One Year Effects of a Workplace Integrated Care Intervention for Workers with Rheumatoid Arthritis: Results of a Randomized Controlled Trial.

Purpose To evaluate the effectiveness of a workplace integrated care intervention on at-work productivity loss in workers with rheumatoid arthritis (RA) compared to usual care. Methods In this randomized controlled trial, 150 workers with RA were randomized into either the intervention or control group. The intervention group received an integrated care and participatory workplace intervention. Outcome measures were the Work Limitations Questionnaire, Work Instability Scale for RA, pain, fatigue and quality of life (RAND 36). Participants filled out a questionnaire at baseline, and after 6 and 12 months. We performed linear mixed models to analyse the outcomes. Results Participants were on average 50 years of age, and mostly female. After 12 months, no significant intervention effect was found on at-work productivity loss. We also found no significant intervention effects on any of the secondary outcomes. Conclusions We did not find evidence for the effectiveness of our workplace integrated care intervention after 12 months of follow up. Future studies should focus on investigating the intervention in groups of workers with severe limitations in work functioning, and an unstable work situation.

Process Evaluation of a Workplace Integrated Care Intervention for Workers with Rheumatoid Arthritis.

Purpose To perform a process evaluation of the implementation of a workplace integrated care intervention for workers with rheumatoid arthritis to maintain and improve work productivity. The intervention consisted of integrated care and a participatory workplace intervention with the aim to make adaptations at the workplace. Methods The implementation of the workplace integrated care intervention was evaluated with the framework of Linnan and Steckler. We used the concepts recruitment, reach, dose delivered, dose received, fidelity and satisfaction with the intervention. Data collection occurred through patient questionnaires and medical records. Results Participants were recruited by sending a letter including a reply card from their own rheumatologist. In total, we invited 1973 patients to participate. We received 1184 reply cards, and of these, 150 patients eventually participated in the study. Integrated care was delivered according to protocol for 46.7 %, while the participatory workplace intervention was delivered for 80.6 %. Dose received was nearly 70 %, which means that participants implemented 70 % of the workplace adaptations proposed during the participatory workplace intervention. The fidelity score for both integrated care and the participatory workplace intervention was sufficient, although communication between members of the multidisciplinary team was limited. Participants were generally satisfied with the intervention. Conclusions This process evaluation shows that our intervention was not entirely implemented as intended. The integrated care was not delivered to enough participants, but for the intervention components that were delivered, the fidelity was good. Communication between members of the multidisciplinary team was limited. However, the participatory workplace intervention was implemented successfully, and participants indicated that they were satisfied with the intervention.

Avoidable sickness absence in a Dutch working population.

INTRODUCTION: Sickness absence has an important impact on employers (e.g. reduced productivity, high costs) and employees (e.g. replacement, job loss). Therefore, we investigated possible reduction by exploring avoidable sickness absence. METHODS: A questionnaire was filled out by 2,954 Dutch workers (internet panel of a marketing research company, 2005). We obtained data on self reported sickness absence (6.5 months), including the main reason for each sickness absence spell (4 health and 3 non-health reasons), self-reported work-relatedness of absence and workers' opinion on whether their absence could have been shorter or prevented, and on 12 listed factors that might have contributed to sickness absence. For each of these factors we calculated the avoidable absence fraction (AAF), analogous to the epidemiological population attributable risk. RESULTS: A total of 1,233 workers reported sickness absence. The absence rate was 4.46%. For 11% of the absence rate health was not the main reason. Yet, when non-health was reported as the main reason for absence, health still contributed in half the cases. 35% of the absence rate was mainly work-related. 15% of the workers mentioned that their sickness absence could have been shorter or prevented. The AAFs of contributory factors were 0.129 for home related factors, 0.136 for work-related factors and 0.101 for (occupational) health care and guidance factors. In total, the AAF showed that 21.5% of the absence rate can be considered possibly avoidable. CONCLUSION: According to the studied workers sickness absence rate can be reduced. In reducing the absence, one should not only consider factors from the home and work situation, but also from (occupational) health care.

What a maleless group can tell us about the constraints on female transfer in Thomas's langurs (Presbytis thomasi).

During a long-term study of wild Thomas's langurs (Presbytis thomasi), the adult male of one of the bisexual study groups, group M, suddenly disappeared. Just after the adult male's disappearance, the females of group M actively avoided other groups and sometimes formed subgroups. Infants were attacked by extra-group males and 1 infant disappeared. After about 2 months, the females initiated affiliative interactions with males of neighbouring groups. Aggressive interactions between females of group M and females of other groups were also observed. Females of group M did not leave their home range in spite of efforts by adult males to lead them away. After about 4.5 months, a former all-male band member joined group M. The coincidences of this case suggest that increased infanticide risk, increased food competition, loss of knowledge of the home range and loss of established social relationships could be important constraints on female transfer. A comparison with 5 other studies of 1-male groups in which the adult male disappeared showed that proximate factors, such as the presence of infants, the size of neighbouring groups and the presence of extra-group males, influence female decisions.

CT scan prediction of neurological deficit in thoracolumbar burst fractures.

In 139 patients with burst fractures of the thoracic, thoracolumbar or lumbar spine, the least sagittal diameter of the spinal canal at the level of injury was measured by computerised tomography. By multiple logistic regression we investigated the joint correlation of the level of the burst fracture and the percentage of spinal canal stenosis with the probability of an associated neurological deficit. There was a very significant correlation between neurological deficit and the percentage of spinal canal stenosis; the higher the level of injury the greater was the probability. The severity of neurological deficit could not be predicted.