Coordinators in the return-to-work process: Mapping their work models

PURPOSE

In recent decades, many countries have implemented return-to-work coordinators to combat high rates of sickness absence and insufficient collaboration in the return-to-work process. The coordinators should improve communication and collaboration between stakeholders in the return-to-work process for people on sickness absence. How they perform their daily work remains unexplored, and we know little about to what extent they collaborate and perform other work tasks to support people on sickness absence. This study examines which work models return-to-work coordinators use in primary healthcare, psychiatry and orthopaedics in Sweden.

METHODS

A questionnaire was sent to all 82 coordinators in one region (89% response rate) with questions about the selection of patients, individual patient support, healthcare collaboration, and external collaboration. Random forest classification analysis was used to identify the models.

RESULTS

Three work models were identified. In model A, coordinators were more likely to select certain groups of patients, spend more time in telephone than in face-to-face meetings, and collaborate fairly much. In Model B there was less patient selection and much collaboration and face-to-face meetings. Model C involved little patient selection, much telephone contact and very little collaboration. Model A was more common in primary healthcare, model C in orthopaedics, while model B was distributed equally between primary healthcare and psychiatry.

CONCLUSION

The work models correspond differently to the coordinator's assignments of supporting patients and collaborating with healthcare and other stakeholders. The differences lie in how much they actively select patients, how much they collaborate, and with whom. Their different distribution across clinical contexts indicates that organisational demands influence how work models evolve in practice.

Time period effects in work disability due to common mental disorders among young employees in Sweden-a register-based cohort study across occupational classes and employment sectors

BACKGROUND

We aimed to investigate time period effects in the risk of work disability, defined as long-term sickness absence (LTSA) and disability pension (DP) due to common mental disorders (CMDs), among young employees according to employment sector (private/public) and occupational class (non-manual/manual).

METHODS

Three cohorts, including all employed individuals with complete information on employment sector and occupational class, aged 19-29 years and resident in Sweden on 31 December 2004, 2009 and 2014 (n = 573 516, 665 138 and 600 889, respectively) were followed for 4 years. Multivariate-adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were estimated to examine the risk of LTSA and DP due to CMDs using Cox regression analyses.

RESULTS

In all cohorts, public sector employees had higher aHRs for LTSA due to CMDs than private sector employees, irrespective of occupational class, e.g. aHR, 95% CI: 1.24, 1.16-1.33 and 1.15, 1.08-1.23 among non-manual and manual workers in cohort 2004. The rates of DP due to CMDs were much lower in cohorts 2009 and 2014 than 2004 leading to uncertain risk estimates in the later cohorts. Still, public sector manual workers had a higher risk for DP due to CMDs than manual workers in the private sector in cohort 2014 than in 2004 (aHR, 95% CI: 1.54, 1.34-1.76 and 3.64, 2.14-6.18, respectively).

CONCLUSIONS

Manual workers in the public sector seem to have a higher risk of work disability due to CMDs than their counterparts in the private sector calling for the need for early intervention strategies to prevent long-term work disability.

Time period effects in work disability due to common mental disorders among young employees

Background

Previous research on period effects in risk for work disability due to common mental disorders across employment sectors and occupational classes in young employees is lacking. Temporal changes in the healthcare system or social insurance policies or other structural/organisational changes could contribute to such time period effects. We aimed to investigate time period effects in the risk of work disability, defined as long-term sickness absence (LTSA) and disability pension (DP) due to common mental disorders (CMDs), among young employees according to their employment sector (private/public) and occupational class (non-manual/manual).

Methods

Three cohorts, including all employed individuals with complete information on employment sector and occupational class, aged 19-29 years and resident in Sweden on the 31-Dec-2004, 2009 and 2014 (n = 573,516, 665,138 and 600,889 individuals in cohort 2004, 2009 and 2014, respectively) were followed for four years. Crude and multivariate-adjusted hazard ratios (HRs and aHRs, respectively) with 95% confidence intervals (CIs) were estimated regarding the risk of LTSA and DP due to CMDs using Cox regression analyses.

Results

In cohort 2004, public sector employees had a higher relative risk for LTSA due to CMDs than private sector employees (aHR, (95%CI): 1.24, 1.16-1.34 and 1.18, 1.11-1.26 among non-manual and manual workers). These associations were similar in the later cohorts. Compared to cohort 2004, the rate of DP due to CMDs was considerably lower in the later cohorts leading to uncertainties in the risk estimates limiting the comparability for time period effects regarding the risk of DP due to CMDs across employment sectors and occupational classes.

Conclusions

Stricter regulation changes regarding the receipt of DP in Sweden, rather than other time period events, may have differentially affected the risk of work disability among young non-manual and manual employees working in the private and public sectors.

Key messages

Associations among Periodontitis, Calcified Carotid Artery Atheromas, and Risk of Myocardial Infarction

Cardiovascular disease is a common cause of morbidity and premature mortality. Cardiovascular disease can be prevented when risk factors are identified early. Calcified carotid artery atheromas (CCAAs), detected in panoramic radiographs, and periodontitis have both been associated with increased risk of cardiovascular disease. This case-control study aimed to 1) investigate associations between periodontitis and CCAA detected in panoramic radiographs and 2) determine the risk of future myocardial infarctions due to CCAA combined with periodontitis. We evaluated 1,482 participants (738 cases and 744 controls) with periodontitis and CCAAs recruited from the PAROKRANK study (Periodontitis and Its Relation to Coronary Artery Disease). Participants were examined with panoramic radiographs, including the carotid regions. Associations between myocardial infarction and periodontitis combined with CCAA were evaluated in 696 cases and 696 age-, sex-, and residential area–matched controls. Periodontitis was evaluated radiographically (as degree of bone loss) and with a clinical periodontal disease index score (from clinical and radiographic assessments). We found associations between CCAA and clinical periodontal disease index score among cases (odds ratio [OR], 1.51; 95% CI, 1.09 to 2.10; P = 0.02) and controls (OR, 1.70; 95% CI, 1.22 to 2.38; P < 0.01), although not between CCAA and the degree of bone loss. In a multivariable model, myocardial infarction was associated with CCAA combined with periodontitis, as assessed by degree of bone loss (OR, 1.75; 95% CI, 1.11 to 2.74; P = 0.01). When the cohort was stratified by sex, only men showed a significant association between myocardial infarction and CCAA combined with periodontitis. Participants with clinically diagnosed periodontitis exhibited CCAA in panoramic radiographs more often than those without periodontitis, irrespective of the presence of a recent myocardial infarction. Participants with combined periodontitis and CCAA had a higher risk of having had myocardial infarction as compared with participants with either condition alone. These findings implied that patients in dental care might benefit from dentists assessing panoramic radiographs for CCAA—particularly, patients with periodontitis who have not received any preventive measures for cardiovascular disease.

Important factors determining the nanoscale tracking precision of dynamic microtubule ends

Tracking dynamic microtubule ends in fluorescence microscopy movies provides insight into the statistical properties of microtubule dynamics and is vital for further analysis that requires knowledge of the trajectories of the microtubule ends. Here we analyse the performance of a previously developed automated microtubule end tracking routine; this has been optimized for comparatively low signal-to-noise image sequences that are characteristic of microscopy movies of dynamic microtubules growing in vitro. Sequences of simulated microtubule images were generated assuming a variety of different experimental conditions. The simulated movies were then tracked and the tracking errors were characterized. We found that the growth characteristics of the microtubules within realistic ranges had a negligible effect on the tracking precision. The fluorophore labelling density, the pixel size of the images, and the exposure times were found to be important parameters limiting the tracking precision which could be explained using concepts of single molecule localization microscopy. The signal-to-noise ratio was found to be a good single predictor of the tracking precision: typical experimental signal-to-noise ratios lead to tracking precisions in the range of tens of nanometres, making the tracking program described here a useful tool for dynamic microtubule end tracking with close to molecular precision.

Short-term bioassay responses to sludge products and leachate

Recycling of sewage sludge is needed in a sustainable society. Quality aspects of sludge include hygiene (pathogens), nutrients (N and P), and toxicants (metals and organics). Metals are of particular concern because they are not degradable, but their hazards are related to their bioavailability and chemical speciation. In this article, the effect on sludge quality of two treatment methods, incineration and pelletization, has been determined for digested sludge from two treatment plants. The combined effect of nutrients and toxicants in sludge and sludge product was determined for spring wheat, Triticum aestivum, and the toxicity of the leachate water was determined for water fleas, Daphnia magna, and seeds of lettuce, Lactuca sativa. Toxicity Identification Evaluation was used to determine whether metals were possible toxicants. The results indicated that incineration decreased toxicity, whereas leachability of metals and the fertilizing effect was unaffected. Pelletization seemed to increase toxicity and leachability of metals and also decreased the fertilizing effect of the sludge. Thus, the results suggest that pelletization of digested sewage sludge increased the toxicity of the sludge and thus decreased the quality of the sludge, whereas incineration apparently reduced toxicity for the two sludges tested.