Previous validation studies of sick leave measures have focused on self-reports. Register-based sick leave data are considered to be valid; however methodological problems may be associated with such ...data. A Danish national register on sickness benefit (DREAM) has been widely used in sick leave research. On the basis of sick leave records from 3,554 and 2,311 eldercare workers in 14 different workplaces, the aim of this study was to: 1) validate registered sickness benefit data from DREAM against workplace-registered sick leave spells of at least 15 days; 2) validate self-reported sick leave days during one year against workplace-registered sick leave.
Agreement between workplace-registered sick leave and DREAM-registered sickness benefit was reported as sensitivities, specificities and positive predictive values. A receiver-operating characteristic curve and a Bland-Altman plot were used to study the concordance with sick leave duration of the first spell. By means of an analysis of agreement between self-reported and workplace-registered sick leave sensitivity and specificity was calculated. Ninety-five percent confidence intervals (95% CI) were used.
The probability that registered DREAM data on sickness benefit agrees with workplace-registered sick leave of at least 15 days was 96.7% (95% CI: 95.6-97.6). Specificity was close to 100% (95% CI: 98.3-100). The registered DREAM data on sickness benefit overestimated the duration of sick leave spells by an average of 1.4 (SD: 3.9) weeks. Separate analysis on pregnancy-related sick leave revealed a maximum sensitivity of 20% (95% CI: 4.3-48.1).The sensitivity of self-reporting at least one or at least 56 sick leave day/s was 94.5 (95% CI: 93.4 - 95.5) % and 58.5 (95% CI: 51.1 - 65.6) % respectively. The corresponding specificities were 85.3 (95% CI: 81.4 - 88.6) % and 98.9 (95% CI: 98.3 - 99.3) %.
The DREAM register offered valid measures of sick leave spells of at least 15 days among eldercare employees. Pregnancy-related sick leave should be excluded in studies planning to use DREAM data on sickness benefit. Self-reported sick leave became more imprecise when number of absence days increased, but the sensitivity and specificity were acceptable for lengths not exceeding one week.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Objectives This study attempted to identify risk factors for musculoskeletal symptoms in the neck and handwrist regions among employees using computers at work. Methods Computer users (N= 5033) first ...received a questionnaire in the beginning of 1999 (69% response rate, N= 3475), and a follow-up questionnaire was mailed in December of 2000 to the 3361 respondents to the baseline survey (77% response rate, N= 2576). Health outcome was defined as musculoskeletal symptoms for >7 days within the last year of follow-up among the nonsymptomatic respondents at baseline. Results Men's and women's previous symptoms, women's low influence at work and high-placed computer screen, and men's short time in the same job and good computer skills were associated with neck symptoms. Hand-wrist symptoms were predicted by previous symptoms and low influence at work for both the men and women and sensorial demands for the women only. The duration of computer use predicted hand-wrist symptoms eg, odds ratio (OR) of 2.3,95% confidence interval (95% CI) 1.2-4.3, for almost continual computer use, but not neck symptoms. For those with almost continual computer use, hand-wrist symptoms were associated with mouse use for at least half of the worktime (OR 4.0, 95% CI 1.0-15.5) and not using the mouse at all (OR 4.0, 95% CI 1.1-14.4), as compared with mouse use for one-fourth of the worktime. Conclusions Limiting computer use to less than three-fourths of the worktime would help to prevent handwrist symptoms. Furthermore, low influence at work predicts both neck and hand-wrist symptoms.
Obesity is related to lower labour force participation, increased sickness absence and reduced productivity. The rehabilitation services in Norway have not had much experience introducing a work ...dimension into lifestyle interventions for persons with obesity. Therefore, this study aimed to evaluate one such type of intervention.
This is a qualitative study seeking to gather data on the participants' experiences. Twenty participants were recruited from two lifestyle interventions. Intervention A, with work focus, included lectures and individual guidance from a work consultant in addition to the lifestyle intervention. Intervention B was a traditional lifestyle intervention. Data were collected by semi-structured interviews held at each stay.
Seven main themes emerged and one of them pointed towards a confusion of the aim of the intervention, which was viewed as focusing on lifestyle rather than a process focused on work. Otherwise, the results showed that persons with obesity struggle with many of the same inhibiting factors as other groups with reduced work ability.
The application process might explain the focus on lifestyle change. Communication, guidance and support reduce barriers for lifestyle change, but work is important for general health and social well-being and a work focus may therefore be beneficial in all lifestyle interventions.
People on or at risk of sick leave from work due to obesity or obesity-related problems participated in a new vocational rehabilitation (VR). The study aimed to examine the outcome changes in the ...participants' health-related quality of life (HRQoL), body mass index (BMI), return to work self-efficacy (RTWSE), work ability scale (WAS) and degree of work participation (DWP) after their participation in the 12-month VR programme. The secondary aim was to examine associations between the outcome changes and HRQoL at 12-month follow-up, measured with the HRQoL 15D instrument (15D).
This prospective observational study included 95 participants. The one-year multidisciplinary VR programme with an integrated work and lifestyle intervention included 4 weeks of inpatient stay followed-up by 5 meetings. A paired sample t-test was used to examine changes in HRQoL, BMI, RTWSE, WAS, and DWP between baseline and the 12-month follow-up. Multiple linear regression analyses explored associations between changes in HRQoL and the outcome variables.
The participants achieved statistically significant changes in HRQoL (2.57, 95% CI: 1.35 to 3.79), BMI (- 2.33, 95% CI: - 3.10 to - 1.56), RTWSE (15.89, 95% CI: 4.07 to 27.71), WAS (1.51, 95% CI: 0.83 to 2.20) and DWP (18.69, 95% CI: 8.35 to 29.02). At 12 months, a significant association was found between HRQoL and BMI (B = - 0.34, 95% CI: - 0.65 to - 0.04), RTWSE (B = 0.02, 95% CI: 0.004 to 0.04), WAS (B = 0.91, 95% CI: 0.55 to 1.28), DWP (B = - 0.02, 95% CI: - 0.04 to 0.001) and work absence (B = - 0.01, 95% CI: - 0.02 to - 0.002). The regression model explained 71.8% of the HRQoL variance.
The results indicated positive changes in HRQoL, BMI, RTWSE, WAS and DWP from baseline to the 12-month follow-up. Factors associated with HRQoL at the 12-month follow-up were decreased BMI, increased RTWSE, improved WAS and reduced work absence. Future studies examining VR programmes with lifestyle interventions for people with obesity are recommended.
Norwegian Regional Committee for Medical and Health Research Ethics (REC) 2017/573, Clinical Trials NCT03286374 , registered 18. September 2017. https://clinicaltrials.gov/ct2/results?cond=Obesity&term=Anita+Dyb+Linge&cntry=NO&state=&city=&dist=.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
While estimates of models with spatial interaction are very sensitive to the choice of spatial weights, considerable uncertainty surrounds the definition of spatial weights in most studies with ...cross-section dependence. We show that, in the spatial error model, the spatial weights matrix is only partially identified, and is fully identified under the structural constraint of symmetry. For the spatial error model, we propose a new methodology for estimation of spatial weights under the assumption of symmetric spatial weights, with extensions to other important spatial models. The methodology is applied to regional housing markets in the UK, providing an estimated spatial weights matrix that generates several new hypotheses about the economic and socio-cultural drivers of spatial diffusion in housing demand.
•Incorrect specification of the spatial weights matrix has important consequences.•We show that the spatial weights matrix is only partially identified by the data.•It is fully identified under the structural constraint of symmetric spatial weights.•We propose an estimator for the spatial weights under the assumption of symmetry.•The estimated matrix enhances understanding of spatial diffusion and its drivers.
Sick-listed employees with low back pain had similar return to work (RTW) rates at one-year follow-up in a randomized trial comparing two interventions, but the effects were modified by specific ...workplace related factors. The present study addressed the sustainability of the intervention effects by performing a two-year follow-up and by using different outcome measures.
A total of 351 employees sick-listed for 3-16 weeks due to LBP were recruited from their general practitioners and were randomly allocated to a hospital-based brief or multidisciplinary intervention. Outcome measures were based on sick leave registered in a national database of social and health-related benefits. RTW rates, RTW status, sick leave weeks and sick leave relapse were studied.
During the two-year follow-up 80.0% and 77.3% had RTW for at least four weeks continuously, and the percentages with RTW at the 104th week were 61.1% and 58.0% in the brief and multidisciplinary intervention groups, respectively. At the 104th week 16.6% and 18.8% were on sick leave in the two groups, respectively, and about 12% were employed in modified jobs or participated in job training. The number of weeks on sick leave in the first year was significantly lower in the brief intervention group (median 14 weeks) than in the multidisciplinary intervention group (median 20 weeks), but during the second year the number of weeks on sick leave were not significantly different between intervention groups. Subgroups characterised by specific work related factors modified the effect of the intervention groups on RTW rates (p = 0.017). No difference in sick leave relapse was found between the intervention groups.
The effects of the brief and multidisciplinary interventions at the two-year follow-up were in general similar to the effects at one-year follow-up.
Current Controlled Trials ISRCTN18609003.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Randomized clinical trial comparing two interventions in employees sick-listed 3 to 16 weeks because of low back pain (LBP).
To compare 1-year return to work (RTW), pain, disability and physical and ...mental health dimensions in subjects offered a hospital-based multidisciplinary intervention or a brief intervention.
Previous studies in sick-listed employees with LBP have indicated efficacy of both brief and more comprehensive multidisciplinary interventions. However, it remains unknown, which is the more effective, and which elements are instrumental in furthering RTW, and improving health.
The brief intervention comprised clinical examination and advice offered by a rehabilitation physician and a physiotherapist. In the multidisciplinary intervention, this intervention was supplemented with the expertise of a team and the assignment of a case manager who drew up a rehabilitation plan in collaboration with the patient and the multidisciplinary team. One-year RTW was estimated by data from a comprehensive national database of social transfer payments. Questionnaires were used to obtain baseline and 1-year data on Roland Morris disability score, LBP Rating Scale, SF36, and fear-avoidance.
A total of 351 patients were included and randomized and 344 (98%) patients participated in all the consultations according to the study protocol. RTW was achieved by 125 (71.0%) participants in the multidisciplinary and 133 (76.0%) participants in the brief intervention group. The hazard ratio was 0.84 after adjustment for sex, age, smoking, compensation claims, disability score, and diagnosis (95% confidence interval CI: 0.65-1.08,P = 0.18). Multiple linear regression analysis displayed no differences in secondary outcomes, except for the mental health score (SF36), which was a little higher in the multidisciplinary intervention group than in the brief intervention group.
Hospital-based multidisciplinary intervention may be no better than brief intervention to increase RTW and improve health in sick-listed employees with low back pain.
Objectives This study aimed to investigate whether inpatient multimodal occupational rehabilitation (I-MORE) reduces sickness absence (SA) more than outpatient acceptance and commitment therapy ...(O-ACT) among individuals with musculoskeletal and mental health disorders. Methods Individuals on sick leave (2-12 months) due to musculoskeletal or common mental health disorders were randomized to I-MORE (N=86) or O-ACT (N=80). I-MORE lasted 3.5 weeks in which participants stayed at the rehabilitation center. I-MORE included ACT, physical exercise, work-related problem solving and creating a return to work plan. O-ACT consisted mainly of 6 weekly 2.5 hour group-ACT sessions. We assessed the primary outcome cumulative SA within 6 and 12 months with national registry-data. Secondary outcomes were time to sustainable return to work and self-reported health outcomes assessed by questionnaires. Results SA did not differ between the interventions at 6 months, but after one year individuals in I-MORE had 32 fewer SA days compared to O-ACT (median 85 interquartile range 33-149 versus 117 interquartile range 59-189), P=0.034). The hazard ratio for sustainable return to work was 1.9 (95% confidence interval 1.2-3.0) in favor of I-MORE. There were no clinically meaningful between-group differences in self-reported health outcomes. Conclusions Among individuals on long-term SA due to musculoskeletal and common mental health disorders, a 3.5-week I-MORE program reduced SA compared with 6 weekly sessions of O-ACT in the year after inclusion. Studies with longer follow-up and economic evaluations should be performed.
Objectives/Hypothesis:
Fine‐needle aspiration (FNA) biopsy and imaging are commonly used in the preoperative assessment of salivary gland mass lesions. The goal of this retrospective study was to ...clarify the role of FNA and imaging in the workup of salivary gland masses.
Study Design:
Retrospective cohort study.
Methods:
A computer search identified patients with an FNA of a salivary gland lesion with subsequent excision during a 10‐year study period. Chart review of study patients was performed, and information on site of lesion, age, gender, radiologic diagnosis, pain in the tumor area, and facial paralysis was recorded and analyzed.
Results:
There were 543 patients who had an FNA and subsequent histopathology. The majority of the tumors were in the parotid gland (n = 492, 90.9%), followed by submandibular gland (n = 45, 8.3%). The incidence of malignancy across all sites was 29.7%. The mean patient age was 54.1 years, and 54.1% were female. The sensitivity and specificity of FNA were 85.7% and 99.5%, respectively. Positive predictive value (PPV) was 98.6%, and negative predictive value (NPV) was 94.3%. A total of 464 patients had available radiologic studies. For the radiological diagnoses, sensitivity was 81.8% and specificity was 67.3%, whereas PPV and NPV were 52.7% and 89.3%, respectively.
Conclusions:
FNA is a reliable method of preoperatively assessing both benign and malignant salivary gland lesions. Preoperative imaging has a lower sensitivity and specificity than FNA in differentiating malignant from benign tumors. Older age, pain, and facial paralysis are clinical features independently associated with malignancy. Laryngoscope, 2013
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