Episódio 1 - Semana Mundial de Aleitamento Materno (SMAM) - A legislação a favor da mulher trabalhadora que amamenta

Este episódio será dividido em duas partes e trará como tema a Semana Mundial de Aleitamento Materno (a SMAM). Ela é lembrada todos os anos entre 1º a 7 de agosto em mais de 170 países, sendo uma importante estratégia de promoção da amamentação, alinhada aos objetivos para o Desenvolvimento Sustentável da Organização Mundial de Saúde. No Brasil, desde 2017, o apoio à amamentação não se promove apenas durante a SMAM, e sim durante todo o mês de agosto, conhecido como Agosto Dourado, devido à cor que simbolizam padrão ouro de qualidade do leite humano.

Episódio 2 - Semana Mundial de Aleitamento Materno (SMAM) - Como as pessoas podem apoiar e a atuação do BLH do IFF/Fiocruz

A Semana Mundial de Aleitamento Materno (SMAM), celebrada de 1 a 7 de agosto, coloca anualmente em debate temas relevantes em prol da promoção, apoio e proteção ao aleitamento materno. “Possibilitando a amamentação: fazendo a diferença para mães e pais que trabalham” é o slogan deste ano. Embora a amamentação seja tradicionalmente considerada domínio da mãe, quando os pais, famílias e a sociedade a apoiam, as taxas aumentam. Diante disso, adotar uma abordagem inclusiva sobre o aleitamento materno que agregue pais, amigos, familiares, colegas de trabalho e comunidade é fundamental para criar um entorno propício, que permita que as mães amamentem de forma otimizada. Nesse contexto, convidamos a coordenadora da Assistência do Banco de Leite Humano do IFF/Fiocruz, Danielle Aparecida da Silva, para falar mais sobre o tema.

Temporary disability pension recipients: Contextual stress factors and their effect on return-to-work-intention.

BACKGROUND AND PURPOSE: In the last decades, Germany has experienced a vast increase in the number of individuals applying for or receiving disability benefit. Only a small proportion of them intends to return to work. The present study aims to identify and describe the percentage of temporary disability pensioners, who have the intention to return to working life. METHODS: The final sample consisted of 496 insured individuals who were receiving temporary disability pension from the Regional German Pension Insurance (DRV) at that time. Participation was voluntary and anonymous. The following self-report instruments were administered: a. Evaluation of Contextual Factors; b. German Symptom Validation Test (BEVA); c. German Patient Health Questionnaire (PHQ-9); d. Readiness for Return-to-Work German Scale (RRTW). RESULTS: The results revealed that approximately 6% of participants were at the stage of "preparation", 31.9% at the stage of "contemplation", and more than half of the participants were at the stage of "pre-contemplation" according to the RRTW. Comparing the groups of "pre-contemplation" (Group 1) and "contemplation+preparation" (Group 2+3), no statistically significant differences were found, except for age. CONCLUSIONS: In conclusion, further research is required to identify possible factors which could predict the stage of RRTW. New interventions are needed that can raise the motivation for and success in the return to work of disability pensioners.

A test-based strategy for early return to work for health-care workers with COVID-19 during the Omicron wave, Brunei Darussalam, 2022.

Objective: This paper summarizes and evaluates a test-based strategy for early return to work for health-care workers (HCWs) with mild coronavirus disease in Brunei Darussalam during the Omicron wave in February 2022 and compares the characteristics of HCWs by how long it took them to return to work. Methods: The early return-to-work strategy involved testing on day 3 of infection with reverse transcription-polymerase chain reaction and with a rapid antigen test on days 5 and 6 or days 5 and 7. Data about infected HCWs were extracted from the Ministry of Health's public health surveillance database. Percentages and proportions were used for descriptive statistics, and Pearson's χ2 test and the paired t-test were used to compare return-to-work patterns with demographic factors and vaccination status of the HCWs, as well as between cycle threshold (Ct) values and occupational groups of HCWs. Results: From 15 February to 15 March 2022, a total of 1121 HCWs were notified as being infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Of these, 175 (15.6%) were able to return to work on day 4 of their infection, 153 (13.6%) on day 6 and 268 (23.9%) on day 7; 525 (46.8%) required 10 days of home isolation. Statistically significant associations were observed between return-to-work periods and occupational group (P < 0.01) and Ct value (P < 0.01), but not between return to work and age, sex or vaccination status. Discussion: This test-based strategy ensured a balance between mitigating a shortage of HCWs and enabling them to return to work early without compromising their safety and that of their patients.

Quality of working life and adaptability of returning to work in nurse cancer survivors: a cross-sectional study.

OBJECTIVE: To explore the relationship between quality of working life (QWL) and adaptability of returning to work (RTW) among nurse cancer survivors (NCSs). METHOD: We conducted a cross-sectional study on nurses previously diagnosed with cancer. QWL was quantified using the Quality of Working Life Scale (QWL7-32), and the level of RTW adaptability was assessed using the Adaptability of Returning to Work for Cancer Survivors (ARTW-CS) scale. Multiple linear regression analysis was used to control for confounding factors, and a simple effect analysis was performed on the interaction term. RESULTS: After controlling for sociodemographic, work-related, and health-related factors, the findings indicated a significant correlation between "adaptation and planning" and QWL score (p < 0.05). Further analysis revealed that "RTW gradualness" and "support seeking" had an interaction effect (p = 0.021). The simple effect analysis demonstrated that when the "RTW gradualness" score was ≥ 16 points, nurses with a high "support seeking" score (≥ 7 points) exhibited a significantly better QWL than those with a low "support seeking" score (< 7 points) (p < 0.001). CONCLUSION: The interaction between "RTW gradualness" and "support seeking" in the ARTW-CS scale significantly impacted the QWL of the NCSs, underscoring the importance of implementing a gradual career plan and seeking support to enhance QWL.

Return to Work After Refractory Out-of-Hospital Cardiac Arrest in Patients Managed With or Without Extracorporeal Cardiopulmonary Resuscitation: A Nationwide Register-Based Study.

BACKGROUND: Extracorporeal cardiopulmonary resuscitation (ECPR) is increasingly used for refractory out-of-hospital cardiac arrest (OHCA). However, survivors managed with ECPR are at risk of poor functional status. The purpose of this study was to investigate return to work (RTW) after refractory OHCA. METHODS AND RESULTS: Of 44 360 patients with OHCA in the period of 2011 to 2020, this nationwide registry-based study included 805 patients with refractory OHCA in the working age (18-65 years) who were employed before OHCA (2% of the total OHCA cohort). Demographics, prehospital characteristics, status at hospital arrival, employment status, and survival were retrieved through the Danish national registries. Sustainable RTW was defined as RTW for ≥6 months without any long sick leave relapses. Median follow-up time was 4.1 years. ECPR and standard advanced cardiovascular life support were applied in 136 and 669 patients, respectively. RTW 1 year after OHCA was similar (39% versus 54%; P=0.2) and sustainable RTW was high in both survivors managed with ECPR and survivors managed with standard advanced cardiovascular life support (83% versus 85%; P>0.9). Younger age and shorter length of hospitalization were associated with RTW in multivariable Cox analysis, whereas ECPR was not. CONCLUSIONS: In refractory OHCA-patients employed prior to OHCA, approximately 1 out of 2 patients were employed after 1 year with no difference between patients treated with ECPR or standard advanced cardiovascular life support. Younger age and shorter length of hospitalization were associated with RTW while ECPR was not.

The Effectiveness of Indonesia's Seven - Step Return to Work Assessment on a Distal Tarsal Tunnel Syndrome : A Case Report Study.

Tarsal tunnel syndrome (TTS) is a nerve entrapment of the posterior tibial nerve. This uncommon condition frequently goes undiagnosed or misdiagnosed even though it interferes with the daily activities of workers. Here we discuss the return to work status of a 37-year-old male patient who manages a manufacturing plant. He was identified as having Tarsal Tunnel Syndrome as a result of a foot abnormality and improper shoe wear. He had moderate pes planus and underwent tarsal tunnel release on his right foot. What are the determinant factors in defining a patient's status for returning to work after a tarsal tunnel release? We conducted a literature review using PubMed, Science Direct, and Cochrane. The Indonesian Occupational Medicine Association used the seven-step return-to-work assessment as a protocol to avoid overlooking the process. Duration of symptoms, associated pathology, and the presence of structural foot problems or a space-occupying lesion are factors affecting outcome. Post-operative foot scores, including Maryland Foot Score (MFS), VAS, and Foot Function Index, can be used to evaluate patient outcomes. Early disability limitation and a thorough return-to-work assessment are needed.

Factors associated with fatigue among people who have returned to work after stroke: an exploratory study.

OBJECTIVE: To explore the associations between fatigue impact and (a) personal and stroke-related characteristics, (b) functional impairments and (c) work-related factors among individuals who have returned to work after stroke. DESIGN: A cross-sectional exploratory study. SUBJECTS: 87 working stroke survivors. METHODS: This study comprises data from a postal survey targeting work ability and perceived stroke-related consequences 1 year after stroke. Fatigue was evaluated using the Fatigue Severity Scale (FSS). Factors associated with having fatigue (FSS total score ≥ 4) were identified using univariable and multivariable logistic regression analyses. Three domain-specific multivariable models and 1 final combined model were created. RESULTS: Fatigue was reported by 43% of the participants. Several factors representing all the investigated domains were associated with fatigue. In the final combined regression model, self-perceived low cognitive functioning, low decision control at work and high quantitative job demands had the strongest independent effects on the odds of having fatigue. CONCLUSION: Among people who were working 1 year after stroke, fatigue was associated with both personal and stroke-related characteristics as well as functional impairments and work-related factors. This highlights the complex nature of post-stroke fatigue. Fatigue management interventions should have a comprehensive approach and also consider the work environment.

Predictors of the return to work for pregnant employees on preventive leave: Patients from an occupational medicine consultation in Switzerland.

According to the Swiss legislation on maternity protection in the workplace (OProMa), if pregnant workers are exposed to occupational hazards and no protective measures are taken, a gynecologist will prescribe a certificate of preventive leave and the women must stop working. Returning to work is only possible if job adjustments are made. This study aims to evaluate the burden of absences on companies and to examine the predictors of the return to work for pregnant workers on preventive leave, by examining both the probability of return to work and the time required to return to work. The study sample includes data on 258 workplaces of pregnant workers on preventive leave, collected during an occupational medicine consultation aimed at supporting the implementation of the OProMa. Information is available on the worker (age, date of consultation), the hazards to which she is exposed, the company's knowledge of the OProMa and whether a risk analysis exists. Descriptive statistics and multivariate regression analysis are carried out. In 58% of the workplaces, it was not possible to return to work before the end of the pregnancy. This corresponds to an average absence of 4.5 months. In 42% of the workplaces, a return to work was possible thanks to workplace adaptations. A conforming risk analysis and a full knowledge of the OProMa for companies, and an early visit to the occupational medicine consultation for workers are good predictors of the likelihood of returning to work. Younger age and exposure to certain types of risks are factors that influence the duration of preventive leave. The implementation of OProMa in Switzerland poses serious challenges, but early identification of occupational hazards and practices that anticipate compliance with the law in the company increase the return to work in safety for pregnant workers.

Return to work, work productivity loss and activity impairment in Chinese breast cancer survivors 12-month post-surgery: a longitudinal study.

Introduction: Existing evidence of returning-to-work (RTW) after cancer comes predominately from Western settings, with none prospectively examined since the initial diagnostic phase. This study prospectively documents RTW-rate, time-to-RTW, work productivity loss, and activity impairment, within the first-year post-surgery among Chinese women with breast cancer (BCW) and identify potential causal co-variants. Methods: This observational longitudinal study followed 371 Chinese BCW who were employed/self-employed at the time of diagnosis at 4-week post-surgery (baseline). RTW-status and time-to-RTW were assessed at baseline (T1), 4-month (T2), 6-month (T3), and 12-month (T4) post-baseline. WPAI work productivity loss and activity impairment were assessed at T4. Baseline covariates included demographics, medical-related factors, work satisfaction, perceived work demand, work condition, RTW self-efficacy, B-IPQ illness perception, COST financial well-being, EORTC QLQ-C30 and QLQ-BR23 physical and psychosocial functioning, and HADS psychological distress. Results: A 68.2% RTW-rate (at 12-month post-surgery), prolonged delay in RTW (median = 183 days), and significant proportions of T4 work productivity loss (20%), and activity impairment (26%), were seen. BCW who were blue-collar workers with lower household income, poorer financial well-being, lower RTW self-efficacy, poorer job satisfaction, poorer illness perception, greater physical symptom distress, impaired physical functioning, and unfavorable work conditions were more likely to experience undesired work-related outcomes. Discussion: Using a multifactorial approach, effective RTW interventions should focus on not only symptom management, but also to address psychosocial and work-environmental concerns. An organizational or policy level intervention involving a multidisciplinary team comprising nurses, psychologists, occupational health professionals, and relevant stakeholders in the workplace might be helpful in developing a tailored organizational policy promoting work-related outcomes in BCW.

Non-medical interventions to enhance return to work for people with cancer.

BACKGROUND: People with cancer are 1.4 times more likely to be unemployed than people without a cancer diagnosis. Therefore, it is important to investigate whether programmes to enhance the return-to-work (RTW) process for people who have been diagnosed with cancer are effective. This is an update of a Cochrane review first published in 2011 and updated in 2015. OBJECTIVES: To evaluate the effectiveness of non-medical interventions aimed at enhancing return to work (RTW) in people with cancer compared to alternative programmes including usual care or no intervention. SEARCH METHODS: We searched CENTRAL (the Cochrane Library), MEDLINE, Embase, CINAHL, PsycINFO and three trial registers up to 18 August 2021. We also examined the reference lists of included studies and selected reviews, and contacted authors of relevant studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and cluster-RCTs on the effectiveness of psycho-educational, vocational, physical or multidisciplinary interventions enhancing RTW in people with cancer. The primary outcome was RTW measured as either RTW rate or sick leave duration measured at 12 months' follow-up. The secondary outcome was quality of life (QoL). DATA COLLECTION AND ANALYSIS: Two review authors independently assessed RCTs for inclusion, extracted data and rated certainty of the evidence using GRADE. We pooled study results judged to be clinically homogeneous in different comparisons reporting risk ratios (RRs) with 95% confidence intervals (CIs) for RTW and mean differences (MD) or standardised mean differences (SMD) with 95% CIs for QoL. MAIN RESULTS: We included 15 RCTs involving 1477 people with cancer with 19 evaluations because of multiple treatment groups. In this update, we added eight new RCTs and excluded seven RCTs from the previous versions of this review that were aimed at medical interventions. All included RCTs were conducted in high-income countries, and most were aimed at people with breast cancer (nine RCTs) or prostate cancer (two RCTs). Risk of bias We judged nine RCTs at low risk of bias and six at high risk of bias. The most common type of bias was a lack of blinding (9/15 RCTs). Psycho-educational interventions We found four RCTs comparing psycho-educational interventions including patient education and patient counselling versus care as usual. Psycho-educational interventions probably result in little to no difference in RTW compared to care as usual (RR 1.09, 95% CI 0.96 to 1.24; 4 RCTs, 512 participants; moderate-certainty evidence). This means that in the intervention and control groups, approximately 625 per 1000 participants may have returned to work. The psycho-educational interventions may result in little to no difference in QoL compared to care as usual (MD 1.47, 95% CI -2.38 to 5.32; 1 RCT, 124 participants; low-certainty evidence). Vocational interventions We found one RCT comparing vocational intervention versus care as usual. The evidence was very uncertain about the effect of a vocational intervention on RTW compared to care as usual (RR 0.94, 95% CI 0.78 to 1.13; 1 RCT, 34 participants; very low-certainty evidence). The study did not report QoL. Physical interventions Four RCTs compared a physical intervention programme versus care as usual. These physical intervention programmes included walking, yoga or physical exercise. Physical interventions likely increase RTW compared to care as usual (RR 1.23, 95% CI 1.08 to 1.39; 4 RCTs, 434 participants; moderate-certainty evidence). This means that in the intervention group probably 677 to 871 per 1000 participants RTW compared to 627 per 1000 in the control group (thus, 50 to 244 participants more RTW). Physical interventions may result in little to no difference in QoL compared to care as usual (SMD -0.01, 95% CI -0.33 to 0.32; 1 RCT, 173 participants; low-certainty evidence). The SMD translates back to a 1.8-point difference (95% CI -7.54 to 3.97) on the European Organisation for Research and Treatment of Cancer Quality of life Questionnaire Core 30 (EORTC QLQ-C30). Multidisciplinary interventions Six RCTs compared multidisciplinary interventions (vocational counselling, patient education, patient counselling, physical exercises) to care as usual. Multidisciplinary interventions likely increase RTW compared to care as usual (RR 1.23, 95% CI 1.09 to 1.33; 6 RCTs, 497 participants; moderate-certainty evidence). This means that in the intervention group probably 694 to 844 per 1000 participants RTW compared to 625 per 1000 in the control group (thus, 69 to 217 participants more RTW). Multidisciplinary interventions may result in little to no difference in QoL compared to care as usual (SMD 0.07, 95% CI -0.14 to 0.28; 3 RCTs, 378 participants; low-certainty evidence). The SMD translates back to a 1.4-point difference (95% CI -2.58 to 5.36) on the EORTC QLQ-C30. AUTHORS' CONCLUSIONS: Physical interventions (four RCTs) and multidisciplinary interventions (six RCTs) likely increase RTW of people with cancer. Psycho-educational interventions (four RCTs) probably result in little to no difference in RTW, while the evidence from vocational interventions (one RCT) is very uncertain. Psycho-educational, physical or multidisciplinary interventions may result in little to no difference in QoL. Future research on enhancing RTW in people with cancer involving multidisciplinary interventions encompassing a physical, psycho-educational and vocational component is needed, and be preferably tailored to the needs of the patient.

Ped Cast SBP: Sala de apoio à amamentação

A Dra. Eneida Perim - membro do Departamento Científico de Aleitamento Materno da Sociedade Brasileira de Pediatria (SBP) - aborda o tema nesta edição do Ped Cast SBP. A sala de apoio à amamentação nas empresas é crucial para a mulher trabalhadora que amamenta poder retirar e armazenar o leite materno que será ofertado ao seu filho.

Ped Cast SBP: Empresa Cidadã

Em comemoração ao Agosto Dourado, o mês do aleitamento materno no Brasil, trouxemos um tema importante para todas as mulheres trabalhadoras que amamentam: o Programa Empresa Cidadã, que oferece o benefício da licença-maternidade estendida para 6 meses, como preconiza a Sociedade Brasileira de Pediatria (SBP). Para falar sobre esse tema, a nossa convidada desta edição é a dra. Dolores Fernandez, do Departamento Científico de Aleitamento Materno da SBP.

Ped Cast SBP: Como manter a amamentação da criança na creche

Está chegando o período de volta às aulas e muitas crianças ainda estão na fase de amamentação, o que deixa as mães preocupadas em como dar continuidade ao aleitamento materno. Nesta edição do PedCast SBP vamos falar sobre “Como manter a amamentação da criança na creche”. E para falar sobre esse assunto, convidamos a dra. Lúcia Rolim, membro do Departamento Científico de Aleitamento Materno da Sociedade Brasileira de Pediatria (SBP).

Navigating work and life- a qualitative exploration of managers' and employees' views of return-to-work after sick leave due to common mental disorders.

BACKGROUND: Incorporating multiple perspectives and contexts in knowledge mobilisation for return-to-work after sick leave due to common mental disorders can promote interprofessional and organisational strategies for facilitating the return-to-work process. This study aimed to explore the facilitators of and barriers to return-to-work after common mental disorders. This exploration considered the perspectives of employees and managers and the realms of work and private life. METHODS: A qualitative approach was used with data from 27 semi-structured telephone interviews. The strategic sample consisted of employees who returned to work after sick leave due to common mental disorders (n = 17) and managers responsible for their return-to-work process (n = 10). Thematic analysis conducted in a six-step process was used to generate themes in the interview data. RESULTS: The analysis generated three main themes with subthemes, illustrating experiences of barriers to and facilitators of return-to-work positioned in the employees' private and work contexts: (1) Getting along: managing personal difficulties in everyday life; (2) Belonging: experiencing social connectedness and support in work and private life; and (3) Organisational support: fostering a supportive work environment. The results contribute to a comprehensive understanding of the return-to-work process, including the challenges individuals face at work and in private life. CONCLUSIONS: The study suggests that return-to-work after sick leave due to CMDs is a dynamic and ongoing process embedded in social, organisational, and societal environments. The results highlight avenues for an interprofessional approach and organisational learning to support employees and managers, including space for the employee to recover during the workday. TRIAL REGISTRATION: This study recruited employees from a two-armed cluster-randomised controlled trial evaluating a problem-solving intervention for reducing sick leave among employees sick-listed due to common mental disorders (reg. NCT3346395).

Rehabilitation of sick-listed LBP patients in occupational health with collaboration of the workplace.

The aim was to evaluate if rehabilitation procedures including occupational health (OH) and workplace participation increase return to work (RTW) rates among patients with subacute and chronic low back pain (LBP). A systematic review of randomized controlled trials was conducted using the PubMed and Cochrane databases. Main outcomes were RTW and days of sick leave. Interventions needed to be multidisciplinary including both OH and active workplace involvement in rehabilitation. Out of 1073 potentially eligible references, 8 met the inclusion criteria. Three studies had OH and 5 case managers involved in rehabilitation. Rehabilitation involving both OH and workplace improved RTW and decreased the number of sick leave days among LBP patients. Having case managers involved had no effect in RTW. In order to improve RTW, workplace visits and work ability meetings (WAMs) between OH and workplace are essential components in the rehabilitation process among patients with chronic LBP. Based on the study results, the authors suggest utilizing these co-operative interventions with workplaces in OH. High quality research investigating only the effect of WAMs in OH setting is needed in future. Int J Occup Med Environ Health. 2024;37(1):3-17.

Effectiveness of the Coordinated Return to Work model after orthopaedic surgery for lumbar discectomy and hip and knee arthroplasty: a register-based study.

OBJECTIVES: This study examined the effectiveness of an individualised Coordinated Return to Work (CRtW) model on the length of the return to work (RTW) period compared with a standard prescription of 2-3 months RTW during recovery after lumbar discectomy and hip and knee arthroplasty among Finnish working-age population. METHODS: Cohorts on patients aged 18-65 years old with lumbar discectomy or hip or knee arthroplasty were extracted from the electronic health records of eight Finnish hospital districts in 2015-2021 and compiled with retirement and sickness benefits. The overall effect of the CRtW model on the average RTW period was calculated as a weighted average of area-specific mean differences in RTW periods between 1 year before and 1 year after the implementation. Longer-term effects of the model were examined with an interrupted time series design estimated with a segmented regression model. RESULTS: During the first year of the CRtW model, the average RTW period shortened by 9.1 days (95% CI 4.1 to 14.1) for hip arthroplasty and 14.4 days (95% CI 7.5 to 21.3) for knee arthroplasty. The observed differences were sustained over longer follow-up times. For lumbar discectomy, the first-year decrease was not statistically significant, but the average RTW had shortened by 36.2 days (95% CI 33.8 to 38.5) after 4.5 years. CONCLUSIONS: The CRtW model shortened average RTW periods among working-age people during the recovery period. Further research with larger samples and longer follow-up times is needed to ensure the effectiveness of the model as a part of the Finnish healthcare system.

Retorno a la actividad completa tras cirugía de reconstrucción de ligamento cruzado anterior en personal militar: metaanálisis / Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis

Objetivo: Se realizó un metaanálisis para evaluar los resultados clínico-funcionales de la cirugía de ligamento cruzado anterior en militares, así como las complicaciones asociadas a la misma. Material y métodos: Se realizó una búsqueda en las 3 principales fuentes de bases de datos hasta diciembre de 2022 (PubMed, Google Scholar y ScienceDirect) en cuanto a los resultados tras la cirugía de ligamento cruzado anterior en personal militar. La revisión sistemática se realizó siguiendo las normas Preferred Reporting Items for Systematic Reviews and Meta-Analyses –PRISMA–, y los criterios de inclusión siguieron la estrategia PICO. Los datos de los estudios incluidos se analizaron mediante el software Review Manager 5.4. Resultados: Se seleccionaron un total de 7 estudios retrospectivos. La tasa general de retorno a la actividad completa en el personal militar fue del 62,3% (61,5% para el grupo de no oficiales frente a 68,3% para el grupo de oficiales), sin ser esta diferencia significativa (p=0,92). La tasa general de lesión meniscal en los militares fue del 58,8%, sin ser esta diferencia significativa (p=0,88). La homogeneidad en ambos casos fue buena (I2=0%, p=0,99). Conclusión: El regreso a la actividad militar completa puede usarse en la población militar como un marcador de éxito después de una reconstrucción de ligamento cruzado anterior. Hay que destacar que una gran cantidad de militares experimentan limitaciones permanentes en la actividad que impiden el regreso completo al servicio.(AU)

Objective: A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. Material and method: Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses –PRISMA– standards, and the inclusion criteria following the PICO strategy. Data from included studies were analyzed using Review Manager 5.4 software. Results: A total of 7 retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group vs. 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). Conclusion: Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.(AU)

[Translated article] Return to full duty after anterior cruciate ligament reconstruction surgery in military personnel: A meta-analysis / Retorno a la actividad completa tras cirugía de reconstrucción del ligamento cruzado anterior en personal militar: metaanálisis

Objetivo: Se realizó un metaanálisis para evaluar los resultados clínico-funcionales de la cirugía de ligamento cruzado anterior en militares, así como las complicaciones asociadas a la misma. Material y métodos: Se realizó una búsqueda en las 3 principales fuentes de bases de datos hasta diciembre de 2022 (PubMed, Google Scholar y ScienceDirect) en cuanto a los resultados tras la cirugía de ligamento cruzado anterior en personal militar. La revisión sistemática se realizó siguiendo las normas Preferred Reporting Items for Systematic Reviews and Meta-Analyses –PRISMA–, y los criterios de inclusión siguieron la estrategia PICO. Los datos de los estudios incluidos se analizaron mediante el software Review Manager 5.4. Resultados: Se seleccionaron un total de 7 estudios retrospectivos. La tasa general de retorno a la actividad completa en el personal militar fue del 62,3% (61,5% para el grupo de no oficiales frente a 68,3% para el grupo de oficiales), sin ser esta diferencia significativa (p=0,92). La tasa general de lesión meniscal en los militares fue del 58,8%, sin ser esta diferencia significativa (p=0,88). La homogeneidad en ambos casos fue buena (I2=0%, p=0,99). Conclusión: El regreso a la actividad militar completa puede usarse en la población militar como un marcador de éxito después de una reconstrucción de ligamento cruzado anterior. Hay que destacar que una gran cantidad de militares experimentan limitaciones permanentes en la actividad que impiden el regreso completo al servicio.(AU)

Objective: A meta-analysis was carried out to evaluate the clinical-functional results of anterior cruciate ligament surgery in military population, as well as the complications associated with it. Material and method: Three major database sources up to December 2022 (PubMed, Google Scholar, and ScienceDirect) were searched for outcomes after anterior cruciate ligament surgery in military personnel. The systematic review was carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses –PRISMA– standards, and the inclusion criteria following the PICO strategy. Data from included studies were analyzed using Review Manager 5.4 software. Results: A total of 7 retrospective studies were selected. The general rate of return to full duty in military personnel was 62.3% (61.5% for the non-officer group vs. 68.3% for the officer group) without this difference being significant (p=0.92). The general rate of meniscal injury in the military was 58.8%, without this difference being significant (p=0.88). The homogeneity in both cases was good (I2=0%, p=0.99). Conclusion: Return to full military duty can be used in the military population as a marker of success after anterior cruciate ligament reconstruction. It should be noted that a large number of military personnel experience permanent activity limitations that prevent full return to service.(AU)

Exploring the status and associated factors of the readiness for return-to-work in young and middle-aged stroke patients.

Stroke increasingly affects individuals of working age. An accurate assessment of Readiness for Return-to-Work (RRTW) can help determine the optimal timing for RRTW and facilitate an early reintegration into society. This study investigates the current state of RRTW and the influencing factors among young and middle-aged stroke patients in China. A sample of young and middle-aged stroke patients hospitalized in a tertiary hospital in Henan Province between December 2021 and May 2022 were included in this study. A general information questionnaire and the Readiness for RRTW scale, the Social Support Rate Scale, the Stroke Self-Efficacy Scale, and the Fatigue Severity Scale were administered to the patients. Of the 203 patients successfully surveyed, 60 (29.6%) were in the pre-contemplation stage, 35 (17.2%) in the contemplation stage, 81 (39.9%) in the prepared for action-self-evaluative stage, and 27 (13.3%) in the prepared for action- behavior stage. Logistic regression analysis identified education level, monthly income, time to start rehabilitation therapy, social support, stroke self-efficacy, and fatigue severity as key factors affecting RRTW scale readiness in young and middle-aged stroke patients. The readiness of young and middle-aged stroke patients to Return-to-Work needs to be increased further. Healthcare professionals should consider the influencing factors of RRTW and design targeted intervention programs to facilitate a successful Return-to-Work and normal life.