Prevalence of Low Back Pain and Associated Risks in School-Age Children.

BACKGROUND: Low back pain (LBP) is highly prevalent in children and adolescents, while psychosocial, anthropometric, developmental, and lifestyle factors have been associated. However, the evidence is inconsistent from a biological point of view, so identifying predictors of LBP in the 6-12 years children through physical examination should be appropriate. AIMS: To estimate the prevalence of LBP and associated factors in schoolchildren in a Brazilian population. DESIGN: Cross-sectional study. SETTING: Three schools in Botucatu, Brazil. PARTICIPANTS/SUBJECTS: 377 students from 6-12 years. METHODS: Data collection consisted of questions regarding personal history, socioeconomic and anthropometric information, kinesiologic evaluation with anthropometry, lumbar biophotogrammetry, and backpack weight and use. Descriptive analyses were performed, and simple and multiple logistic regression models were used for risk factors. RESULTS: The prevalence of LBP was 27.32% (confidence interval [CI] 95% = 23.07-32.03). The mean age was 8.85 years (± 1.83) in the group with LBP and 8 years (± 1.76) in the group without LBP (p = .006). Variables such as backpack weight (odds ratio [OR] = 1.45, CI 95% = 1.018-2.064) and exceeding 3 hours per day in front of the television (OR = 7.97, CI 95% = 1.957-32.515) increased the chance of LBP in these students. CONCLUSION: LBP is prevalent in younger schoolchildren, and the factors associated with this outcome can be effectively addressed through the promotion of health measures. LBP in schoolchildren is a musculoskeletal discomfort that negatively affects the quality of life of these individuals and persists in adulthood.

Carpal tunnel syndrome during the third trimester of pregnancy: prevalence and risk factors.

PURPOSE: To estimate the prevalence of indicative signs and symptoms of carpal tunnel syndrome (CTS) during the third trimester of pregnancy; assess the severity of symptoms and functional impairment; evaluate associated factors; and to evaluate the complaint of CTS in pregnant women through ultrasonography (USG). METHODS: A cross-sectional study, in which participants were classified into two groups: presence and absence of indicative signs and symptoms of CTS. Severity of symptoms and functional status was assessed by the Boston Carpal Tunnel Questionnaire. USG was performed by multiplanar technique of static and dynamic evaluation. Association between USG and indicative signs and symptoms of CTS was estimated using Fischer's exact test and Poisson regression models were used to estimate the association of exploratory variables and indicative signs and symptoms of CTS. RESULTS: Altogether, 482 women were recruited and 111 presented indicative signs and symptoms of CTS, resulting in a prevalence of 23.03%. USG was not able to distinguish indicative signs and symptoms of CTS groups. Both the severity of the symptoms and the impairment of the manual function were mild. Being left-handed, gestational diabetes mellitus and maternal age were associated with indicative signs and symptoms of CTS. CONCLUSIONS: The high prevalence of indicative signs and symptoms of CTS and the difficulties that they can cause reinforce the importance of adequate diagnosis and treatment. Further studies are needed to assess the value of USG as a diagnostic method for CTS during pregnancy.

Risk perception of healthcare workers in the first wave of the COVID-19 pandemic in Brazil.

Objectives: To validate the items of the Emotional Impact Questionnaire coronavirus disease-2019 (COVID-19) related to risk perception, estimating its degree, among healthcare workers in the first wave of COVID-19 pandemic, identifying possible associated factors.Methods: cross-sectional study in 1872 healthcare workers of Brazil. The population was characterized by sociodemographic and occupational information, knowledge about COVID-19, quality of information received, risk perception and preventive measures about the disease, and sense of coherence. Results: Being divorced, having a chronic disease, spending more than 1 h per day getting informed about COVID-19, and always or almost always wearing a mask regardless of symptoms, as well as self-perception of health were associated with high-risk perception. An inverse association was found between risk perception, sense of coherence and not knowing if one has had occasional contact with confirmed COVID-19 cases. Conclusion: Risk perception is influenced by emotions, experiences, and knowledge. Sense of coherence and resilience have a role in reducing risk perception. Understanding risk perception is crucial for developing effective strategies to mitigate the impact of the COVID-19 pandemic and other similar scenarios.

Assessment and indicators of kinematic behavior and perceived fatigability.

OBJECTIVE: The objective of this study was to investigate the relationship between upper limb kinetics and perceived fatigability in elderly individuals during an upper limb position sustained isometric task. METHODS: A total of 31 elderly participants, 16 men (72.94±4.49 years) and 15 women (72.27±6.05 years), performed a upper limb position sustained isometric task. Upper-limb acceleration was measured using an inertial measurement unit. Perceived fatigability was measured using the Borg CR10 scale. RESULTS: Higher mean acceleration in the x-axis throughout the activity was associated with higher final perceived fatigability scores. Moderate correlations were observed between perceived fatigability variation and mean acceleration cutoffs in all axes during the second half of the activity. In women, significant correlations were found between all perceived fatigability cutoffs and mean acceleration in the y- and x-axes. However, in men, the relationships between perceived fatigability variation and mean acceleration were more extensive and stronger. CONCLUSION: The acceleration pattern of the upper limb is linked to perceived fatigability scores and variation, with differences between sexes. Monitoring upper limb acceleration using a single inertial measurement unit can be a useful and straightforward method for identifying individuals who may be at risk of experiencing high perceived fatigability or task failure.

Psychological distress among Brazilian workers during the initial stage of the COVID-19 pandemic: a descriptive study.

Background: COVID-19 pandemic imposed drastic and abrupt changes to working environment and organization and that might have caused additional negative effects on mental health. Thus, this study aimed to quantify and assess the severity of psychological distress experienced by Brazilian essential and nonessential workers during the first months of the COVID-19 pandemic. Methods: This descriptive study included 2,903 participants who answered an online questionnaire between April and May 2020. The research questionnaire was translated and culturally adapted to the Brazilian population from a questionnaire developed and validated for the Spanish population. Variables were analyzed using simple and cumulative percentage distributions and measures of central tendency and dispersion. The Wilson score interval was used to calculate confidence interval (CI) for the main outcome, psychological distress. Results: It was observed a high prevalence (72.6%) of psychological distress among the study's participants. They also presented a median risk perception score of 60 (out of a maximum of 90), and their greatest concern was transmitting the virus to family members, close contacts or patients. Furthermore, it was found a lower sense of coherence and work engagement among the participants than those observed in previous studies conducted in other countries. Conclusion: Almost three quarters of the study's participants were classified as presenting psychological distress. Thus, it is imperative to provide mental health remotely delivered interventions to workers during public health events that require prolonged social distancing measures.

The Impact of Low Back Pain on the Quality of Life of Children between 6 and 12 Years of Age.

This study aimed to evaluate the impact of low back pain on the perceived health-related quality of life of children between 6 and 12 years of age. This is a cross-sectional study of three hundred seventy-seven students from three schools (two private and one public) located in the city of Botucatu, São Paulo. Data were collected using the Pediatric Quality of Life Inventory (PedsQL, version 4.0), a questionnaire comprising questions on personal background, sociodemographic and socioeconomic information, and a questionnaire about quality of life. Comparisons were made between groups with and without low back pain. The chi-squared test was used for analyzing categorical variables, and the non-parametric Mann-Whitney test was used for continuous variables. According to the findings obtained in this study, it was observed that low back pain in the last month was reported by 27.3% of the total participants. The perceived health-related quality of life was lower among individuals who had low back pain, and the scores of physical and emotional functioning domains were also lower in the presence of low back pain. The prevalence of low back pain among children and adolescents is relatively high. Furthermore, the repercussions of low back pain may lead to a lower overall perception of the health-related quality of life in this population and affect aspects of physical and emotional functioning.

Upper-Limb Kinematic Behavior and Performance Fatigability of Elderly Participants Performing an Isometric Task: A Quasi-Experimental Study.

Upper-limb position-sustained tasks (ULPSIT) are involved in several activities of daily living and are associated with high metabolic and ventilatory demand and fatigue. In older people, this can be critical to the performance of daily living activities, even in the absence of a disability. OBJECTIVES: To understand the ULPSIT effects on upper-limb (UL) kinetics and performance fatigability in the elderly. METHODS: Thirty-one (31) elderly participants (72.61 ± 5.23 years) performed an ULPSIT. The UL average acceleration (AA) and performance fatigability were measured using an inertial measurement unit (IMU) and time-to-task failure (TTF). RESULTS: The findings showed significant changes in AA in the X- and Z-axes (p < 0.05). AA differences in women started earlier in the baseline cutoff in the X-axis, and in men, started earlier between cutoffs in the Z-axis. TTF was positively related to AA in men until 60% TTF. CONCLUSIONS: ULPSIT produced changes in AA behavior, indicative of movement of the UL in the sagittal plane. AA behavior is sex related and suggests higher performance fatigability in women. Performance fatigability was positively related to AA only in men, where movement adjustments occurred in an early phase, though with increased activity time.

Healthcare workers' knowledge for safe handling and moving of the patient.

Objectives. Healthcare workers are at risk of injury during patient handling activities. There is a lack of research in safe patient handling. The objective of this study was to examine the knowledge level of safe patient handling among Brazilian healthcare workers and to analyze its associated factors. Methods. This cross-sectional study was performed in two hospitals and 47 outpatient facilities with 644 participants in Brazil. Healthcare workers completed a self-administered questionnaire about their working characteristics, history of lower back pain and knowledge of safe patient handling. Results. The mean score of safe patient handling knowledge was 11.89 out of 22 maximum points. More than half (59%) of the participants did not see the risk of their activity. Educational level, type of healthcare facility and outpatient clinics were associated with safe patient handling knowledge in the logistic regression model. Conclusion. There was a substantial deficit in safe patient handling knowledge. There is a need for courses and textbooks to move beyond ineffective preventive strategies and minimize the risk of manual patient handling. Healthcare workers are at risk of injury during patient handling activities. Nursing schools in developing countries must focus on researching this topic to ensure safe patient handling.

The impact of manual patient handling on work ability: A cross-sectional study in a Brazilian hospital.

AIM: To investigate the level of self-reported work ability and its association with manual patient handling in healthcare workers. DESIGN: Cross-sectional study adhering to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. METHODS: A total of 320 healthcare workers answered a self-administered questionnaire regarding manual patient handling, work ability, occupational factors, occurrence of low back pain and sociodemographic and lifestyle factors from November 2016 to March 2017. The association between manual patient handling and low back pain was analysed with Poisson regression models. RESULTS: The prevalence ratio of inadequate work ability was 43.42%. Manual patient handling (PR 1.375, 95% CI 1.038-1.821), bachelor education (PR 2.150, 95% CI 1.272-3.632), less than bachelor education (PR 2.166, 95% CI 1.218-3.855), seniority (PR 1.049, 95% CI 1.024-1.086), poor sleep quality (PR 1.425, 95% CI 1.13-1.796) and presence of low back pain (PR 2.003, 95% CI 1.314-3.052) were all positively associated with an inadequate work ability.

Knowledge of COVID-19 among Brazilian health care professionals and associated factors.

ABSTRACT: Health care professional's knowledge is essential to contain epidemics. This research aimed to evaluate the knowledge of Brazilian health care professionals regarding COVID-19 to analyze whether there is a difference in knowledge between professionals in Primary Health Care and those in other levels of care or not; and to identify factors associated with knowledge. This is a cross-sectional study, including 716 participants who answered an online questionnaire between April and May 2020. Descriptive statistics, difference tests between groups, and logistic regression models were used to analyze the data. The average knowledge score was 12.42 points (out of a possible total of 15). There was no significant difference between professionals in Primary Health Care and those in other levels of care. Knowledge was associated with age, profession, perception regarding media's information quality, and hours exposed to information on COVID-19. Participants showed adequate knowledge, despite some specific gaps. Continuing education actions should prioritize younger nonmedical professionals.

Communication, information, and knowledge in the pandemic by COVID-19 in Brazil.

As coronavirus disease 2019 (COVID-19) is asserting itself as a health crisis, it is necessary to assess the knowledge and perceptions of people about the disease. The aim of this study is to assess the knowledge of the general population about COVID-19 and how the media influence this knowledge. This is a cross-sectional study with 5066 participants who answered an online questionnaire between April and May 2020. Data analysis was performed using descriptive statistics and logistic regression models. Over 75% have obtained a high degree of knowledge regarding signs, symptoms, and transmission, 95% stated to check the veracity of the information received, and also showed that the total knowledge about COVID-19 was associated with the level of instruction, with the perception of the quality of information disseminated by the media, and with the risk perception. Despite the high level of knowledge of participants, the results pointed to the need to reinforce information for individuals with less education and the importance of avoiding denialism that reduces the risk perception about COVID-19.

The impact of disease changes and mental health illness on readapted return to work after repeated sick leaves among Brazilian public university employees.

Introduction: Health affects work absenteeism and productivity of workers, making it a relevant marker of an individual's professional development. Objectives: The aims of this article were to investigate whether changes in the main cause of the sick leaves and the presence of mental health illnesses are associated with return to work with readaptation. Materials and methods: A historical cohort study was carried out with non-work-related illnesses suffered by statutory workers of university campuses in a medium-sized city in the state of São Paulo, Brazil. Two exposures were measured: (a) changes, throughout medical examinations, in the International Classification of Diseases (ICD-10) chapter regarding the main condition for the sick leave; and (b) having at least one episode of sick leave due to mental illness, with or without change in the ICD-10 chapter over the follow-up period. The outcome was defined as return to work with adapted conditions. The causal model was established a priori and tested using a multiple logistic regression (MLR) model considering the effects of several confounding factors, and then compared with the same estimators obtained using Targeted Machine Learning. Results: Among workers in adapted conditions, 64% were health professionals, 34% had had changes in the ICD-10 chapter throughout the series of sick leaves, and 62% had diagnoses of mental health issues. In addition, they worked for less time at the university and were absent for longer periods. Having had a change in the illness condition reduced the chance of returning to work in another function by more than 30%, whereas having had at least one absence because of a cause related to mental and behavioral disorders more than doubled the chance of not returning to work in the same activity as before. Conclusion: These results were independent of the analysis technique used, which allows concluding that there were no advantages in the use of targeted maximum likelihood estimation (TMLE), given its difficulties in access, use, and assumptions.

A low-cost and efficient participatory ergonomic intervention to reduce the burden of work-related musculoskeletal disorders in an industrially developing country: an experience report.

Work-related musculoskeletal disorders (WMSDs) are the first cause of occupational illness in Brazil and the number of cases in the industrial sector has increased progressively in the last 6 years. In order to prevent WMSDs, workplace ergonomics interventions are frequently implemented worldwide. This article describes the implementation strategy of a participatory ergonomic intervention conducted in the quality control department of a medium-sized Brazilian garment company. The intervention was carried out based on the nine steps presented by Vink, Imada and Zinck, and workers' exposure to risk factors was investigated using the rapid upper limb assessment method. A low-tech and low-cost solution that successfully reduced workers' exposure to WMSD risk factors was proposed, prototyped, tested and, finally, introduced. Participatory ergonomic interventions can be a feasible and effective approach to reduce the exposure to work-related risk factors for WMSDs in industrially developing countries.

Predictive Factors for Severe Maternal Morbidity in Brazil: A Case-Control Study.

The maternal mortality or "maternal near miss" ratio in Brazil reflects the socioeconomic indicators as well as the healthcare quality in some areas of this country, pointing out fragile points in the health services. The aim of this study was to estimate the association of diverse variables related to pregnancy and the occurrence of Near Miss in a population of women who were cared in public maternity wards in Brazil. A case-control study was performed. The association between variables and outcomes was verified through a chi-square test. A multiple analysis was carried out, producing odds ratio (OR) estimates with values of p≤0.25 in the univariate model. The results point to the following risk factors for Severe Maternal Morbidity: non-white (<0.001, OR 2.973), family income of up to two minimum wage salaries (<0.001; OR 2.159), not having a partner (<0.001, OR 2.694), obesity (<0.001, OR 20.852), not having received pre-natal care (<0.001, OR 2.843), going to less than six prenatal appointments (<0.001, OR 3.498), undergoing an inter-hospital transfer (<0.001, OR 24.655), and the absence of labor during admission (<0.001, OR 25.205). Although the results vary, the incidence of women with potential life-threatening complications is high in Brazil, which reinforces the need to universalize more complex interventions as well as coverage of primary care. The presence of precarious socio-economic indicators and unqualified obstetric care were risk factors for Severe Maternal Morbidity.

Effects of the COVID-19 Pandemic on Mental Health in Peru: Psychological Distress.

This pandemic has been classified as a "psychological pandemic" that produces anxiety, depression, post-traumatic stress disorder, and sleep disorders. As the mental health effects of the Coronavirus Disease 2019 (COVID-19), caused by SARS-CoV-2, continue to unfold, there are still large knowledge gaps about the variables that predispose individuals to, or protect individuals against the disease. However, there are few publications on the effects of the COVID-19 pandemic on the mental health of citizens in Latin American countries. In this study, the effects that COVID-19 had on citizens of Peru have been described. For this, 1699 questionnaires, collected between 2 April and 2 September 2020, were analyzed. Descriptive, bivariate analysis was performed with odds ratio (OR) calculations and a data mining methodology. Sociodemographic variables (from the General Health Questionnaire), health conditions and perception, symptoms, and variables related to contact and preventive measures regarding COVID-19 were analyzed. As compared to other countries, less affectation of mental health and increased use of preventive measures were observed. It has been suggested that the country's precarious health system and poverty rates prior to the pandemic may justify higher mortality figures in Peru than in other Latin American countries, despite prompt action for its containment and compliance with the protective measures. Psychological distress had a greater incidence in women, young people, people without a partner, and people without university studies. The most significant conditioning variables were self-perceived health status, headache or muscle pain over the past 14 days, level of studies, and age. The extensive use of preventive measures against COVID-19 is in line with the strict legislative measures taken, and this is, in turn, in line with other countries when looking at the lower effect on mental health, but contrary when focusing on the high lethality identified. The need to include the economy or availability and quality of healthcare in future studies arises, as well as the suitability to analyze the cause for differences between countries.

Information on COVID-19 and Psychological Distress in a Sample of Non-Health Workers during the Pandemic Period.

Methods by which the population should be informed when going through a pandemic such as COVID-19 have been questioned because of its influence on the adoption of preventive measures and its effects on mental health. Non-health workers are at risk of psychological distress from exposure to contaminated people or materials or by having to stay at home and adapt their activity to telework. The objective of the study is to analyze information the public receives about COVID-19 and its influence on their level of distress. For this, 1089 questionnaires from non-health workers were collected online between 26 March and 26 April 2020 in Spain, and analysed and distributed by snowball effect. 492 participants carried out essential activities away from home, and 597 did so from home. They were surveyed about information received about COVID-19 regarding its source, time, assessment, or the beliefs expressed in it. Mental health was also measured with Goldberg's General Health Questionnaire (GHQ-12). The classification and regression tree (CART) method was used to design a binary tree with sample cases. It has been found that the time spent learning about COVID-19 and the level of knowledge about symptoms, pathways, prevention, treatment, or prognosis are associated with the level of distress, where 25% of participants were found to have spent more than 3 h daily on this activity. Social media and television are the most widely used sources, but they are considered to be of lower quality and usefulness than official sources. There is greater confidence in healthcare professionals than in the health system, and the main concern of those working away from home is spreading the virus to family members. It has been concluded that there is a need to enhance quality and truthful information on the Internet for non-health workers due to its accessibility, which should be constantly updated, a fact which international and national public bodies, research centers, and journal publishers have begun to understand during the current pandemic. Such quality information is needed to combat distress.

Violence against women: what happens when the Women's Protection Police Station is closed? / Violência contra a mulher: o que acontece quando a Delegacia de Defesa da Mulher está fechada?

The study analyzes the differences among cases of violence against women registered in police reports (PR) at the Women's Protection Police Station (WPPS) during regular working hours, and those registered during after-hours, in a medium-sized city in the inland state of São Paulo, Brazil. This is a cross-sectional study based on data from PRs registered for one year (2013/2014). PRs were differentiated by period of registration, at regular working hours and after-hours (dependent variable). A chi-square test was used to compare groups. In total, 440 PRs were registered, 373 during regular working hours, and 67 during after-hours. Cases of violence registered during after-hours evidenced more significant threats to women's integrity, as shown by the higher number of cases of perpetrators' flagrante delicto, requests for protective measures and greater severity of assaults, such as bruises, need for hospitalization and referral to forensic medicine (IML), which characterize the greater severity of occurrences when WPPS are closed. Thus, women lack a specialized reception service and a full guarantee of rights in periods of highest risk and vulnerability.

Este estudo analisa as diferenças entre os casos de violência contra a mulher, formalizados em boletins de ocorrência (BO) na Delegacia de Defesa da Mulher (DDM), durante a rotina dos formalizados nas Delegacias Civis durante os plantões policiais, em um município de médio porte do interior paulista. Trata-se de um estudo transversal, com base nos BOs realizados no período de um ano (2013/2014). As ocorrências foram diferenciadas conforme o período em que foram lavrados os BOs, na rotina ou nos plantões, sendo este último tomado como variável dependente. As comparações entre os grupos foram realizadas pelo teste χ2. Foram registrados 440 boletins, sendo 373 na rotina e 67 no plantão. As ocorrências realizadas nos plantões apresentaram maior ameaça à integridade da mulher com um maior número de flagrantes do agressor, solicitação de medidas protetivas e gravidade das agressões, como hematomas, hospitalização e encaminhamento ao IML; caracterizando maior gravidade das ocorrências no período em que a DDM está fechada. Deste modo, falta às mulheres um serviço especializado de acolhimento e ampla garantia de direitos nos períodos de maior risco e vulnerabilidade.

Predictors of return to work with and without restrictions in public workers.

BACKGROUND: Sick leaves are important events for both the worker and the employer. Many factors are related with sick leaves and depending on the factors the worker could perform a successful return to work. In this sense, the objective of this study is to identify those factors associated with return to work after sick leaves in a group of public workers in Brazil. METHODS: A case-control study of return to work after sick leaves in a university campus from 2010 to 2015. Logistic regression models were adjusted for two different response variables: return to work with and without restrictions. A digital database was created and completed with data from manual sources. RESULTS: A computerised database has been created, based on manual records, which has allowed us to identify labour and non-labour factors associated with the return to work after a sick leave and the possible functional readaptation, with or without restrictions, in public workers. Age at the beginning of the process, number of sick leaves, those of more than 16 days, average duration (total time of sick leaves / number of medical records), and mid-level healthcare positions were associated with return to work without restrictions. In the model of return to work with restrictions, the age of hiring by the university, the number of sick leaves, those of more than 16 days, and mid-level healthcare positions, both rural work and operational positions, were associated to the response variable. CONCLUSIONS: This study has allowed us to identify the factors associated with the return to work after a period of sick leave in a large group of public workers. However, more research is needed on the mental disorders that cause sick leaves, their evaluation and the handling of these situations.

Assessment and indicators of kinematic behavior and perceived fatigability

SUMMARY OBJECTIVE: The objective of this study was to investigate the relationship between upper limb kinetics and perceived fatigability in elderly individuals during an upper limb position sustained isometric task. METHODS: A total of 31 elderly participants, 16 men (72.94±4.49 years) and 15 women (72.27±6.05 years), performed a upper limb position sustained isometric task. Upper-limb acceleration was measured using an inertial measurement unit. Perceived fatigability was measured using the Borg CR10 scale. RESULTS: Higher mean acceleration in the x-axis throughout the activity was associated with higher final perceived fatigability scores. Moderate correlations were observed between perceived fatigability variation and mean acceleration cutoffs in all axes during the second half of the activity. In women, significant correlations were found between all perceived fatigability cutoffs and mean acceleration in the y- and x-axes. However, in men, the relationships between perceived fatigability variation and mean acceleration were more extensive and stronger. CONCLUSION: The acceleration pattern of the upper limb is linked to perceived fatigability scores and variation, with differences between sexes. Monitoring upper limb acceleration using a single inertial measurement unit can be a useful and straightforward method for identifying individuals who may be at risk of experiencing high perceived fatigability or task failure.

Factors Affecting Sick Leave Duration for Non-Work-Related Temporary Disabilities in Brazilian University Public Servants.

Sickness absenteeism in public institutions compromises the execution of services, and may also generate direct impacts on the population that receives coverage. To determine if sick leave duration for temporary disabilities is associated with non-work-related illnesses (NWRI), a historical cohort study was carried out of workers at a Brazilian University. The Charlson Comorbidity Index (CCI) was obtained from the most prevalent diagnoses in each expert examination and from the corresponding days of sick leave per episode, adjusting simple and multiple Cox regression models. As a result, 70% of the NWRI temporary disabilities were due to depressive disorders, convalescence, and dorsalgia with a sick leave duration between 4 and 320 days. The factors of protection for sick leave durations until the rehabilitation were non-insulin-dependent diabetes mellitus and hypertension. Long-term sick leaves were observed in the cases that required rehabilitation of those workers diagnosed with recurrent depressive disorders, conjunctivitis, acute sinusitis, skin disorders, calculus of kidney and ureter, abdominal and pelvic pain, and same-level fall accidents. It is also worth noting that even in a disease that can justify long-term sick leaves, such as breast cancer, the duration may be shorter according to the worker's capacity and self-efficacy.