Safely Returning America to Work: Part I: General Guidance for Employers.

: Businesses are struggling to re-open as the world continues to deal with the coronavirus 2019 (COVID-19) pandemic. The reopening of businesses will require employers to implement safe return-to-work strategies through evaluation, testing, work modifications, and development of appropriate workplace policies. There will be unique challenges along the way as no one approach will be ideal for all workplaces and industries. This document is intended to provide return-to-work guidance for both employers and the occupational and environmental medicine physicians who will be supporting businesses in implementing safe return-to-work strategies.

Building Bridges to Integrate Care (BRIDGES): Incubating Health Service Innovation across the Continuum of Care for Patients with Multiple Chronic Conditions.

Integrating care for people with complex needs is challenging. Indeed, evidence of solutions is mixed, and therefore, well-designed, shared evaluation approaches are needed to create cumulative learning. The Toronto-based Building Bridges to Integrate Care (BRIDGES) collaborative provided resources to refine and test nine new models linking primary, hospital and community care. It used mixed methods, a cross-project meta-evaluation and shared outcome measures. Given the range of skills required to develop effective interventions, a novel incubator was used to test and spread opportunities for system integration that included operational expertise and support for evaluation and process improvement.

Capturing the experiences of patients across multiple complex interventions: a meta-qualitative approach.

OBJECTIVES: The perspectives, needs and preferences of individuals with complex health and social needs can be overlooked in the design of healthcare interventions. This study was designed to provide new insights on patient perspectives drawing from the qualitative evaluation of 5 complex healthcare interventions. SETTING: Patients and their caregivers were recruited from 5 interventions based in primary, hospital and community care in Ontario, Canada. PARTICIPANTS: We included 62 interviews from 44 patients and 18 non-clinical caregivers. INTERVENTION: Our team analysed the transcripts from 5 distinct projects. This approach to qualitative meta-evaluation identifies common issues described by a diverse group of patients, therefore providing potential insights into systems issues. OUTCOME MEASURES: This study is a secondary analysis of qualitative data; therefore, no outcome measures were identified. RESULTS: We identified 5 broad themes that capture the patients' experience and highlight issues that might not be adequately addressed in complex interventions. In our study, we found that: (1) the emergency department is the unavoidable point of care; (2) patients and caregivers are part of complex and variable family systems; (3) non-medical issues mediate patients' experiences of health and healthcare delivery; (4) the unanticipated consequences of complex healthcare interventions are often the most valuable; and (5) patient experiences are shaped by the healthcare discourses on medically complex patients. CONCLUSIONS: Our findings suggest that key assumptions about patients that inform intervention design need to be made explicit in order to build capacity to better understand and support patients with multiple chronic diseases. Across many health systems internationally, multiple models are being implemented simultaneously that may have shared features and target similar patients, and a qualitative meta-evaluation approach, thus offers an opportunity for cumulative learning at a system level in addition to informing intervention design and modification.

Prevalence, clinical characteristics and treatment patterns of low high-density lipoprotein cholesterol in the US population: National Health and Nutrition Examination Survey 2005-2008.

AIMS: The aims of this study were to estimate the prevalence of low high-density lipoprotein cholesterol (HDL-C) in US adults, assess the association between low HDL-C levels and clinical characteristics, and quantify the utilization of dyslipidemic agents as it relates to the distribution of HDL-C. METHODS: We analyzed a sample of 4129 adults (>20 years) who underwent fasting blood evaluations in the National Health and Nutrition Examination Survey (NHANES) 2005-2008. Sex-specific crude and adjusted logistic models were developed to evaluate the association between individual characteristics and low HDL-C, in which low HDL-C was defined as less than 40  mg/dl for men and less than 50  mg/dl for women. RESULTS: Approximately 24% of men and 27% of women had low HDL-C levels. Factors most strongly associated with low HDL-C levels for men included being obese [odds ratio (OR) = 3.27, 95% confidence interval (CI): 1.98-5.40], having elevated triglyceride levels (>200  mg/dl: OR = 8.17, 95% CI: 5.54-12.03) and having apolipoprotein B levels more than 117  mg/dl (OR = 5.99, 95% CI: 2.74-13.13). The same factors were associated with low HDL-C levels among women: being obese (OR = 2.89, 95% CI: 1.78-4.71), having elevated triglyceride levels (>200  mg/dl: OR = 13.35, 95% CI: 7.49-23.77) and having apolipoprotein B levels more than 117  mg/dl (OR = 5.88, 95% CI: 2.29-15.11). Approximately 82% of men and 79% of women with low HDL-C levels reported not using any dyslipidemic medication. CONCLUSION: Although having low HDL-C was common among US adults, few reported taking a dyslipidemic agent. Our study also confirmed some of the known risk factors associated with low HDL-C levels in the general US population.