An interdisciplinary integrated specialized one-stop outpatient clinic for idiopathic intracranial hypertension - an assessment of sick leave, presenteeism, and health care utilization.

BACKGROUND: Management of idiopathic intracranial hypertension (IIH) is complex requiring contributions from multiple specialized disciplines. In practice, this creates considerable organizational and communicational challenges. To meet those challenges, we established an interdisciplinary integrated outpatient clinic for IIH with a central coordination and a one-stop- concept. Here, we aimed to evaluate effects of this concept on sick leave, presenteeism, and health care utilization. METHODS: In a retrospective cohort study, we compared the one-stop era with integrated care (IC, 1-JUL-2021 to 31-DEC-2022) to a reference group receiving standard care (SC, 1-JUL-2018 to 31-DEC-2019) regarding economic outcome parameters assessed over 6 months. Multivariate binary logistic regression models were used to adjust for confounders. RESULTS: Baseline characteristics of the IC group (n = 85) and SC group (n = 81) were comparable (female: 90.6% vs. 90.1%; mean age: 33.6 vs. 32.8 years, educational level: ≥9 years of education 60.0% vs. 59.3%; located in Vienna 75.3% vs. 76.5%). Compared to SC, the IC group showed significantly fewer days with sick leave or presenteeism (-5 days/month), fewer unscheduled contacts for IIH-specific problems (-2.3/month), and fewer physician or hospital contacts in general (-4.1 contacts/month). Subgroup analyses of patients with migration background and language barrier consistently indicated stronger effects of the IC concept in these groups. CONCLUSIONS: Interdisciplinary integrated management significantly improves the burden of IIH in terms of sick leave, presenteeism and healthcare consultations - particularly in socioeconomically underprivileged patient groups.

"Recovery activities are needed every step of the way"-exploring the process of long-term recovery in people previously diagnosed with exhaustion disorder.

BACKGROUND: Sick-leave rates are high due to stress-related illnesses, but little is still known about the process of recovery from these conditions. The aim of this study was to explore the experiences of the recovery process, 6 to 10 years after treatment in people previously diagnosed with exhaustion disorder (ED), focusing on facilitators and barriers for the process of recovery from ED, and recovery activities experienced as helpful during the recovery process. METHOD: Thirty-eight participants (average age: 52 years, 32 females) previously diagnosed with ED were interviewed with semi-structured interviews 6-10 years after undergoing treatment. The interviews were analyzed with thematic analysis. RESULTS: Three themes resulted from the analysis. The first theme, "A long and rocky road", summarizes the fluctuating path to feeling better and emphasizes barriers and facilitators that affected the process of recovery, with a focus on external life events and the participants' own behaviors. Facilitators were changing workplace, receiving support, a reduction in stressors, and changed behaviors. Barriers were a poor work environment, caregiver responsibilities, negative life events and lack of support. The second theme "Recovery activities are needed every step of the way" describes how both the need for recovery activities and the types of activities experienced as helpful changed during the recovery process, from low-effort recovery activities for long periods of time to shorter and more active recovery activities. Recovery activities were described as important for self-care but hard to prioritize in everyday life. The last theme, "Reorienting to a new place", captures the struggle to cope with the remaining impact of ED, and how internal facilitators in terms of understanding and acceptance were important to reorient and adjust to a new way of functioning. CONCLUSIONS: Recovering from ED is a long and ongoing process where recovery activities are needed every step of the way. Our results highlight the importance of supporting personal recovery and long-term behavioral change, addressing individual stressors that may perpetuate the condition, and adjusting recovery activities according to where the person is in the recovery process. TRIAL REGISTRATION: ClinicalTrials.gov: NCT0073772 . Registered on March 8, 2017. This study was pre-registered on Open Science Framework (osf.io).

Sickness absence and associations with sociodemographic factors, health risk behaviours, occupational stressors and adverse mental health in 40,343 UK police employees.

AIMS: Police employees may experience high levels of stress due to the challenging nature of their work which can then lead to sickness absence. To date, there has been limited research on sickness absence in the police. This exploratory analysis investigated sickness absence in UK police employees. METHODS: Secondary data analyses were conducted using data from the Airwave Health Monitoring Study (2006-2015). Past year sickness absence was self-reported and categorised as none, low (1-5 days), moderate (6-19 days) and long-term sickness absence (LTSA, 20 or more days). Descriptive statistics and multinomial logistic regressions were used to examine sickness absence and exploratory associations with sociodemographic factors, occupational stressors, health risk behaviours, and mental health outcomes, controlling for rank, gender and age. RESULTS: From a sample of 40,343 police staff and police officers, forty-six per cent had no sickness absence within the previous year, 33% had a low amount, 13% a moderate amount and 8% were on LTSA. The groups that were more likely to take sick leave were women, non-uniformed police staff, divorced or separated, smokers and those with three or more general practitioner consultations in the past year, poorer mental health, low job satisfaction and high job strain. CONCLUSIONS: The study highlights the groups of police employees who may be more likely to take sick leave and is unique in its use of a large cohort of police employees. The findings emphasise the importance of considering possible modifiable factors that may contribute to sickness absence in UK police forces.

Getting an outsider's perspective - sick-listed workers' experiences with early follow-up sessions in the return to work process: a qualitative interview study.

PURPOSE: The aim of this study was to explore how early follow-up sessions (after 14 and 16 weeks of sick leave) with social insurance caseworkers was experienced by sick-listed workers, and how these sessions influenced their return-to-work process. METHODS: A qualitative interview study with sick-listed workers who completed two early follow-up sessions with caseworkers from the Norwegian Labor and Welfare Administration (NAV). Twenty-six individuals aged 30 to 60 years with a sick leave status of 50-100% participated in semi-structured interviews. The data was analyzed with thematic analysis. RESULTS: Participants' experiences of the early follow-up sessions could be categorized into three themes: (1) Getting an outsider's perspective, (2) enhanced understanding of the framework for long term sick-leave, and (3) the empathic and personal face of the social insurance system. Meeting a caseworker enabled an outsider perspective that promoted critical reflection and calibration of their thoughts. This was experienced as a useful addition to the support many received from their informal network, such as friends, family, and co-workers. The meetings also enabled a greater understanding of their rights and duties, possibilities, and limitations regarding welfare benefits, while also displaying an unexpected empathic and understanding perspective from those working in the social insurance system. CONCLUSION: For sick-listed individuals, receiving an early follow-up session from social insurance caseworkers was a positive experience that enhanced their understanding of their situation, and promoted reflection towards RTW. Thus, from the perspective of the sick-listed workers, early sessions with social insurance caseworkers could be a useful addition to the overall sickness absence follow-up.

Effect of Reliable Recovery on Health Care Costs and Productivity Losses in Emotional Disorders.

Despite the high economic costs associated with emotional disorders, relatively few studies have examined the variation in costs according to whether the patient has achieved a reliable recovery. The aim of this study was to explore differences in health care costs and productivity losses between primary care patients from a previous randomized controlled trial (RCT)-PsicAP-with emotional symptoms who achieved a reliable recovery and those who did not after transdiagnostic cognitive-behavioral therapy (TD-CBT) plus treatment as usual (TAU) or TAU alone. Sociodemographic and cost data were obtained for 134 participants treated at five primary care centers in Madrid for the 12-month posttreatment period. Reliable recovery rates were higher in the patients who received TD-CBT + TAU versus TAU alone (66% vs. 34%, respectively; chi-square = 13.78, df = 1, p < .001). Patients who did not achieve reliable recovery incurred more costs, especially associated with general practitioner consultations (t = 3.01, df = 132, p = .003), use of emergency departments (t = 2.20, df = 132, p = .030), total health care costs (t = 2.01, df = 132, p = .040), and sick leaves (t = 1.97, df = 132, p = .048). These findings underscore the societal importance of achieving a reliable recovery in patients with emotional disorders, and further support the value of adding TD-CBT to TAU in the primary care setting.

Musculoskeletal disorders and work ability among dentists and dental students in Finland.

BACKGROUND: Musculoskeletal disorders are leading causes for long sickness absences and early retirement. Dental work is physically strenuous, and many studies have shown a relation between work-related MSDs and dentistry. However, fewer studies have focused on how these conditions affect the work ability of dentists. OBJECTIVE: This study aimed to reveal the relationship between MSD, work ability and sickness absences in Finnish dentists and dental students. METHODS: A questionnaire was sent to 1200 dental workers and students. It inquired of age, gender, use of dental loupes, physical exercise, use of health care, and site, length and frequency of musculoskeletal complaints. Work ability was assessed with four parameters: work ability score (WAS), future work ability (FWA), self-estimation of MSD-related work disability, and sickness absence days. RESULTS: The questionnaire gained 255 responses (response rate 21%). The majority (90%) of the respondents had experienced MSD during the past year but only eleven percent of them had been on sick leave. MSDs correlated significantly with WAS, FWA and MSD-related work disability. Results remained significant even age adjusted. Age was a strong predictor of declined work ability, but gender, physical exercise or dental loupe use did not have a significant impact. CONCLUSIONS: Despite all the ergonomic advances in modern dentistry, the occurrence of MSD symptoms is still high. MSDs seem to affect dentists' work ability significantly, but amount of sickness absence is relatively low, which may indicate a high level of presenteeism.

Appendectomy versus antibiotic treatment for acute appendicitis.

BACKGROUND: Acute appendicitis is one of the most common emergency general surgical conditions worldwide. Uncomplicated/simple appendicitis can be treated with appendectomy or antibiotics. Some studies have suggested possible benefits with antibiotics with reduced complications, length of hospital stay, and the number of days off work. However, surgery may improve success of treatment as antibiotic treatment is associated with recurrence and future need for surgery. OBJECTIVES: To assess the effects of antibiotic treatment for uncomplicated/simple acute appendicitis compared with appendectomy for resolution of symptoms and complications. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and two trial registers (World Health Organization International Clinical Trials Registry Platform and ClinicalTrials.gov) on 19 July 2022. We also searched for unpublished studies in conference proceedings together with reference checking and citation search. There were no restrictions on date, publication status, or language of publication. SELECTION CRITERIA: We included parallel-group randomised controlled trials (RCTs) only. We included studies where most participants were adults with uncomplicated/simple appendicitis. Interventions included antibiotics (by any route) compared with appendectomy (open or laparoscopic). DATA COLLECTION AND ANALYSIS: We used standard methodology expected by Cochrane. We used GRADE to assess the certainty of evidence for each outcome. Primary outcomes included mortality and success of treatment, and secondary outcomes included number of participants requiring appendectomy in the antibiotic group, complications, pain, length of hospital stay, sick leave, malignancy in the antibiotic group, negative appendectomy rate, and quality of life. Success of treatment definitions were heterogeneous although mainly based on resolution of symptoms rather than incorporation of long-term recurrence or need for surgery in the antibiotic group. MAIN RESULTS: We included 13 studies in the review covering 1675 participants randomised to antibiotics and 1683 participants randomised to appendectomy. One study was unpublished. All were conducted in secondary care and two studies received pharmaceutical funding. All studies used broad-spectrum antibiotic regimens expected to cover gastrointestinal bacteria. Most studies used predominantly laparoscopic surgery, but some included mainly open procedures. Six studies included adults and children. Almost all studies aimed to exclude participants with complicated appendicitis prior to randomisation, although one study included 12% with perforation. The diagnostic technique was clinical assessment and imaging in most studies. Only one study limited inclusion by sex (male only). Follow-up ranged from hospital admission only to seven years. Certainty of evidence was mainly affected by risk of bias (due to lack of blinding and loss to follow-up) and imprecision. Primary outcomes It is uncertain whether there was any difference in mortality due to the very low-certainty evidence (Peto odds ratio (OR) 0.51, 95% confidence interval (CI) 0.05 to 4.95; 1 study, 492 participants). There may be 76 more people per 1000 having unsuccessful treatment in the antibiotic group compared with surgery, which did not reach our predefined level for clinical significance (risk ratio (RR) 0.91, 95% CI 0.87 to 0.96; I2 = 69%; 7 studies, 2471 participants; low-certainty evidence). Secondary outcomes At one year, 30.7% (95% CI 24.0 to 37.8; I2 = 80%; 9 studies, 1396 participants) of participants in the antibiotic group required appendectomy or, alternatively, more than two-thirds of antibiotic-treated participants avoided surgery in the first year, but the evidence is very uncertain. Regarding complications, it is uncertain whether there is any difference in episodes of Clostridium difficile diarrhoea due to very low-certainty evidence (Peto OR 0.97, 95% CI 0.24 to 3.89; 1 study, 1332 participants). There may be a clinically significant reduction in wound infections with antibiotics (RR 0.25, 95% CI 0.09 to 0.68; I2 = 16%; 9 studies, 2606 participants; low-certainty evidence). It is uncertain whether antibiotics affect the incidence of intra-abdominal abscess or collection (RR 1.58, 95% CI 0.61 to 4.07; I2 = 19%; 6 studies, 1831 participants), or reoperation (Peto OR 0.13, 95% CI 0.01 to 2.16; 1 study, 492 participants) due to very low-certainty evidence, mainly due to rare events causing imprecision and risk of bias. It is uncertain if antibiotics prolonged length of hospital stay by half a day due to the very low-certainty evidence (MD 0.54, 95% CI 0.06 to 1.01; I2 = 97%; 11 studies, 3192 participants). The incidence of malignancy was 0.3% (95% CI 0 to 1.5; 5 studies, 403 participants) in the antibiotic group although follow-up was variable. Antibiotics probably increased the number of negative appendectomies at surgery (RR 3.16, 95% CI 1.54 to 6.49; I2 = 17%; 5 studies, 707 participants; moderate-certainty evidence). AUTHORS' CONCLUSIONS: Antibiotics may be associated with higher rates of unsuccessful treatment for 76 per 1000 people, although differences may not be clinically significant. It is uncertain if antibiotics increase length of hospital stay by half a day. Antibiotics may reduce wound infections. A third of the participants initially treated with antibiotics required subsequent appendectomy or two-thirds avoided surgery within one year, but the evidence is very uncertain. There were too few data from the included studies to comment on major complications.

Long-term benzodiazepine use and risk of labor market marginalization in Finland: A cohort study with 5-year follow-up.

BACKGROUND: Benzodiazepines and related drugs (BZDRs) are widely used in the treatment of anxiety and sleep disorders, but cognitive adverse effects have been reported in long-term use, and these may increase the risk of labor market marginalization (LMM). The aim of this study was to investigate whether the risk of LMM is associated with new long-term BZDR use compared to short-term use. METHODS: This register-based nationwide cohort study from Finland included 37,703 incident BZDR users aged 18-60 years who initiated BZDR use in 2006. During the first year of use, BZDR users were categorized as long-term users (≥180 days) versus short-term users based on PRE2DUP method. The main outcome was LMM, defined as receipt of disability pension, long-term sickness absence (>90 days), or long-term unemployment (>180 days). The risk of outcomes was analyzed with Cox regression models, adjusted with sociodemographic background, somatic and psychiatric morbidity, other types of medication and previous sickness absence. RESULTS: During 5 years of follow-up, long-term use (34.4%, N = 12,962) was associated with 27% (adjusted Hazard Ratio, aHR 1.27, 95% CI 1.23-1.31) increased risk of LMM compared with short-term use. Long-term use was associated with 42% (aHR 1.42, 95% CI 1.34-1.50) increased risk of disability pension and 26% increased risk of both long-term unemployment and long-term sickness absence. CONCLUSIONS: These results indicate that long-term use of BZDRs is associated with increased risk of dropping out from labor market. This may be partly explained by cognitive adverse effects of prolonged BZDR use, which should be taken into account when prescribing BZDRs.

Predictability of the National Psychological Stress Screening for Subsequent Long-Term Psychiatric Sick Leave Among Employees: A Multicenter Nested Case-Control Study.

OBJECTIVE: The aim of the study is to predict employees' long-term sick leave due to psychiatric disorders using the national psychological stress screening program. METHODS: University employees who took long-term psychiatric sick leave in 2016-2018 were assigned as cases. Those who were present at work and matched for sex, age, and occupation type were assigned as controls. Answers in a 57-item questionnaire were analyzed by multivariable regression, and a prediction model was developed. It was validated in cases and matched controls in 2019. RESULTS: Six items were identified as independent predictors by multivariable regression and included in a prediction model. The area under the receiver-operating characteristics curve was 0.768 (95% confidence interval: 0.723-0.813). This finding was similar to that in the validation sample. CONCLUSIONS: The performance of the prediction model was modest and the national Stress Check Program should be further refined.

Savings in social expenditures for work incapacity in patients with inflammatory bowel disease depend on access to innovative therapies in Poland.

OBJECTIVES: Inflammatory bowel diseases (IBD) are an increasing burden for societies. We examined Polish Social Insurance Institution (ZUS) work incapacity expenditures for people with IBD compared with the general population. METHODS: Aggregate data were obtained on ZUS expenditures between 2012 and 2021 in Polish zlotys (PLN). Annual work incapacity benefit expenditures were analyzed and IBD benefit expenditures were examined relative to innovative IBD drug utilization in individual provinces. RESULTS: Between 2012 and 2021, annual ZUS expenditures per person increased, while expenditures per IBD patient decreased. Proportionally, absenteeism was the largest ZUS expenditure in the general population, while disability pensions were the largest in the IBD population. ZUS expenditures due to absenteeism in the general population increased by PLN 282 per person; those due to disability pensions decreased by PLN 85. Disability pension spending due to Crohn's disease (CD) and ulcerative colitis (UC) decreased by PLN 371 and PLN 284, respectively, while absenteeism spending per person with CD and UC decreased (PLN 58 and PLN 35, respectively). Nationwide in 2021, 8.5% of people with CD and 1.9% of those with UC received innovative drugs. The percentage of people receiving innovative drugs and ZUS expenditure per person were inversely related in 9/16 provinces for CD and 5/16 for UC. CONCLUSION: Polish state spending on work incapacity benefits increased in the general population but decreased in people with IBD between 2012 and 2021. Use of innovative drugs was associated with reduced spending per person with IBD in some provinces.

Does country of resettlement influence the risk of labor market marginalization among refugees? A cohort study in Sweden and Norway.

OBJECTIVES: This study aimed to compare the risk of labor market marginalization among refugees across different host countries of resettlement and examine the moderating role of birth country and length of stay on these associations. METHODS: Cohorts of refugees and native-born individuals aged 19-60 in Sweden (N=3 605 949, 3.5% refugees) and Norway (N=1 784 861, 1.7% refugees) were followed during 2010-2016. Rates (per 1000 person-years) of long-term unemployment, long-term sickness absence, and disability pension were estimated for refugees and the host populations. Cox regression models estimated crude and adjusted (for sex, age, educational level, and civil status) hazard ratio (HRadj) for refugees compared to their respective host population, with 95% confidence intervals (CI). Analyses were also stratified by birth country and length of stay. RESULTS: Refugees in Norway and Sweden had a higher incidence of labor market marginalization compared to their host population. Refugees in Sweden had a comparatively lower relative risk of long-term unemployment but higher risk of disability pension (HRadj 3.44, 95% CI, 3.38-3.50 and HRadj 2.45, 2.35-2.56, respectively) than refugees in Norway (HRadj 3.70, 3.58-3.82 and HRadj 1.57, 1.49-1.66, respectively). These relative risks varied when stratifying by birth country. A shorter length of stay was associated with a higher risk of long-term unemployment and a lower risk of disability pension, with a stronger gradient in Sweden than in Norway. CONCLUSIONS: The relative risk of labor market marginalization varied by the refugees' birth country but followed similar trends in Sweden and Norway. Although speculative, these findings may hint at non-structural factors related to the refugee experience playing a more important role than host country structural factors for the risk of labor market marginalization among refugees. Future research, including host countries with more variability in structural factors, is required to further investigate these associations. The higher risk of long-term unemployment among refugees with shorter length of stay indicates a need for more efficient labor market integration policies for newly-arrived refugees.

Religion and mental health in young adulthood: a register-based study on differences by religious affiliation in sickness absence due to mental disorders in Finland.

BACKGROUND: Religiosity and spirituality are known to be positively correlated with health. This is the first study to analyse the interrelation between religious denomination and sickness absence due to mental disorders using population register data with detailed ICD codes. METHODS: The follow-up study was based on the entire population born in Finland between 1984 and 1996 (N=794 476). Each person was observed from age 20 over the period from 2004 to 2018. Cox proportional hazards models were applied to analyse the association between religious denomination and first-time sickness allowance receipts for any cause and mental disorder. Mental disorders were categorised as severe mental illness (F20-F31), depression (F32-F33), anxiety (F40-F48) and any other mental disorder (all other F codes). Men and women were analysed separately. RESULTS: The differences in sickness absence due to mental disorder were substantial between religious affiliations. Compared with members of the Evangelical Lutheran state church, the relative hazard for mental disorders among non-affiliated women was 1.34 (95% CI 1.30 to 1.39), while that among women with other religions was 1.27 (95% CI 1.19 to 1.35), after adjusting for own and parental characteristics. The corresponding numbers for men were 1.45 (95% CI 1.39 to 1.50) and 1.42 (95% CI 1.30 to 1.54), respectively. The gradient was larger for severe mental illness and depression than for anxiety and other mental disorders. For any cause of sickness absence, there was no difference between Lutherans, non-affiliated individuals and those with other religions. CONCLUSIONS: Epidemiologists and public health practitioners should further examine the association between mental disorders and church membership using administrative registers.

Cancer Screening after the Adoption of Paid-Sick-Leave Mandates.

BACKGROUND: By the end of 2022, nearly 20 million workers in the United States have gained paid-sick-leave coverage from mandates that require employers to provide benefits to qualified workers, including paid time off for the use of preventive services. Although the lack of paid-sick-leave coverage may hinder access to preventive care, current evidence is insufficient to draw meaningful conclusions about its relationship to cancer screening. METHODS: We examined the association between paid-sick-leave mandates and screening for breast and colorectal cancers by comparing changes in 12- and 24-month rates of colorectal-cancer screening and mammography between workers residing in metropolitan statistical areas (MSAs) that have been affected by paid-sick-leave mandates (exposed MSAs) and workers residing in unexposed MSAs. The comparisons were conducted with the use of administrative medical-claims data for approximately 2 million private-sector employees from 2012 through 2019. RESULTS: Paid-sick-leave mandates were present in 61 MSAs in our sample. Screening rates were similar in the exposed and unexposed MSAs before mandate adoption. In the adjusted analysis, cancer-screening rates were higher among workers residing in exposed MSAs than among those in unexposed MSAs by 1.31 percentage points (95% confidence interval [CI], 0.28 to 2.34) for 12-month colorectal cancer screening, 1.56 percentage points (95% CI, 0.33 to 2.79) for 24-month colorectal cancer screening, 1.22 percentage points (95% CI, -0.20 to 2.64) for 12-month mammography, and 2.07 percentage points (95% CI, 0.15 to 3.99) for 24-month mammography. CONCLUSIONS: In a sample of private-sector workers in the United States, cancer-screening rates were higher among those residing in MSAs exposed to paid-sick-leave mandates than among those residing in unexposed MSAs. Our results suggest that a lack of paid-sick-leave coverage presents a barrier to cancer screening. (Funded by the National Cancer Institute.).

[The administrative violation of granting sick leave with an evident absence of medical grounds and the bill that facilitates its sanction]. / La infracción administrativa de otorgar licencias con evidente ausencia de fundamento médico y el proyecto de ley que facilita su sanción.

This article deals with the regulatory violation of issuing sick leave with an evident absence of medical grounds. Two problematic aspects present in the sanctioning practice of the Social Security Regulatory Agency are analyzed: the discrepancy between the wording of the regulation and its application, and the multiplicity of duties that can configure the behavior defined by the law, although they do not constitute fraud against the sick leave system. The context of this study is the bill that seeks to lower the standard for the regulator to impose administrative penalties on offenders who issue unjustified sick leave and aggravate those penalties.

Covid-19 en trabajadores de la Salud: Experiencia en la Residencia de Pediatría de un hospital de La Plata, Argentina / Covid-19 in health workers: Experience in the Pediatric Residence of a hospital in La Plata, Argentina

Introducción: Los trabajadores de la salud (TS) poseen la mayor exposición laboral al contagio SARS-CoV-2. Los residentes forman parte fundamental de los servicios de salud por lo que no se encuentran exentos del impacto físico, psíquico, social y económico negativo producido por la pandemia por COVID-19. Objetivo: : Describir el impacto epidemiológico de la enfermedad profesional por COVID-19 en médicos residentes de pediatría. Material y métodos: Estudio descriptivo de corte transversal en médicos residentes de pediatría del H.I.A.E.P "Sor María Ludovica". El período comprendido en el estudio fue del 01/10/2020 al 30/09/2021. Se evaluaron los siguientes datos: género, edad, antecedentes personales, vacunación, cuadro clínico, métodos diagnósticos, aislamientos epidemiológicos, evolución y licencias tramitadas. Los datos fueron registrados por la jefatura de residentes. Resultados: 143 casos sospechosos de COVID-19, de ellos 30 resultaron confirmados de COVID-19. La edad media de los enfermos fue de 31 años (26-46 años) de los cuales 14 (47%) no estaban vacunados contra SARS COV-2, 11 (36%) estaban completamente inmunizados y 5 (17%) tenían calendario incompleto. 2 casos (6,6%) reportaron comorbilidad previa. Se realizaron pruebas de laboratorio en 130 de los 143 casos. 13 casos se descartaron por criterio clínico. La tasa de positividad fue 23,1%. 26 casos fueron confirmados por laboratorio y 4 casos mediante criterio clínico epidemiológico. Todos los casos fueron leves y evolucionaron favorablemente. Fueron gestionadas 326 licencias relacionadas a la pandemia por COVID-19 que significaron la pérdida de 2.830 días laborales. Conclusión: En el presente estudio se evidenció una alta tasa de incidencia de COVID-19 en residentes de pediatría en un año: 23,1%

Introduction: Health workers (HCWs) have the highest occupational exposure to SARS-CoV-2 contagion. Residents are a fundamental part of health services, so they are not exempt from the negative physical, psychological, social and economic impact caused by the COVID-19 pandemic. Objectives: To describe the epidemiological impact of the occupational disease by COVID-19 in resident pediatricians. Material and methods: Descriptive cross-sectional study in pediatric residents of the H.I.A.E.P "Sor María Ludovica". The period covered by the study was from 10/01/2020 to 09/30/2021. The following data were evaluated: gender, age, personal history, vaccination, clinical picture, diagnostic methods, epidemiological isolates, evolution and licenses processed. The data was recorded by the head of residents. Results: 143 suspected cases of COVID-19, of which 30 were confirmed to be COVID-19. The mean age of the patients was 31 years (26-46 years), of which 14 (47%) were not vaccinated against SARS COV.-2, 11 (36%) were fully immunized and 5 (17%) had an incomplete schedule. 2 cases (6.6%) reported previous comorbidity. Laboratory tests were performed in 130 of the 143 cases. 13 cases were ruled out based on clinical criteria. The positivity rate was 23.1%. 26 cases were confirmed by laboratory and 4 cases by clinical epidemiological criteria. All cases were mild and evolved favorably. 326 licenses related to the COVID-19 pandemic were managed, which meant the loss of 2,830 working days. Conclusion: In the present study, a high rate of incidence of COVID-19 was evidenced in pediatric residents in one year: 23.1%

Potential of micro-exercise to prevent long-term sickness absence in the general working population: prospective cohort study with register follow-up.

This study assesses the potential of workplace-based micro-exercise (brief and simple exercise bouts) to prevent long-term sickness absence (LTSA) at the population level. In the Work Environment and Health in Denmark Study (2012-2018), we followed 70,130 workers from the general working population, without prior LTSA, for two years in the Danish Register for Evaluation of Marginalisation. We used Cox regression with model-assisted weights and controlled for various confounders. From 2012 to 2018, the percentage of workers in Denmark using workplace-based micro-exercise during and outside of working hours increased from 7.1 to 10.9% and from 0.8 to 1.4%, respectively. The incidence of long-term sickness absence (at least 30 days) was 8.4% during follow-up. The fully adjusted model showed reduced risk of long-term sickness absence from using micro-exercise during working hours, (HR 0.86, 95% CI 0.77-0.96), but not when used outside of working hours. If used by all workers, micro-exercise during working hours could potentially prevent 12.8% of incident long-term sickness absence cases (population attributable fraction). In conclusion, micro-exercise performed during working hours holds certain potential to prevent incident long-term sickness absence in the general working population. Large-scale implementation of workplace-based micro-exercise may represent an unexploited opportunity for public health promotion.

Long COVID symptoms in SARS-CoV-2-positive adolescents and matched controls (LongCOVIDKidsDK): a national, cross-sectional study.

BACKGROUND: Many adolescents have been affected by the COVID-19 pandemic either directly by being infected with the virus or indirectly by lockdowns and restrictions influencing normal living. We aimed to investigate health, including symptoms of long COVID, in adolescents (aged 15-18 years) who tested positive for SARS-CoV-2 compared with a control group. METHODS: LongCOVIDKidsDK was a national, cross-sectional study carried out in Denmark, which included SARS-CoV-2-positive adolescents and matched controls. All Danish adolescents aged 15-18 years with a positive SARS-CoV-2 test during the period Jan 1, 2020, to July 12, 2021, and a control group matched (1:4) by age and sex were sent a survey from July 20, 2021. Participants had until Sept 15, 2021, to respond. Symptoms associated with COVID-19, school attendance, and health-related quality of life were investigated using ancillary questions and validated questionnaires (Paediatric Quality of Life Inventory [PedsQL] and Children's Somatic Symptoms Inventory-24 [CSSI-24]). Statistical analyses included descriptive statistics and logistic regression. This study is registered at ClinicalTrials.gov, NCT04786353. FINDINGS: 24 315 adolescents with a positive SARS-CoV-2 test (case group) and 97 257 matched controls were invited to participate. 3013 matched controls were excluded because of suspected SARS-CoV-2 infection. 6630 (27·3%) responded in the case group and 21 640 (22·3%) responded and were eligible to participate in the control group. Across both groups, median age was 17·6 years (IQR 16·4-18·5), 16 277 (57·6%) of 28 270 responders were female, and 11 993 (42·4%) were male. Participants in the case group had greater odds of having at least one long COVID symptom lasting at least 2 months compared with the control group (3159 [61·9%] vs 12 340 [57·0%], odds ratio 1·22 [95% CI 1·15-1·30]; p<0·0001). Participants in the case group reported significantly lower symptom scores (ie, less somatic distress) on the CSSI-24 than in the control group: mean 10·7 (SD 11·4, median 7·0 [IQR 2·0-15·0]) versus 11·9 (10·6, 9·0 [4·0-17·0]; p<0·0001). Participants in the case group had better quality of life scores on the PedsQL than in the control group: physical functioning mean score 88·7 (SD 13·9, median 93·8 [IQR 84·4-100·0]) versus 86·5 (14·3, 90·6 [81·3-96·9]; p<0·0001); emotional functioning 77·1 (20·3, 80·0 [65·0-95·0]) versus 71·7 (21·4, 75·0 [60·0-90·0]; p<0·0001); social functioning 93·1 (12·5, 100·0 [90·0-100·0]) versus 88·4 (16·2, 95·0 [80·0-100·0]; p<0·0001); and school functioning 66·9 (22·5, 65·0 [60·0-85·0]) versus 62·9 (22·1, 65·0 [50·0-80·0]; p<0·0001). More participants in the case group than in the control group reported 16 or more sick days (1205 [18·2%] vs 2518 [11·6%]; p<0·0001) and 16 or more days of school absence (695 [10·5%] vs 1777 [8·2%]; p<0·0001). INTERPRETATION: Participants with SARS-CoV-2-positive tests had more long-lasting symptoms and sick leave, whereas participants in the control group had more short-lasting symptoms and worse quality of life. Knowledge of long COVID in adolescents is important to guide clinical recognition and management of this condition. FUNDING: AP Møller and Chastine McKinney Møller Foundation.

Trajectory analyses in insurance medicine studies: Examples and key methodological aspects and pitfalls.

BACKGROUND: Trajectory analyses are being increasingly used in efforts to increase understanding about the heterogeneity in the development of different longitudinal outcomes such as sickness absence, use of medication, income, or other time varying outcomes. However, several methodological and interpretational challenges are related to using trajectory analyses. This methodological study aimed to compare results using two different types of software to identify trajectories and to discuss methodological aspects related to them and the interpretation of the results. METHODS: Group-based trajectory models (GBTM) and latent class growth models (LCGM) were fitted, using SAS and Mplus, respectively. The data for the examples were derived from a representative sample of Spanish workers in Catalonia, covered by the social security system (n = 166,192). Repeatedly measured sickness absence spells per trimester (n = 96,453) were from the Catalan Institute of Medical Evaluations. The analyses were stratified by sex and two birth cohorts (1949-1969 and 1970-1990). RESULTS: Neither of the software were superior to the other. Four groups were the optimal number of groups in both software, however, we detected differences in the starting values and shapes of the trajectories between the two software used, which allow for different conclusions when they are applied. We cover questions related to model fit, selecting the optimal number of trajectory groups, investigating covariates, how to interpret the results, and what are the key pitfalls and strengths of using these person-oriented methods. CONCLUSIONS: Future studies could address further methodological aspects around these statistical techniques, to facilitate epidemiological and other research dealing with longitudinal study designs.

Integrating quantitative and qualitative approaches to assess wintertime illness-related absenteeism and its direct and indirect costs among the private sector in Ulaanbaatar.

Causes for employee absenteeism vary. The commonest cause of work absenteeism is "illness-related." Mongolia's capital city, Ulaanbaatar, experiences high employee absenteeism during the winter than during other seasons due to the combination of extreme cold and extreme air pollution. We identified direct and indirect costs of absenteeism attributed to air pollution among private-sector employees in Ulaanbaatar. Using a purposive sampling design, we obtained questionnaire data for 1,330 employees working for private-sector companies spanning six economic sectors. We conducted 26 employee focus groups and 20 individual employer in-depth interviews. We used both quantitative and qualitative instruments to characterize the direct and indirect costs of absence due to illnesses attributed to severe air pollution during wintertime. Female employees and employees with a young child at home were more likely to be absent. Respiratory diseases accounted for the majority of reported air pollution-related illnesses. All participants perceived that air pollution adversely affected their health. Individual employee direct costs related to absence totaled 875,000 MNT ($307.10) for an average of three instances of three-day illness-related absences during the winter. This sum included diagnostic and doctor visit-related, medication costs and hospitalization costs. Non-healthcare-related direct cost (transportation) per absence was 50,000₮ ($17.60). Individual indirect costs included the value of lost wages for the typical 3-day absence, amounting to 120,000₮ ($42.10). These total costs to employees, therefore, may amount to as much as 10% of annual income. The majority of sick absences were unpaid. Overall, the cost of wintertime absences is substantial and fell disproportionately on female employees with young children.

A systematic review and meta-analysis uncovering the relationship between alcohol consumption and sickness absence. When type of design, data, and sickness absence make a difference.

AIM: Earlier research has revealed a strong relationship between alcohol use and sickness absence. The aim of this review was to explore and uncover this relationship by looking at differences in type of design (cross-sectional vs. longitudinal), type of data (self-reported vs. registered data), and type of sickness absence (long-term vs. short term). METHOD: Six databases were searched through June 2020. Observational and experimental studies from 1980 to 2020, in English or Scandinavian languages reporting the results of the association between alcohol consumption and sickness absence among working population were included. Quality assessment, and statistical analysis focusing on differences in the likelihood of sickness absence on subgroup levels were performed on each association, not on each study. Differences in the likelihood of sickness absence were analyzed by means of meta-analysis. PROSPERO registration number: CRD42018112078. RESULTS: Fifty-nine studies (58% longitudinal) including 439,209 employees (min. 43, max. 77,746) from 15 countries were included. Most associations indicating positive and statistically significant results were based on longitudinal data (70%) and confirmed the strong/causal relationship between alcohol use and sickness absence. The meta-analysis included eight studies (ten samples). The increased risk for sickness absence was likely to be found in cross-sectional studies (OR: 8.28, 95% CI: 6.33-10.81), studies using self-reported absence data (OR: 5.16, 95% CI: 3.16-8.45), and those reporting short-term sickness absence (OR: 4.84, 95% CI: 2.73-8.60). CONCLUSION: This review supports, but also challenges earlier evidence on the association between alcohol use and sickness absence. Certain types of design, data, and types of sickness absence may produce large effects. Hence, to investigate the actual association between alcohol and sickness absence, research should produce and review longitudinal designed studies using registry data and do subgroup analyses that cover and explain variability of this association.