Coordinated and tailored work rehabilitation: a randomized controlled trial with economic evaluation undertaken with workers on sick leave due to musculoskeletal disorders

Introduction In Denmark, the magnitude and impact of work disability on the individual worker and society has prompted the development of a new "coordinated and tailored work rehabilitation" (CTWR) approach. The aim of this study was to compare the effects of CTWR with conventional case management (CCM) on return-to-work of workers on sick leave due to musculoskeletal disorders (MSDs). Methods The study was a randomized controlled trial with economic evaluation undertaken with workers on sick leave for 4-12 weeks due to MSDs. CTWR consists of a work disability screening by an interdisciplinary team followed by the collaborative development of a RTW plan. The primary outcome variable was registered cumulative sickness absence hours during 12 months follow-up. Secondary outcomes were work status as well as pain intensity and functional disability, measured at baseline, 3 and 12 months follow-up. The economic evaluation (intervention costs, productivity loss, and health care utilization costs) was based on administrative data derived from national registries. Results For the time intervals 0-6 months, 6-12 months, and the entire follow-up period, the number of sickness absence hours was significantly lower in the CTWR group as compared to the control group. The total costs saved in CTWR participants compared to controls were estimated at US $1,366 per person at 6 months follow-up and US$ 10,666 per person at 12 months follow-up. Conclusions Workers on sick leave for 4-12 weeks due to MSD who underwent "CTWR" by an interdisciplinary team had fewer sickness absence hours than controls. The economic evaluation showed that-in terms of productivity loss-CTWR seems to be cost saving for the society

How physicians caring for adult patients presenting a chronic mental disturbance take account of the difficulties their patients’ children under 18: Preliminary study

AbstractAimsTo study how physicians caring for adult patients presenting a chronic mental disturbance take account of the difficulties of their patients’ children under 18.MethodExploratory and qualitative study based on an in-depth study of interviews.Study populationThirteen physiatrists or neurologists following brain-damaged patients and 12 psychiatrists following patients with chronic psychiatric disorders.ResultsIn the two groups of physicians, diversified practices in catering for the issues of the patient's parenthood, child–parent relationships, and difficulties experienced by the child. The child's difficulties are not approached as such. For many of the physicians, representations of the parenting function, and of the child's needs and difficulties are not often used in work with the patient. Patient-centred care appears at odds with catering for the patient's children and their specific difficulties. The seriousness of the mental pathologies, their chronic nature, and the fact that they can affect the patient in his/her parental functioning and concerns, appear as factors in the reluctance of physicians. Other reasons are lack of familiarity with issues relating to childhood, and the feeling of encroaching on a private and intimate sphere. The representations of physicians with regard to parenthood, parent–child relations, and the needs and difficulties of children, are often not integrated into the corpus of knowledge. These issues are more often aspects of physicians’ own experience.ConclusionThe conflict of values and the uneasiness of the physicians suggest the need for ethical reflection groups or Balint groups

Randomised controlled trial of integrated care to reduce disability from chronic low back pain in working and private life

Objective To evaluate the effectiveness of an integrated care programme, combining a patient directed and a workplace directed intervention, for patients with chronic low back pain

Conformational changes of polymers in model batter systems

Cake batters - made of flour, egg, sugar and fat - are complex systems. Ingredients interactions and their impact on protein secondary structure and starch conformational structures were studied in model batter systems using Attenuated Total Reflectance Fourier Transform Infrared (ATR-FTIR) spectroscopy. The results showed the possibility of using the pregelatinized starch without affecting protein conformation. The estimation of protein secondary structure highlighted the prevalence of \u3b1-helical structures in the model batter system, while \u3b2-sheets are predominant in flour systems as known in dough systems. The protein conformation in batter system is related to fat-protein interactions and could explain fat functionality in the final product. Starch crystallinity increased when each ingredient - except for pregelatinized starches - was added to the flour. Changes in starch conformation could be related to the redistribution of water between the batter ingredients. The overall results highlighted the importance of ingredients on the structural conformation of the batter polymers - starch and proteins - which could be the key factor to understand the functional properties of the batter

The Force-Velocity Relation for Growing Biopolymers

The process of force generation by the growth of biopolymers is simulated via a Langevin-dynamics approach. The interaction forces are taken to have simple forms that favor the growth of straight fibers from solution. The force-velocity relation is obtained from the simulations for two versions of the monomer-monomer force field. It is found that the growth rate drops off more rapidly with applied force than expected from the simplest theories based on thermal motion of the obstacle. The discrepancies amount to a factor of three or more when the applied force exceeds 2.5kT/a, where a is the step size for the polymer growth. These results are explained on the basis of restricted diffusion of monomers near the fiber tip. It is also found that the mobility of the obstacle has little effect on the growth rate, over a broad range.Comment: Latex source, 9 postscript figures, uses psfig.st

An integrated care program to prevent work disability due to chronic low back pain: a process evaluation within a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>In the past decade, a considerable amount of research has been carried out to evaluate the effectiveness of innovative low back pain (LBP) interventions. Although some interventions proved to be effective, they are not always applied in daily practice. To successfully implement an innovative program it is important to identify barriers and facilitators in order to change practice routine. Because usual care is not directly aimed at return to work (RTW), we evaluated an integrated care program, combining a patient-directed and a workplace-directed intervention provided by a multidisciplinary team, including a clinical occupational physician to reduce occupational disability in chronic LBP patients. The aims of this study were to describe the feasibility of the implementation of the integrated care program, to assess the satisfaction and expectations of the involved stakeholders and to describe the needs for improvement of the program.</p> <p>Methods</p> <p>Eligible for this study were patients who had been on sick leave due to chronic LBP. Data were collected from the patients, their supervisors and the involved health care professionals, by means of questionnaires and structured charts, during 3-month follow-up. Implementation, satisfaction and expectations were investigated.</p> <p>Results</p> <p>Of the 40 patients who were eligible to participate in the integrated care program, 37 patients, their supervisors and the health care professionals actually participated in the intervention. Adherence to the integrated care program was in accordance with the protocol, and the patients, their supervisors and the health care professionals were (very) satisfied with the program. The role of the clinical occupational physician was of additional value in the RTW process. Time-investment was the only barrier for implementation reported by the multidisciplinary team.</p> <p>Conclusion</p> <p>The implementation of this program will not be influenced by any flaws in its application that are related to the program itself, or to the adherence of patients with chronic LBP and their health care professionals.</p> <p>This program is promising in terms of feasibility, satisfaction and compliance of the patients, their supervisors and the health care professionals. Before implementation on a wider scale, the communication and the information technology of the program should be improved.</p> <p>Trials Registration</p> <p>[ISRCTN28478651]</p

Theoretical and experimental activities on opacities for a good interpretation of seismic stellar probes

Opacity calculations are basic ingredients of stellar modelling. They play a crucial role in the interpretation of acoustic modes detected by SoHO, COROT and KEPLER. In this review we present our activities on both theoretical and experimental sides. We show new calculations of opacity spectra and comparisons between eight groups who produce opacity spectra calculations in the domain where experiments are scheduled. Real differences are noticed with real astrophysical consequences when one extends helioseismology to cluster studies of different compositions. Two cases are considered presently: (1) the solar radiative zone and (2) the beta Cephei envelops. We describe how our experiments are performed and new preliminary results on nickel obtained in the campaign 2010 at LULI 2000 at Polytechnique.Comment: 6 pages, 4 figures, invited talk at SOHO2