Results of a feasibility study: barriers and facilitators in implementing the Sherbrooke model in France.

OBJECTIVES: Return-to-work interventions associated with the workplace environment are often more effective than conventional care. The Sherbrooke model is an integrated intervention that has proved successful in preventing work disability due to low-back pain. Implementation, however, runs up against many obstacles, and failure has been reported in many countries. The present study sought to identify barriers to and facilitators of the implementation of the Sherbrooke model within the French health system. METHODS: A multiple case study with nested levels of analysis was performed in two regions of France. A conceptual framework was designed and refined to identify barriers and facilitators at the individual, organizational and contextual levels. Qualitative data were collected via semi-structured interview (N=22), focus groups (N=7), and observation and from the gray literature. Participants (N=61) belonged to three fields: healthcare, social insurance, and the workplace. RESULTS: Numerous barriers and facilitators were identified in each field and at each level, some specific and others common to workers in all fields. Individual and organizational barriers comprised lack of time and resources, discordant professional values, and perceived risk. Legal barriers comprised medical confidentiality, legal complexity, and priority given to primary prevention. Individual-level facilitators comprised needs and perceived benefits. Some organizations had concordant values and practices. Legal facilitators comprised possibilities of collaboration and gradual return to work. CONCLUSION: The present feasibility analysis of implementing the Sherbrooke model revealed numerous barriers and facilitators suggesting a new implementation strategy be drawn up if failure is to be avoided

Douleurs et travail : aider le patient à garder un emploi

Introduction.— A significant part of the workers suffer from musculoskeletal pain (back pain,upper limb). Some of them are at risk to ose their job due to their health condition. Objective. — The aim of the article is to describe synthetically what actors and measure can be used in order to help a patient keep his/her job in spite of the pain. Results.— First place measures include a visit with the occupational physician before work resumption, part-time return to work and workplace accommodation.Second place measures require that a professional project is built by the patient supported by a knowledgeable person. These measures depend on the funding agency.They are devoted to compensate the work disability situation, and/or to provide the training required by the patient’s project. Discussion and conclusion. — Work disability prevention faces many challenges due to barriers between the stakeholders, scattering of the knowledge and the complexity of legislative issues.However, it remains possible provided the patient is committed and supported by a case manager in charge of coordinating the information and the stakeholders. Confidence and collaboration are key issues in the process.

Impact of a comprehensive prevention programme aimed at reducing incivility and verbal violence against healthcare workers in a French ophthalmic emergency department: an interrupted time-series study.

Primary prevention, comprising patient-oriented and environmental interventions, is considered to be one of the best ways to reduce violence in the emergency department (ED). We assessed the impact of a comprehensive prevention programme aimed at preventing incivility and verbal violence against healthcare professionals working in the ophthalmology ED (OED) of a university hospital. The programme was designed to address long waiting times and lack of information. It combined a computerised triage algorithm linked to a waiting room patient call system, signage to assist patients to navigate in the OED, educational messages broadcast in the waiting room, presence of a mediator and video surveillance. All patients admitted to the OED and those accompanying them. Single-centre prospective interrupted time-series study conducted over 18 months. Violent acts self-reported by healthcare workers committed by patients or those accompanying them against healthcare workers. Waiting time and length of stay. There were a total of 22 107 admissions, including 272 (1.4%) with at least one act of violence reported by the healthcare workers. Almost all acts of violence were incivility or verbal harassment. The rate of violence significantly decreased from the pre-intervention to the intervention period (24.8, 95% CI 20.0 to 29.5, to 9.5, 95% CI 8.0 to 10.9, acts per 1000 admissions, p<0.001). An immediate 53% decrease in the violence rate (incidence rate ratio=0.47, 95% CI 0.27 to 0.82, p=0.0121) was observed in the first month of the intervention period, after implementation of the triage algorithm. A comprehensive prevention programme targeting patients and environment can reduce self-reported incivility and verbal violence against healthcare workers in an OED. NCT02015884

Pre-return-to-work medical consultation for low back pain workers. Good practice recommendations based on systematic review and expert consensus

Objectives The pre-return-to-work medical consultation during sick leave for low back pain (LBP) aims at assessing the worker's ability to resume working without risk for his/her health, and anticipating any difficulties inherent to returning to work and job retention. This article summarizes the good practices guidelines proposed by the French Society of Occupational Medicine (SFMT) and the French National Health Authority (HAS), and published in October 2013. Methods Good practices guidelines developed by a multidisciplinary and independent task force (24 experts) and peer review committee (50 experts) based on a literature review from 1990 to 2012, according to the HAS methodology. Results According to the labour regulations, workers can request a medical consultation with their occupational physician at any time. The pre-return-to-work consultation precedes the effective return-to-work and can be requested by the employee regardless of their sick leave duration. It must be scheduled early enough to: (i) deliver reassuring information regarding risks to the lower back and managing LBP; (ii) evaluate prognostic factors of chronicity and prolonged disability in relations to LBP and its physical, social and occupational consequences in order to implement the necessary conditions for returning to work; (iii) support and promote staying at work by taking into account all medical, social and occupational aspects of the situation and ensure proper coordination between the different actors. Conclusion A better understanding of the pre-return-to-work consultation would improve collaboration and coordination of actions to facilitate resuming work and job retention for patients with LB

Functional capacity evaluations for the prevention of occupational re-injuries in injured workers

Background Functional capacity evaluation (FCE) has been widely used to assess workers' physical state of readiness to return to work (RTW) after an injury and to make recommendations for the time and capacity in which they might return. FCEs are also used to prevent re-injury after RTW. Despite being a commonly used tool, little is known about how effective FCE is in preventing occupational injuries. Objectives To assess the effectiveness of FCE-based return to work recommendations in preventing occupational re-injuries of injured workers compared with no intervention or alternative interventions. Search strategy We searched the following electronic databases: the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 4), MEDLINE (1966 to December 2009), EMBASE (1980 to December 2009), CINAHL (1980 to December 2009), PsycINFO (1983 to December 2009) and PEDro (1929 to December 2009). The searches were not restricted by date, language or type of publication. Selection criteria We included randomised controlled trials (RCTs) of FCE-based return to work recommendations for preventing occupational re-injuries in injured workers. Data collection and analysis Four authors (NM, ES, JV, ML), in pairs, independently selected studies for inclusion, extracted data and assessed risk of bias. Main results We found no studies that compared FCE to no intervention. We found one RCT with 372 participants in which a short-form of one FCE was compared to the standard long-form FCE (Isernhagen Work Systems). Outcomes were recurrence rates of re-injuries. There was no significant difference between the two forms of FCE. We rated the overall quality of the evidence as low. Authors' conclusions There is no evidence for or against the effectiveness of FCE compared to no intervention. A short version of FCE showed similar effectiveness to a long version in preventing re-injury. More RCTs are needed

Mental health in hospitals: A cross-sectional study of the representations of professionals in a French university hospital: Considering mental health is essential for the individual and society. Healthcare professionals are at risk of poor mental health. On the occasion of WHO World Mental Health Day on October 10th, 2021, a survey was conducted by the Occupational Health Service and the Direction of quality in Healthcare of the University Hospital of Lyon (Hospices civils de Lyon, HCL). The aim of the study was to collect the representations and beliefs of hospital staff on the/their mental health. Methods: A short and anonymous questionnaire was sent electronically to the 22,904 HCL professionals, with a link towards a short educational video. Results: Seven hundred and sixty-six responses were collected. Representations of mental health were generally positive among professionals, with a transactional vision including known determinants such as living and working conditions. The most chosen words related to mental health were ?equilibrium? and ?well-being?. The measures considered to be the most relevant by professionals to promote mental health were the establishment of rest ?bubble? times, times for discussions (colleagues and management), prevention programs, easier access to a ?psy? and to the occupational health service. Conclusion: This survey contributed to a better understanding of the representations of HCL professionals regarding mental health and to their awareness in this field. These results can be used to develop a mental health promotion plan in the workplace, adapted to hospital professionals.

Considering mental health is essential for the individual and society. Healthcare professionals are at risk of poor mental health. On the occasion of WHO World Mental Health Day on October 10th, 2021, a survey was conducted by the Occupational Health Service and the Direction of quality in Healthcare of the University Hospital of Lyon (Hospices civils de Lyon, HCL). The aim of the study was to collect the representations and beliefs of hospital staff on the/their mental health.La prise en considération de la santé mentale est essentielle pour l'individu et la société. Les professionnels de santé sont à risque d'une santé mentale dégradée. À l'occasion de la Journée mondiale de la santé mentale de l'OMS le 10 octobre 2021, une enquête a été conduite par le Service de médecine et santé au travail (SMST) et la Direction qualité usagers et santé populationnelle (DQUSP) des Hospices civiles de Lyon (HCL). L'objectif était de recueillir les représentations et croyances des personnels hospitaliers sur la/leur santé mentale. Méthode: Un questionnaire court et anonyme a été adressé par voie électronique aux 22 904 professionnels des HCL, accompagné d'une courte vidéo pédagogique. Résultats: Au total, 766 réponses ont été recueillies. Les représentations de la santé mentale étaient globalement positives parmi les professionnels, avec une vision transactionnelle incluant les déterminants connus comme les conditions de vie et de travail. Les mots les plus choisis en lien avec la santé mentale étaient « équilibre » et « bien-être ». Les mesures considérées comme les plus pertinentes pour promouvoir la santé mentale par les professionnels étaient la mise en place de temps de « bulle » de repos, des temps d'échanges (collègues et encadrement), des programmes de prévention, l'accès facilité à un(e) « psy » et au service de médecine et santé au travail. Conclusion: Cette enquête a contribué à mieux connaître les représentations des professionnels des HCL quant à la/leur santé mentale, et a participé à leur sensibilisation dans ce domaine. Ces résultats pourront participer à élaborer un plan de promotion de la santé mentale au travail adapté aux professionnels hospitaliers

Laws, Policies, and Collective Agreements Protecting Low-wage and Digital Platform Workers During the COVID-19 Pandemic

In the context of the COVID-19 pandemic, this commentary describes and compares shifting employment and occupational health social protections of low-wage workers, including self-employed digital platform workers. Through a focus on eight advanced economy countries, this paper identifies how employment misclassification and definitions of employees were handled in law and policy. Debates about minimum wage and occupational health and safety standards as they relate to worker well-being are considered. Finally, we discuss promising changes introduced during the COVID-19 pandemic that protect the health of low-wage and self-employed workers. Overall, we describe an ongoing "haves" and a "have not" divide, with on the one extreme, traditional job arrangements with good work-and-health social protections and, on the other extreme, low-wage and self-employed digital platform workers who are mostly left out of schemes. However, during the pandemic small and often temporary gains occurred and are discussed