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1.
Cancers (Basel) ; 12(10)2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-33003546

RESUMO

Recent studies have shown that the efficacy of PARP inhibitors in epithelial ovarian carcinoma (EOC) is related to tumor-specific defects in homologous recombination (HR) and extends beyond BRCA1/2 deficient EOC. A robust method with which to identify HR-deficient (HRD) carcinomas is therefore of utmost clinical importance. In this study, we investigated the proficiency of a functional HR assay based on the detection of RAD51 foci, the REcombination CAPacity (RECAP) test, in identifying HRD tumors in a cohort of prospectively collected epithelial ovarian carcinomas (EOCs). Of the 39 high-grade serous ovarian carcinomas (HGSOC), the RECAP test detected 26% (10/39) to be HRD, whereas ovarian carcinomas of other histologic subtypes (n = 10) were all HR-proficient (HRP). Of the HRD tumors that could be sequenced, 8/9 showed pathogenic BRCA1/2 variants or BRCA1 promoter hypermethylation, indicating that the RECAP test reliably identifies HRD, including but not limited to tumors related to BRCA1/2 deficiency. Furthermore, we found a trend towards better overall survival (OS) of HGSOC patients with RECAP-identified HRD tumors compared to patients with HRP tumors. This study shows that the RECAP test is an attractive alternative to DNA-based HRD tests, and further development of a clinical grade RECAP test is clearly warranted.

2.
Disabil Rehabil ; : 1-14, 2020 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-31957498

RESUMO

Purpose: To examine current practices of occupational health professionals in assessing significant others' cognitions and behavioral responses that may influence work outcomes of workers with a chronic disease.Methods: A survey study among occupational health professionals, focusing on the assessment of illness perceptions, work-related beliefs and expectations, and behavioral responses of significant others of workers with a chronic disease. We performed linear regression analyses to investigate which factors are related to occupational health professionals' assessment practices. We used thematic analysis to analyze qualitative data on occupational health professionals' reasons to assess or overlook significant others' cognitions and behavioral responses.Results: Our study sample included 192 occupational health professionals. Most seldom asked about significant others' cognitions and behavioral responses. Organizational norms and occupational health professionals' self-efficacy were related to reported assessment practices. Reasons to assess significant others' cognitions and behavioral responses included recognizing their influence on work participation, and occurrence of stagnation. However, occupational health professionals indicated some doubt whether such assessment would always contribute to better care.Conclusions: It is not common practice for occupational health professionals to assess significant others' cognitions and behavioral responses, although they recognize the influence of these factors on work outcomes. More research is needed as to how occupational health professionals can best address the role of significant others, and apply these new insights in their daily practice.Implications for rehabilitationMost occupational health professionals do not commonly ask about significant others' cognitions and behavioral responses despite the possible influence of these factors on work outcomes.Occupational health professionals may be able to better support workers with a chronic disease by paying more attention to the influence of significant others.Aside from asking about practical support, occupational health professionals should consider asking about significant others' illness perceptions, work-related beliefs and expectations, and other behavioral responses.

3.
BMJ Open ; 9(1): e021742, 2019 01 21.
Artigo em Inglês | MEDLINE | ID: mdl-30670501

RESUMO

OBJECTIVE: It is widely recognised that significant others (SOs), such as a partner, family member or friend, can influence health outcomes of individuals with a chronic disease. However, not much is known about which specific cognitions (ie, illness perceptions and expectation of work ability) and behaviours (eg, emotional and practical support) of SOs influence work participation. Therefore, we aimed to identify cognitions and behaviours of SOs that are related to work participation of individuals with a chronic disease. DESIGN: A systematic review and thematic synthesis. DATA SOURCES: PubMed, Embase, PsycINFO, SocINDEX and Web of Science were searched until 28 March 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: We included studies reporting on cognitions and behaviours of SOs related to work participation in populations with various chronic diseases. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted the data and performed a quality assessment using the Quality Assessment Tool for Quantitative Studies from the Effective Public Health Practice Project 2007 and a checklist for assessment of qualitative studies derived from the Cochrane Supplemental Handbook Guidance. Evidence was thematically synthesised. RESULTS: Out of 5168 articles, 18 were included (15 qualitative and 3 quantitative) of moderate to high quality. Studies were on cancer, chronic pain, brain injuries and mental health disorders. After thematic synthesis 27 factors could be distinguished. Consistent evidence was found that SOs' positive and encouraging attitudes regarding work participation, encouragement and motivating behaviour and open communication with patients are facilitators for work participation. Consistently reported barriers were SOs' positive attitudes towards sickness absence and advise, encouragement or pressure to refrain from work. CONCLUSIONS: Our findings show that several cognitions and behaviours of SOs can facilitate or hinder work participation of individuals with a chronic disease. Intervening on these factors by involving SOs in disability prevention and return to work intervention strategies may be beneficial. More prognostic studies are needed, as the current evidence is mostly based on qualitative studies.


Assuntos
Atitude Frente a Saúde , Doença Crônica/psicologia , Emprego/psicologia , Relações Interpessoais , Cônjuges/psicologia , Cuidadores , Família , Humanos , Pesquisa Qualitativa
4.
Arch Toxicol ; 91(5): 2093-2105, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-27738743

RESUMO

Differentiated human bronchial epithelial cells in air liquid interface cultures (ALI-PBEC) represent a promising alternative for inhalation studies with rodents as these 3D airway epithelial tissue cultures recapitulate the human airway in multiple aspects, including morphology, cell type composition, gene expression and xenobiotic metabolism. We performed a detailed longitudinal gene expression analysis during the differentiation of submerged primary human bronchial epithelial cells into ALI-PBEC to assess the reproducibility and inter-individual variability of changes in transcriptional activity during this process. We generated ALI-PBEC cultures from four donors and focussed our analysis on the expression levels of 362 genes involved in biotransformation, which are of primary importance for toxicological studies. Expression of various of these genes (e.g., GSTA1, ADH1C, ALDH1A1, CYP2B6, CYP2F1, CYP4B1, CYP4X1 and CYP4Z1) was elevated following the mucociliary differentiation of airway epithelial cells into a pseudo-stratified epithelial layer. Although a substantial number of genes were differentially expressed between donors, the differences in fold changes were generally small. Metabolic activity measurements applying a variety of different cytochrome p450 substrates indicated that epithelial cultures at the early stages of differentiation are incapable of biotransformation. In contrast, mature ALI-PBEC cultures were proficient in the metabolic conversion of a variety of substrates albeit with considerable variation between donors. In summary, our data indicate a distinct increase in biotransformation capacity during differentiation of PBECs at the air-liquid interface and that the generation of biotransformation competent ALI-PBEC cultures is a reproducible process with little variability between cultures derived from four different donors.


Assuntos
Brônquios/citologia , Células Epiteliais/efeitos dos fármacos , Regulação da Expressão Gênica/efeitos dos fármacos , Xenobióticos/farmacocinética , Benzo(a)Antracenos/farmacocinética , Benzo(a)pireno/farmacocinética , Biotransformação/genética , Técnicas de Cultura de Células/métodos , Diferenciação Celular/efeitos dos fármacos , Citocromos/genética , Citocromos/metabolismo , Enzimas/genética , Células Epiteliais/metabolismo , Humanos , Dibenzodioxinas Policloradas/farmacocinética , Reprodutibilidade dos Testes , Xenobióticos/metabolismo
5.
J Occup Rehabil ; 26(1): 70-9, 2016 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-26094030

RESUMO

PURPOSE: Only a limited number of studies have investigated return to work of sick-listed workers with mental health problems, and more knowledge is needed about the influence of non-disorder-related factors. This study aimed to identify longitudinal associations between demographic, personality, disorder-related and work-related characteristics and sustainable return to work of sicklisted workers with a depressive or anxiety disorder. METHODS: We used data of a large Dutch cohort study to prospectively study longitudinal associations between biopsychosocial factors and sustainable return to work in 2 years. Associations were studied by means of univariable and multivariable logistic regression analysis. Participants who were sick-listed at baseline and had a lifetime diagnosis of a depressive and/or anxiety disorder were included in this study (N = 215). RESULTS: In 2 years, 51.6% of the participants returned to work sustainably. Age, household income, extraversion, employment status, skill discretion and job security were significantly (P B 0.05) associated with sustainable RTW in 2 years in the univariable analyses. The multivariable analysis revealed significant associations between sustainable return to work and age (OR per 10 years = 0.67; 95% CI 0.47­0.95), household income (OR per 100 Euro's a month = 1.04; 95% CI 1.00­1.08) and being on sickness benefit versus being (self-)employed (OR 0.39; 95% CI 0.20­0.77). CONCLUSIONS: In the long-run not disorder-related factors, but an older age, the absence of a job and a low household income seem to complicate return to work. Policy and research should focus on facilitators and barriers for return to work of workers with these characteristics.


Assuntos
Transtornos de Ansiedade/reabilitação , Transtorno Depressivo/reabilitação , Retorno ao Trabalho , Licença Médica , Adolescente , Adulto , Fatores Etários , Idoso , Estudos de Coortes , Emprego , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Países Baixos , Personalidade , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
6.
BMC Cancer ; 15: 63, 2015 Feb 18.
Artigo em Inglês | MEDLINE | ID: mdl-25886150

RESUMO

BACKGROUND: Despite long-term or permanent health problems, cancer survivors are often motivated to return to work. For cancer survivors who have lost their job, return to work can be more challenging compared to employed survivors, as they generally find themselves in a more vulnerable social and financial position. Cancer survivors with job loss may therefore be in need of tailored return to work support. However, there is a lack of return to work intervention programs specifically targeting these cancer survivors. The number of cancer survivors with job loss in developed countries is rising due to, amongst others, increases in the incidence and survivor rate of cancer, the retirement age and the proportion of flexible employment contracts. Hence, we consider it important to develop a tailored return to work intervention program for cancer survivors with job loss, and to evaluate its effectiveness compared to usual care. METHODS/DESIGN: This study employs a two-armed randomised controlled trial with a follow-up period of 12 months. The study population (n = 164) will be recruited from a national sample of cancer survivors (18-60 years), who have been sick-listed for 12-36 months. Participants will be randomised by using computerized blocked randomisation (blocks of four). All participants will receive usual care as provided by the Dutch Social Security Agency. Additionally, participants in the intervention group will receive a tailored return to work intervention program, which includes vocational rehabilitation and supportive psychosocial components, as well as (therapeutic) placement at work. The primary outcome measure is duration until sustainable return to work; the secondary outcome measure is rate of return to work. Other parameters include, amongst others, fatigue, coping strategy and quality of life. We will perform Cox regression analyses to estimate hazard ratios for time to sustainable return to work. DISCUSSION: The hypothesis of this study is that a tailored approach for cancer survivors with job loss is more effective, regarding return to work, compared to usual care. The results of this study will provide insight into the ways in which return to work can be facilitated for cancer survivors with job loss. TRIAL REGISTRATION: Netherlands Trial Register: NTR3562 .


Assuntos
Neoplasias/psicologia , Neoplasias/reabilitação , Reabilitação Vocacional/métodos , Sobreviventes/psicologia , Adolescente , Adulto , Análise Custo-Benefício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/economia , Países Baixos , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida , Retorno ao Trabalho/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Adulto Jovem
7.
BMC Public Health ; 14: 594, 2014 Jun 12.
Artigo em Inglês | MEDLINE | ID: mdl-24919561

RESUMO

BACKGROUND: Workers without a permanent employment contract represent a vulnerable group within the working population. Mental disorders are a major cause of sickness absence within this group. Common mental disorders are stress-related, depressive and anxiety disorders. To date, little attention has been paid to effective return to work interventions for this type of sick-listed workers. Therefore, a participatory supportive return to work program has been developed. It combines elements of a participatory return to work program, integrated care and direct placement in a competitive job.The objective of this paper is to describe the design of a randomised controlled trial to evaluate the cost-effectiveness of this program compared to care as usual. METHODS/DESIGN: The cost-effectiveness of the participatory supportive return to work program will be examined in a randomised controlled trial with a follow-up of twelve months.The program strongly involves the sick-listed worker in the identification of obstacles for return to work and possible solutions, resulting in a consensus based action plan. This plan will be used as a starting point for the search of suitable competitive employment with support of a rehabilitation agency. During this process the insurance physician of the sick-listed worker contacts other caregivers to promote integrated care.Workers eligible to participate in this study have no permanent employment contract, have applied for a sickness benefit at the Dutch Social Security Agency and are sick-listed between two and fourteen weeks due to mental health problems.The primary outcome measure is the duration until first sustainable return to work in a competitive job. Outcomes are measured at baseline and after three, six, nine and twelve months. DISCUSSION: If the participatory supportive return to work program proves to be cost-effective, the social security system, the sick-listed worker and society as a whole will benefit. A cost-effective return to work program will lead to a reduction of costs related to sickness absence. For the sick-listed worker a cost-effective program results in earlier sustainable return to work, which can be associated with both social and health benefits. TRIAL REGISTRATION: The trial registration number and date is NTR3563, August 7, 2012.


Assuntos
Transtornos Mentais/reabilitação , Retorno ao Trabalho/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Adolescente , Adulto , Análise Custo-Benefício , Emprego/economia , Feminino , Humanos , Masculino , Transtornos Mentais/economia , Pessoa de Meia-Idade , Países Baixos , Serviços de Saúde do Trabalhador/economia , Avaliação de Programas e Projetos de Saúde , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Inquéritos e Questionários
8.
Scand J Work Environ Health ; 39(1): 46-56, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22854773

RESUMO

OBJECTIVES: The aim of the study was to evaluate the cost-effectiveness, -utility, and -benefit of a newly developed participatory return-to-work (RTW) program for temporary agency and unemployed workers, sick-listed due to musculoskeletal disorders. METHODS: An economic evaluation was conducted alongside a randomized controlled trial with a 12-month follow-up. Temporary agency and unemployed workers, sick-listed for 2â€"8 weeks due to musculoskeletal disorders, were randomized to the participatory RTW program (N=79) or usual care group (N=84). The new RTW program was aimed at making a consensus-based RTW action plan with the possibility of a temporary (therapeutic) workplace. Effect outcomes were sustainable RTW and quality-adjusted life years (QALY). Healthcare utilization was measured from the social insurer’s perspective and societal perspective. RESULTS: Total healthcare costs in the participatory RTW program group [10 189 (standard deviation [SD] 7055) euros] were statistically significantly higher compared to care-as-usual [7862 (SD 7394) euros]. The cost-effectiveness analyses showed that the new intervention was more effective but also more costly than usual care (ie, to gain RTW one day earlier in the participatory RTW program group approximately 80 euros needed to be invested). The net societal benefit of the participatory RTW program compared to care-as-usual was 2073 euros per worker. CONCLUSIONS: The newly developed participatory RTW program was more effective but also more costly than usual care. The program enhanced work resumption and generated a net socioeconomic benefit. Hence, implementation of the participatory RTW program may have potential to achieve a sustainable contribution of vulnerable workers to the labor force.


Assuntos
Doenças Musculoesqueléticas/economia , Doenças Profissionais/economia , Retorno ao Trabalho/economia , Licença Médica/economia , Adolescente , Adulto , Custos e Análise de Custo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional , Anos de Vida Ajustados por Qualidade de Vida , Adulto Jovem
9.
Radiat Res ; 177(5): 602-13, 2012 May.
Artigo em Inglês | MEDLINE | ID: mdl-22468706

RESUMO

The recent steep increase in population dose from radiation-based medical diagnostics, such as computed tomography (CT) scans, requires insight into human health risks, especially in terms of cancer development. Since the induction of genetic damage is considered a prominent cause underlying the carcinogenic potential of ionizing radiation, we quantified the induction of micronuclei and loss of heterozygosity events in human cells after exposure to clinically relevant low doses of X rays. A linear dose-response relationship for induction of micronuclei was observed in human fibroblasts with significantly increased frequencies at doses as low as 20 mGy. Strikingly, cells exposed during S-phase displayed the highest induction, whereas non S-phase cells showed no significant induction below 100 mGy. Similarly, the induction of loss of heterozygosity in human lymphoblastoid cells quantified at HLA loci, was linear with dose and reached significance at 50 mGy. Together the findings favor a linear-no-threshold model for genetic damage induced by acute exposure to ionizing radiation. We speculate that the higher radiosensitivity of S-phase cells might relate to the excessive cancer risk observed in highly proliferative tissues in radiation exposed organisms.


Assuntos
Aberrações Cromossômicas , Cromossomos Humanos/efeitos da radiação , Linfócitos/efeitos da radiação , Raios X/efeitos adversos , Divisão Celular/efeitos da radiação , Células Cultivadas/efeitos da radiação , Células Cultivadas/ultraestrutura , Relação Dose-Resposta à Radiação , Fibroblastos/efeitos da radiação , Fibroblastos/ultraestrutura , Genes MHC Classe I/efeitos da radiação , Humanos , Perda de Heterozigosidade , Linfócitos/ultraestrutura , Testes para Micronúcleos , Tolerância a Radiação , Radiografia , Reprodutibilidade dos Testes , Fase S/efeitos da radiação
10.
J Occup Rehabil ; 22(1): 127-40, 2012 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21656252

RESUMO

INTRODUCTION: Beside (cost-)effectiveness, the feasibility of an intervention is important for successful implementation in daily practice. This study concerns the process evaluation of a newly developed participatory return-to-work (RTW) program for workers without an employment contract, sick-listed due to musculoskeletal disorders. The program consisted of a stepwise process, guided by an independent RTW coordinator, aimed at making a consensus-based RTW plan with the possibility of a temporary (therapeutic) workplace. The aims of this study were to describe the reach and extent of implementation of the new program, the satisfaction and experiences of all stakeholders, and the perceived barriers and facilitators for implementation of the program in daily practice. METHODS: Temporary agency workers and unemployed workers, sick-listed for 2-8 weeks due to musculoskeletal disorders were eligible for this study. Data were collected from the workers; their insurance physicians and labour experts at the Dutch Social Security Agency; RTW coordinators; and case managers from participating vocational rehabilitation agencies. Data collection took place using professionals' reports, standardized matrices, questionnaires at baseline and at 3-month follow-up, and group interviews with the professionals. RESULTS: Of the 79 workers who were allocated to the participatory RTW program group, 72 workers actually started with the intervention. Overall, implementation of the program was performed according to protocol. However, offering of suitable temporary workplaces was delayed with 44.5 days. Results showed satisfaction with the RTW coordinator among the workers and three quarters of the labour experts experienced a minor or major contribution of the presence of the RTW coordinator. Several barriers for implementation were identified, such as the administrative time-investment, unclear information about the program, no timely offering of temporary (therapeutic) workplaces, and the need for additional support in case of complex health problems. CONCLUSIONS: This study indicates overall feasibility for implementation of the participatory RTW program in daily practice. However, to overcome important barriers, more attention should be paid to improve timely offering of suitable temporary workplaces, to describe more clearly the program goals and the professional's roles, and to offer additional support for workers suffering from complex multi-causal health problems. TRIAL REGISTRATION: NTR1047.


Assuntos
Emprego , Doenças Musculoesqueléticas/reabilitação , Serviços de Saúde do Trabalhador/organização & administração , Reabilitação Vocacional/economia , Licença Médica/economia , Desemprego , Adolescente , Adulto , Serviços Contratados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/economia , Países Baixos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Reabilitação Vocacional/métodos , Licença Médica/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , Resultado do Tratamento , Avaliação da Capacidade de Trabalho , Adulto Jovem
11.
J Occup Rehabil ; 21(3): 313-24, 2011 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-21336673

RESUMO

INTRODUCTION: Within the labour force workers without an employment contract represent a vulnerable group. In most cases, when sick-listed, these workers have no workplace/employer to return to. Therefore, the aim of this study was to evaluate the effectiveness on return-to-work of a participatory return-to-work program compared to usual care for unemployed workers and temporary agency workers, sick-listed due to musculoskeletal disorders. METHODS: The workers, sick-listed for 2-8 weeks due to musculoskeletal disorders, were randomly allocated to the participatory return-to-work program (n = 79) or to usual care (n = 84). The new program is a stepwise procedure aimed at making a consensus-based return-to-work plan, with the possibility of a temporary (therapeutic) workplace. Outcomes were measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure was time to sustainable first return-to-work. Secondary outcome measures were duration of sickness benefit, functional status, pain intensity, and perceived health. RESULTS: The median duration until sustainable first return-to-work was 161 days in the intervention group, compared to 299 days in the usual care group. The new return-to-work program resulted in a non-significant delay in RTW during the first 90 days, followed by a significant advantage in RTW rate after 90 days (hazard ratio of 2.24 [95% confidence interval 1.28-3.94] P = 0.005). No significant differences were found for the measured secondary outcomes. CONCLUSIONS: The newly developed participatory return-to-work program seems to be a promising intervention to facilitate work resumption and reduce work disability among temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders.


Assuntos
Emprego , Doenças Musculoesqueléticas/reabilitação , Serviços de Saúde do Trabalhador , Encaminhamento e Consulta , Licença Médica , Adulto , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Países Baixos , Participação do Paciente , Avaliação de Programas e Projetos de Saúde , Modelos de Riscos Proporcionais , Fatores de Tempo , Resultado do Tratamento , Avaliação da Capacidade de Trabalho
12.
BMC Musculoskelet Disord ; 11: 60, 2010 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-20346183

RESUMO

BACKGROUND: Within the working population there is a vulnerable group: workers without an employment contract and workers with a flexible labour market arrangement, e.g. temporary agency workers. In most cases, when sick-listed, these workers have no workplace/employer to return to. Also, for these workers access to occupational health care is limited or even absent in many countries. For this vulnerable working population there is a need for tailor-made occupational health care, including the presence of an actual return-to-work perspective. Therefore, a participatory return-to-work program has been developed based on a successful return-to-work intervention for workers, sick-listed due to low back pain.The objective of this paper is to describe the design of a randomised controlled trial to study the (cost-)effectiveness of this newly developed participatory return-to-work program adapted for temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders, compared to usual care. METHODS/DESIGN: The design of this study is a randomised controlled trial with one year of follow-up. The study population consists of temporary agency workers and unemployed workers sick-listed between 2 and 8 weeks due to musculoskeletal disorders. The new return-to-work program is a stepwise program aimed at making a consensus-based return-to-work implementation plan with the possibility of a (therapeutic) workplace to return-to-work. Outcomes are measured at baseline, 3, 6, 9 and 12 months. The primary outcome measure is duration of the sickness benefit period after the first day of reporting sick. Secondary outcome measures are: time until first return-to-work, total number of days of sickness benefit during follow-up; functional status; intensity of musculoskeletal pain; pain coping; and attitude, social influence and self-efficacy determinants. Cost-benefit is evaluated from an insurer's perspective. A process evaluation is part of this study. DISCUSSION: For sick-listed workers without an employment contract there can be gained a lot by improving occupational health care, including return-to-work guidance, and by minimising the 'labour market handicap' by creating a return-to-work perspective. In addition, reduction of sickness absence and work disability, i.e. a reduction of disability claims, may result in substantial benefits for the Dutch Social Security System. TRIAL REGISTRATION NUMBER: NTR1047.


Assuntos
Ensaios Clínicos como Assunto/métodos , Análise Custo-Benefício/métodos , Doenças Musculoesqueléticas/reabilitação , Serviços de Saúde do Trabalhador/métodos , Reabilitação Vocacional/métodos , Licença Médica/legislação & jurisprudência , Adolescente , Adulto , Efeitos Psicossociais da Doença , Avaliação da Deficiência , Pessoas com Deficiência/reabilitação , Custos de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Seguro por Invalidez , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/economia , Programas Nacionais de Saúde/normas , Programas Nacionais de Saúde/tendências , Países Baixos , Doenças Profissionais/economia , Serviços de Saúde do Trabalhador/economia , Serviços de Saúde do Trabalhador/tendências , Avaliação de Resultados em Cuidados de Saúde/economia , Desenvolvimento de Programas/economia , Avaliação de Programas e Projetos de Saúde/economia , Reabilitação Vocacional/economia , Autoeficácia , Licença Médica/estatística & dados numéricos , Licença Médica/tendências , Resultado do Tratamento , Desemprego/estatística & dados numéricos , Desemprego/tendências , Avaliação da Capacidade de Trabalho , Carga de Trabalho/economia , Adulto Jovem
13.
BMC Public Health ; 9: 216, 2009 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-19573229

RESUMO

BACKGROUND: In the past decade in activities aiming at return-to-work (RTW), there has been a growing awareness to change the focus from sickness and work disability to recovery and work ability. To date, this process in occupational health care (OHC) has mainly been directed towards employees. However, within the working population there are two vulnerable groups: temporary agency workers and unemployed workers, since they have no workplace/employer to return to, when sick-listed. For this group there is a need for tailored RTW strategies and interventions. Therefore, this paper aims to describe the structured and stepwise process of development, implementation and evaluation of a theory- and practise-based participatory RTW program for temporary agency workers and unemployed workers, sick-listed due to musculoskeletal disorders (MSD). This program is based on the already developed and cost-effective RTW program for employees, sick-listed due to low back pain. METHODS: The Intervention Mapping (IM) protocol was used to develop a tailor-made RTW program for temporary agency workers and unemployed workers, sick-listed due to MSD. The Attitude-Social influence-self-Efficacy (ASE) model was used as a theoretical framework for determinants of behaviour regarding RTW of the sick-listed worker and development of the intervention. To ensure participation and facilitate successful adoption and implementation, important stakeholders were involved in all steps of program development and implementation. Results of semi-structured interviews and 'fine-tuning' meetings were used to design the final participatory RTW program. RESULTS: A structured stepwise RTW program was developed, aimed at making a consensus-based RTW implementation plan. The new program starts with identifying obstacles for RTW, followed by a brainstorm session in which the sick-listed worker and the labour expert of the Social Security Agency (SSA) formulate solutions/possibilities for suitable (therapeutic) work. This process is guided by an independent RTW coordinator to achieve consensus. Based on the resulting RTW implementation plan, to create an actual RTW perspective, a vocational rehabilitation agency is assigned to find a matching (therapeutic) workplace. The cost-effectiveness of this participatory RTW program will be evaluated in a randomised controlled trial. CONCLUSION: IM is a promising tool for the development of tailor-made OHC interventions for the vulnerable working population.


Assuntos
Dor nas Costas/reabilitação , Emprego , Saúde do Trabalhador , Licença Médica , Desemprego , Dor nas Costas/fisiopatologia , Estudos de Coortes , Necessidades e Demandas de Serviços de Saúde , Humanos , Estudos Longitudinais , Países Baixos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde
14.
BMC Public Health ; 9: 232, 2009 Jul 14.
Artigo em Inglês | MEDLINE | ID: mdl-19602219

RESUMO

BACKGROUND: In the past decade flexible labour market arrangements have emerged as a significant change in the European Union labour market. Studies suggest that these new types of labour arrangements may be linked to ill health, an increased risk for work disability, and inadequate vocational rehabilitation. Therefore, the objectives of this study were: 1. to examine demographic characteristics of workers without an employment contract sick-listed for at least 13 weeks, 2. to describe the content and frequency of occupational health care (OHC) interventions for these sick-listed workers, and 3. to examine OHC interventions as possible determinants for return-to-work (RTW) of these workers. METHODS: A cohort of 1077 sick-listed workers without an employment contract were included at baseline, i.e. 13 weeks after reporting sick. Demographic variables were available at baseline. Measurement of cross-sectional data took place 4-6 months after inclusion. Primary outcome measures were: frequency of OHC interventions and RTW-rates. Measured confounding variables were: gender, age, type of worker (temporary agency worker, unemployed worker, or remaining worker without employment contract), level of education, reason for absenteeism (diagnosis), and perceived health. The association between OHC interventions and RTW was analysed with a logistic multiple regression analysis. RESULTS: At 7-9 months after the first day of reporting sick only 19% of the workers had (partially or completely) returned to work, and most workers perceived their health as fairly poor or poor. The most frequently reported (49%) intervention was 'the OHC professional discussed RTW'. However, the intervention 'OHC professional made and discussed a RTW action plan' was reported by only 19% of the respondents. The logistic multiple regression analysis showed a significant positive association between RTW and the interventions: 'OHC professional discussed RTW'; and 'OHC professional made and discussed a RTW action plan'. The intervention 'OHC professional referred sick-listed worker to a vocational rehabilitation agency' was significantly associated with no RTW. CONCLUSION: This is the first time that characteristics of a large cohort of sick-listed workers without an employment contract were examined. An experimental or prospective study is needed to explore the causal nature of the associations found between OHC interventions and RTW.


Assuntos
Serviços Contratados , Emprego , Licença Médica , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Inquéritos e Questionários
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