Sickness certification of workers compensation claimants by general practitioners in Victoria, 2003-2010

Objective: To examine patterns of the sickness certification of workers compensation claimants by general practitioners in Victoria, Australia, by nature of injury or illness. Design, setting and patients: Retrospective analysis of Victorian workers compensation data for all injured and ill workers with an accepted workers compensation claim between 2003 and 2010. Main outcome measures: Type (unfit for work, alternative duties, or fit for work) and duration of initial medical certificates relating to workers compensation claims that were issued by GPs, in six categories of injury and illness. Results: Of 124 424 initial medical certificates issued by GPs, 74.1% recommended that workers were unfit for work and 22.8% recommended alternative duties. Unfit-for-work certificates were issued to 94.1% of workers with mental health conditions, 81.3% of those with fractures, 79.1% of those with other traumatic injuries, 77.6% of those with back pain and strains, 68.0% of those with musculoskeletal conditions and 53.0% of those with other diseases. Alternative-duties certificates were significantly longer in duration than unfit-for-work certificates in all injury and illness categories (P<0.001) but certificates for workers with musculoskeletal injuries and diseases, back pain and strains and other traumatic injuries were of lesser duration than those for workers with fractures, mental health conditions and other diseases. Conclusion: The high proportion of medical certificates recommending complete absence from work presents major challenges in terms of return to work, labour force productivity, the viability of the compensation system, and long-term social and economic development. There is substantial variation in the type and duration of medical certificates issued by GPs. People with mental health conditions are unlikely to receive a certificate recommending alternative duties. Further research is required to understand GP certification behaviour

An overall inequality reducing and horizontally equitable tax system with application to Polish data

In the case of homogeneous populations progressive taxation is usually associated with a reduction of inequality in after tax income distribution. In the real world, populations of tax payers are not homogeneous and households differ not only with respect to income but also in other social, demographic and economic characteristics. The aim of the paper is to propose an inequality reducing tax system taking into account, in some way, differences in needs between tax payers. A population of households is considered and each household is distinguished by two attributes: pre-tax income and family size. To compare incomes in this heterogeneous environment an affine transformation is proposed as equivalent income function, from which income dependent equivalence scales are derived. By first, the horizontal equity concern of a tax system has to be faced. Ebert and Lambert (2004) define horizontal equity requirements for income dependent scales. Applying the proposed scales a tax system can be derived and we show that it satisfies the horizontal equity conditions as defined by two authors. Then, we consider the redistributive effects of a tax system by introducing an inequality parameterized measure as in Ebert and Moyes (2000). We show that, when the reference type family is fixed, the application of the suggested equivalence income function is such that the tax system can be overall inequality reducing provided that the reference type tax function is average rate or minimal progressive. As it is known, conditions ensuring that a tax system is overall inequality reducing are not sufficient to guarantee inequality reduction within each set of households with the same size. We derive restrictions which allow the equivalent income function to generate a tax system which is overall inequality reducing and within type inequality reducing. These restrictions concern the tax function for the reference family type and the domain of incomes. To see where these restrictions come from, it is important to note that a tax system which is overall inequality reducing for a fixed reference may well increase inequality (or keep it unaltered) when another reference type is chosen. But, if a tax system is within type inequality reducing, it is also overall inequality reducing for any reference type. Ebert and Moyes (2000) show that only two particular form of equivalence function can be adopted when reference independence is required. The first function yields an income independent absolute scale; the second function yields an income independent relative. The former has to be used when inequality is considered from the absolute point of view, the latter has to be used when an intermediate between absolute and relative concept of inequality is adopted or when relative inequality is considered. Here we suggest only an income transformation function which originates income depending scales. On considering inequality either in absolute or in relative sense, using this function we obtain a tax system which is overall inequality reducing and reference independent if some restrictions hold on income domain, on the set of taxable income and on the tax function for the reference type: we think that these restrictions are not too limitative as it can be understood from the applicative part. The paper is organized as follows. In the first part, following Ebert-Lambert (2004), horizontal equity (HE) conditions are defined in both cases when equivalence scales are income dependent or income independent. Then, following Ebert-Moyes (2000), we summarize what has to be meant for an overall inequality reducing tax system (OIR), for a within type inequality reducing (WIR) tax system and for a reference independent tax system (RI). In the second part the paper we describe the particular affine income transformation function that we adopt and we investigate on the conditions allowing to this function to generate a tax system which is OIR and WIR. In the third part we simulate modifications to the present personal income tax in Poland, with the aim to design a more family oriented system. The paper is completed by an appendix which analyzes the relation among the most important instruments used in the real world to take into account horizontal equity. Quotient, exemption and tax credit are discussed under different hypotheses on tax functio

Cold Climate Building Enclosure Solutions

This project investigates the energy performance and cost effectiveness of several state-of-the-art retrofit strategies that could be used in triple-deckers and colonial houses, common house types in New England. Several emerging building enclosure technologies were integrated, including high R-value aerogel and vacuum insulations, in forms that would be energy efficient, flexible for different retrofit scenarios, durable, and potentially cost-competitive for deep energy retrofits

Development of New Generation of Thermally-Enhanced Fiber Glass Insulation

This report presents experimental and numerical results from thermal performance studies. The purpose of this Cooperative Research and Development Agreement (CRADA) between UT-Battelle, LLC and John s Manville was to design a basic concept of a new generation of thermally-enhanced fiber glass insulation. Different types of Phase Change Materials (PCMs) have been tested as dynamic components in buildings during the last 4 decades. Most historical studies have found that PCMs enhance building energy performance. Some PCM-enhanced building materials, like PCM-gypsum boards or PCM-impregnated concretes have already found their limited applications in different countries. Today, continued improvements in building envelope technologies suggest that throughout Southern and Central U.S. climates, residences may soon be routinely constructed with PCM in order to maximize insulation effectiveness and maintain low heating and cooling loads. The proposed thermally-enhanced fiber glass insulation will maximize this integration by utilizing a highly-efficient building envelope with high-R thermal insulation, active thermal mass and superior air-tightness. Improved thermal resistance will come from modifications in infrared internal characteristics of the fiber glass insulation. Thermal mass effect can be provided by proprietary thermally-active microencapsulated phase change material (PCM). Work carried out at the Oak Ridge National Laboratory (ORNL) on the CRADA is described in this report

Staying at work with back pain: patients' experiences of work-related help received from GPs and other clinicians. A qualitative study

<p>Abstract</p> <p>Background</p> <p>Low back pain commonly affects work ability, but little is known about the work-related help and advice that patients receive from GPs and other clinicians. The purpose of this study was to explore the experiences of employed people with back pain and their perceptions of how GPs and other clinicians have addressed their work difficulties.</p> <p>Methods</p> <p>A qualitative approach with thematic analysis was used. Individual interviews were carried out with twenty-five employed patients who had been referred for back pain rehabilitation. All had expressed concern about their ability to work due to low back pain.</p> <p>Results</p> <p>The perception of the participants was that GPs and other clinicians had provided little or no work-focused guidance and support and rarely communicated with employers. Sickness certification was the main method that GPs used to manage participants' work problems. Few had received assistance with temporary modifications and many participants had remained in work despite the advice they had received. There was little expectation of what GPs and other clinicians could offer to address work issues.</p> <p>Conclusions</p> <p>These findings question the ability of GPs and other clinicians to provide work-focused support and advice to patients with low back pain. Future research is recommended to explore how the workplace problems of patients can be best addressed by health professionals.</p

Recommendations to facilitate the ideal fit note: are they achievable in practice?

Background: Although the UK fit note has been broadly welcomed as a tool to facilitate return to work, difficulties and uncertainties have resulted in wide variation in its use. Agreement on what constitutes the ‘ideal’ fit note from the perspective of all stakeholders is needed to inform best practice. A recent Delphi study conducted by the authors reached consensus on 67 recommendations for best practice in fit note use for employed patients. However, such recommendations are not necessarily followed in practice. The purpose of this study was therefore to investigate the perceived achievability of implementing these Delphi recommendations with a further reference panel of stakeholders. Methods: Potential participants were identified by the research team and study steering group. These included representatives of employers, government departments, trades unions, patient organisations, general and medical practitioners and occupational health organisations who were believed to have the knowledge and experience to comment on the recommendations. The consensus Delphi statements were presented to the participants on-line. Participants were invited to comment on whether the recommendations were achievable, and what might hinder or facilitate their use in practice. Free text comments were combined with comments made in the Delphi study that referred to issues of feasibility or practicality. These were synthesised and analysed thematically. Results: Twelve individuals representing a range of stakeholder groups participated. Many of the recommendations were considered achievable, such as improved format and use of the electronic fit note, completion of all fields, better application and revision of guidance and education in fit note use. However a number of obstacles to implementation were identified. These included: legislation governing the fit note and GP contracts; the costs and complexity of IT systems and software; the limitations of the GP consultation; unclear roles and responsibilities for the funding and delivery of education, guidance and training for all stakeholders, and the evaluation of practice. Conclusions: This study demonstrated that although many recommendations for the ideal fit note are considered achievable, there are considerable financial, legal, organisational and professional obstacles to be overcome in order for the recommendations to be implemented successfully

Return-to-Work Self-Efficacy:Development and Validation of a Scale in Claimants with Musculoskeletal Disorders

Introduction We report on the development and validation of a 10-item scale assessing self-efficacy within the return-to-work context, the Return-to-Work Self-Efficacy (RTWSE) scale. Methods Lost-time claimants completed a telephone survey 1 month (n = 632) and 6 months (n = 446) after a work-related musculoskeletal injury. Exploratory (Varimax and Promax rotation) and confirmatory factor analyses of self-efficacy items were conducted with two separate subsamples at both time points. Construct validity was examined by comparing scale measurements and theoretically derived constructs, and the phase specificity of RTWSE was studied by examining changes in strength of relationships between the RTWSE Subscales and the other constructs at both time measures. Results Factor analyses supported three underlying factors: (1) Obtaining help from supervisor, (2) Coping with pain (3) Obtaining help from co-workers. Internal consistency (alpha) for the three subscales ranged from 0.66 to 0.93. The total variance explained was 68% at 1-month follow-up and 76% at 6-month follow-up. Confirmatory factor analyses had satisfactory fit indices to confirm the initial model. With regard to construct validity: relationships of RTWSE with depressive symptoms, fear-avoidance, pain, and general health, were generally in the hypothesized direction. However, the hypothesis that less advanced stages of change on the Readiness for RTW scale would be associated with lower RTWSE could not be completely confirmed: on all RTWSE subscales, RTWSE decreased significantly for a subset of participants who started working again. Moreover, only Pain RTWSE was significantly associated with RTW status and duration of work disability. With regard to the phase specificity, the strength of association between RTWSE and other constructs was stronger at 6 months post-injury compared to 1 month post-injury. Conclusions A final 10-item version of the RTWSE has adequate internal consistency and validity to assess the confidence of injured workers to obtain help from supervisor and co-workers and to cope with pain. With regard to phase specificity, stronger associations between RTWSE and other constructs at 6-month follow-up suggest that the association between these psychological constructs consolidates over time after the disruptive event of the injury

Development of a workplace intervention for sick-listed employees with stress-related mental disorders: Intervention Mapping as a useful tool

Background. To date, mental health problems and mental workload have been increasingly related to long-term sick leave and disability. However, there is, as yet, no structured protocol available for the identification and application of an intervention for stress-related mental health problems at the workplace. This paper describes the structured development, implementation and planning for the evaluation of a return-to-work intervention for sick-listed employees with stress-related mental disorders (SMDs). The intervention is based on an existing successful return-to-work intervention for sick-listed employees with low back pain. Methods. The principles of Intervention Mapping were applied to combine theory and evidence in the development, implementation and planning for the evaluation of a participatory workplace intervention, aimed at an early return-to-work for sick-listed employees with SMDs. All stakeholders were involved in focus group interviews: i.e. employees recently sick-listed with SMDs, supervisors and occupational health professionals. Results. The development of the participatory workplace intervention according to the Intervention Mapping principles resulted in a structured return-to-work intervention, specifically tailored to the needs of sick-listed employees with SMDs. Return-to-work was proposed as a behavioural change, and the Attitude - Social influence - self-Efficacy model was identified as a theoretical framework. Stakeholder involvement in focus group interviews served to enhance the implementation. The cost-effectiveness of the intervention will be evaluated in a randomised controlled trial. Conclusion. Intervention Mapping was found to be a promising method to develop interventions tailored to a specific target group in the field of occupational health. Trial registration. ISRCTN92307123. © 2007 van Oostrom et al; licensee BioMed Central Ltd