickness absence with greater odds when it is a back pain (OR = 3.05; 95% CI: 1.66–5.62). Increased age, physical activity, and sleep were not associated with sick leave. Conclusion Several variables were statistically associated with the occurrence of sickness absenteeism. One primary concern is the limited research in this area despite alarming rates of sick leave in healthcare. More research is required to identify predictors of sickness absence, and thereby, implement preventative measures.

Introduction: The high incidence of thrombotic events in patients with COVID-19 affects health care worldwide and results in an increased workload in haemostasis laboratories due to more frequent testing of D-dimer, haemostatic parameters and anti-Xa tests. However, the impact of this increase in assay requests on the quality of performance in haemostasis laboratories remains unclear. In this study, the impact of the COVID-19 pandemic on the quality of performance and management of haemostasis laboratories was evaluated.Methods: The impact on the quality of performance was studied using external quality assessment data from 2019 to 2020 derived from ECAT surveys. A questionnaire was sent to Dutch haemostasis laboratories to identify challenges and management strategies. Furthermore, the number of assays performed in 2019 and 2020 was supplied by four Dutch hospitals, located in regions with different disease incidence.Results: No differences in response rate nor the quality of the measurements were observed between the EQA surveys in 2019 and 2020. The questionnaire results showed a large increase of >25% in the number of test requests for anti-Xa, D-dimer and fibrinogen assays in 2020 compared to 2019. Extreme peaks in test requests were also observed in the four evaluated hospitals. Additionally, 84% of the respondents indicated that they had experienced increased work pressure, and increased sick leave was observed in 71% of the participating laboratories.Conclusions: The enormous increase in test requests, especially for D-dimer assays and anti-Xa activity, did not affect the quality of performance within haemostatic laboratories during the COVID-19 pandemic.

OBJECTIVES: To conduct a needs assessment of Marshallese food processing workers and compare workplace experiences during the COVID-19 pandemic with Marshallese workers in other occupations. METHODS: Marshallese adults residing in the continental United States (US) and Hawaii took part in an online survey. The sample was divided into two categories: food processing workers and workers in all other occupations. To examine differences between food processing workers and workers from all other occupations, we used Wilcoxon-Mann-Whitney U tests and Fisher’s Exact tests. RESULTS: Of those employed at the time of the survey (n=113), 31 were employed in food processing plants, and 82 were employed in another occupation. Food processing workers and workers in other occupations differed significantly on level of education, length of residence in the US, English speaking ability, and health literacy. More food processing workers reported their employers installed barriers or provided shields (45%), provided temperature screenings (71%), and tested for COVID-19 (61%) compared with those in other occupations. A larger proportion of food processing workers reported having no sick leave compared with workers in other occupations, although they reported COVID-19 testing and being insured at similar rates. CONCLUSION: This is the first study to examine Marshallese food processing workers’ experiences during the COVID-19 pandemic. Our findings show that while some food processing employers implemented government-recommended guidelines to prevent the spread of COVID-19, preventative and protective measures were not comprehensively applied across the food processing industry, despite efforts by public health agencies and community partners.

Kobuszewski Bartosz.Sickness absence during the COVID-19 pandemic. Journal of Education, Health and Sport. 2021;11(11):11-24. eISSN 2391-8306. DOI http://dx.doi.org/10.12775/JEHS.2021.11.11.001 https://apcz.umk.pl/JEHS/article/view/JEHS.2021.11.11.001 https://zenodo.org/record/5651069 The journal has had 5 points in Ministry of Science and Higher Education parametric evaluation. § 8. 2) and § 12. 1. 2) 22.02.2019. © The Authors 2021; This article is published with open access at Licensee Open Journal Systems of Nicolaus Copernicus University in Torun, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author (s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non commercial license Share alike. (http://creativecommons.org/licenses/by-nc-sa/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 25.10.2021. Revised: 25.10.2021. Accepted: 06.11.2021. Sickness absence during the COVID-19 pandemic Absencja chorobowa w dobie pandemii COVID-19 Bartosz Kobuszewski bkobuszewski@cmkp.edu.pl ORCID iD https://orcid.org/0000-0001-5828-1341 Department of Medical Law and Decisions, Schoolof Public Health, Centre of Postgraduate Medical Education, Warsaw, Poland Zakład Prawa Medycznego i Orzecznictwa Lekarskiego, Szkoła Zdrowia Publicznego, Centrum Medyczne Kształcenia Podyplomowego, Warszawa, Polska Abstract The aimof this research was to perform a comparative analysis of the publicly availabledata of the Social Insurance Institution (ZUS) on sickness absence of insured persons in Poland in 2016-2021 (before the outbreak and during the COVID-19 pandemic). Materials and methods.The research material consisted of data from the Social Insurance Institution for the years 2016-2021 (Q1) concerning the sickness absence of the insured. Due to the publication of data in an aggregated form, quantitative analysis was performed instead of statistical analysis. The data used in the analysis included the number of insured persons, the number of people receiving sickness benefits, the number of issued medical certificates on temporary incapacity to work and the reasons for the incapacity to work. Results and Conclusion.Since the beginning of the COVID-19 pandemic, following numbers have increased compared to 2019: the number of people receiving sickness benefit in Poland (by 10%), the number of days of sickness absence (by 7%) and the number of issued medical certificates of temporary incapacity for work (by 4%). The largest increase in the number of beneficiaries, the number of days of sickness absence and the number of medical certificates was recorded in the Q4 of 2020 (respectively by 21%, 16% and 24% compared to Q4 of 2019). Due to COVID-19, 4.84 million days of sickness absence were used in 2020 – it was the tenth cause of absence. The largest changes in the number of people receiving sickness benefit and the number of days of sickness absence can be observed in Q1 and Q4, which may result from the seasonality of COVID-19 and the subsequent wave of infections. Importantly, COVID-19 is not the only factor contributing overall increase in the number of days of sickness absence in Poland – absence due to non-communicable diseases also increased during the pandemic. Keywords: COVID-19, SARS-CoV-2, pandemic, sickness absence, sick leave

Objective This study aimed to examine duration of sickness absence due to knee osteoarthritis (OA) and sustained return to work (RTW) among municipal employees, who had at least one compensated sickness absence period due to knee OA. The contribution of sociodemographic characteristics, diabetes and previous sickness absence were assessed. We differentiated between participants with and without total knee arthroplasty (TKA). Methods Data from 123 506 employees in the Finnish Public Sector Study were linked with national health and mortality register information. There were 3 231 sickness absence periods (2372 participants) due to knee OA in 2005−2011. Kaplan-Meier curves for sustained RTW were obtained and median time with inter-quartile range (IQR) calculated for those with and without TKA. Cox regression analyses were carried out in multivariable analyses. Results The median time to RTW from the beginning of sickness absence was 21–28 days when TKA was not related to sickness absence and 92–145 days when it was. Among participants with no TKA, age 60−64, non-sedentary work, diabetes, and previous sickness absences predicted longer time to RTW, while pain medication predicted a shorter time. Among participants with TKA, non-sedentary work and previous sickness absences predicted a longer time to RTW. Conclusions The clinical relevance of the difference in time to RTW between employees with or without TKA was substantial. Employees with knee OA working in physically demanding jobs need work modifications after TKA, and this calls for a dialog between occupational health care professionals and workplaces.

BACKGROUND: Sinus barotraumas are a common condition in aviation medicine, sometimes compromising flight safety and even permanently grounding aircrew. Considering this and the ever-increasing amount of commercial aviation, a thorough examination is required.METHODS: In this survey study, an anonymous, electronic questionnaire was distributed to commercial aircrew of the three major commercial airlines operating in Finland (N = 3799), covering 93% of the target population (i.e., all commercial aircrew operating in Finland, N = 4083). Primary outcomes were self-reported prevalence, clinical characteristics, and health and occupational effects of sinus barotraumas in flight. Secondary outcomes were adjusted odds ratios (OR) for frequency of sinus barotraumas with respect to possible risk factors.RESULTS: Response rate was 47% (N = 1789/3799), with 61% (N = 1088) of the respondents having experienced sinus barotraumas in flight. Of those affected, 59% had used medications, 18% had undergone surgical procedures, and 53% had been on sick leave due to sinus barotraumas (38% during the last year) in flight. Factors associated with sinus barotraumas were female sex [OR, 2.47; 95% confidence interval (CI) 1.35–4.50] and a high number of upper respiratory tract infections (≥3 vs. CONCLUSION: Sinus barotraumas were reported by 61% of commercial aircrew. They caused an increased need for medications, otorhinolaryngology-related surgical procedures, and sickness absence from flight duty. The possible risk factors were female sex and a high number of URTIs/yr.Lindfors OH, Ketola KS, Klockars TK, Leino TK, Sinkkonen ST. Sinus barotraumas in commercial aircrew. Aerosp Med Hum Perform. 2021; 92(11):857–863.

Publisher Copyright: © 2021 The Author(s). Published with license by Taylor & Francis Group, LLC. Physicians often work long hours and on-call shifts, which may expose them to circadian misalignment and negative health outcomes. However, few studies have examined whether these working hour characteristics, ascertained using objective working hour records, are associated with the physicians’ risk of sickness absence. We investigated the associations of 14 characteristics of payroll-based working hours and on-call work with the risk of short sickness absence among hospital physicians. In this cohort study, 2845 physicians from six Finnish hospital districts were linked to electronic payroll-based records of daily working hours, on-call duty and short (1–3 days) sickness absence between 2005 and 2019. A case-crossover design was applied using conditional logistic regression with the 28 day case and control windows to estimate odds ratios (ORs) and 95% confidence intervals (CI) for short sickness absence. After controlling for weekly working hours and the number of normal (≤12 h) shifts, a higher number of long (>12 h) shifts (ORs for ≥5 versus none: 2.54, 95% CI 1.68–3.84), very long (>24 h) shifts (ORs for ≥5 versus none: 2.62, 95%CI 1.61–4.27), and on-call shifts (OR for ≥5 versus none: 2.15, 95% CI 1.44–3.21) and a higher number of short (

The use of psychoactive drugs remains a public health and social issue in Benin and impacts health, medical and social life at working place. The study aims to determine the prevalence and the factors associated with psychoactive drugs use in 2019 in two companies based in Cotonou, Benin. A cross-sectional survey was carried out from 09 to 31 December 2019. The study involved 455 workers aged 22 to 60 in two companies, selected by using a stratified survey technique. Data were collected using a questionnaire providing the socio-demographic and occupational factors, individual characteristics and labor conditions of workers. Associated factors were determine by a univariate and multivariate analysis. Alcohol was the substance most consumed with an abuse prevalence of 7.7% followed by tobacco with a prevalence of 5.5% and drugs at 4.6% and finally cannabis at 1.3%. After adjusting for the other variables: sick leave decreased with alcohol consumption, OR=0.31 [0.10-0.95]; regular leave increased with alcohol consumption OR=16.90 [1.96-145.75]; and overinvestment decreased with alcohol consumption OR=0.33 [0.14-0.78]. The use of PAD is a public health problem in the workplace. Awareness-raising for workers and training actions towards medical staff are required in the workplace in other to improve working conditions and the reduce drugs consumption. Key words: Psychoactive drugs, workplace, alcohol, tobacco, drugs, Benin.

Mielenterveyshäiriöt aiheuttavat yhteiskunnalle kustannuksia terveydenhuollon, sairauspoissaolojen ja työn tuottavuuden alenemisen kautta. Työssä jatkamisen tukeminen on tarpeen inhimillisistä, poliittisista ja taloudellisista syistä. Artikkelissa tarkastellaan henkilöstöjohdon asenteita mielenterveysongelmia kohtaan sekä mielenterveyshäiriöiden vuoksi alentuneen työkyvyn tukemista työpaikoilla. Aineisto on kerätty työpaikkojen henkilöstöjohdolle osoitetulla kyselyllä (n = 300). Aineisto analysoitiin tilastollisin menetelmin hyödyntäen suoria jakaumia, ristiintaulukointia, logistista regressioanalyysiä ja tilastollisia testejä. Henkilöstöjohto suhtautui mielenterveysongelmiin myönteisesti ja toivoi työntekijöiltä avoimuutta niiden suhteen, vaikka puolet vastaajista uskoi tiedon yksilön mielenterveysongelmasta voivan johtaa kielteisiin seuraamuksiin työpaikalla. Yleisimpiä työkyvyn tukemisen toimenpiteitä olivat työajan joustomahdollisuudet ja työn uudelleen organisoiminen. Toimenpiteitä toteutettiin useimmiten julkisella sektorilla ja suurissa työpaikoissa. Teollisuuden alalla työn mukauttamista oli tehty vähiten ja siihen suhtauduttiin kielteisimmin. Toimenpiteitä käytettiin enemmän kaikille työntekijöille suunnattuina työkykyä ylläpitävinä toimina kuin mielenterveyskuntoutujille kohdennettuina. Vahvin selittävä tekijä työn mukauttamisen toimenpiteiden toteuttamiselle oli organisaation koko. Vaikka henkilöstöjohto piti työn mukauttamista mielenterveyssyistä lähes poikkeuksetta tarpeellisena, oli toimenpiteiden toteuttaminen edelleen vähäistä. Abstract Personnel management attitudes and measures to support work ability in Finnish workplaces in connection with mental health disorders Mental health disorders impose costs on society through health expenditure, increased sick leave and declining labor productivity. Support for work continuation is necessary for human, political and economic reasons. The article examines the attitudes of personnel management towards mental health problems and the measures to support reduced work ability in the workplace due to mental disorders. The article is based on a survey addressed to the personnel management of workplaces (n=300). The data was analyzed using statistical methods such as direct distributions, cross-tabulation, logistic regression analysis and statistical tests. Personnel managements’ attitudes towards mental health problems were mostly positive and they wanted transparency from employees, although half of the respondents believed that knowledge of a person’s mental health problem could lead to negative consequences in the workplace. The most common measures to support work ability were flexible working hours and reorganization of work. Work adaptation was more common in the public sector and in large workplaces. In the industrial sector, the measures were fewer and attitudes more negative. The measures were more often used to support all employees’ work ability rather than targeted at mental health rehabilitators. Although personnel management considered the adaptation of work for mental health reasons almost invariably necessary, the measures were still limited. Keywords: mental health problems, work ability, work adaptation, attitudes

Purpose We lack knowledge on whether the advice of “being physically active” should be the same for prevention and rehabilitation of low back pain (LBP). Sickness absence is a key outcome for LBP prevention and rehabilitation. We investigated the associations between physical activity and long-term sickness absence (LTSA) among employees with and without LBP. Methods Between 2011 and 2013, 925 Danish employees wore a Actigraph GTX3 accelerometer for 1–5 workdays to measure physical activity and reported LBP in past 7 days. Employees were followed for 4 years to determine their first register-based LTSA event (≥ 6 consecutive weeks). Results Among employees with LBP, increasing moderate-to-vigorous-intensity physical activity at work by 20 min and decreasing the remaining behaviors at work (ie., sitting, standing and light-intensity activity) by 20 min was associated with 38% (95% CI 17%; 63%) higher LTSA risk. Increasing light-intensity activity at work by 20 min and decreasing 20 min from the remaining behaviors was associated with 18% (95% CI 4%; 30%) lower risk. During leisure, increasing moderate-to-vigorous-intensity activity by 20 min or standing by 40 min was associated with 26% (95% CI 3%; 43%) lower and 37% (95% CI 0%; 87%) higher risk, respectively. Among employees without LBP, we found no such associations. Conclusions The physical activity advice ought to be different for LBP prevention and rehabilitation to reduce LTSA risk, and specified by domain and activity intensity. At work, employees with LBP should be advised to spend time on light-intensity physical activity and limit their time on moderate-to-vigorous-intensity physical activity. During leisure, employees should spend time on moderate-to-vigorous-intensity physical activity.

Spondyloarthritis (SpA) affects patients in the prime of their economic productivity and can cause loss of work productivity and unemployment. We aim to identify factors associated with poor work outcomes in patients with SpA.A cross-sectional study was performed in 100 patients with SpA who were employed, retired, or off work because of SpA. Data on sociodemographic and professional characteristics were collected as well as specific indices: BASDAI, ASDAS-CRP, BASFI, and BASMI. Work productivity in employed patients was assessed by the Work Productivity and Activity Impairment scale (WPAI:SpA).Patients were divided into 73 men and 27 women; the mean age was 43.68 ± 10.3 years. Fifty-nine percent of patients were employed and 26% were off work. The average disease duration was 12.24 ± 8.73 years. The mean BASDAI score was 4.4 ± 2.4, the average BASFI score was 4.6 ± 2.7, and the average ASDAS-CRP score was 2.77 ± 1.18. The mean BASMI was 4.4 ± 2.8. Among employed patients, the mean of absenteeism, presenteeism, and work productivity loss was 21.8 ± 33.13%, 42 ± 32%, and 46.5 ± 35.31%, respectively. In multivariable analysis, absenteeism was associated with ASDAS ≥ 2.1 (β = 20.14), peripheral joint involvement (β = 15.6), manual work (β = 14.31), low level of education (β = 7.92), and BASFI ≥ 4 (β = 6.39). Presenteeism and work productivity loss were associated with manual work, BASFI ≥ , body mass index ≥ 25 kg/mSpondyloarthritis affects work productivity. Screening for predictive factors should be considered by the clinician in the overall management of the disease. Key Points • SpA occurs among young and active patients; it could affect their professional lives and thus lead to loss of work productivity and unemployment. • The management of patients with SpA must be multidisciplinary; this includes assessing contextual factors in order to act on modifiable factors such as smoking and BMI, optimal management of the disease to maintain at least a low disease activity, and to ensure workstation layout and elimination of professional constraints that can affect work outcomes in patients with SpA.

Objectives: Examine short-term disability (STD) and workers’ compensation (WC) associated leave and wage replacements, and overall direct healthcare payments, among employees with osteoarthritis (OA) versus other chronically painful conditions; quantifying the impact of opioid use. Methods: Analysis of employees with more than or equal to two STD or WC claims for OA or pre-specified chronically painful conditions (control) in the IBM MarketScan Research Databases (2014 to 2017). Results: The OA cohort (n = 144,355) had an estimated +1.2 STD days, +$152 STD payments, and +$1410 healthcare payments relative to the control cohort (n = 392,639; P

We investigated the benefit of a 6-week ambulant psychiatric rehabilitation program in an ambulant psychiatric rehabilitation clinic in Vienna, Austria, from January 2014 to December 2016 by an uncontrolled repeated measures study. The potential of this intervention program was assessed by effectiveness and cost measures using suitable statistical analyses. We compared the effectiveness and cost measures of this ambulant psychiatric rehabilitation program on patients for the period of up to 12 months after discharge to the period of 12 months before admission to the intervention program based on self-reported catamnesis questionnaires. For the program’s effectiveness measures, we accounted for both psychological indices for measuring depression severity, symptom burden, and functioning to document the health improvement of patients and economy-related indices such as the number of sick leave days for patients. For the program’s cost measures, both direct tangible treatment and medication costs and indirect tangible costs based on the productivity loss measured in non-working days of the patients were considered. The results significantly demonstrated that all psychological effectiveness measures for the patients highly improved by the 6-weeks rehabilitation program and remained rather stable 12 months after discharge. We found that costs for the 6-week ambulant psychiatric rehabilitation program could be easily covered within 12 months after discharge once a total societal cost perspective was considered. Even additional total cost savings of up to over 5000 Euro could be achieved which were highest for employed patients, followed by unemployed patients receiving rehabilitation allowance due to both their high direct medication and treatment costs as well as high indirect costs for productivity loss. The most important finding was that this treatment program was especially beneficial for rehabilitation patients in earlier stages of psychiatric diseases who were still employed, indicating the need for early intervention in mental disorder.

Publisher Copyright: © 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under CC BY-NC-ND 4.0 license Background: High emotional demands at work can affect employees’ health and there is a need to understand whether such an association might be modified by other working conditions. We aimed to examine emotional demands at work as a risk factor for long-term sickness absence and analyse whether influence, possibilities for development, role conflicts, and physical demands at work might modify this risk. Methods: We did a nationwide, population-based, prospective cohort study in Denmark and included employed individuals who were residing in Denmark in 2000, aged 30–59 years, who had complete data on age, sex, and migration background, with information on emotional demands and possible effect modifiers from job exposure matrices, and covariates and outcome (sickness absence) from population registers. Individuals with long-term sickness absence (≥6 weeks of consecutive sickness absence) between Jan 1, 1998, and Dec 31, 2000, and self-employed individuals were excluded. We assessed long-term sickness absence during a 10-year period from Jan 1, 2001, to Dec 31, 2010. Using Cox regression, we estimated hazard ratios (HRs) and 95% CIs and tested interaction as departure from additivity, estimating relative excess risk due to interaction (RERI). Multivariable adjusted models included sex, age, cohabitation, migration background, and income. Findings: 1 521 352 employed individuals were included and contributed data between Jan 1, 2000, and Dec 31, 2010. During 11 919 021 person-years (mean follow-up 7·8 years), we identified 480 685 new cases of long-term sickness absence. High emotional demands were associated with increased risk of long-term sickness absence compared with low emotional demands, after adjusting for age, sex, cohabitation, migration background, income, and the four possible effect modifiers (adjusted HR 1·55 [95% CI 1·53–1·56]). The association between high emotional demands and risk of long-term sickness absence was stronger in a synergistic way when individuals were also exposed to low possibilities for development (RERI 0·35 [95% CI 0·22–0·47]; 28·9 additional cases per 1000 person-years) and high role conflicts (0·13 [0·11–0·15]; 22·0 additional cases per 1000 person-years). No synergy was observed for influence and physical demands at work. Interpretation: People in occupations with high emotional demands were at increased risk of long-term sickness absence. Our findings on synergistic interactions suggest that, in emotionally demanding occupations, increasing possibilities for development and reducing work-related role conflicts might reduce long-term sickness absence. Further interventional studies are needed to confirm or refute this hypothesis. Funding: Danish Work Environment Research Fund, NordForsk.

Purpose Physical work exposures are associated with sickness absence among older employees. We aimed to examine if they similarly contribute to all-cause sickness absence during early and mid-careers. Methods We used questionnaire data on physical work exposures linked to register data on sickness absence from 3542 municipal employees aged 19–39 years. Follow-up for the number of sickness absence days was 12 months. Exposures to physical workload, occupational environmental hazards, and sedentary work were divided into quartiles. In addition, duration of daily exposure to heavy work was included. Negative binomial regression models were used. Results Higher exposure to physical workload or hazardous exposures was associated with a higher number of sickness absence days. The age and gender adjusted rate ratios for sickness absence days among the participants whose exposure to physical workload was in the highest exposure quartile were 2.1 (95% CI 1.8‒2.5) compared with those whose exposure was in the lowest quartile. In addition, rate ratios for sickness absence days among participants who reported that they do heavy physical work 1.1‒2.0 h, 2.1‒4.0 h or over 4 h daily were 1.6 (1.3‒1.9), 1.5 (1.3‒1.8) and 1.7 (1.5‒2.1), respectively, compared with those who reported not doing physical work. Further adjustment for lifestyle factors or health characteristics attenuated the associations only slightly. Conclusion Exposure to physically demanding work is associated with a higher number of sickness absence days among municipal employees below 40 years of age. Physical working conditions should be considered when aiming to support later work ability.

Chronic pain-related sickness absence is an enormous socioeconomic burden globally. Optimized interventions are reliant on a lucid understanding of the distribution of social insurance benefits and their predictors. This register-based observational study analyzed data for a 7-year period from a population-based sample of 44,241 chronic pain patients eligible for interdisciplinary treatment (IDT) at specialist clinics. Sequence analysis was used to describe the sickness absence over the complete period and to separate the patients into subgroups based on their social insurance benefits over the final 2 years. The predictive performance of features from various domains was then explored with machine learning-based modeling in a nested cross-validation procedure. Our results showed that patients on sickness absence increased from 17% 5 years before to 48% at the time of the IDT assessment, and then decreased to 38% at the end of follow-up. Patients were divided into 3 classes characterized by low sickness absence, sick leave, and disability pension, with eight predictors of class membership being identified. Sickness absence history was the strongest predictor of future sickness absence, while other predictors included a 2008 policy, age, confidence in recovery, and geographical location. Information on these features could guide personalized intervention in the specialized healthcare. PERSPECTIVE: This study describes sickness absence in patients who visited a Swedish pain specialist interdisciplinary treatment clinic during the period 2005 to 2016. Predictors of future sickness absence are also identified that should be considered when adapting IDT programs to the patient's needs. Funding: Swedish Research Council (Vetenskapsradet)Swedish Research Council [2015-02512]; Swedish Research Council for Health Working Life & Welfare (Forte) [FORTE: 2016-07414, 2017-00177]

Tutkimuksen tarkoituksena oli selvittää alaselkäkipuisten asiakkaiden kokemuksia käynnistään terveyskeskuksessa fysioterapeutin suoravastaanotolla. Tutkimus on retrospektiivinen, kuvaileva kyselytutkimus, joka toteutettiin strukturoidulla kyselylomakkeella kolme kuukautta fysioterapeutin vastaanotolla käynnin jälkeen. Lomakkeella selvitettiin selkäkivun lievittymisestä, ohjattujen harjoitteiden toteutumisesta, kivun uusiutumisesta, asiakkaan käsityksistä uusiutumisen syistä, kipuun liittyvästä pelosta, uudelleen hakeutumisesta lääkärin tai fysioterapeutin vastaanotolle ja työssäkäyvien sairauspoissaoloista. Lähetettyyn 150 kyselyyn vastasi 80 henkilöä (53 %), jotka jakaantuivat kolmeen ryhmään: 1. eläkeläiset (n = 26), 2. työttömät (n = 15) ja 3. työssä olevat/opiskelijat (n = 39). Aineisto analysoitiin SPSS-tilasto-ohjelmalla ja avointen kysymysten vastaukset litteroitiin ja luokiteltiin yhtäläisyyksien mukaan. Tulokset osoittivat, että 80–82 prosenttia asiakkaista kaikissa ryhmissä koki hyötyvänsä fysioterapeutilla käynnistään paljon tai kohtalaisesti. Kolmen kuukauden aikana selkäkivun uusiutuminen oli vähäisintä työssä olevat/opiskelijat -ryhmässä (5 %) ja suurinta eläkeläisten ryhmässä (30 %). Saman selkäongelman vuoksi vain 10 prosenttia vastanneista hakeutui uudelleen fysioterapeutille tai lääkärille. Työssä olevien ja opiskelijoiden ryhmässä ainoastaan yksi henkilö ilmoitti olevansa kyselyhetkellä sairauslomalla. Tutkimuksen tulokset viittaavat siihen, että fysioterapeutin suoravastaanotolla käyneet asiakkaat ovat tyytyväisiä toimintaan ja ovat kokeneet saaneensa apua selkäkipuunsa. Yhteiskunnallisen kustannus-hyöty ajattelun mukaan vähäiset uusintakäynnit fysioterapeutin tai lääkärin vastaanotolla, sekä alhaiset sairauspoissaolot vaikuttavat merkittäviltä. Jatkossa tarvitaan korkeatasoisia, pidemmällä seuranta-ajalla toteutettuja satunnaistettuja tutkimuksia kustannusanalyyseineen fysioterapian varhaisesta toteuttamisesta. Abstract Patients’ experiences of their visit to direct access physiotherapists in the early phase of low back pain: A retrospective descriptive survey The purpose of the study was to investigate the experiences of low back pain patients regarding their visit to direct access physiotherapists at a health center. The study is a retrospective descriptive survey conducted in a structured questionnaire three months after a visit to a physiotherapist. The questionnaire included questions, in particular, information on the relief of back pain, the management of the instructed exercises, the recurrence of back pain, patients’ perceptions of the causes of pain, the fear of pain, reasons for a repeat visit to a doctor or physiotherapist, and eventual absences due to sickness. The questionnaire was sent to 150 people who were picked up from the health care centers. Eighty (53%) low back pain patients responded. They were divided into three groups: retired people (n=26); unemployed people (n=15); and students and employed people (n=39). The data were analyzed using SPSS statistical software. The open answers were transcribed and the similarities of the answers were combined. The results showed that 80-82% of patients in all groups experienced the benefits from their visit to a physiotherapist as being great or moderate. During the three months after their visit, the recurrence of back pain was at its lowest among students and employed people (5%) and the highest among retired people (30%). Only 10% of the respondents made a repeat visit to a physiotherapist or doctor for the same back problem. Only one person in the students and employed people group was on sick leave. The results show that the patients viewed the early visit to a physiotherapist as useful in the treatment of back pain and in the prevention of new episodes. From a social cost–benefit point of view the results; the low need for repeat visits to the physiotherapist or to the doctor, and the low rates of absence due to sickness let us assume those to be notable. Additional high-quality research involving longer prospective randomized designs and economic impact analyses is required to further investigate the outcomes associated with early initiation of physiotherapy. Keywords: physiotherapy, direct access, low back pain, patients` experiences

BACKGROUND Return to work (RTW) after surgery for a work-related rotator cuff disorder (WRRCD) is often difficult. The study's purpose was to identify preoperative factors predicting RTW. METHODS Ninety-two workers with a WRRCD were identified by four surgeons. Before surgery, the workers completed a series of standardized questionnaires related to working conditions, health, and health beliefs. They were followed up prospectively for 20 months. Statistical analysis was based on single and multiple-factor Cox models of the duration of absence from the time of surgery until RTW. RESULTS The median age at inclusion was 49 years (27-62), with 52 women included (57%). Sixty-one subjects (66%) were employed in highly physically demanding jobs. Forty-two (46%) stayed at work until their surgery, whereas preoperative sick leave exceeded 100 days in 20 subjects (21%). Twenty months after surgery, 14 were still not back at work. For the other participants, the mean duration until RTW was 225 days (SD 156). In the fully adjusted model, variables that were significantly predictive of the duration until RTW were: work physical demand levels, preoperative sick leave, the number of body parts causing pain or discomfort in the last 12 months, self-assessed 2-year workability, and the Readiness for RTW (RRTW) Scale. CONCLUSIONS Several physical, psychological, and work-related factors, easily recorded, can be identified preoperatively. They may be predictive of delayed return, loss of employment, or employability as a result of shoulder surgery.

The impact of obesity on quality of life (QoL) and working ability vary in different dimensions. This study investigated the association of obesity with QoL and working ability in Finnish adults. Comorbidities as associative factors were also characterised. This cross-sectional study included 4956 randomly selected adults. QoL (EUROHIS-QOL 8 total score and individual components), perceived physical and psychological working ability, and sick leave days were analysed in different body mass index (BMI) groups. Regression models were used to study the role of comorbidities as associative factors. EUROHIS-QOL 8 total score was significantly lower in BMI group 25.0–29.9 kg/m2 (4.01; 95% confidence interval 3.97–4.05), BMI 30.0–34.9 kg/m2 (3.85; 3.79–3.91), BMI 35.0–39.9 kg/m2 (3.75; 3.66–3.85), and BMI ≥ 40.0 kg/m2 (3.73; 3.46–4.00) compared to individuals with normal (18.5–24.9 kg/m2) BMI (4.08; 4.04–4.12). Individuals with obesity (BMI ≥ 30.0 kg/m2) rated their QoL lower than individuals with normal BMI in seven of the eight EUROHIS-QOL 8 components. A lesser proportion of individuals (53–73%) with obesity rated their physical working ability as very or fairly good compared to individuals with normal BMI (90%, p values

ObjectiveThis study investigates if gradual return to work (GRTW) is associated with full sustainable return to work (RTW) for seriously injured workers with a musculoskeletal disorder (MSD), in British Columbia, Canada.MethodsThis is an effectiveness study using a retrospective cohort study design. Accepted workers’ compensation lost-time claims were extracted for workers with an MSD who were on full work disability for at least 30 days, between 2010 and 2015 (n=37 356). Coarsened exact matching yielded a final matched cohort of 12 494 workers who experienced GRTW at any point 30 days post-injury and 12 494 workers without any GRTW. The association between GRTW and sustainable RTW through to end of 12 months was estimated with multivariable quantile regression.ResultsWorkers who were provided with GRTW experienced more time-loss days until sustainable RTW between the 2nd and 5th months after the first time-loss day (ConclusionsFor seriously injured workers with at least 30 days of disability due to a work-acquired MSD, the effect of GRTW becomes apparent at longer disability durations (more than 6 months), with larger beneficial effects for women, workers with soft-tissue injuries and for trade and manufacturing sectors.

The retrospective study showed that the effect of the middle ear pressure treatment by the tramstympanic membrane massage (TMM) device was similar to that of the Meniett device.The new TMM device named EFET device was prospectively evaluated in patients with Meniere's disease (MD) and delayed endolymphatic hydrops (DEH) and we compared the effects to the Meniett device.23 ears of 19 patients were treated with an EFET device, and 17 ears of 15 patients were treated with the Meniett device. All patients suffering from intractable MD and DEH were treated for 4 months. The insertion of a transtympanic ventilation tube was necessary for the Meniett device, but not the EFET device.In patients treated by the EFET and Meniett devices, the frequency of vertigo significantly improved after treatment. The distribution of vertigo outcomes at 4 months after treatment did not differ between patients treated with the both devices.Middle ear pressure treatment by the EFET device is effective and provides minimally invasive options for intractable MD and DEH like the Meniett device.

ObjectiveTo explore impacts of the COVID-19 pandemic on patterns of sickness absence among staff employed by the National Health Service (NHS) in England.MethodsWe analysed prospectively collected, pseudonymised data on 959,356 employees who were continuously employed by NHS trusts during 1 January 2019 to 31 July 2020, comparing the frequency of new sickness absence in 2020 with that at corresponding times in 2019.ResultsAfter exclusion of episodes directly related to COVID-19, the overall incidence of sickness absence during the initial 10 weeks of the pandemic (March-May 2020) was more than 20% lower than in corresponding weeks of 2019, but trends for specific categories of illness varied. Marked increases were observed for asthma (122%), infectious diseases (283%) and mental illness (42.3%), while reductions were apparent for gastrointestinal problems (48.4%), genitourinary/gynaecological disorders (33.8%), eye problems (42.7%), injury and fracture (27.7%), back problems (19.6%), other musculoskeletal disorders (29.3%), disorders of ear, nose and throat (32.7%), cough/flu (24.5%) and cancer (24.1%). A doubling of new absences for pregnancy-related disorders during 18 May to 19 July of 2020 was limited to women with earlier COVID-19 sickness absence.ConclusionsVarious factors will have contributed to the large and divergent changes that were observed. The findings add to concerns regarding delays in diagnosis and treatment of cancers, and support a need to plan for a large backlog of treatment for many other diseases. Further research should explore the rise in absence for pregnancy-related disorders among women with earlier COVID-19 sickness absence.1. What is already known about this subject?Historically, rates of sickness absence among the NHS workforce in England have been relatively high but stable. Reports of a marked increase during the first wave of the COVID-19 pandemic have not distinguished between different categories of underlying illness.2. What are the new findings?During the first wave of COVID-19, incidence of sickness-absence changed markedly when compared to the previous year, with major increases for some categories of illness, and large declines for many others, including cancer.3. How might this impact on policy or clinical practice in the foreseeable future?The findings support a need to plan for effects from delayed diagnosis and treatment of cancer, and to manage a large backlog of treatment for many other diseases.

Research has demonstrated that paid sick leave reduces spread of COVID-19 and other infectious diseases and improves preventive care and access to treatment across a wide range of conditions. Howev...

Objectives This prospective cohort study aimed to investigate gender harassment and sexual harassment as risk factors for prospective long-term sickness absence (LTSA, ≥21 days). Furthermore, support from colleagues was investigated as a moderating factor of this association. Methods Information on gender harassment, sexual harassment and support by colleagues were derived from the biannual Swedish Work Environment Survey 1999–2013, a representative sample of the Swedish working population (N=64 297). Information on LTSA as well as demographic and workplace variables were added from register data. Relative rates of LTSA the year following the exposure were determined using modified Poisson regression. Results Monthly to daily exposure to gender harassment was a risk factor for prospective LTSA among women [rate ratio (RR) 1.04, 95% confidence interval (CI) 1.02–1.05] and men (RR 1.07, 95% CI 1.04–1.10). Monthly to daily exposure to sexual harassment was also a risk factor for LTSA among women (RR 1.05, 95% CI 1.01–1.10) and men (RR 1.07, 95% CI 1.02–1.13). Exposure to sexual or gender harassment once in the last 12 months was not associated with LTSA. There was no support for an interaction between either of the exposures and support from colleagues in relation to LTSA. Conclusions Sexual harassment and gender harassment appear to contribute to a small excess risk for LTSA among women and men. For both kinds of offensive behaviors, the pervasiveness appears to be important for the outcome. The role of support by colleagues was inconclusive and needs further investigation.

Background There is no consensus for when publicly funded breast reduction is indicated and recommendations in guidelines vary greatly, indicating a lack of evidence and unequal access. The primary aim of this review was to examine risks and benefits of breast reduction to treat breast hypertrophy. Secondary aims were to examine how the studies defined breast hypertrophy and indications for a breast reduction. Methods A systematic literature search was conducted in PubMed, MEDLINE All, Embase, the Cochrane Library, and PsycInfo. The included articles were critically appraised, and certainty of evidence was assessed using the GRADE approach. Meta-analyses were performed when possible. Results Fifteen articles were included; eight reporting findings from four randomised controlled trials, three non-randomised controlled studies, three case series, and one qualitative study. Most studies had serious study limitations and problems with directness. Few of the studies defined breast hypertrophy. The studies showed significantly improved health-related quality of life and sexuality-related outcomes in patients who had undergone breast reduction compared with controls, as well as reduced depressive symptoms, levels of anxiety and pain. Most effect sizes exceeded the reported minimal important difference for the scale. Certainty of evidence for the outcomes above is low (GRADE ⊕ ⊕). Although four studies reported significantly improved physical function, the effect is uncertain (very low certainty of evidence, GRADE ⊕). None of the included studies reported data regarding work ability or sick leave. Three case series reported a 30-day mortality of zero. Reported major complications after breast reduction ranged from 2.4 to 14% and minor complications from 2.4 to 69%. Conclusion There is a lack of high-quality studies evaluating the results of breast reduction. A breast reduction may have positive psychological and physical effects for women, but it is unclear which women benefit the most and which women should be offered a breast reduction in the public healthcare system. Several priorities for further research have been identified. Pre-registration The study is based on a Health Technology Assessment report, pre-registered and then published on the website of The Regional HTA Centre of Region Västra Götaland, Sweden.

Introduction US employee absence benefits may include workers' compensation (WC) for work-related injuries/illnesses, short- and long-term disability (STD and LTD, respectively) for non–work-related injuries/illnesses, and discretionary sick leave (SL). Absences can significantly impact business performance, and employers are intensifying efforts to manage benefits and connections with employee health. This research compares all-cause STD/LTD/WC/SL use and variation from baseline (2002) for eligible employees (EMPs) with mental disorders (MDs) and SUDs to determine if use/payments varied over time. Methods Employees incurring medical claims with Agency for Healthcare Research and Quality MD and SUD ICD-9/10 codes were identified in the WorkPartners database (January 1, 2002 to December 31, 2019). Retrospective analysis was performed on annual prevalence, benefit use, mean days of leave, and median payments as a percent of salary (including lump-sum distributions and potentially extending beyond initiation year). WC claims without work absences were excluded. For each benefit, annual outcomes were calculated as a percent of baseline to show variability. Results Use was 48.1% to 202.2% (median, 102.8%) of baseline rates for SL (SUD-EMPs), and 87.3% to 108.4% (median, 97.3%) for STD (MD-EMPs). Days of LTD leaves were 21.5% to 657.8% (median, 359.2%) of baseline days (MD-EMPs), and 122.7% to 1042.2% (median, 460.0%) of baseline days for (SUD-EMPs). Median payments for WC were 78.6% to 253.6% (median, 114.6%) of baseline (MD-EMPs) and 97.9% to 481.6% (median, 104.0%) for SUD-EMPs. Discussion Employees with MD/SUD used absence benefits at differing rates over time with varying days of leave and payments as a percent of salary. Using a constant cost or salary replacement factor over time for all benefits is not accurate or appropriate.