Coordinated and tailored work rehabilitation: a randomized controlled trial with economic evaluation undertaken with workers on sick leave due to musculoskeletal disorders

Introduction In Denmark, the magnitude and impact of work disability on the individual worker and society has prompted the development of a new "coordinated and tailored work rehabilitation" (CTWR) approach. The aim of this study was to compare the effects of CTWR with conventional case management (CCM) on return-to-work of workers on sick leave due to musculoskeletal disorders (MSDs). Methods The study was a randomized controlled trial with economic evaluation undertaken with workers on sick leave for 4-12 weeks due to MSDs. CTWR consists of a work disability screening by an interdisciplinary team followed by the collaborative development of a RTW plan. The primary outcome variable was registered cumulative sickness absence hours during 12 months follow-up. Secondary outcomes were work status as well as pain intensity and functional disability, measured at baseline, 3 and 12 months follow-up. The economic evaluation (intervention costs, productivity loss, and health care utilization costs) was based on administrative data derived from national registries. Results For the time intervals 0-6 months, 6-12 months, and the entire follow-up period, the number of sickness absence hours was significantly lower in the CTWR group as compared to the control group. The total costs saved in CTWR participants compared to controls were estimated at US $1,366 per person at 6 months follow-up and US$ 10,666 per person at 12 months follow-up. Conclusions Workers on sick leave for 4-12 weeks due to MSD who underwent "CTWR" by an interdisciplinary team had fewer sickness absence hours than controls. The economic evaluation showed that-in terms of productivity loss-CTWR seems to be cost saving for the society

Absence from work due to occupational and non-occupational accidents

AIMS: The aim of the present study was to investigate absence from work in Denmark due to occupational and non-occupational accidents.BACKGROUND: Since the beginning of the last decade, political focus has been placed on the population's working capacity and the scope of absence due to illness. Absence from work is estimated at between 3% and 6% of working hours in the EU and costs are estimated at approximately 2.5% of GNP.METHODS: Victims of accidents treated at two emergency departments were interviewed regarding absence for the injured, the family and others. All answers were linked to the hospital information on the injury, so that it was possible to examine the relation between absence and injury type, and cause of the accident.RESULTS: In total, 1,479 injured persons were interviewed. 36% of these reported absence from work by themselves or others. In mean, an injury caused 3.21 days of absence. Based on this the total absence due to injuries in Denmark was estimated to 1,822,000 workdays, corresponding to approximately 6% of the total absence from work due to all types of illness. Non-occupational injuries resulted in more absence than did occupational injuries.CONCLUSIONS: Absence due to accidents contributed to a considerable part of the total absence from work, and non-occupational accidents caused more absence than did occupational accidents.</p

Behavioral determinants as predictors of return to work after long-term sickness absence: an application of the theory of planned behavior

Background The aim of this prospective, longitudinal cohort study was to analyze the association between the three behavioral determinants of the theory of planned behavior (TPB) model-attitude, subjective norm and self-efficacy-and the time to return-to-work (RTW) in employees on long-term sick leave. Methods The study was based on a sample of 926 employees on sickness absence (maximum duration of 12 weeks). The employees filled out a baseline questionnaire and were subsequently followed until the tenth month after listing sick. The TPB-determinants were measured at baseline. Work attitude was measured with a Dutch language version of the Work Involvement Scale. Subjective norm was measured with a self-structured scale reflecting a person's perception of social support and social pressure. Self-efficacy was measured with the three subscales of a standardised Dutch version of the general self-efficacy scale (ALCOS): willingness to expend effort in completing the behavior, persistence in the face of adversity, and willingness to initiate behavior. Cox proportional hazards regression analyses were used to identify behavioral determinants of the time to RTW. Results Median time to RTW was 160 days. In the univariate analysis, all potential prognostic factors were significantly associated (P < 0.15) with time to RTW: work attitude, social support, and the three subscales of self-efficacy. The final multivariate model with time to RTW as the predicted outcome included work attitude, social support and willingness to expend effort in completing the behavior as significant predictive factors. Conclusions This prospective, longitudinal cohort-study showed that work attitude, social support and willingness to expend effort in completing the behavior are significantly associated with a shorter time to RTW in employees on long-term sickness absence. This provides suggestive evidence for the relevance of behavioral characteristics in the prediction of duration of sickness absence. It may be a promising approach to address the behavioral determinants in the development of interventions focusing on RTW in employees on long-term sick leave

Implementation and Outcome Evaluation of LA DOOR: A Proposition 47-Funded Program in Los Angeles: Cohort 2 Final Evaluation Report

The Los Angeles Diversion, Outreach, and Opportunities for Recovery (LA DOOR) program is designed by the Los Angeles City Attorney\u27s Office (LACA) to provide a comprehensive, health-focused, preventative approach that proactively engages individuals at elevated risk of returning to LACA on a new misdemeanor offense. In this study, the authors document the findings of a process and outcome evaluation of Cohort 2 of the LA DOOR program

Final Evaluation of LA DOOR: Proposition 47 Grant Program

The Los Angeles Diversion, Outreach, and Opportunities for Recovery program (LA DOOR) was designed by the Los Angeles City Attorney\u27s Office (LACA) to provide a comprehensive, health-focused, preventative approach that proactively engages individuals at elevated risk of returning to LACA on a new misdemeanor offense related to substance use, mental illness, or homelessness. LA DOOR was funded through the grant program of Proposition 47. Programs funded through Proposition 47 are intended to serve individuals with a history of criminal justice involvement and mental health issues or substance use disorders and to offer mental health services, substance use disorder treatment, and diversion programs for justice-involved individuals. Grant-funded projects such as LA DOOR are required to be evaluated to understand how they are being implemented and whether they are achieving their intended outcomes. The formal evaluation of the program is being conducted by the RAND Corporation and its subcontractor, KH Consulting Group. This final evaluation summarizes the authors\u27 findings from a process and outcome evaluation of Cohort 1 of LA DOOR, which provided services from July 2018 to March 2021. Interested stakeholders of this research include LACA, the California Board of State and Community Corrections, the City of Los Angeles, and other jurisdictions that provide supportive services to criminal justice populations or might be interested in implementing a similar program

Urban Voids After the Pandemic. A New Chance for Greenway

Our proposal deals with the meaning of urban voids in the post-COVID-19 period to suggest new understandings of how urban green corridors can positively affect design for healthier and more sustainable cities. According to Secchi (1986), planning through the void involves a profound revision of the way we think about the city, reversing the points of interest, proposing as polarities the spaces that do not usually emerge. The void thus becomes an opportunity, a chance to improve the structure of our urban landscape (Lopez-Pineiro, 2020). A city is a powerful place, always in motion and transformation. It has an artificial spirit full of surprises and vague limits. It is the scene of remarkable transformations that in their wildness are partially ungovernable by the designers themselves. The desire to control them leaves a series of abandoned and unfinished spaces, “holes” that live from their discontinuity with the surroundings (Labriola, 2021). During a period of crisis, like the one that we are still living with COVID-19 (Fabris et al, 2020), it is common to re-think our cities to create better places for the community. After the long period of forced distance that we lived, an evolution of public space is recommended. During the pandemic, the emptiness of our cities permitted Nature to re-appropriate its spaces. Following this trend and thinking about a new kind of public space where Nature and its inside processes are the protagonists, it is possible to intervene in our cities. The porosity of the urban fabric in towns without humans, blocked at home by the never-ending lockdowns, became a new green corridor that revealed the presence of wildlife (both fauna and flora) as part of a forgotten urban layer that turned visible again. The preservation of this new asset should be possible. The spaces to allow this change can be the abandoned and empty areas present in the contemporary city’s sick body that we can finally heal. The so-called wastelands, voids, or terrain vague, have a significant value independent from the environment in which they are inserted, showing a relationship with the contemporary city extraneous to its rhythms. For this reason, they are the perfect place for experimentation in terms of greenways, a possible starting point to re-think how green can be part of the urban texture and how to conceive public and open spaces after the nowadays crisis. The paper considers the Metropolitan City of Milan as a remarkable case study to understand the pivotal role played by urban voids in the formation of greenways and their capacity of reshaping the environmental, aesthetic and healthy dimensions of urban landscapes

Transient plasma cell dyscrasia in COVID-19 patients linked to IL-6 triggering

An unusual clonal gammopathy was reported in COVID-19 patient but whether this anomaly is related or not to the disease has not yet been clarified. To this aim, we selected a cohort of 35 COVID-19 patients swab positive and investigated serological levels of IL-6, immune response to major viral antigens and electrophoretic profile. Elevated levels of IL-6 were accompanied by a significative humoral response to viral Spike protein, revealing an altered electrophoretic profile in the gamma region. We can conclude that elevated levels of IL-6 triggers humoral response inducing a transient plasma cell dyscrasia in severe COVID-19 patients

Chronic kidney disease and arrhythmias: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.

Patients with chronic kidney disease (CKD) are predisposed to heart rhythm disorders, including atrial fibrillation (AF)/atrial flutter, supraventricular tachycardias, ventricular arrhythmias, and sudden cardiac death (SCD). While treatment options, including drug, device, and procedural therapies, are available, their use in the setting of CKD is complex and limited. Patients with CKD and end-stage kidney disease (ESKD) have historically been under-represented or excluded from randomized trials of arrhythmia treatment strategies,1 although this situation is changing.2 Cardiovascular society consensus documents have recently identified evidence gaps for treating patients with CKD and heart rhythm disorders [...

How Work Impairments and Reduced Work Ability are Associated with Health Care Use in Workers with Musculoskeletal Disorders, Cardiovascular Disorders or Mental Disorders

__Abstract__ Purpose the aim of this study was to explore how work impairments and work ability are associated with health care use by workers with musculoskeletal disorders (MSD), cardiovascular disorders (CVD), or mental disorders (MD). Methods in this cross-sectional study, subjects with MSD (n = 2,074), CVD (n = 714), and MD (n = 443) were selected among health care workers in 12 Dutch organizations. Using an online questionnaire, data were collected on in