BACKGROUND: Women with breast cancer face many barriers to return to work (RTW) after their cancer. The main objective of the FASTRACS-RCT is to evaluate the impact of the FASTRACS (Facilitate and Sustain Return to Work after Breast Cancer) intervention on the sustainable RTW of breast cancer patients, 12 months after the end of active treatment.
METHODS: FASTRACS-RCT is a prospective, national, multicentre, randomized, controlled and open-label study. A total of 420 patients with early breast cancer scheduled for surgery and (neo)adjuvant chemotherapy, will be randomly assigned (1:1 ratio) to: (i) the intervention arm comprising four steps over 6 months : Handing over the intervention tools; transitional medical consultation with the general practitioner (GP); pre-RTW visit with the company\'s occupational physician (OP); catch-up visit with a hospital-based RTW expert (if sick leave > 10 months) (ii) the control arm to receive usual care. The design of the FASTRACS intervention was informed by intervention mapping for complex interventions in health promotion planning, and involved patients and representatives of relevant stakeholders. Specific tools were developed to bridge the gap between the hospital, the GP, the OP and the workplace: a toolkit for breast cancer patients comprising a theory-based guide; specific checklists for the GP and the OP, respectively; and a theory-based guide for workplace actors (employer, manager, colleagues). The primary endpoint will associate sustainable RTW (full-time or part-time work at 50% or more of working time, for at least 28 consecutive days) and days off work. It will be assessed at 4, 8 and 12 months after the end of active oncological treatment. Secondary endpoints will include quality of life, anxiety, depression, RTW self-efficacy, physical activity, social support, job accommodations, work productivity, job status, and the usefulness and acceptability of the intervention\'s tools.
CONCLUSIONS: FASTRACS-RCT will be supplemented by a realist evaluation approach aimed at understanding the influence of context in activating the intervention\'s mechanisms and effects. If the expected impact of the intervention is confirmed, the intervention will be adapted and scaled-up for other cancers and chronic diseases to better integrate healthcare and work disability prevention.
BACKGROUND: NCT04846972 ; April 15, 2021.

BACKGROUND: Most studies about accidents and about PTSD, respectively, have been conducted either on blue-collar workers, or on the entire working population. There are very few such studies on white-collar workers.
OBJECTIVE: To examine diagnosis-specific sickness absence (SA) and disability pension (DP) after a work accident or PTSD, respectively, among white-collar workers in the private retail and wholesale industry.
METHODS: A prospective population-based cohort study of all 192,077 such workers aged 18-67 (44% women) in Sweden in 2012, using linked microdata from nationwide registers. We identified individuals who had secondary healthcare due to work-related accidents (n = 1114; 31% women) or to PTSD (n = 216; 79% women) in 2012-2016. Their average number of net days of diagnosis-specific SA (in SA spells > 14 days) and DP were calculated for 365 days before and 365 days after the healthcare visit.
RESULTS: 35% of the women and 24% of the men had at least one new SA spell during the 365 days after healthcare due to work accidents. Among women, the average number of SA/DP days increased from 14 in the year before the visit to 31 days the year after; among men from 9 to 21 days. SA days due to fractures and other injuries increased most, while SA days due to mental diagnoses increased somewhat. 73% of women and 64% of men who had healthcare due to PTSD had at least one new SA spell in the next year. Women increased from 121 to 157 SA/DP days and men from 112 to 174. SA due to stress-related disorders and other mental diagnoses increased the most, while DP due to stress-related diagnoses and SA due to musculoskeletal diagnoses increased slightly.
CONCLUSIONS: About a quarter of those who had secondary healthcare due to work accidents, and the majority of those with such healthcare due PTSD, had new SA in the following year. SA due to injury and mental diagnoses, respectively, increased most, however, SA/DP due to other diagnoses also increased slightly. More knowledge is needed on factors associated with having or not having SA/DP in different diagnoses after work accidents and among people with PTSD.

BACKGROUND: Common mental health problems, such as stress, anxiety and depression, are highly prevalent among workers and often lead to long-term absenteeism and work disability. Effective elements found in previous researched interventions were to explicitly focus on return to work (RTW) and not solely on symptom reduction, to take into account the employees\' cognition towards RTW and to include the workplace environment. Based on these elements, a stepped-care approach was developed. The aim of this paper is to present the study design of a randomized controlled trial (RESTART), evaluating the effectiveness of the stepped-care approach on lasting RTW and the implementation process.
METHODS: RESTART is a randomized controlled trial with a 2 × 2 factorial design and a follow-up of one year. Employees eligible for this study are those who reported sick within 2 to 8 weeks with psychological distress based on a distress screener. Participants will be randomized to a group receiving a tailored e-Health app or usual care, as well as randomized to a group receiving a Participatory Approach (PA; conversational method) in the workplace or usual care. The PA will however only be provided in case of persistent sickness absence at 8 weeks. Measurements take place at baseline, after the e-Health intervention period (3 months), and after the PA intervention period (6 months) and 12 months. Primary outcome is lasting RTW, defined as full RTW in previous or equal work for at least four consecutive weeks. Secondary outcomes are (the severity of) stress-related symptoms, total number of sickness absence days, self-efficacy for RTW and self-reported health. A process evaluation including a realist evaluation will also be conducted.
CONCLUSIONS: Early intervention that focuses on RTW, the cognition towards RTW despite symptoms and involves the workplace environment, plays a crucial role in managing sickness absence among employees with psychological distress. If effective, the stepped-care approach is relevant for employees, employers and society as a whole.
BACKGROUND: ISRCTN: 90663076. Registered on 5 October 2023.

UNASSIGNED: Although work provides many benefits, occupational mental disorders, such as mental distress, depression, and stress-related illnesses have significantly increased.
UNASSIGNED: This study aims to identify and present the spatial distribution of the major mental and behavioral disorders that lead to sick leave in Brazil Northeastern states.
UNASSIGNED: This descriptive study with an ecological time series design aimed to identify the distribution of occupational mental and behavioral disorders in Brazil Northeastern states. Data collection included downloading information from the Observatório de Segurança e Saúde no Trabalho (SmartLab, Occupational Health and Safety Observatory) from 2012 to 2018. Data were analyzed using Python.
UNASSIGNED: Grants of sick leave according to the type of illness were recorded for nonaccident-related leave (B31) and accident-related leave (B91). Bahia had the highest number of cases reported for B31, as did Rio Grande do Norte for B91. Rio Grande do Norte and Alagoas stood out with the highest rates of sick leave due to mental and behavioral disorders. Phobic-anxiety disorders had the highest number of notifications. The building construction industry had the highest number of work-related notifications.
UNASSIGNED: This study has contributed to identifying the main occupational disorders. Public policies need to be implemented to tackle the public health crisis which directly impacts on domestic social and economic conditions.
UNASSIGNED: Mesmo diante dos benefícios que a atividade laboral proporciona, tem-se observado um aumento significativo no número de trabalhadores com sofrimento psíquico, depressão e doenças associadas ao estresse.
UNASSIGNED: Identificar e apresentar a distribuição espacial por estado do Nordeste dos principais transtornos mentais e comportamentais que geram afastamento da atividade laboral.
UNASSIGNED: Realizou-se um estudo descritivo com desenho ecológico de série temporal, cuja finalidade é identificar a distribuição de transtornos mentais e comportamentais em trabalhadores da região Nordeste. Para a coleta de dados, utilizou-se o Observatório de Segurança e Saúde no Trabalho (SmartLab) mediante o download das informações notificadas no período de 2012 a 2018. A análise foi realizada por meio da linguagem de programação Python.
UNASSIGNED: As concessões de auxílios por afastamento conforme o tipo de doença foram registradas para afastamentos não acidentários (B31) e acidentários (B91). A Bahia apresentou um maior número de casos notificados para B31, assim como o Rio Grande do Norte para B91. O Rio Grande do Norte e Alagoas se destacaram como os estados que concentram o maior percentual de casos de afastamento por transtornos mentais e comportamentais. Os transtornos fóbico-ansiosos obtiveram o maior número de notificações entre os estados. A atividade de construção de edifícios se revelou com os maiores números de notificações relacionadas ao trabalho.
UNASSIGNED: Este estudo contribuiu para a identificação dos principais transtornos que acometem os trabalhadores. É necessário que sejam adotadas políticas públicas no enfrentamento da crise de saúde pública que impacta diretamente as condições sociais e econômicas do país.

BACKGROUND: Returning to work after long-term sick leave can be challenging, particularly in small- and medium-sized enterprises (SMEs) where support may be limited. Recognizing the responsibilities and challenges of SME employers, a web-based intervention (hereafter the SME tool) has been developed. The SME tool aims to enhance the employer\'s intention and ability to support the sick-listed employee. Based on the Self-Determination Theory, it is hypothesized that this intention is enhanced by intervening in the employer\'s autonomy, competences, and relatedness targeted at, e.g., communication with sick-listed employee, involvement of other stakeholders, and practical support. This is achieved by means of providing templates, communication videos, and information on legislation. This article describes the design of an effect and process evaluation of the SME tool.
METHODS: A randomized controlled trial (RCT) with a 6-month follow-up will be conducted with a parallel-group design with two arms: an intervention group and a control group. Sick-listed employees (≤ 8 weeks) of SMEs (≤ 250 employees) at risk of long-term sick leave and their employers will be recruited and randomly allocated as a dyad (1:1). Employers randomized to the intervention group receive unlimited access to the SME tool, while those in the control group will receive care as usual. The primary outcome is the satisfaction of the employee with the return to work (RTW) support provided by their employer. Secondary outcomes include social support, work performance, and quality of work life at the employee level and self-efficacy in providing RTW support at the employer level. Outcomes will be assessed using questionnaires at baseline and 1, 3, and 6 months of follow-up. Process evaluation measures include, e.g., recruitment and use of and perceived usefulness of the SME tool. Additionally, semi-structured interviews with employers, employees, and occupational physicians will explore the interpretation of the RCT results and strategies for the national implementation of the SME tool.
CONCLUSIONS: The SME tool is hypothesized to be valuable in addition to usual care helping employers to effectively support the RTW of their long-term sick-listed employees, by improving the employers\' intention and ability to support.
BACKGROUND: ClinicalTrials.gov, NCT06330415. Registered on February 14, 2024.

BACKGROUND: High rates of sickness absence is a challenge within the healthcare sector, highlighting the need for effective interventions. Despite this, limited research has been conducted on the impact of such interventions within the healthcare context. This study evaluates an intervention aimed at improving the work environment influences sickness absence rates in Norwegian hospital units. The intervention is a comprehensive framework for discovering and tailoring solutions to each units\' specific needs, with a focus on employee involvement and collaboration between leader, union representatives and safety delegates.
METHODS: We employed two methodological approaches. Method 1 involved using HR-registered sickness absence data to track changes in sickness absence across all intervention units and matched control groups over a three-year period. In Method 2, we used a pre- and post-survey design in 14 intervention units, focusing on employees\' job satisfaction and self-reported health.
RESULTS: The results of the intervention were mixed. There was a significant decrease in total sickness absence in the intervention units the first year after the intervention, and a significant decrease in long-term sickness absence both in the first and second year after the intervention, measured with HR registries. However, we did not see a significant larger decrease in total sickness absence in the intervention units compared to the control units and only partial support for a larger decrease in long-term absence in the intervention units. In the subsample of units that also participated in the survey, we observed significant improvements in employee job satisfaction post intervention.
CONCLUSIONS: There is a need for research on effective interventions to reduce sickness absence in the healthcare sector. \"Where the shoe pinches\" provides a potential methodological framework for reducing sickness absence by addressing challenges in the work environment, however with uncertain results. Further exploration is warranted to refine strategies for effectively managing sickness absence within healthcare organizations.

OBJECTIVE: Studies usually investigate a limited number or a predefined combinations of risk factors for sickness absence in employees with pain. We examined frequently occurring combinations across a wide range of work-related factors and pain perceptions.
METHODS: Cross-sectional study.
METHODS: Belgian companies that are under supervision of IDEWE, an external service for prevention and protection at work.
METHODS: In total, 249 employees experiencing pain for at least 6 weeks were included and filled out an online survey.
RESULTS: Latent profile analysis was used to differentiate profiles of work-related factors (physical demands, workload, social support and autonomy) and pain perceptions (catastrophising, fear-avoidance beliefs and pain acceptance). Subsequently, profiles were compared on sociodemographics (age, gender, level of education, work arrangement, duration of complaints, multisite pain and sickness absence in the previous year) and predictors of sickness absence (behavioural intention and perceived behavioural control).
RESULTS: Four profiles were identified. Profile 1 (38.2%) had favourable scores and profile 4 (14.9%) unfavourable scores across all indicators. Profile 2 (33.3%) had relatively high physical demands, moderate autonomy levels and favourable scores on the other indicators. Profile 3 (13.7%) showed relatively low physical demands, moderate autonomy levels, but unfavourable scores on the other indicators. Predictors of profiles were age (OR 0.93 and 95% CI (0.89 to 0.98)), level of education (OR 0.28 and 95% CI (0.1 to 0.79)) and duration of sickness absence in the previous year (OR 2.29 and 95% CI (0.89 to 5.88)). Significant differences were observed in behavioural intention (χ2=8.92, p=0.030) and perceived behavioural control (χ2=12.37, p=0.006) across the four profiles.
CONCLUSIONS: This study highlights the significance of considering the interplay between work-related factors and pain perceptions in employees. Unfavourable scores on a single work factor might not translate into maladaptive pain perceptions or subsequent sickness absence, if mitigating factors are in place. Special attention must be devoted to employees dealing with unfavourable working conditions along with maladaptive pain perceptions. In this context, social support emerges as an important factor influencing sickness absence.

UNASSIGNED: Police activity exposes the workers to several conditions that can cause physical and mental health problems, leading to sickness absenteeism.
UNASSIGNED: To describe the reasons for sickness absenteeism in Federal Highway Patrol Officers in the state of Rio Grande do Sul, Brazil.
UNASSIGNED: We used secondary data from official records of sickness absenteeism of Federal Highway Patrol Officers in Rio Grande do Sul. Sickness absenteeism was classified according to the International Classification of Diseases - 10th Revision. The variables analyzed were: reasons for sickness absenteeism, by code and category of the International Classification of Diseases - 10th Revision, and days absent from work by International Classification of Diseases - 10th Revision code. Descriptive data were reported using frequency distribution and measures of central tendency and dispersion. We used the Kruskal-Wallis test to compare the days absent from work between the International Classification of Diseases - 10th Revision codes.
UNASSIGNED: The most common reason for sickness absenteeism was diseases of the musculoskeletal system and connective tissue (24.6%). Mental and behavioral disorders were associated with the highest number of days absent from work (32.6 ± 19.9 days). Within the most prevalent disease groups, depressive disorders (30%), fractures (30%), and low back pain (15.9%) were the disease categories with the highest frequencies.
UNASSIGNED: Sickness absenteeism among Federal Highway Patrol Officers is predominantly related to diseases of the musculoskeletal system and connective tissue, and prolonged sick leave is due mainly to mental and behavioral disorders. Therefore, this police organization needs to promote and implement prevention programs to manage the main morbidities.
UNASSIGNED: A atividade policial expõe seus trabalhadores a diversas condições que podem ocasionar problemas de saúde tanto físicos quanto mentais e consequente absenteísmo do profissional.
UNASSIGNED: Descrever os motivos de absenteísmo-doença em agentes da Polícia Rodoviária Federal do Rio Grande do Sul.
UNASSIGNED: Utilizamos dados secundários de registros oficiais de absenteísmo do trabalho de agentes da Polícia Rodoviária Federal do Rio Grande do Sul. Os absenteísmos-doença foram classificados conforme a Classificação Internacional de Doenças - 10ª Revisão. As variáveis analisadas foram: motivos de absenteísmo-doença, por grupo e categoria da Classificação Internacional de Doenças - 10ª Revisão e dias de afastamento por grupo da Classificação Internacional de Doenças - 10ª Revisão. Dados descritivos foram reportados através de distribuição de frequências e de tendência central e dispersão. Utilizamos o teste de Kruskall-Wallis para comparação dos dias de afastamento entre os grupos de Classificação Internacional de Doenças - 10ª Revisão.
UNASSIGNED: A maior prevalência de afastamentos foi por doenças do sistema osteomuscular e do tecido conjuntivo (24,6%). O grupo de doenças dos transtornos mentais e de comportamento foi o que apresentou maior número de dias de afastamento (32,6 ± 19,9 dias). Entre os grupos mais prevalentes, transtornos depressivos (30%), fraturas (30%) e dor lombar (15,9%) foram as categorias de doença que apresentaram maiores frequências.
UNASSIGNED: O absenteísmo-doença entre os agentes da Polícia Rodoviária Federal predomina por doenças do sistema osteomuscular e do tecido conjuntivo, bem como possui elevada duração por transtornos mentais e de comportamento. Assim, existe uma necessidade dessa organização policial de promover a prevenção e implementação de programas de gerenciamento dessas principais morbidades.

OBJECTIVE: To explore frontline employees\' experiences of how to create a purposeful sick leave and rehabilitation process (SRP) with the best interest of patients\' long-term health in focus.
METHODS: Qualitative design based on focus group interviews in a primary care context in Region Västra Götaland, Sweden. Strategically selected professionals from different SRP organizations discussed sick leave outcomes and the rehabilitation process. Analysis was performed with Systematic text condensation.
METHODS: General practitioners (n = 6), rehabilitation coordinators and/or healthcare professionals from primary healthcare (n = 13), caseworkers from the Social Insurance Agency, the Employment Agency, and Social Services (n = 12).
RESULTS: The outcome of the SRP was described to depend upon the extent to which the process meets patients\' bio-psycho-social needs. Aspects considered crucial were: 1) early bio-psycho-social assessments, including medical specialist consultations when needed, 2) long-term realistic planning of sick leave and rehabilitation alongside medical treatment, 3) access to a wide range of early rehabilitative and supportive interventions, including situation-based, non-medical practical problem solving, and 4) trusting relationships over time for all involved professions and roles to maximize process quality and person-centeredness. A gap between the desired scope of the SRP and existing guidelines was identified.
CONCLUSIONS: Interviewees perceived that successful outcomes from the sick leave and rehabilitation process in a primary care context depend on consensus, person-centeredness, and relationship continuity for all involved professions. An extended process scope and relationship continuity for all involved professionals were suggested to improve process outcomes.

BACKGROUND: Stress-induced exhaustion disorder (SED) is the most common reason for long-term sick leave in Sweden and the recovery process may be long and troublesome. This study explores the symptoms of burnout, depression and anxiety among patients with SED 10 years after termination of a multimodal rehabilitation program. Another aim of the study was to investigate work situation, work functioning, and any remaining exhaustion and sleeping disorders among those who were gainfully employed at the 10-year follow-up.
METHODS: This longitudinal study included 107 patients (91 women and 16 men), who had been diagnosed with SED 10 years prior to the study. After establishing the diagnosis they all underwent and completed an multimodal rehabilitation program. Data on symptoms of burnout, anxiety and depression were collected before and after the multimodal rehabilitation program, and at follow-ups after additional 1 year and an additional 10 years. At the 10-year follow-up, work situation, work functioning, and symptoms of exhaustion and sleep disorders were assessed in those who were gainfully employed (89 patients).
RESULTS: Symptoms of burnout, anxiety, and depression remained stable from the 1- to the 10-year follow-up after completed rehabilitation. Among participants who were gainfully employed, 73% had changed workplaces, and 31.5% had reduced their working hours. Common reasons for these changes were lack of energy or because they had chosen to prioritise their lives differently. Work functioning was rated as moderate, one third self-reported SED to some extent, and one fifth reported moderate-to-severe insomnia.
CONCLUSIONS: A relatively large proportion of former patients with SED have residual health problems 10 years after rehabilitation and some have not been able to return to full-time work. Preventive and early rehabilitative interventions with adjustments and measures at the organisational level are probably needed to achieve a more sustainable working life.