Psychosocial work conditions and registered sickness absence: a 3-year prospective cohort study among office employees

Purpose To investigate associations between a wide variety of psychosocial work conditions and sickness absence in a medium-sized company. Methods Prospective cohort study of 395 employees working in an insurance office. Self-reported psychosocial work conditions were measured by questionnaire in January 2002 and linked to registered sickness absence in the period January 2002 to December 2004 adjusting for earlier sick leave and psychological distress. Results The questionnaires of 244 employees were eligible for analysis. Decision authority and co-worker support were associated with sickness absence days, but their associations with sickness absence episodes were not significant. Role clarity was associated with the number of sickness absence days, but only with the number of short sickness absence episodes in women. Conclusions The wide variety of investigated psychosocial work conditions contributed little to the explanation of sickness absence in the medium-sized insurance office

Information and feedback to improve occupational physicians’ reporting of occupational diseases: a randomised controlled trial

To assess the effectiveness of supplying occupational physicians (OPs) with targeted and stage-matched information or with feedback on reporting occupational diseases to the national registry in the Netherlands. In a randomized controlled design, 1076 OPs were divided into three groups based on previous reporting behaviour: precontemplators not considering reporting, contemplators considering reporting and actioners reporting occupational diseases. Precontemplators and contemplators were randomly assigned to receive stage-matched, stage-mismatched or general information. Actioners were randomly assigned to receive personalized or standardized feedback upon notification. Outcome measures were the number of OPs reporting and the number of reported occupational diseases in a 180-day period before and after the intervention. Precontemplators were significantly more male and self-employed compared to contemplators and actioners. There was no significant effect of stage-matched information versus stage-mismatched or general information on the percentage of reporting OPs and on the mean number of notifications in each group. Receiving any information affected reporting more in contemplators than in precontemplators. The mean number of notifications in actioners increased more after personalized feedback than after standardized feedback, but the difference was not significant. This study supports the concept that contemplators are more susceptible to receiving information but could not confirm an effect of stage-matching this information on reporting occupational diseases to the national registr

Telephone Cognitive-Behavioral Therapy for Subthreshold Depression and Presenteeism in Workplace: A Randomized Controlled Trial

Subthreshold depression is highly prevalent in the general population and causes great loss to society especially in the form of reduced productivity while at work (presenteeism). We developed a highly-structured manualized eight-session cognitive-behavioral program with a focus on subthreshold depression in the workplace and to be administered via telephone by trained psychotherapists (tCBT).We conducted a parallel-group, non-blinded randomized controlled trial of tCBT in addition to the pre-existing Employee Assistance Program (EAP) versus EAP alone among workers with subthreshold depression at a large manufacturing company in Japan. The primary outcomes were depression severity as measured with Beck Depression Inventory-II (BDI-II) and presenteeism as measured with World Health Organization Health and Work Productivity Questionnaire (HPQ). In the course of the trial the follow-up period was shortened in order to increase acceptability of the study.The planned sample size was 108 per arm but the trial was stopped early due to low accrual. Altogether 118 subjects were randomized to tCBT+EAP (n = 58) and to EAP alone (n = 60). The BDI-II scores fell from the mean of 17.3 at baseline to 11.0 in the intervention group and to 15.7 in the control group after 4 months (p<0.001, Effect size = 0.69, 95%CI: 0.32 to 1.05). However, there was no statistically significant decrease in absolute and relative presenteeism (p = 0.44, ES = 0.15, -0.21 to 0.52, and p = 0.50, ES = 0.02, -0.34 to 0.39, respectively).Remote CBT, including tCBT, may provide easy access to quality-assured effective psychotherapy for people in the work force who present with subthreshold depression. Further studies are needed to evaluate the effectiveness of this approach in longer terms. The study was funded by Sekisui Chemicals Co. Ltd.ClinicalTrials.gov NCT00885014

Comodulation Masking Release Determined in the Mouse (Mus musculus) using a Flanking-band Paradigm

Comodulation masking release (CMR) has been attributed to auditory processing within one auditory channel (within-channel cues) and/or across several auditory channels (across-channel cues). The present flanking-band (FB) experiment—using a 25-Hz-wide on-frequency noise masker (OFM) centered at the signal frequency of 10 kHz and a single 25-Hz-wide noise FB—was designed to separate the amount of CMR due to within- and across-channel cues and to investigate the role of temporal cues on the size of within-channel CMR. The results demonstrated within-channel CMR in the Naval Medical Research Institute mouse, while no unambiguous evidence could be found for CMR occurring due to across-channel processing (i.e., “true CMR”). The amount of within-channel CMR was dependent on the frequency separation between the FB and the OFM. CMR increased from 4 to 6 dB for a frequency separation of 1 kHz to 18 dB for a frequency separation of 100 Hz. The large increase for a frequency separation of 100 Hz is likely to be due to the exploitation of changes in the temporal pattern of the stimulus upon the addition of the signal. Temporal interaction between both masker bands results in modulations with a large depth at a modulation frequency equal to the beating rate. Adding a signal to the maskers reduces the depth of the modulation. The auditory system of mice might be able to use the change in modulation depth at a beating frequency of 100 Hz as a cue for signal detection, while being unable to detect changes in modulation depth at high modulation frequencies. These results are consistent with other experiments and model predictions for CMR in humans which suggested that the main contribution to the CMR effect stems from processing of within-channel cues

Masking Release for Sweeping Masker Components with Correlated Envelopes

To separate sounds from different sound sources, common properties of natural sounds are used by the auditory system, such as coherent temporal envelope fluctuations and correlated changes of frequency in different frequency regions. The present study investigates how the auditory system processes a combination of these cues using a generalized comodulation masking release (CMR) paradigm. CMR is the effect of a better signal detectability in the presence of comodulated maskers than in the presence of maskers with uncorrelated envelope fluctuations across frequencies. Using a flanking-band paradigm, the results of the first experiment of the present study show that CMR is still observed for the masker and the signal coherently sweeping up or down in frequency over time, up to a sweep rate of six octaves per second. Motivated by the successful modeling of CMR using filters sensitive to temporal modulations and recent physiological evidence of spectro-temporal modulation filters, the second experiment investigates whether CMR is also observed for spectro-temporal masker modulations generated using time-shifted versions of the masker envelope for each component. The thresholds increase as soon as the temporally coherent masker modulation is changed to a spectro-temporal masker modulation, indicating that spectro-temporal modulation filters are presumably not required in CMR models

Double target concept for smoking cessation

Tobacco use is estimated to be the largest single cause of premature death in the world. Nicotine is the major addictive substance in tobacco products. After cigarette smoking, nicotine quickly acts on its target, nicotinic acetylcholine receptors (nAChRs), which are widely distributed throughout the mammalian central nervous system and are expressed as diverse subtypes on cell bodies, dendrites and/or nerve terminals. Through the nAChRs in brain reward circuits, nicotine alters dopaminergic (DA) neuronal function in the ventral tegmental area (VTA) and increases dopamine release from VTA to nuclear accumbens (NA), which leads to nicotine reward, tolerance and dependence. After quitting smoking, smokers experience withdrawal symptoms, including depression, irritability, difficulty concentrating or sleeping, headache, and tiredness. Recently, evidence has been accumulated to reveal the molecular and cellular mechanisms of nicotine reward, tolerance and dependence. The outcomes of these investigations provide pharmacological basis for smoking cessation. Here, I briefly summarize recent advancements of our understanding of nicotine reward, tolerance and dependence. Based on these understandings, I propose a double target hypothesis, in which nAChRs and dopamine release process are two important targets for smoking cessation. Dysfunction of nAChRs (antagonism or desensitization) is crucial to abolish nicotine dependence and the maintenance of an appropriate level of extracellular dopamine eliminates nicotine withdrawal syndromes. Therefore, the medications simultaneously act on these two targets should have the desired effect for smoking cessation. I discuss how to use this double target concept to interpret recent therapies and to develop new candidate compounds for smoking cessation

Technical Medicine: Designing Medical Technological Solutions for Improved Health Care

Introduction Complex medical technology is rapidly being introduced in health care, aimed at improving diagnosis and treatment. However, mistakes in the use of medical technology show that adequate expertise to apply it safely is often lacking, let alone to improve patient care through innovative technology use. We argue that a new health care professional, the Technical Physician, should be trained to have the expertise to translate medical technology use into improved patient-specific procedures. Method An educational design model was followed, consisting of analysis, design, construction, implementation, and formative evaluation. Analysis of technology use in health care and the required expertise was conducted to derive the professional profile and core competencies. Adaptive expertise theory and research-based design form the foundation of the professional profile. Cognitive integration, self-directed learning, and technical medical design projects were selected as leading instructional principles. Evaluation The curriculum was implemented in 2003 in the Netherlands. Over 300 Technical Physicians have graduated since 2009. Internal evaluations showed that curriculum changes were necessary to (1) address the application of mathematical principles, (2) enhance reflection by increasing experience-based learning, (3) support development of adaptive expertise related to basic technical skills, and (4) aid faculty in translating their knowledge and skills to the Technical Medicine domain. Discussion We recommend a strong focus on supporting both faculty within the Technical Medicine program and the Technical Physicians in clinical practice with the translation of knowledge and skills between the technical and medical domains. Future research should systematically evaluate the design and effects of the Technical Medicine curriculum