Persistent musculoskeletal pain and productive employment; a systematic review of interventions.

A systematic analysis of the literature was undertaken to determine which characteristics of workplace interventions are most effective in assisting people with persistent musculoskeletal pain (PMP) to remain productively employed. Databases of Medline, PsychINFO, CINAHL and Embase were searched using MeSH and other relevant terms. Studies that reported on interventions at, or involving, the workplace were included. Interventions were considered as either focused on the individual or multilevel. Outcome measures assessed included: job loss, productivity, sick leave, pain and cost benefit. A quality assessment was undertaken using GRADE criteria with development of impact statements to synthesise the results. Eighteen relevant articles (14 studies) were identified for inclusion in the review. No high-level evidence for workplace interventions to assist people with PMP were identified. Low numbers of participants and limited studies resulted in downgrading of evidence. However, individually focused interventions will probably reduce job loss and sick leave, but are unlikely to reduce pain. Multilevel focused interventions will probably result in decreased sick leave and provide some cost benefit. The evidence on productivity was limited and of poor quality. Further research is required because sustainable employment for individuals with PMP is important and understanding what works is necessary to ensure effective workplace interventions are developed

Protecting and promoting mental health in the workplace: developing a systems approach to job stress

Issue addressed: Job stress has been linked to a wide range of adverse effects on mental, physical, and organisational health. Despite the evidence that systems approaches are most effective in reducing the adverse impact of job stress, prevalent practice is dominated by worker- or individual-focused strategies in the absence of commensurate intervention on working conditions. Methods: A literature review and cross-disciplinary conceptual synthesis were combined in the articulation of a systems approach to job stress. Results: An outline of the job stress process is followed by explanation of how a systems approach addresses the various steps in the stress process. Systems approaches to job stress emphasise primary prevention or focusing on stressors as the upstream determinants of job stress. Additionally, systems approaches integrate primary with worker-directed secondary and illness-directed tertiary intervention, include the meaningful participation of groups targeted by intervention, and are context- sensitive. Systems approach intervention principles are illustrated by concrete examples of intervention strategies and activities. Conclusions: Further efforts are needed to promote, disseminate, implement, and evaluate systems approaches to job stress and to improve cross-disciplinary cooperation in this effort

Estimates of drug treated diabetes incidence and prevalence using Australian administrative pharmaceutical data

IntroductionThe incidence and prevalence of diabetes within a population are important public health metrics. Pharmaceutical administrative data may offer a resource that can contribute to quantifying these measures using the recorded signals derived from the drugs used to treat people with diabetes. ObjectiveTo estimate the longitudinal incidence and prevalence of drug treated (DT) diabetes in Australia utilising an Australian Pharmaceutical Benefits Scheme (PBS) dataset and compare estimates with community survey data for all diabetes reported in the Australian National Health Survey (NHS). MethodsPersons with DT diabetes were identified within the PBS dataset using assigned Anatomic Therapeutic Chemical codes for `Drugs used in diabetes\u27. Prevalent persons with DT diabetes were determined by a single annual treatment, and incident cases from the earliest treatment with diabetes medications. Counts were aggregated by age group and utilised Australian national census data as a denominator to calculate diabetes disease frequencies for the period 2004--14. Comparison of PBS prevalence data was made with NHS surveys over equivalent years. ResultsThe age adjusted incidence of DT diabetes was 3.4/1000 in 2006 and increased to 3.8/1000 in 2011 and 5.1/1000 in 2014. Age adjusted prevalence of DT diabetes in Australia also rose from 26.7/1000 in 2006 to 32.1/1000 in 2011 and 42.1/1000 in 2014. DT diabetes prevalence estimates correlated with NHS estimates of self-reported diabetes prevalence across age groups and in 2014 was r = 0.987. However, PBS estimates of DT diabetes prevalence generally underestimated NHS values of self-reported diabetes in older age groups with mean percentage differences of -22% to -3%. In contrast, PBS data captured more younger persons with diabetes in comparison to NHS data. These differences were then used to adjust DT diabetes incidence rates to provide age specific estimates that could potentially reflect diabetes incidence estimates acquired by community survey. ConclusionsPBS data representing dispensed medications prescribed to persons with diabetes offers a perspective for the assessment of diabetes incidence and prevalence. PBS derived DT diabetes prevalence estimates correlate well with community survey estimates of self-reported diabetes, but underestimate NHS data in older age groups. Calibrated DT incidence estimates may potentially reflect community survey derived diabetes incidence estimates and may offer a method for longitudinal monitoring

A comparison of australian chronic disease prevalence estimates using administrative pharmaceutical dispensing data with international and community survey data

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