Prevalence, associated factors and reasons for sickness presenteeism: a cross-sectional nationally representative study of salaried workers in Spain, 2016.
ABSTRACT: The aim of this study was to estimate the prevalence of sickness presenteeism (SP), its associated factors and the reasons given for SP episodes, among the overall salaried population and excluding the 'healthy' workers.Population-based cross-sectional study.Salaried population in Spain.Data were obtained from the third Spanish Psychosocial Risks Survey (2016), carried out between October and December 2016, n=1615.Self-reported episodes of SP and their reasons.23.0% (95% CI 19.2 to 26.8) of the workers exhibit SP, whereas among those manifesting having had some health problem in the preceding year, the figure was 53.0% (95% CI 46.9 to 59.1). The factors associated with SP when we study all workers are age, seniority, salary structure, working more than 48?hours, the contribution of worker's wage to the total household income and downsizing; factors among the 'unhealthy' workers are working more than 48?hours and not having a contract. The most common reason for SP is 'did not want to burden my colleagues', 45.7% (95% CI 37.3 to 54.4), whereas 'I could not afford it for economic reasons' ranked third, 35.9% (29.4% to 42.9%), and 27.5% (21.3% to 34.6%) of the workers report 'worried about being laid off' as a reason for going to work despite being ill.The estimated frequency of SP in Spain is lower than certain other countries, such as the Scandinavian countries. The factors associated vary depending on the population analysed (all workers or excluding 'healthy' workers). The reason 'I was worried about being laid off' was much more common than the estimates for Sweden or Norway.
Project description:<h4>Objectives</h4>This article investigates various reasons for sickness presenteeism (SP), that is, going to work despite illness. The research questions asked is: What are the main reported reasons for SP in Norway and Sweden?<h4>Design</h4>Cross-sectional survey in Norway and Sweden. Use of binomial logistic regression analysis.<h4>Participants</h4>A random sample of people aged between 20 and 60 years was obtained from complete and updated databases of the Norwegian and Swedish populations. A postal questionnaire was sent to the selected individuals, with response rate 33% (n=2843). 2533 workers responded to questions about SP during the last 12 months.<h4>Primary and secondary outcome measures</h4>The article informs about the distribution of reasons for SP in Norway and Sweden, selected by the respondents from a closed list. The article also examines which factors influence the most often reported reasons for SP.<h4>Results</h4>56% of the Norwegian and Swedish respondents experienced SP in the previous year. The most frequently reported reasons for SP include not burden colleagues (43%), enjoy work (37%) and feeling indispensable (35%). A lower proportion of Norwegians state that they cannot afford taking sick leave adjusted OR (aOR 0.16 (95% CI 0.10 to 0.22)), while a higher proportion of Norwegians refer to that they enjoy their work (aOR=1.64 (95% CI 1.28 to 2.09)). Women and young workers more often report that they do not want to burden their colleagues. Managers (aOR=2.19 (95% CI 1.67 to 2.86)), highly educated persons and the self-employed more often report that they are indispensable.<h4>Conclusions</h4>Positive and negative reasons for SP are reported, and there are significant differences between respondents from the two countries. The response rate is low and results must be interpreted with caution.<h4>Study design</h4>Cross-sectional study.
Project description:<h4>Introduction</h4>Delivery of intermittent preventive treatment with sulphadoxine-pyrimethamine to pregnant women (IPTp-SP) through antenatal clinic (ANC) in Mali is low, and whilst ANC delivery of insecticide treated nets (ITNs) is higher, coverage is still below national and international targets. The aim of this study was to explain quantitative data from a related study which identified ineffective processes in the delivery of these interventions in one district in Mali.<h4>Methods</h4>In-depth interviews were conducted with health workers at the national, regional, district and health facility levels on their perceptions of reasons for the ineffective processes identified in the quantitative study, and their reported practices. Themes were coded for each ineffective process, and within these a health systems lens was used. Content analysis was used for emergent themes within this framework. MindMaps were used to display the findings.<h4>Results</h4>Intervention specific factors for the ineffective delivery of IPTp-SP included misunderstanding of the upper limit of the gestational age at which SP could be given and side effects of SP. Incorrect practices had been recommended in training and supervision of health workers. Pregnant women who were ill on attendance at ANC were not consistently managed across health facilities. The most common reason for not offering women an ITN on their first ANC visit was if they were from outside the health facility catchment area. Broader health systems issues influencing the effectiveness of delivery of each of these interventions were also identified.<h4>Conclusion</h4>In this setting, intervention-specific factors resulted in the ineffective delivery of IPTp-SP. These relate to complex policy guidelines, lack of guidance on how to implement the guidelines, and the institutionalising of practices that undermine the national guidelines. Interventions may be implemented and show real gains in the shorter-term whilst waiting for broader health systems issues to be addressed.
Project description:OBJECTIVES:This study evaluated the prevalence rate of vaso-occlusive crisis (VOC) episodes, rates of uncomplicated and complicated VOC episodes, and the primary reasons for emergency room (ER) visits and inpatient admissions for sickle cell disease (SCD) patients. METHODS:The Medicaid Analytic extracts database was used to identify adult SCD patients using claims from 01JUL2009-31DEC2012. The date of the first observed SCD claim was designated as the index date. Patients were required to have continuous medical and pharmacy benefits for ?6 months baseline and ?12 months follow-up period. Patient demographics, baseline clinical characteristics, the rate of uncomplicated and complicated VOC (VOC with concomitant SCD complications) episodes, and reasons for ER visits and inpatient stays were analyzed descriptively. RESULTS:A total of 8,521 patients were included in the analysis, with a median age of 30 years. The average follow-up period was 2.7 years. The rate of VOC episodes anytime in the follow-up was 3.31 in person-years. During the first-year follow-up period, an average of 2.79 VOC episodes were identified per SCD patients, with 1.06 VOC episodes treated in inpatient setting and 0.90 VOC episodes in ER without admission. A total of 76,154 VOC episodes were identified during the entire follow-up period for the overall SCD patients. Most of the VOC episodes (70.3% [n = 53,523]) were uncomplicated episodes, and 29.7% were complicated episodes. Using primary diagnosis claims only, the most frequent complications during the VOC episode were infectious diseases (25.9%), fever (21.8%), and pulmonary disorders (16.2%). Among ER and hospitalizations related to VOC or SCD complication, ~85.0% had VOCs as the primary reason for admission; 15.0% had SCD complications as the primary reason. CONCLUSION:In summary, SCD and its related comorbidities and complications result in high acute health care utilization. In addition, VOC remains the primary reason for SCD patients' ER visits and inpatient admissions.
Project description:<h4>Background</h4>In April 2020, two independent clinical trials to assess SARS-CoV-2 prophylaxis strategies among health care workers were initiated at our hospital: MeCOVID (melatonin vs placebo) and EPICOS (tenofovir disoproxil/emtricitabine vs hydroxychloroquine vs combination therapy vs placebo).<h4>Objective</h4>This study aimed to evaluate the reasons why health care workers chose to participate in the MeCOVID and EPICOS trials, as well as why they chose one over the other.<h4>Methods</h4>Both trials were offered to health care workers through an internal news bulletin. After an initial screening visit, all subjects were asked to respond to a web-based survey.<h4>Results</h4>In the first month, 206 health care workers were screened and 160 were randomized. The survey participation was high at 73.3%. Health care workers cited "to contribute to scientific knowledge" (n=80, 53.0%), followed by "to avoid SARS-CoV-2 infection" (n=33, 21.9%) and "the interest to be tested for SARS-CoV-2" (n=28, 18.5%), as their primary reasons to participate in the trials. We observed significant differences in the expected personal benefits across physicians and nurses (P=.01). The vast majority of volunteers (n=202, 98.0%) selected the MeCOVID trial, their primary reason being their concern regarding adverse reactions to treatments in the EPICOS trial (n=102, 69.4%).<h4>Conclusions</h4>Health care workers' reasons to participate in prophylaxis trials in an acute pandemic context appear to be driven largely by their desire to contribute to science and to gain health benefits. Safety outweighed efficacy when choosing between the two clinical trials.
Project description:BACKGROUND:Increasing retirement age is a pivotal issue in labour market reforms. This study analyses factors conditioning retirement intentions. METHODS:In SeniorWorkingLife, 11 444 employed workers ?50 years replied to questions in random order about expected reasons for leaving and potential reasons for staying longer at the labour market. Respondents were stratified based on the Danish version of International Standard Classification of Occupations (ISCO). Representative estimates were produced using the SurveyFreq and SurveyLogistic procedures of SAS combined with model-assisted weights based on national registers. RESULTS:For ISCO groups 1-4 (seated work) main expected reasons for retiring were freedom to choose and desire for more leisure time, but many would consider staying longer if there were better possibilities for additional senior days, longer vacations and flexible working hours. For ISCO groups 5-9 (physical work), poor physical health and not being capable of doing the job were common expected reasons for retiring, but many would consider staying longer if the work were less physically demanding and there were more senior days. Possibility for pension was a general expected reason for retiring. Expected reasons differed to a less extent between genders than between ISCO groups, e.g. economic factors were more important for men and high work demands more important for women. CONCLUSION:Different barriers and opportunities for prolonging working life exist across different occupational groups of the labour market-with most consistent differences between those with seated and physical work. Targeting these specifically seems opportune for policy makers and future interventions.
Project description:Interruption of enteral nutrition (EN) in the intensive care unit (ICU) occurs frequently for various reasons including feeding intolerance and the conduct of diagnostic and therapeutic procedures. However, few studies have investigated the details of EN interruption practices including reasons for and duration of interruptions. There is no standard protocol to minimize EN interruptions.This is a retrospective review of 100 patients in the ICU staying more than 72 h and receiving EN in a 12-bed, medical/surgical ICU in a tertiary care center in 2013. Data collected include total time designated for EN; the number of EN interruption episodes; reason for each interruption categorized as diagnostic study, therapeutic intervention, or gastrointestinal (GI) event, and their individual subcategories; duration of each interruption; and the presence of written orders for interruptions.One hundred patients staying in the ICU for at least 72 h and receiving EN were included. There were 567 episodes of EN interruption over a median ICU length of stay of 17.1 (interquartile range 8.0-22.0) days. There were a median of three EN interruption episodes per patient. EN interruption was performed for undetermined reasons (166 episodes, 29%), airway manipulation (103 episodes, 18%), GI events (78 episodes, 14%), and intermittent dialysis (71 episodes, 13%). Median duration of EN interruption in all patients was 5.5 (3.0-10.0) h. The cumulative interruption time corresponds to 19% of the total time designated for EN. Duration of EN interruption varied according to reason, including airway manipulation (9.0 [5.0-21.0] h), tracheostomy (9.5 [7.5-14.0] h), and GI events (6.5 [3.0-14.0] h). The average calorie deficits due to interruptions were 11.5% of daily target calories. Only 60 episodes (12%) had clear written orders for interruption.Based on this single-center retrospective chart review, interruption of EN in the ICU is frequent, reasons for and duration of interruption varied, and airway procedures are associated with a relatively longer duration of interruption. Documentation and orders were frequently missing. These results warrant development of a protocol for EN interruption.
Project description:Aim: Analyse factors affecting retirement decisions comparing employees expecting to retire before, at, and after the state pension age. Methods: In the SeniorWorkingLife cohort, 12,269 workers aged +50 replied to questions about expected retirement age, reasons for leaving, and reasons for staying longer. Results: For all groups, poor health, wish for more leisure, and economy were the most salient expected reasons for retiring. Many would stay longer if there were better possibilities for more leisure time, more work flexibility, and economic benefits. Those expecting to retire before state pension age were more likely to point at desire for more leisure time as expected reason for retiring, and less likely to point at economic reasons, and more likely to point at health and work demands as possible reasons for prolonging working life. Those expecting to retire after state pension age were more likely to point at external factors and recognition from the management. Conclusion: Factors influencing retirement decisions are similar across the groups. Initiatives for better work-life balance, healthy lifestyle, and economic incentives to continue working may help prevent early retirement and motivate prolonging work life beyond retirement. Results also indicate that less strenuous work is particularly relevant to prevent early retirement.
Project description:Liver transplantation (LT) is definitive treatment for end-stage liver disease. This study evaluated factors predicting successful evaluation in patients transferred for urgent inpatient LT evaluation. Eighty-two patients with cirrhosis were transferred for urgent LT evaluation from January 2016 to December 2018. Alcohol-associated liver disease was the common etiology of liver disease (42/82). Of these 82 patients, 35 (43%) were declined for LT, 27 (33%) were wait-listed for LT, 5 (6%) improved, and 15 (18%) died. Psychosocial factors were the most common reasons for being declined for LT (49%). Predictors for listing and receiving LT on multivariate analysis included Hispanic race (odds ratio [OR], 1.89; <i>P</i> = 0.003), Asian race (OR, 1.52<i>; P</i> = 0.02), non-Hispanic ethnicity (OR, 1.49<i>; P</i> = 0.04), hyponatremia (OR, 1.38; <i>P</i> = 0.04), serum albumin (OR, 1.13<i>; P</i> = 0.01), and Model for End-Stage Liver Disease (MELD)-Na (OR, 1.02<i>; P</i> = 0.003). Public insurance (i.e., Medicaid) was a predictor of not being listed for LT on multivariate analysis (OR, 0.77<i>; P</i> = 0.02). Excluding patients declined for psychosocial reasons, predictors of being declined for LT on multivariate analysis included Chronic Liver Failure Consortium (CLIF-C) score >51.5 (OR, 1.26<i>; P</i> = 0.03), acute-on-chronic liver failure (ACLF) grade 3 (OR, 1.41<i>; P</i> = 0.01), hepatorenal syndrome (HRS) (OR, 1.38<i>; P</i> = 0.01), and respiratory failure (OR, 1.51<i>; P</i> = 0.01). Predictors of 3-month mortality included CLIF-C score >51.5 (hazard ratio [HR], 2.52; <i>P</i> = 0.04) and intensive care unit (HR, 8.25<i>; P</i> < 0.001). <i>Conclusion:</i> MELD-Na, albumin, hyponatremia, ACLF grade 3, HRS, respiratory failure, public insurance, Hispanic race, Asian race, and non-Hispanic ethnicity predicted liver transplant outcome. Lack of psychosocial support was a major reason for being declined for LT. The CLIF-C score predicted being declined for LT and mortality.
Project description:OBJECTIVES:This study aimed to assess the degree to which the 'social cure' model of psychosocial health captures the understandings and experiences of healthcare staff and patients in a social prescribing (SP) pathway and the degree to which these psychosocial processes predict the effect of the pathway on healthcare usage. DESIGN:Mixed-methods: Study 1: semistructured interviews; study 2: longitudinal survey. SETTING:An English SP pathway delivered between 2017 and 2019. PARTICIPANTS:Study 1: general practitioners (GPs) (n=7), healthcare providers (n=9) and service users (n=19). Study 2: 630 patients engaging with SP pathway at a 4-month follow-up after initial referral assessment. INTERVENTION:Chronically ill patients experiencing loneliness referred onto SP pathway and meeting with a health coach and/or link worker, with possible further referral to existing or newly created relevant third-sector groups. MAIN OUTCOME MEASURE:Study 1: health providers and users' qualitative perspectives on the experience of the pathway and social determinants of health. Study 2: patients' primary care usage. RESULTS:Healthcare providers recognised the importance of social factors in determining patient well-being, and reason for presentation at primary care. They viewed SP as a potentially effective solution to such problems. Patients valued the different social relationships they created through the SP pathway, including those with link workers, groups and community. Group memberships quantitatively predicted primary care usage, and this was mediated by increases in community belonging and reduced loneliness. CONCLUSIONS:Methodological triangulation offers robust conclusions that 'social cure' processes explain the efficacy of SP, which can reduce primary care usage through increasing social connectedness (group membership and community belonging) and reducing loneliness. Recommendations for integrating social cure processes into SP initiatives are discussed.
Project description:BACKGROUND:The global pandemic of coronavirus disease of 2019 (COVID-19) has led to unprecedented psychological stress on health workers (HCWs). We aimed to assess the psychological impact of COVID-19 on HCWs in comparison to the stress brought on by the Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic in Saudi Arabia. METHOD:Between February 5th and 16th, 2020, 811 health-care workers (HCWs) of a tertiary care teaching hospital were invited to fill a questionnaire regarding concerns and worries about the novel coronavirus pandemic, along with Generalized Anxiety Disorder (GAD-7) Anxiety Severity screening tool. RESULTS:Out of 582 HCWs who completed the survey questionnaire (response rate of 71.8%), about 40% were exposed previously to MERS-CoV infected or suspected patients during a previous hospital outbreak. While there were no COVID-19 cases reported yet in Saudi Arabia at the time of data collection, still, the anxiety level from COVID-19 was significantly higher than that from MERS-CoV or seasonal influenza: 41.1% were more worried about COVID-19, 41.4% were similarly worried about both MERS-CoV and COVID-19, and 17.5% were more stressed by the previous MERS-CoV hospital outbreak. The most frequent concern was transmitting the infection to family and friends (2.71/5) than to themselves only (2.57/5). CONCLUSION:Pandemic and epidemic infectious diseases such as COVID-19 or MERS-CoV impose a significant level of anxiety and stress on healthcare workers who are caring of infected patients, with their main concern being the risk of transmitting the infection to their families or to acquire it themselves. Therefore, optimizing the compliance of healthcare workers with the proper infection prevention and control measures is paramount during the infectious disease outbreak, to ensure their safety, to decrease the likelihood of getting infected or transmitting the infection to others, and consequently to alleviate their psychological stress and anxiety.