Feasibility test of WORK-ON: a vocational rehabilitation intervention for people with chronic inflammatory arthritis.

BACKGROUND: People with chronic inflammatory arthritis (IA) often have a reduced work ability. Consequently, they are at high risk of losing their jobs and being permanently excluded from the labor market. Therefore, we developed a new context-specific vocational rehabilitation intervention for people with IA based on the Medical Research Council's framework for complex interventions. This intervention is called "WORK-ON" and consists of: (1) Initial assessment and goal setting by an occupational therapist experienced in rheumatology rehabilitation; (2) coordinated support from the same occupational therapist, including assistance in navigating the primary and secondary healthcare and social care systems; (3) group sessions for peer support; and (4) individually tailored consultations with physiotherapists, nurses, and/or social workers. This study investigates the feasibility of WORK-ON. METHODS: A 6-month single-arm feasibility study with a pre-test post-test design was conducted to evaluate recruitment, intervention fidelity and delivery, data collection, and possible outcome measures. Work ability was the primary outcome, and sick leave, quality of life, fatigue, pain, physical activity, sleep, and well-being were the secondary outcomes evaluated. RESULTS: In total, 19 participants (17 women and 2 men) with a median age of 55 years (range, 34-64) participated and completed WORK-ON. Of these, 17 participants completed patient-reported outcomes at baseline and follow-up, and the results indicated a tendency to improvement in work ability, quality of life, level of physical activity, decrease in pain, and increase in days of sick leave during the 6-month intervention period. The rehabilitation clinicians spent an average of 15.3 h per participant, and the participants spent an average of 13.5 h in the intervention. CONCLUSIONS: WORK-ON is considered feasible and has the potential to increase work ability among people with IA who are concerned about their future ability to keep working. Though, an adjustment of the intervention is needed before testing in a randomized controlled trial.

Future sick leave, disability pension, and unemployment among patients with cancer after returning to work: Swedish register-based matched prospective cohort study.

INTRODUCTION: Despite increasing numbers of working-age cancer survivors, evidence on their future work-related circumstances is limited. This study examined their future sick leave, disability pension, and unemployment benefits compared to matched cancer-free individuals. METHODS: A matched cohort study was conducted using nationwide Swedish registers. In total, 94,411 individuals aged 25 to 59 years when diagnosed with incident cancer in 2001-2012 and who returned to work after cancer were compared with their matched cancer-free individuals (N = 354,814). Follow-up started from the year before cancer diagnosis and continued up to 14 years. Generalized estimating equations were used to calculate incidence rate ratios (IRR) and odds ratios for the difference between cancer survivors and matched cancer-free individuals. RESULTS: Compared with cancer-free individuals, cancer survivors had six times higher sick-leave days per year after cancer (IRR 6.25 [95% CI, 5.97-6.54] for men; IRR, 5.51 [5.39-5.64] for women). This higher number of sick-leave days declined over time but a two-fold difference persisted. An approximate 1.5 times higher risk of receiving disability pension remained during follow-up. The unemployment days tended to be lower for cancer survivors (IRR, 0.84 [0.75-0.94] for men; IRR, 0.91 [0.86-0.96] for women). Risk of sick leave and disability pension was higher among those with leukemia, colorectal, and breast cancer than skin and genitourinary cancers. CONCLUSIONS: Cancer survivors who returned to work experienced a high and persisting sick leave and disability pension for over a decade. Prolonged receipt of a high amount of benefits may have long-term adverse impacts on financial circumstances; more knowledge to promote the environment that encourages returning to and remaining in work is needed.

Trajectories of work disability and unemployment before and after a common mental disorder diagnosis among young private sector employees in Sweden-a register-based longitudinal study.

PURPOSE: To identify trajectory groups of work disability (WD), including sick leave and disability pension, and unemployment three years before and six years (from Y-3 to Y + 6) after a common mental disorder (CMD) diagnosis and to investigate associations of socio-demographic, work-related and clinical factors with trajectory membership. METHODS: A longitudinal nationwide register-based study was conducted including individuals aged 22-29 years, gainfully employed in the private sector, with a CMD diagnosis in specialised healthcare or prescribed antidepressant (N = 12,121) in 2014 (Year 0/Y0), with follow-up from Y-3 to Y + 6. Group-based trajectory analyses identified groups of individuals who followed similar trajectories of months of WD and unemployment, respectively. Multinomial logistic regression determined associations between socio-demographic, work-related and clinical factors and trajectory membership. RESULTS: In the CMD group, we identified three trajectory groups, each for WD and unemployment. Only 7% individuals belonged to a 'Fluctuant high' trajectory group with four months of WD in Y0, which peaked at 7 months in Y + 3 and reduced to 5 months in Y + 6. For unemployment, 15% belonged to an 'Increasing medium' trajectory group that steadily increased from 1.3 months in Y0 to 2.6 months in Y + 6. Sex, educational level and musculoskeletal disorders for WD, and educational level, living area and occupational class for unemployment, influentially determined the variance across the CMD trajectory groups. CONCLUSIONS: Specific vulnerable groups regarding unfavourable WD (women, low education and musculoskeletal disorders) and unemployment (manual work, low education and rural residence) trajectories require special attention regarding their return-to-work process following a CMD diagnosis.

Rejected sickness cash benefit claims after 180 days of sick leave in the Swedish rehabilitation chain: A nationwide register-based study.

AIM: Since a lack of financial security among vulnerable groups could further hamper health and well-being, this study scrutinises factors predicting rejected prolonged sickness cash benefit claims among people on compensated sick leave of more than 180 days with a rejection between days 181 and 365. METHODS: All 246,872 claims for employed people on sick leave recorded in the Swedish official statistics register between January 2018 and June 2021 were analysed. Claim outcome was evaluated using logistic regression with odds ratios recalculated to relative risks (RR) with 95% confidence intervals (CI), mutually adjusted for sociodemographic, work and health-related factors. RESULTS: Overall, 46,611 (19%) of the claims were rejected, with slightly lower rates among women (RR=0.97; 95% CI 0.95-0.99). Musculoskeletal diseases had the highest rejection rates (RR=1.84; 95% CI 1.75-1.94) followed by injuries (RR=1.57; 95% CI 1.50-1.64) and symptoms (RR=1.51; 95% CI 1.46-1.56). Mental disorders also had above-average rates (RR=1.14; 95% CI 1.09-1.19), whereas the lowest rates were found among pregnancy-related diagnoses (RR=0.13; 95% CI 0.12-0.14) and neoplasms (RR=0.18; 95% CI 0.18-0.18). Higher rates were found among immigrants (RR=1.37; 95% CI 1.34-1.40), those with only primary education (RR=1.09; 95% CI 1.06-1.12) and among blue-collar workers. The regional variation was substantial (RR range 0.41-1.72). CONCLUSIONS: High rejection rates were found for complex diagnoses and diagnoses with presupposed work ability in physically lighter occupations and among groups with assumed precarious positions at the labour market. Systematic differences in rates were identified between geographic regions. More studies are warranted to conclude if the differences found could be justified by other factors.

Severe Itch Related to Hard Workload Treated with Acupuncture: Unexpected Results - A Case report.

INTRODUCTION: The effects of work-related stress (WRS) on occupational health often lead to reduced well-being and long-term sick leave. Itching or pruritus, a skin inflammation with a rash that provokes the desire to scratch, often occurs during stressful periods in patients with a history of atopic dermatitis (AD). CASE PRESENTATION: This patient suffered from severe WRS together with long-term therapeutically resistant pruritus for 8 years, resulting in severe itching. He was provided with an intervention with acupuncture treatment (AT) to prevent a long-term sick leave. The results showed an unexpected reduction in itching, skin inflammation, and eczema. Additionally, the treatment enhanced the patient's emotional and cognitive well-being and eliminated the need for sick leave. CONCLUSION: Acupuncture can be an effective complementary treatment for severe itching related to WRS, in addition to standard medical treatments.

Dizziness and vertigo sick leave before and after insurance restrictions - a descriptive Swedish nationwide register linkage study.

BACKGROUND: Vertigo and dizziness can be disabling symptoms that result in sick leave. Research regarding sickness absence due to dizziness has focused on specific vestibular diagnoses rather than the nonspecific vertigo/dizziness diagnoses. Strict sick leave regulations were introduced in Sweden in 2008. The aim of this study was to describe the vertigo/dizziness sick leave prevalence and duration considering both specific and nonspecific diagnoses according to International Classification of diseases 10th revision (ICD-10) on the 3-digit level, including the less specific "R" diagnoses. METHODS: Through Swedish nationwide registers we identified individuals aged 16-64 years who during the years 2005-2018 were sickness absent > 14 consecutive days - minimum register threshold - due to vertigo/dizziness diagnoses according to ICD10 codes: specific diagnoses (H81.0, H81.1, H81.2, H81.3, H81.4, G11x) and nonspecific (R42, R26, R27, H81.9). We described the demographic characteristics, prevalence and duration of such sick-leave spells. Data were stratified according to diagnostic groups: ataxias, vestibular and nonspecific. RESULTS: We identified 52,179 dizziness/vertigo sick leave episodes > 14 days in 45,353 unique individuals between 2005-2018, which constitutes 0.83% from all sick leave episodes in the given period.The nonspecific diagnoses represented 72% (n = 37741) of sick leave episodes and specific vestibular H-diagnoses 27% (n = 14083). The most common specific vestibular codes was Benign paroxysmal positional vertigo (BPPV) 9.4% (n = 4929). The median duration of sick leave was 31 days (IQR 21-61). Women on sick leave were younger than men (47 vs 51 years, p < 0.05) and had a higher proportion of nonspecific diagnoses compared with men (74% vs 70%, p < 0.05). CONCLUSIONS: The vast majority of vertigo/dizziness sick leave episodes were coded as nonspecific diagnoses and occurred in women. BPPV, a curable vestibular condition, was the most common specific diagnosis. This suggests a potential for improved diagnostics. Women on sick leave due to dizziness/vertigo were younger and more often received nonspecific diagnostic codes. Future studies should determine the frequency of use of evidence based therapies and investigate further the gender differences.

A systematic review of programs and interventions for reduction of sickness absence in nursing staff with work-related musculoskeletal disorders.

Negative consequences of musculoskeletal pain and injuries on the nurses' health and well-being can increase job dissatisfaction and impose high costs on healthcare centers due to lost workdays and compensation claims. This study aimed to identify policies, programs, and interventions that might be effective in the prevention and reduction of sickness absence and improvement of work outcomes in nursing staff with these problems. The systematic review was conducted according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. Electronic databases were searched up to November 9-23, 2022. The keywords "musculoskeletal disorders", "nurse", "return to work", "sickness absence", and "sick leave" and their equivalents were combined using Boolean operators OR/AND. Reference lists of eligible literatures were also screened to identify related studies. In this study, a total of 3365 records were retrieved. After two rounds of screening, 15 studies were selected for qualitative synthesis. These studies included seven randomized controlled trial, five pre-post studies, two cohort, and one cross-sectional. Six types of interventions identified including back college, early workplace-based intervention, physical activity/training, psychosocial education, multifaceted intervention, and ergonomics program. There is insufficient evidence to identify effective interventions in preventing and reducing sickness absence, and improvement of work outcomes in nursing personnel with work-related musculoskeletal disorders. Numerous factors affected the occurrence of such disorders, and their consequences, therefore comprehensive strategy tailored to the injured person's needs should be considered.

Trajectories of work disability among individuals with anxiety-, mood/affective-, or stress-related disorders in a primary healthcare setting.

BACKGROUND: Anxiety-, mood/affective-, or stress-related disorders affect up to one-third of individuals during their lives and often impact their ability to work. This study aimed to delineate trajectories of work disability (WD) among individuals diagnosed with anxiety-, mood/affective-, or stress-related disorder in primary healthcare and to examine associations between trajectory group membership and sociodemographic, clinical, and clinical-related factors. METHODS: The study population included working-age individuals, aged 22-62 years, living in Stockholm County, Sweden, who experienced a new episode of any anxiety-, mood/affective, or stress-related disorder in primary healthcare in 2017 (N = 11,304). Data were obtained from Swedish national and regional registers and were linked using pseudonymised unique personal identification numbers. The primary outcome was days with WD (sum of sickness absence and disability pension days) during the three years before and three years after a diagnosis of anxiety-, mood/affective-, or stress-related disorders in primary healthcare. A zero-inflated Poisson group-based trajectory model was used to identify groups of individuals with similar patterns of WD over the study period, with a multinomial logistic regression used to examine associations of sociodemographic, clinical, and clinical-related factors with trajectory group membership. RESULTS: Four distinct trajectory groups were found, high increasing (5.1%), with high levels, from 16 to 80 days of WD in six-monthly intervals during follow-up, peak (11.1%), with a peak in WD, up to 32 days of WD, around the time of the diagnosis, low increasing (12.8%), with an increase in days of WD from 4 to 22 during the study period, and constant low (71.1%), with almost no WD over the study period. In multinomial regression models, diagnostic category, psychotropic medication use, a diagnosis of a psychiatric disorder within secondary healthcare, age at diagnosis, and occupation were associated with WD trajectory groups. CONCLUSIONS: Around two-thirds of individuals treated for a new episode of any anxiety-, mood/affective-, or stress-related disorder in primary healthcare have an excellent prognosis regarding WD. Several sociodemographic and clinical characteristics were associated with group membership; these factors could identify individuals at risk of long-term welfare dependency and who might benefit from interventions to promote a return to work.

Occupational prestige and future sickness absence and disability pension in women and men: a Swedish nationwide prospective cohort study.

BACKGROUND: Little is known about associations between occupational prestige, that is, the symbolic evaluation and social positioning of occupations, and sickness absence (SA) or disability pension (DP). We explored whether occupational prestige was associated with future SA or DP among women and men. METHODS: A Swedish 4-year prospective cohort study of all those in paid work and aged 25-59 in 2010 (N = 2,605,227; 47% women), using linked microdata from three nationwide registers and Standard International Occupational Prestige Scale values, categorised as 'very low', 'low', 'medium', 'high', or 'very high'. Odds ratios (ORs), 95% confidence intervals (CIs), crude and adjusted for several sociodemographic factors, were calculated for three outcomes: at least one SA spell (>14 days), >90 SA days, or DP occurrence, during follow-up (2011-2013). RESULTS: The mean number of SA days in 2010 varied by occupational prestige group, for example, 'very high': 3.0, 'very low': 6.5. Compared to those in occupations with 'very high' prestige, all other groups had higher adjusted ORs for all three outcomes. Among men, those with 'very low' occupational prestige had the highest OR for at least one SA spell: OR 1.51 (95% CI 1.47-1.56); among women, the 'medium' group had the highest OR: 1.30 (1.27-1.32). The results were similar for SA >90 days. OR for DP among women with 'very low' occupational prestige was 2.01 (1.84-2.19), and 3.55 (3.15-4.01) for men. CONCLUSIONS: Working in lower occupational prestige occupations was generally associated with higher odds of future SA/DP than working in higher prestige occupations; these associations were stronger for men than for women.

Does Knee Arthroplasty Have a Beneficial Effect on Return to Work in Patients with Knee Osteoarthritis who Receive Long-Term Disability Benefits in the Netherlands?

PURPOSE: Optimal timing of knee arthroplasty (KA) is complex: operating at a younger age increases life time risk of revision, while delay results in an increased risk of job loss. This study evaluates whether disability benefits recipients due to knee osteoarthritis have an increased odds of returning to work (RTW) following KA. METHODS: A retrospective cohort study was performed among long-term disability benefits recipients due to knee osteoarthritis using data of the Dutch Employee Insurance Agency. Logistic regression assessed whether recipients with KA had a higher odds of RTW in 10 years following start of disability benefits, compared to those without KA. RESULTS: A total of 159 participants were included. During 10-year follow up, 42% had received KA and 37% had returned to work. No association was observed between KA and RTW (OR 1.39, 95% CI 0.62-3.12). Prognostic factors for RTW were being the main breadwinner (OR 7.93, 95% CI 2.95-21.32) and classification as 100% work disability (OR 0.20, 95% CI 0.09-0.45). CONCLUSIONS: KA has no beneficial effect on RTW among patients with knee osteoarthritis granted long-term disability in the Netherlands. For RTW, KA is probably best performed within the two years of paid sick leave before long-term disability is assessed in the Netherlands.

Sickness absence after work accidents and post-traumatic stress among white-collar workers in the retail and wholesale industry; a longitudinal Swedish cohort study.

BACKGROUND: Most studies about accidents and about PTSD, respectively, have been conducted either on blue-collar workers, or on the entire working population. There are very few such studies on white-collar workers. AIM: To examine diagnosis-specific sickness absence (SA) and disability pension (DP) after a work accident or PTSD, respectively, among white-collar workers in the private retail and wholesale industry. METHODS: A prospective population-based cohort study of all 192,077 such workers aged 18-67 (44% women) in Sweden in 2012, using linked microdata from nationwide registers. We identified individuals who had secondary healthcare due to work-related accidents (n = 1114; 31% women) or to PTSD (n = 216; 79% women) in 2012-2016. Their average number of net days of diagnosis-specific SA (in SA spells > 14 days) and DP were calculated for 365 days before and 365 days after the healthcare visit. RESULTS: 35% of the women and 24% of the men had at least one new SA spell during the 365 days after healthcare due to work accidents. Among women, the average number of SA/DP days increased from 14 in the year before the visit to 31 days the year after; among men from 9 to 21 days. SA days due to fractures and other injuries increased most, while SA days due to mental diagnoses increased somewhat. 73% of women and 64% of men who had healthcare due to PTSD had at least one new SA spell in the next year. Women increased from 121 to 157 SA/DP days and men from 112 to 174. SA due to stress-related disorders and other mental diagnoses increased the most, while DP due to stress-related diagnoses and SA due to musculoskeletal diagnoses increased slightly. CONCLUSIONS: About a quarter of those who had secondary healthcare due to work accidents, and the majority of those with such healthcare due PTSD, had new SA in the following year. SA due to injury and mental diagnoses, respectively, increased most, however, SA/DP due to other diagnoses also increased slightly. More knowledge is needed on factors associated with having or not having SA/DP in different diagnoses after work accidents and among people with PTSD.

Associations between work-related factors and sickness presenteeism: a prospective study using the national French working conditions survey.

OBJECTIVES: The objectives were to assess the prospective associations between work-related factors, including psychosocial and physical work factors and working time/hours factors, and sickness presenteeism alone or combined with sickness absence. METHODS: The study relied on prospective data of a national representative sample of 16 129 employees followed up from 2013 to 2016 in France. Work-related factors were assessed in 2013 and included 20 psychosocial work factors, 4 working time/hours factors and 4 physical work factors. Sickness presenteeism was studied using two items in 2016: the presence and duration of sickness presenteeism within the last 12 months. Weighted Hurdle and multinomial logistic regression models were performed to study the prospective associations between work-related factors at baseline and sickness presenteeism (both presence and duration) and sickness absence at follow-up. Models were adjusted for covariates. RESULTS: Almost all psychosocial and physical work factors were predictive of sickness presenteeism (ORs ranging from 1.30 to 2.07 for men, and from 1.16 to 2.30 for women) but only some of them predicted its duration. Dose-response associations were observed between multiple exposures to these factors and sickness presenteeism. These factors predicted more sickness presenteeism alone or combined with sickness absence than sickness absence alone. Gender differences were observed in these associations, as some associations were found to be stronger among women than among men. CONCLUSIONS: There is a need to study sickness presenteeism and sickness absence combined. Prevention oriented towards the psychosocial and physical work environment may contribute to reduce sickness presenteeism and sickness absence.

Cooperation in Return-to-work Interventions for Common Mental Disorders: An Ideal Theory Analysis of Actors, Goals, and Ethical Obstacles.

The rise in the number of people on sick leave for common mental disorders is a growing concern, both from a societal and individual perspective. One common suggestion to improve the return-to-work process is increased cooperation between the relevant parties, including at least the employer, the social insurance agency and health care. This suggestion is often made on the presumption that all parties share the common goal of reintegrating the patient-employee back into the workplace. In this paper we investigate this presumption by mapping out the ethical frameworks of these three key actors in any return-to-work process. We show that although the goals of these actors often, and to a large extent, overlap there are potential differences and tensions between their respective goals. Further, we emphasise that there may be other limitations to an actor's participation in the process. In particular the health care system is required to respect patient autonomy and confidentiality. There is also an inherent tension in the dual roles of health care professionals as therapists and expert witnesses in work ability assessment. In conclusion, there are potential tensions between the key actors in the return-to-work process. These tensions need to be addressed in order to enable an increased cooperation between actors and to facilitate the development of a feasible plan of action for all parties, including the employee.

Self-reported body function and daily life activities 18 months after Covid-19: A nationwide cohort study.

AIMS: This study aimed to investigate body function and daily life activities 18 months after Covid-19 infection, depending on the initial severity of disease and according to sex. METHODS: All 11,955 individuals on sick leave due to Covid-19 during the first wave of the pandemic in Sweden were invited to answer a questionnaire regarding experiencing negative changes in body function and daily life activities approximately 18 months after the start of sick leave. The analysis of data included descriptive statistics, group comparisons and multivariable binary logistic regressions (two groups). RESULTS: Of 5464 responders (45.7%), 4676 (85.6%) reported experiencing at least one problem with body function, and the reported prevalence of problems with daily life activities was 46%. The most frequently reported problems were fatigue (66.3%), cognition, sleep and movement. In general, women and those initially hospitalised reported more problems. In the regression analyses, problems with body function could partly explain whether individuals experienced problems with daily life activities. However, only fatigue and movement significantly contributed throughout all groups (p<0.001). Furthermore, the odds ratios for fatigue were larger in regressions for women than for men. CONCLUSIONS: In this nationwide study, more than 8 out of 10 individuals experienced problems with body function 18 months after being on sick leave due to Covid-19, with women and those initially hospitalised reporting more problems. Problems with body function, such as fatigue, could partly explain problems with daily life activities. However, the mechanisms behind the consequences are not yet clear and need to be further investigated.

The effect of parental pain, disability benefits and education on risk of long-term sick leave due to musculoskeletal disorders and the modifying effect of sleep and physical activity: the HUNT study.

BACKGROUND: Family factors, sleep, and physical activity have previously been associated with risk of sick leave and disability benefits due to musculoskeletal disorders. However, how these factors act during adolescence and young adulthood is unclear. The aim of this study was to (i) examine if chronic pain, disability benefits and education in parents influence the risk of long-term sick leave due to musculoskeletal disorders in young adulthood, and (ii) to explore if offspring sleep problems and physical activity modify these effects. METHODS: A population-based prospective study of 18,552 adolescents and young adults (≤ 30 years) in the Norwegian HUNT Study. Survey data was linked to national registry data on sick leave, disability benefits, family relations and educational attainment. We used Cox regression to estimate hazard ratio (HR) with 95% confidence interval (CI) for long-term (≥ 31 days) sick leave due to a musculoskeletal disorder in offspring associated with parental factors and the joint effect of parental factors and offspring lifestyle factors. RESULTS: Parental chronic pain (HR 1.36, 95% CI 1.27-1.45), disability benefits (HR 1.41, 95% CI 1.33-1.48) and low educational attainment (HR 1.78, 95% CI 1.67-1.90) increased the risk of long-term sick leave due to musculoskeletal disorders among offspring. There was no strong evidence that sleep and physical activity modified these effects. CONCLUSION: Chronic pain, disability benefit and low education in parents increased the risk of long-term sick leave due to musculoskeletal disorders among offspring, but these effects were not modified by offspring sleep problems or physical activity level. The findings suggest that efforts beyond individual lifestyle factors might be important as preventive measures.

Hair glucocorticoid levels decrease after multimodal inpatient treatment and predict therapy outcome in burnout-related depressive disorders.

OBJECTIVES: Hair cortisol concentration (HCC) indicates chronic stress exposure, which is a risk factor in the pathogenesis of burnout and depression. However, findings on HCC are inconsistent. Similarly, intervention studies show mixed effects on HCC. The present study aimed to shed light on these inconsistencies, by additionally considering also hair cortisone. METHODS: Twenty-five patients with a burnout-related depressive disorder receiving a multimodal inpatient treatment for clinical burnout and 17 matched healthy controls participated in this study. All participants provided 1 cm long hair samples at the beginning and end of the treatment. HCC and hair cortisone levels (HCNC) were determined. Meteorological data and duration of sick leave were considered as potential covariates. Burnout and depression were assessed with self-ratings, the latter also with examiner ratings. RESULTS: There were no significant group differences in glucocorticoid levels. Treatment led to a decrease in both depression severity and hair glucocorticoid concentration in inpatients, while lower HCNC in particular predicted a greater reduction in depression severity. Moreover, meteorological data and the duration of sick leave were also found to have an effect on hair glucocorticoid concentrations. CONCLUSIONS: These results suggest that multimodal inpatient treatment of clinical burnout considerably reduced stress on both a psychological and biological level. In parallel, hair glucocorticoids appear to be sensitive biomarkers for the evaluation of treatment success and prediction. Examining both HCC and HCNC in intervention studies may provide clearer results than the usual examination of HCC alone.

Airport security personnel's working hour characteristics and associations with sickness absence-a retrospective cohort study in 2016-2019.

We aimed to investigate the associations of working hour characteristics based on the international and local definitions with sickness absence (SA) among airport security personnel. The payroll-based registry data of daily working hours for 2016-2019 at one airport was limited to those with ≥30 work shifts in a year (n=377-687 employees). The conditional Poisson model for incidence rate ratios (IRR) with 95% confidence intervals (CI) was used for analyses. Based on the international definitions, only a few associations were found: each one-unit increase in weekly working hours and the number of consecutive working days were associated with a lower likelihood of SA. The local definitions were more consistently associated with SA: Each one-unit increase in shift length and time between shifts, higher variation in shift length, and the number of consecutive evening and night shifts were associated with a higher likelihood of SA. To conclude, especially the local definitions of working hour characteristics seem to be important limits for short SA. Thus, high variability of shift lengths and prolonged shifts could be avoided to reduce the risk of SA. Overall, keeping the working hours within any of the recommendations among airport security personnel could support well-being and health.

Sick leave due to occupational mental disorders in Brazil Northeastern states: an ecological study.

Introduction: Although work provides many benefits, occupational mental disorders, such as mental distress, depression, and stress-related illnesses have significantly increased. Objectives: This study aims to identify and present the spatial distribution of the major mental and behavioral disorders that lead to sick leave in Brazil Northeastern states. Methods: This descriptive study with an ecological time series design aimed to identify the distribution of occupational mental and behavioral disorders in Brazil Northeastern states. Data collection included downloading information from the Observatório de Segurança e Saúde no Trabalho (SmartLab, Occupational Health and Safety Observatory) from 2012 to 2018. Data were analyzed using Python. Results: Grants of sick leave according to the type of illness were recorded for nonaccident-related leave (B31) and accident-related leave (B91). Bahia had the highest number of cases reported for B31, as did Rio Grande do Norte for B91. Rio Grande do Norte and Alagoas stood out with the highest rates of sick leave due to mental and behavioral disorders. Phobic-anxiety disorders had the highest number of notifications. The building construction industry had the highest number of work-related notifications. Conclusions: This study has contributed to identifying the main occupational disorders. Public policies need to be implemented to tackle the public health crisis which directly impacts on domestic social and economic conditions.

Introdução: Mesmo diante dos benefícios que a atividade laboral proporciona, tem-se observado um aumento significativo no número de trabalhadores com sofrimento psíquico, depressão e doenças associadas ao estresse. Objetivos: Identificar e apresentar a distribuição espacial por estado do Nordeste dos principais transtornos mentais e comportamentais que geram afastamento da atividade laboral. Métodos: Realizou-se um estudo descritivo com desenho ecológico de série temporal, cuja finalidade é identificar a distribuição de transtornos mentais e comportamentais em trabalhadores da região Nordeste. Para a coleta de dados, utilizou-se o Observatório de Segurança e Saúde no Trabalho (SmartLab) mediante o download das informações notificadas no período de 2012 a 2018. A análise foi realizada por meio da linguagem de programação Python. Resultados: As concessões de auxílios por afastamento conforme o tipo de doença foram registradas para afastamentos não acidentários (B31) e acidentários (B91). A Bahia apresentou um maior número de casos notificados para B31, assim como o Rio Grande do Norte para B91. O Rio Grande do Norte e Alagoas se destacaram como os estados que concentram o maior percentual de casos de afastamento por transtornos mentais e comportamentais. Os transtornos fóbico-ansiosos obtiveram o maior número de notificações entre os estados. A atividade de construção de edifícios se revelou com os maiores números de notificações relacionadas ao trabalho. Conclusões: Este estudo contribuiu para a identificação dos principais transtornos que acometem os trabalhadores. É necessário que sejam adotadas políticas públicas no enfrentamento da crise de saúde pública que impacta diretamente as condições sociais e econômicas do país.

[Translated article] Temporary work disability following trapezial resection and suspension arthroplasty for thumb carpometacarpal osteoarthritis.

PURPOSE: The aim of this study is to assess the time to return to work (TRW) in patients undergoing trapezial resection using the Mini TightRope® system at our centre and to investigate factors that might delay return to work following this surgery. MATERIAL AND METHODS: A retrospective study was conducted on patients who underwent Trapezial resection and suspensionplasty using the Mini TightRope® system between 2015 and 2016, with a minimum one-year follow-up. Telephone interviews were conducted along with a review of medical records and radiology reports, as well as temporary work disability documents, collecting epidemiological and occupational data. Groups were compared based on age, gender, dominant hand, biomechanical occupational requirements of the patients, and whether they had experienced prior temporary work disability. RESULTS: A total of 36 patients (29 women and 7 men) with an average age of 55.7 years were included. The median time to return to work was 126 days. Self-employed workers re-entered the workforce 72 days earlier on average; workers who had experienced prior temporary work disability had a greater total temporary work disability duration and took 91 days longer to return to work compared to those who had not. CONCLUSIONS: Patients employed by others and those who had experienced prior temporary work disability before the surgery had longer temporary work disability periods. In our study, no differences were observed based on gender, dominant hand, or biomechanical work demands of the intervened patients.