Return to work after chronic disease: A theoretical framework for understanding the worker-employer dynamic.

OBJECTIVES: Return to work after chronic disease is important for workers, employers and society. The process, however, is challenging. This article provides an analytical and theoretical framework for explaining this process informed by the person-environment fit theory. METHODS: This article uses a narrative method to (1) review the key concepts, benefits and influencing factors in the literature on return to work after chronic diseases, (2) analyse and critique the most important theoretical models used for explaining return to work after chronic diseases, and (3) review the person-environment fit theory and how it has been used so far. RESULTS: The existing models highlight different aspects, but they overlook the relationship between the worker and the employer. An analytical and theoretical framework is proposed to comprehensively explain the worker-employer dynamic. The framework also considers the role of broader factors (policy, labour market) and other stakeholders (health professionals, civil society actors) emphasising the idea that return to work is a phased and cyclical process. DISCUSSION: The framework can be used to guide future qualitative and quantitative studies, or as a map for identifying problematic areas related to the worker or the work environment. The model should be empirically tested in future studies.

Characteristics of shared decision making in Romania from the patient perspective: A cross-sectional multicentric study.

BACKGROUND: Shared decision making (SDM) is very important from patients' perspective. This process has not yet been evaluated in Romania. The study aims to evaluate SDM from the patients' perspective and to evaluate patients' characteristics that associate with SDM. MATERIAL AND METHODS: A cross-sectional multicentric study comprising eight recruitment centres was performed. Inpatients and outpatients who referred to Hospital Units treating autoimmune diseases or atrial fibrillation were included. Another sample consisted of members of the Autoimmune Disease Patient Society, who completed an online anonymous questionnaire. All participants completed the Romanian translated version of the 9-item Shared Decision Making Questionnaire (SDM-Q-9), as these samples were used for the validation of this questionnaire, too. Patients had to refer to the visit in which the decision concerning the antithrombotic treatment was taken (atrial fibrillation patients), or the immunosuppressive treatment was last time changed (autoimmune disease patients). Ordinal regression having the total SDM score as dependent variable was used. RESULTS: A total of 665 questionnaires were filled in within the hospital setting (n = 324; 48.7%) and online (n = 341; 51.3%). The median score for SDM was 34 of 45, but it differed between hospital completion -39/45 and online completion (anonymous) -20/45 (P < .001). Patients with higher education were influenced most by the setting, giving the best marks in hospital and low marks online, while those with lower education gave lower marks in both settings. In ordinal regression with SDM score as dependent variable, hospital completion of the questionnaire (OR = 9.5, 95% confidence interval, 5.69-16), collagen disease diagnosis (OR = 2.4, 95% confidence interval, 1.39-4.14), and immunosuppressive treatment (OR = 2.16, 95% confidence interval, 1.43-3.26) were independent predictors. CONCLUSION: In our study, full anonymity was associated with significantly lower scores for the SDM process. The patients with higher education were most influenced by this condition, while those with the lowest education were the most critical.

Romanian version of SDM-Q-9 validation in Internal Medicine and Cardiology setting: a multicentric cross-sectional study.

BACKGROUND: Shared decision making (SDM) is becoming more and more important for the patient-physician interaction. There has not been a study in Romania evaluating patients' point of view in the SDM process yet. Therefore, the present study aims to evaluate the psychometric parameters of the translated Romanian version of SDM-Q-9. MATERIAL AND METHODS: A multicentric cross-sectional study was performed comprising eight recruitment centers. The sample consisted of in- and outpatients who referred to Hospital Units for treatment for atrial fibrillation or collagen diseases. Furthermore, patients who were members of Autoimmune Disease Patient Society were able to participate via an online survey. All participants completed the Romanian translated SDM-Q-9. RESULTS: Altogether, 665 questionnaires were filled in within the hospital setting (n = 324; 48.7%) and online (n = 341; 51.3%). The Romanian version had good internal consistency (Cronbach α coefficient of 0.96.) Corrected item correlations were good ranging from 0.64 to 0.89 with low corrected item correlations for item 1 and item 7. PCA found a one-factorial solution (similar with previous reports) but the first item had the lowest loading. CONCLUSION: SDM-Q-9 is a useful tool for evaluation and improvement in health care that was validated in Romania and can be used in clinical setting in this country.

New Approach to Prepare Willow Bark Extract-Lipid Based Nanosystems with Enhanced Antioxidant Activity.

In this study the conventional oils used for lipid nanocarriers (NLCs) synthesis were replaced by high concentration of fish oils (e.g., fish oil concentrated in omega-3 fatty acids, fish oil enriched in omega-3 and omega-6 fatty acids and salmon oil), in order to produce appropriate lipid based nanosystems able to entrap willow bark extract (WBE). Formulation factors such as the nature of the fish oil, glycerol content and WBE loading were evaluated to produce optimum lipid based nanosystems with suitable physical stability and enhanced antioxidant activity. The synthesized WBE-NLC showed spherical and homogeneous particles and average diameters in the range of 200-250 nm, as determined by TEM measurements. The electrokinetic potentials were negative for all free- and WBE-loaded NLCs, with values between -29.1 ÷ - 35.8 mV, which reveal an excellent physical stability. By scanning calorimetry measurements it has been shown that the lipid crystallization and melting behavior of NLCs before and after loading with WBE were no significantly influenced by the type of fish oil used and only in a few NLCs formulations an obvious perturbation of lipid network have been detected. The chemiluminescence technique has been used to assess the effect of fish oil type on the in vitro antioxidant activity of WBE-NLCs. Ability of WBE entrapped within NLCs to scavange the free radicals was greater than for native WBE and fish oils. The difference between the antioxidant activity of WBE-NLC (98%) and those of pure WBE (AA% = 77.2) and fish oil (AA% = 83.7), may be explained by the occurrence of a synergistic effect between the components of lipid nanocarriers.