SARS-CoV-2 screening of asymptomatic health care workers: experience of a General hospital.

Health care workers (HCWs) are at major risk to be infected by SARS-CoV-2 and transmit the virus to the patients. Furthermore, travels are a major factor in the diffusion of the virus. We report our experience regarding the screening of asymptomatic HCWs returning from holidays, following the issue of a national guideline on 08/20/2020. The organization of the occupational health department and the clinical laboratory was adapted in order to start the screening on August, 24, 2020. All HCWs tested for SARS-CoV-2 the week before and 4 weeks after the implementation of the screening were included. The mean number of tests was analyzed per working day and working week. Overall, 502 (31.4%) HCWs were tested for SARS-CoV-2 during the study period. The mean number of HCWs tested per working day was 27.1. HCWs accounted for 36.9% (n = 167) and 11.2% (n = 84) of the tests performed in the 1st and the 4th week following the implementation of the guidelines. The number of tests performed each week in HCWs increased by at least 20-fold after the implementation of the guidelines. No asymptomatic HCW was tested positive. Screening of asymptomatic HCWs was poorly effective in the context of low circulation of the virus. We suggest giving priority to infection prevention and control measures and screening of symptomatic subjects and asymptomatic contacts.

Prevalence and utilization of company integration management in Germany: Results of the 2018 BiBB/BAuA survey of employed persons.

OBJECTIVES: This secondary analysis aims to investigate the implementation of the legally required company integration management ("BEM") in case of an incapacity for work of at least six weeks and to identify predictors. METHODS: Database is the representative randomized 2018 BIBB/BAuA Employment Survey of 20 012 employed persons in Germany. RESULTS: Of the 1367 employees entitled to company integration management, 40% received an offer from their employer and 27% accepted it. In the public sector, half of those who were entitled reported an offer. Among those entitled to company integration management, employees under the age of 30, at risk of dismissal, or with fixed-term employment contract received an offer particularly rarely. Entitled employees with disabilities or in companies with works/staff councils received disproportionately often an offer of company integration management. Logistic regression analyses reveal strong associations between company integration management offer and the duration of incapacity to work. The probability of receiving an offer is almost halved for those entitled in medium-sized compared to small companies. The higher the level of educational qualification, the higher are odds ratios for an offer. In companies in which employees were less or not satisfied with their work overall, the chance of a company integration management offer is significantly reduced almost by half. The chance of an offer is more than three times higher in companies with workplace health promotion compared to those without. CONCLUSIONS: Only a minority of eligible employees received an offer that is closely associated with health-promoting corporate culture and job satisfaction.

Frequent short sickness absence, occupational health service utilisation and long-term sickness absence due to mental disorders among young employees.

OBJECTIVES: We examined whether frequent short-term sickness absence (FSTSA) and primary care use in occupational health service (OHS) were associated with medically-certified long-term sickness absence (LTSA) due to mental disorders among young employees. METHODS: We used record-linkage data covering the young employees (< 35 years) of the City of Helsinki, Finland (n = 8,282) from 2010 to 2014. The outcome was LTSA due to mental disorders. Cox regression models were fitted. RESULTS: FSTSAs were associated with subsequent LTSA. Also OHS use predicted LTSA due to mental disorders; however, this association was not found for those with prior FSTSA. CONCLUSIONS: Both FSTSA and primary care use indicate subsequent LTSA independently, and together these indicators identify a larger proportion of individuals at risk of LTSA due to mental disorders.

Health service use and health outcomes among international migrant workers compared with non-migrant workers: A systematic review and meta-analysis.

OBJECTIVES: The review aimed to synthesise recent evidence on health service use and health outcomes among international migrant workers, compared with non-migrant workers. METHODS: A search was carried out in MEDLINE, PubMed, Embase, and CINAHL for studies published between Jan 1, 2010, and Feb 29, 2020. Included outcomes were: occupational health service use, fatal occupational injury, HIV, and depression. Two authors independently screened records, extracted data, assessed risk of bias and judged quality of evidence. We meta-analysed estimates and conducted subgroup analyses by sex, geographical origin, geographical destination, and regularity of migration. RESULTS: Twenty-one studies were included comprising >17 million participants in 16 countries. Most studies investigated regular migrant workers in high-income destination countries. Compared with non-migrant workers, migrant workers were less likely to use health services (relative risk 0·55, 95% confidence interval 0·41 to 0·73, 4 studies, 3,804,131 participants, I2 100%, low quality of evidence). They more commonly had occupational injuries (1·27, 95% confidence interval 1·11 to 1·45, 7 studies, 17,100,626 participants, I2 96%, low quality of evidence). Relative risks differed by geographical origin and/or destination. There is uncertainty (very low quality of evidence) about occupational health service use (0 studies), fatal occupational injuries (5 studies, N = 14,210,820), HIV (3 studies, N = 13,775), and depression (2 studies, N = 7,512). CONCLUSIONS: Migrant workers may be less likely than non-migrant workers to use health services and more likely to have occupational injuries. More research is required on migrant workers from and in low- and middle-income countries, across migration stages, migrating irregularly, and in the informal economy.

Effect of reminder letters after health checkups on the consultation behavior of participants with possible hypertension, hyperglycemia, and dyslipidemia: A retrospective cohort study using administrative claims data in Japan.

OBJECTIVES: Prevention of and early treatment for noncommunicable diseases such as hypertension, hyperglycemia, and dyslipidemia are important, as these diseases are asymptomatic in early stages but can lead to critical conditions such as macro- and microvascular disorders later on. While screening is conducted worldwide, low rates of hospital visits after screening is a common issue. We aimed to investigate the effect of reminder letters on the consultation behavior of screened participants. METHODS: We used administrative claims data from a database managed by JMDC Inc for participants of health checkups in 2014, 2015, 2016, and 2017, who belonged to a health insurance society. Reminder letters were sent regularly 6 months after checkups to improve participant consultation behavior. Participants who screened positive for hypertension, hyperglycemia, and dyslipidemia, and who were not taking medication for any of these diseases at the time of health checkups, were included in the analyses. RESULTS: A total of 1739 participants in 2014, 1693 in 2015, 2002 in 2016, and 2144 in 2017 were included in the analysis for hypertension. The cumulative proportion of hospital visits gradually increased over the course of 12 months after checkups in all years. After 2015, spikes, albeit very small ones, were observed at 6 months after checkups in accordance with the timing of reminder letters. Similar trends were observed for hyperglycemia and dyslipidemia. CONCLUSIONS: Sending reminder letters is a potentially effective approach to increase hospital visits, but further improvements (ie, multiple reminders) may be necessary to affect enhancements in participant consultation behavior.

Aspectos preventivos en migraña y trabajo. Encuesta europea / Preventive Aspects for Migraine and the workplace: A European Survey

INTRODUCCIÓN: La promoción de la salud en el trabajo integra las iniciativas en salud y seguridad en ámbito ocupacional, con mejoras personales, incremento de productividad y menores riesgos y gastos sociales, especialmente en migraña, como enfermedad neurológica con prevalencia estimada en el 11% de la población. El objetivo de este trabajo fue conocer las condiciones preventivas de los trabajadores con migraña y las opciones de gestión preventiva en sus empresas. MÉTODO: Estudio observacional transversal realizado en 3.342 pacientes de España, Italia, Francia, Portugal, Irlanda, Reino Unido, Alemania y otros países de la UE mediante encuesta anónima en la web de la European Migraine & Headache Alliance (EMHA-web), entre septiembre de 2018 y enero de 2019. RESULTADOS: Estrés laboral y uso de PVD son los riesgos más referidos por los trabajadores con migraña. El 43.71% de trabajadores desconoce el tipo de Servicio de Prevención de su empresa, 49.06% no dispone de servicio médico; el 67.67% no ha tenido impedimentos de acceso laboral por migraña, ni despido o no renovación del contrato, pero el 42,14% tuvo algún conflicto por pérdida de productividad; el 26,54% desconoce el concepto de especial sensibilidad o no lo ha solicitado por migraña; un 55,42% no se ha sentido comprendido ni apoyado por su empresa en sus limitaciones por migraña, pero sí por los compañeros. CONCLUSIÓN: Se observa una deficiente información preventiva y escaso uso de las opciones de gestión adaptativa en las empresas para personas con migraña

INTRODUCTION: Workplace health promotion integrates initiatives in health and safety in the occupational field, with personal improvements, increased productivity and lower risks and social cost, especially with respect to migraine headaches, a neurological disorder affecting approximately 11% of the population. The objective of this study was to know the preventive resources available to workers with migraine headaches and the preventive management options in their companies. METHOD: Cross-sectional observational study of 3,342 patients from Spain, Italy, France, Portugal, Ireland, United Kingdom, Germany and other European Union countries, conducted through an anonymous survey on the web of the European Migraine & Headache Alliance (EMHA-web), from September 2018 to January 2019. RESULTS: Occupational stress (77.65%) and use of computer monitors (63.87%) are the most common risks described by workers with migraine. About. 43.71% of workers are not familiar with the type of occupational health service present in their company, 49.06% do not have a medical service; 67.67% reported no work-related limitations due to migraine, neither dismissal nor non-renewal of their contract (88.29%), but 42.14% had experienced some conflict due to decreased productivity; 26.54% were unaware of the concept of vulnerable workers or had not requested this status because of their migraine (63.8%), nor had they demanded job accommodations (67.64%) or job change (80.89%); 55.42% did not feel understood or supported by their company in their limitations due to migraine, although they did feel they were supported by their colleagues (63.07%). CONCLUSION: We found that preventive resources and information were deficient, and that there was little use of adaptive management options for workers with migraine in their companies

The impact of COVID-19 on Bangladeshi readymade garment (RMG) workers.

This paper describes the potential impact of the coronavirus disease 2019 (COVID-19) pandemic on the readymade garment (RMG) workers of Bangladesh. It articulates the RMG workers' existing vulnerability during the COVID-19 pandemic based on currently available evidence and personal conversations/communications with RMG workers. COVID-19 has already impacted RMG workers' health (both physical and mental health status) and wellbeing, and resulted in loss of employment. We argue that the COVID-19 pandemic will have long-lasting effects on the garment workers, especially related to their health issues, financial hardship and inability to pay for essentials such as food, and future employment opportunities. The stakeholders (such as the international retailers/brands, Bangladesh Garment Manufacturers and Exporters Association, Government of Bangladesh) responsible for the global supply chain RMG factories should reconsider the health and overall wellbeing needs of the RMG workers during the ongoing COVID-19 pandemic.

[Factors related to the one-month retention of 8507 employees declared medically unfit in Hauts-de-France companies between 2014 and 2018]. / Facteurs liés au maintien dans l'entreprise à un mois chez 8507 salariés déclarés médicalement inaptes en Hauts-de-France entre 2014 et 2018.

BACKGROUND: Given the low rate of retention in a company after an employee has been found unfit for the job, our aim was to determine the factors related to employees being kept by their company one month after being declared unfit for the job due to either a musculoskeletal disease (MSD) or a mental health disorder (MHD). METHODS: This study was based on all employees declared unfit for the job by the occupational physicians in the "Unfitness" survey in the French "Hauts-de-France" region between 2014 and 2018. For each of the two groups of workers, factors related to the employees being kept by their company one month after being declared unfit for the job were studied by logistic regression. RESULTS: Only 6.9% of the 5352 workers declared unfit for the job due to MSD were kept in their company whereas 3.6% of the 3155 workers declared unfit for the job due to MHD were kept in theirs. For the two groups of workers, the proportion of employees kept by their company decreased with female gender (OR=0.63 95%CI [0.47-0.84] for MSD and OR=0.50 [0.32-0.78] for MHD for female vs. male), long sick-leave (OR=0.26 [0.18-0.40] for MSD and OR=0.22 [0.11-0.45] for MHD for sick-leave>6 months vs. no sick leave), small size of the company (<50 employees) and working in the construction field or services sector (vs. industry or administration). Concerning the employees declared unfit due to MSD alone, the proportion of employees kept by their company decreased for seniors (>50 years old) and for those with low seniority (<5 years). CONCLUSION: "Retention in a company" as a tool for "maintenance of employment" is a little-discussed subject, lending further credence to the current recommendations for reduction of inequalities in working conditions and vocational training of employees according to age and socio-occupational category, and also for reduction of inequalities in occupational pathways according to gender.

Adaptación y validación del cuestionario del empleado saludable del modelo HERO / Adaptation and validation of the healthy employee questionnaire of the HERO model

Las organizaciones están implementando acciones para la mejora de la salud y calidad de vida de sus empleados. Este hecho repercute por tanto en las empresas y en sus empleados, caracterizándose éstos últimos por disponer de cinco fortalezas como son el engagement, la resiliencia, la autoeficacia, el optimismo y la esperanza. El cuestionario del empleado saludable mide ocho dimensiones, por lo que el objetivo del trabajo es validar el instrumento reduciendo el constructo del empleado saludable de ocho dimensiones a cinco dimensiones y constatar la fiabilidad del mismo como medio de evaluación del empleado saludable. 287 empleados (208 hombres y 79 mujeres) de edades comprendidas entre 20-59 años participaron en es-te estudio. Se analizó el ajuste de los modelos de cinco y ocho dimensiones mediante un Análisis Factorial Confirmatorio (AFC), utilizando el método de estimación de Máxima Verosimilitud Robusto. Los índices incrementa-les (CFI y NNFI) y el absoluto SRMR mostraron un buen ajuste en ambos modelos al ser superiores a ,90 e inferior a ,08 respectivamente. En cuanto a la comparación de modelos se observa un aumento significativo del estadístico de contraste Chi Cuadrado de Satorra-Bentler en el modelo de cinco frente al de ocho dimensiones, aunque la reducción del CFI en el modelo de cinco dimensiones no superó el criterio de ,01, lo que permitió considerar ambos modelos como similares en cuanto a ajuste. Ambos modelos mostraron resultados satisfactorios en cuanto al ajuste, este hecho confirma el uso del cuestionario del empleado saludable de ocho dimensiones a cinco dimensiones

Organisations are implementing actions to improve the health and quality of life of their employees. This fact therefore has an impact on companies and their employees, the latter being characterised by five strengths: engagement, resilience, self-efficacy, optimism and hope. The Healthy Employee Questionnaire measures eight dimensions, so the aim of the work is to validate the instrument by reducing the construct of the healthy employee from eight dimensions to five dimensions and to ascer-tain the reliability of the instrument as a means of evaluating the healthy employee. 287 employees (208 men and 79 women) aged 20-59 participat-ed in this study. The fit of the five- and eight-dimensional models was ana-lysed by Confirmatory Factor Analysis (CFA), using the Robust Maximum Likelihood estimation method. The incremental indices (CFI and NNFI) and the absolute SRMR showed a good fit in both models being higher than .90 and lower than .08, respectively. In terms of model comparison, a significant increase in the Satorra-Bentler Chi Square contrast statistic was observed in the five versus eight-dimensional model, although the reduc-tion of the CFI in the five-dimensional model did not exceed the criterion of .01, which allowed both models to be considered as similar in terms of fit. The two models showed satisfactory results in terms of fit, this fact confirming the reduction of the healthy employee questionnaire from eight dimensions to five dimensions

Health-Related Quality of Life and Cost-Utility Analysis of Employees With Musculoskeletal Disorders Receiving Vocational Physiotherapy.

Background: The purpose of this project was to evaluate both health-related quality of life (HRQoL) and cost-utility associated with care for employees with musculoskeletal disorders who received vocational physiotherapy at a North London National Health Service (NHS) Foundation Trust in the United Kingdom. Methods: A pre- and post-physiotherapy EuroQol 5 Dimension (EQ-5D) questionnaire was administered to employees presenting to the vocational physiotherapy service (VPS) with musculoskeletal disorders. The cost-utility analysis of the physiotherapy service was calculated using cost data provided by VPS billing information and benefits measured using Quality-Adjusted Life Years (QALYs). Findings: Overall, there was a significant improvement in the EQ-5D index from baseline to discharge in all HRQoL domains. The visual analog scale (VAS) improved from a mean of 31.5 (SD = 18.3) at baseline to 73.2 (SD = 18.5) at discharge. A cost-utility analysis indicated that the VPS would continue to be cost-effective until the cost per employee increased by 82.5%. Conclusion/Application to Practice: The project supports integration of vocational physiotherapy services into an occupational health department.

The Effect of Obstructive Sleep Apnea on Absolute Risk of Central Serous Chorioretinopathy.

PURPOSE: To determine the incidence of central serous chorioretinopathy (CSC) stratified by age, sex, and diagnosis with obstructive sleep apnea (OSA), and to determine whether some patients with newly diagnosed CSC may be candidates for OSA evaluation. DESIGN: Retrospective cohort study. METHODS: We used the IBM MarketScan database to select 59,016,145 commercially insured patients in the United States between 2007 and 2016. We identified patients' first diagnosis with CSC, and defined patients as having OSA if they had a diagnosis following a sleep study. We specified Cox proportional hazard models with interactions between age, sex, and OSA status to determine patients' risk of developing CSC. We estimated the positive predictive value (PPV) that a new diagnosis of CSC would have in predicting a subsequent diagnosis of OSA. RESULTS: Risk of CSC increased with age in years (hazard ratio [HR] = 1.030, P < .001) and OSA diagnosis (HR = 1.081, P < .033), and was lower in women (HR = 0.284, P < .001). We estimated the annual incidence of CSC was 9.6 and 23.4 per 100,000 women and men, respectively. Incidence was higher in women and men with OSA (17.2 and 40.8 per 100,000). The PPV of CSC diagnosis as a predictor of OSA was highest in the fifth decade of life. CONCLUSION: The incidence of CSC in our patient sample is higher than previously reported. Risk of CSC is higher in men than in women, and OSA increases risk of CSC in both men and women. Some patients, particularly older male patients, may be good candidates for OSA evaluation following a CSC diagnosis.

Control médico en migraña y variables relacionadas. Resultados de la encuesta europea Trabajo y Migraña / Migraine medical control and related variables. Results of the European Work and Migraine survey

OBJETIVO: Es objetivo de este trabajo conocer las preferencias asistenciales y el uso requerido de atención médica por pacientes con migraña en distintos países de Europa y las diferencias en función de las condiciones sociales y demográficas. MATERIAL Y MÉTODOS: Estudio observacional transversal mediante encuesta anónima vía web a 3.342 pacientes de España, Italia, Francia, Portugal, Irlanda, Reino Unido, Alemania y un grupo mixto de países no incluidos en el diseño inicial. VARIABLES: edad, género, país, tipo de localidad, nivel de estudios y ámbito rural o urbano. Se recoge demanda asistencial por neurólogo, médico de atención primaria/de familia/médico general, médico del trabajo, enfermería, otro médico/otra especialidad, o no control médico/autocontrol. RESULTADOS: Acuden más a Neurología los pacientes de 21-60 años y alto nivel cultural. La asistencia por atención primaria/familia es mayor en áreas urbanas. Medicina del trabajo, enfermería y otras especialidades predominan en grandes ciudades. Mayor autocontrol en pacientes de 21-40 años y en mujeres. España y Alemania son los países con mayor demanda asistencial en Neurología y Atención Primaria. CONCLUSIONES: La demanda médica asistencial por migraña en Europa muestra resultados irregulares por países, siendo principalmente en Neurología y con menor participación de médicos de atención primaria, médicos del trabajo, enfermería u otras especialidades. Se observan diferencias por edad, género y nivel cultural tanto en la demanda asistencial como en la elección de especialista. Un importante porcentaje de pacientes se automedican o no llevan ningún control médico

OBJECTIVE: This purpose of this work is to determine the care preferences and the required use of medical care by migraine patients in the different countries of Europe, and the observed differences depending on their social and demographic conditions. MATERIAL AND METHODS: Cross-sectional observational study by anonymous web survey of 3,342 patients from Spain, Italy, France, Portugal, Ireland, United Kingdom, Germany, and a mixed group of countries not included in the initial design. VARIABLES: age, gender, country, type of location, level of studies and rural or urban area. The demand for care is collected by neurologist, primary care doctors/family/general practitioners, by occupational health doctors, nurses, by other doctors/other specialists, non-medical control/self-control. RESULT: The patients more seen by a neurologist were about 21-60 years old and with a high cultural level. Primary care/family doctor care is higher in urban areas. Occupational medicine, nursing, and other specialties predominate in large cities. Self-control is greater in patients aged 21-40 years and in women. Spain and Germany are the countries with the greatest demand for care in Neurology and Primary Care. CONCLUSIONS: The medical demand for migraine care in Europe shows irregular results according to countries, with it being a priority in neurology and with less participation of Primary Care physicians, work doctors, nurses, or other specialties. Differences are observed by age, gender, and cultural level both in the demand for care and in the choice of specialist. It is important to take into account the percentage of patients who have no medical control

Socioeconomic differences in use of public, occupational and private health care: A register-linkage study of a working-age population in Finland.

There is little knowledge on socioeconomic differences in use of health care organized by different care schemes and on exclusive and concurrent use of health care at different schemes in different socioeconomic groups. In Finland, public, occupational and private schemes offer parallel outpatient primary health care services. Each scheme mainly reaches different population groups because of differences in availability, costs and gatekeeping. This study aimed to analyse how the probability of using health care organized by the three schemes differed by socioeconomic status in a working-age population. Individual-level register-based data on use of public, occupational and private outpatient primary health care during 2013 as well as data on sociodemographic covariates were linked for the total population aged 25-64 of the city of Oulu, Finland. Data were analysed with descriptive methods and multinomial logistic regression models. Those in the study population most often used only occupational care or only public care, or did not use any of the studied health care schemes at all. The lower the socioeconomic status, the higher was the probability of not using care or using only public care. The higher the socioeconomic status, the higher was the probability of using occupational care-either only occupational care or occupational care in combination with private care. Education, occupational class and income were all associated with care use also when adjusted for sociodemographic covariates and chronic disease, but income proved to be the strongest predictor of the three. The results reflect the design of the Finnish health care system, with a strong occupational health care scheme for the employed population contributing to inequality in use of health care and potentially to health inequality between socioeconomic groups.

[Health promotion in enterprises counteracting the consequences of workforce ageing. How does it differ from interventions in other companies and what kind of barriers does it face?] / Promocja zdrowia w zakladach pracy przeciwdzialajacych skutkom starzenia sie personelu. Czym rózni sie od dzialan w innych firmach i jakie przeszkody napotyka?

BACKGROUND: The aim of the article is to address the question of whether companies implementing personnel's health promotion to counteract the consequences of workforce ageing differ in their health-related activities from enterprises not having such a motivation. The analyzed differences concern the frequency of implementing and evaluating selected health promotion interventions, assessing employees' health needs and expectations, managers' interest in population ageing, and other motives of health promotion implementation. Moreover, obstacles to health promotion in the context of ageing are analyzed. Directions of supporting enterprises in diminishing the consequences of this demographic process via health promotion are recommended. MATERIAL AND METHODS: Quantitative analysis: standardized computer-assisted personal interviews with representatives of management boards (October- November 2017). Sample: 940 companies from Poland implementing health promotion activities (including 424 organizations willing przedsiewzieto counteract the consequences of workforce ageing), selected from a representative sample of 1000 enterprises employing ≥50 people. Qualitative analysis: focus groups interviews (FGIs) with employers concerning their attitudes to managing personnel's health in the context of population ageing (March 2017). Sample: 64 respondents in 8 FGIs. RESULTS: Companies promoting employees' health to diminish the consequences of workforce ageing more often implement and evaluate most workplace health-related activities, and provide more reasons for promoting personnel's health. Their managers are more often interested in the issue of demographic changes, and they less frequently complain about the obstacles of health promotion implementation. Major obstacles are employers' reluctance or impossibility to pay for health promotion, low managers' awareness/know-how concerning health promotion, insufficient human and infrastructure resources, unfavorable employees' attitudes, and disadvantageous legal/fiscal issues. CONCLUSIONS: Companies' willingness to counteract implications of personnel's ageing is conducive to their engagement in health promotion. The dissemination/intensification of workplace health-oriented activities, which fosters minimizing the consequences of demographic changes, requires increasing employers' interest in the issue of population ageing and health promotion as a tool of coping with this problem, facilitating gaining the knowledge of workplace health promotion management by companies' representatives, and diminishing legislative/fiscal barriers to the implementation of workplace health-related activities. Med Pr. 2020;71(3):289-307.

Identifying return to work trajectories among employees on sick leave due to mental health problems using latent class transition analysis.

OBJECTIVES: To develop effective return to work (RTW) interventions for employees on sick leave due to mental health problems (MHPs), a better understanding of individual variation in the RTW process is needed. We investigated which RTW trajectories can be identified among employees with MHPs in terms of RTW duration and relapse occurrence during the RTW process. Additionally, we examined how different RTW trajectories can be described in terms of personal and work characteristics. METHODS: Longitudinal sickness absence registry data were collected retrospectively from the largest Dutch occupational health service. Quantitative RTW information as well as personal and work characteristics were extracted. In total, 9517 employees with a sickness absence due to MHPs were included in the analyses (62 938 data points; RTW durations from 29 to 730 days). RESULTS: A latent class transition analysis revealed five distinct RTW trajectories, namely (1) fast RTW with little chance of relapse, (2) slow RTW with little chance of relapse, (3) fast RTW with considerable chance of relapse, (4) slow RTW with considerable chance of relapse and (5) very fast RTW with very small chance of relapse. Differences between employees in the slower and faster trajectories were observed regarding gender, age, type of MHP, organisation sector and organisation size but not regarding part-time work. CONCLUSIONS: RTW trajectories among employees with MHPs showed large individual variability and differed on personal and work characteristics. Knowledge on different RTW trajectories and their characteristics contributes to the development of personalised RTW treatments, tailored to specific individuals and organisations.

Experiences and outcomes of nurses referred to a peer health assistance program: Recommendations for nursing management.

AIM: To provide recommendations for nursing management based on the experiences of current and former nurses who were served by a peer health assistance program (PHAP). BACKGROUND: Providing help for nurses with impaired practice is critical to their health and well-being, assuring patient safety and public trust, as well as returning competent nurses to the healthcare workforce. METHODS: Nurses (n = 268) who were current clients or former clients of a PHAP were surveyed about their experiences. RESULTS: Nearly half of nurses were referred by the board of nursing with 69% reporting the referral was due to substance use, alcohol being the most common. Most (62%) did not believe that their substance use affected their practice yet relayed that recognition of their emotional or physical condition could have led to earlier identification. Key barriers to seeking assistance were fear and embarrassment, along with concerns about losing their nursing license. CONCLUSIONS: Nurses in management are in key roles to identify and intervene with nurses who are at risk for impaired practice. IMPLICATIONS FOR NURSING MANAGEMENT: Nurses in management and nurse colleagues would benefit from workplace education on the warning signs of impaired nursing practice and how to address it.

The Association Between Participation in Mahatma Gandhi National Rural Employment Guarantee Program and Smoking in India.

BACKGROUND: This paper examines whether participating in Mahatma Gandhi National Rural Employment Guarantee Program (NREGA) is associated with the likelihood of smoking among program participants in India. METHODS: We use two-stage residual inclusion (2SRI) estimation method and two waves of India Human Development Surveys completed before (2005) and after (2012) NREGA implementation. RESULTS: The likelihood of smoking increased with NREGA participation. For every 10% increase in NREGA income, the likelihood of smoking bidis (but not cigarettes) increased by 0.88 percentage point. A bidi, a stick of unprocessed tobacco wrapped in temburini leaves, is a significantly cheaper alternative to cigarettes. Nonparticipants who had a comparable increase in income between the two India Human Development Survey waves did not show an increase in likelihood of smoking. The heterogeneity in NREGA treatment effect shows that smoking tendency is not influenced by caste/religion or literacy. CONCLUSIONS: NREGA, as the largest workfare program, most certainly has had a significantly positive influence on the rural poor in India. The findings highlight its small but meaningful influence of a negative health behavior, greater likelihood of uptake of smoking bidis/hookah among program participants. IMPLICATIONS: Existing studies have found mixed evidence of an exogenous increase in income among low-income adults and its impact on smoking. No studies to date have tested the influence of workfare programs in rural areas of developing countries, where unemployment rates are higher and a substantial share of population in those areas is poor. Based on participation in employment guarantee programs as a proxy for exogenous increase in guaranteed income among rural population in India, we find that participants in the program were more likely to smoke bidis/hookah but not cigarettes.

[Occupational factors associated with suicide among French employees from the special agricultural social security scheme (MSA) working between 2007 and 2013]. / Facteurs professionnels en lien avec le suicide au sein des salariés affiliés à la Mutualité sociale agricole (MSA) et en activité entre 2007 et 2013.

BACKGROUND: Work and related exposures may play a role in suicide and there has been evidence in the literature that some occupational factors may be associated with suicide. The identification of occupational risk factors of suicide mortality among employees affiliated to the French special agricultural social security scheme (MSA), an understudied population, appears important. The objective of this study was to identify the occupational factors associated with suicide mortality among French employees from the MSA working between 2007 and 2013. METHODS: The study population included all the employees affiliated to the MSA working between 1st January 2007 and 31st December 2013, i.e. 1,699,929 men and 1,201,017 women. The studied occupational factors included: economic activity, skill level, and work contract. Survival analyses (Cox models) stratified on gender were performed using age as time scale and region and year of contract as adjustment variables. RESULTS: Among men, the factors associated with an elevated suicide risk were: economic activities of forestry, agriculture and related activities, and manufacture of food products and beverages (e.g. meat, wine), low-skilled level and working in the regions of Brittany, Burgundy Franche-Comté, Pays de la Loire, Normandy, Grand Est and Centre-Val-de-Loire. No association was observed among women. CONCLUSION: These results suggest that economic activity and low-skilled level may be associated with suicide among men affiliated to the MSA and may contribute to the implementation of prevention interventions. Further studies are needed to confirm and better understand these associations.

Disseminating Evidence-Based Interventions in Small, Low-Wage Worksites: A Randomized Controlled Trial in King County, Washington (2014-2017).

Objectives. To determine whether (1) participating in HealthLinks, and (2) adding wellness committees to HealthLinks increases worksites' evidence-based intervention (EBI) implementation.Methods. We developed HealthLinks to disseminate EBIs to small, low-wage worksites. From 2014 to 2017, we conducted a site-randomized trial in King County, Washington, with 68 small worksites (20-200 employees). We assigned worksites to 1 of 3 arms: HealthLinks, HealthLinks plus wellness committee (HealthLinks+), or delayed control. At baseline, 15 months, and 24 months, we assessed worksites' EBI implementation on a 0% to 100% scale and employees' perceived support for their health behaviors.Results. Postintervention EBI scores in both intervention arms (HealthLinks and HealthLinks+) were significantly higher than in the control arm at 15 months (51%, 51%, and 23%, respectively) and at 24 months (33%, 37%, and 24%, respectively; P < .001). Employees in the intervention arms perceived greater support for their health at 15 and 24 months than did employees in control worksites.Conclusions. HealthLinks is an effective strategy for disseminating EBIs to small worksites in low-wage industries.Public Health Implications. Future research should focus on scaling up HealthLinks, improving EBI maintenance, and measuring impact of these on health behavior.