The association between body mass index status and sick leave and the role of emotional exhaustion-a mediation analysis among a representative sample of dutch employees.

OBJECTIVE: To investigate the associations between body mass index (BMI) and sick leave, and the mediating role of emotional exhaustion. METHODS: Data were collected from a large survey among Dutch employees (n = 35,022). The causal pathway approach consisting of four regression analyses was applied. RESULTS: In women, moderate overweight and obesity were associated with higher sick leave; in men, obesity, but not moderate overweight, was associated with higher sick leave. Obese workers were at increased risk for emotional exhaustion. Emotional exhaustion was also associated with higher sick leave rates. Adjustment for emotional exhaustion in the association between BMI and sick leave hardly changed the effect size and significance remained. CONCLUSIONS: The association between BMI status and sick leave can be explained partially by the presence of emotional exhaustion. Workplace health promotion initiatives should take this into account.

Adherence to guidelines and protocols in the prehospital and emergency care setting: a systematic review.

A gap between guidelines or protocols and clinical practice often exists, which may result in patients not receiving appropriate care. Therefore, the objectives of this systematic review were (1) to give an overview of professionals' adherence to (inter)national guidelines and protocols in the emergency medical dispatch, prehospital and emergency department (ED) settings, and (2) to explore which factors influencing adherence were described in studies reporting on adherence. PubMed (including MEDLINE), CINAHL, EMBASE and the Cochrane database for systematic reviews were systematically searched. Reference lists of included studies were also searched for eligible studies. Identified articles were screened on title, abstract and year of publication (≥1990) and were included when reporting on adherence in the eligible settings. Following the initial selection, articles were screened full text and included if they concerned adherence to a (inter)national guideline or protocol, and if the time interval between data collection and publication date was <10 years. Finally, articles were assessed on reporting quality. Each step was undertaken by two independent researchers. Thirty-five articles met the criteria, none of these addressed the emergency medical dispatch setting or protocols. Median adherence ranged from 7.8-95% in the prehospital setting, and from 0-98% in the ED setting. In the prehospital setting, recommendations on monitoring came with higher median adherence percentages than treatment recommendations. For both settings, cardiology treatment recommendations came with relatively low median adherence percentages. Eight studies identified patient and organisational factors influencing adherence. The results showed that professionals' adherence to (inter)national prehospital and emergency department guidelines shows a wide variation, while adherence in the emergency medical dispatch setting is not reported. As insight in influencing factors for adherence in the emergency care settings is minimal, future research should identify such factors to allow the development of strategies to improve adherence and thus improve quality of care.