Work outcomes of sickness absence related to mental disorders: a systematic literature review.

ObjectivesThe purpose of this systematic literature review is to examine the current state of knowledge regarding the return-to-work outcomes of sickness absences related to mental disorders that increase costs borne by employers. We address two questions: (1) Based on the existing literature, from the employer's perspective, what are the relevant economic return-to-work outcomes for sickness absences related to mental disorders? and (2) From the employer's economic perspective, are there gaps in knowledge about the relevant return-to-work outcomes for sickness absences related to mental disorders?SettingThe included studies used administrative data from either an employer, insurer or occupational healthcare provider.ParticipantsStudies included working adults between 18 and 65 years old who had a sickness absence related to a mental disorder.Primary and secondary outcome measuresThe studies considered two general return-to-work outcome categories: (1) outcomes focusing on return-to-work and (2) outcomes focusing on sickness absence recurrence.ResultsA total of 3820 unique citations were identified. Of these, 10 studies were identified whose quality ranged from good to excellent. Half of the identified studies came from one country. The studies considered two characteristics of sickness absence: (1) whether and how long it took for a worker to return-to-work and (2) sickness absence recurrence. None of the studies examined return-to-work outcomes related to work reintegration.ConclusionsThe existing literature suggests that along with the incidence of sickness absence related to mental disorders, the length of sickness absence episodes and sickness absence recurrence (ie, number and time between) should be areas of concern. However, there also seems to be gaps in the literature regarding the work reintegration process and its associated costs

An estimate of the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada.

BackgroundInterest in the impact of burnout on physicians has been growing because of the possible burden this may have on health care systems. The objective of this study is to estimate the cost of burnout on early retirement and reduction in clinical hours of practicing physicians in Canada.MethodsUsing an economic model, the costs related to early retirement and reduction in clinical hours of physicians were compared for those who were experiencing burnout against a scenario in which they did not experience burnout. The January 2012 Canadian Medical Association Masterfile was used to determine the number of practicing physicians. Transition probabilities were estimated using 2007-2008 Canadian Physician Health Survey and 2007 National Physician Survey data. Adjustments were also applied to outcome estimates based on ratio of actual to planned retirement and reduction in clinical hours.ResultsThe total cost of burnout for all physicians practicing in Canada is estimated to be $213.1 million ($185.2 million due to early retirement and $27.9 million due to reduced clinical hours). Family physicians accounted for 58.8% of the burnout costs, followed by surgeons for 24.6% and other specialists for 16.6%.ConclusionThe cost of burnout associated with early retirement and reduction in clinical hours is substantial and a significant proportion of practicing physicians experience symptoms of burnout. As health systems struggle with human resource shortages and expanding waiting times, this estimate sheds light on the extent to which the burden could be potentially decreased through prevention and promotion activities to address burnout among physicians

How does burnout affect physician productivity? A systematic literature review

BACKGROUND: Interest in the well-being of physicians has increased because of their contributions to the healthcare system quality. There is growing recognition that physicians are exposed to workplace factors that increase the risk of work stress. Long-term exposure to high work stress can result in burnout. Reports from around the world suggest that about one-third to one-half of physicians experience burnout. Understanding the outcomes associated with burnout is critical to understanding its affects on the healthcare system. Productivity outcomes are among those that could have the most immediate effects on the healthcare system. This systematic literature review is one of the first to explore the evidence for the types of physician productivity outcomes associated with physician burnout. It answers the question, “How does burnout affect physician productivity?” METHODS: A systematic search was performed of: Medline Current, Medline in process, PsycInfo, Embase and Web of Science. The search period covered 2002 to 2012. The searches identified articles about practicing physicians working in civilian settings. Articles that primarily looked only at residents or medical students were excluded. Productivity was captured by hours worked, patients seen, sick leave, leaving the profession, retirement, workload and presenteeism. Studies also were excluded if: (1) the study sample was not comprised of at least 50% physicians, (2) the study did not examine the relationship between burnout and productivity or (3) a validated measure of burnout was not used. RESULTS: The search identified 870 unique citations; 5 met the inclusion/exclusion criteria. This review indicates that globally there is recognition of the potential impact of physician burnout on productivity. Productivity was examined using: number of sick leave days, work ability, intent to either continue practicing or change jobs. The majority of the studies indicate there is a negative relationship between burnout and productivity. However, there is variation depending on the type of productivity outcome examined. CONCLUSIONS: There is evidence that burnout is associated with decreased productivity. However, this line of inquiry is still developing. A number of gaps are yet to be filled including understanding how to quantify the changes in productivity related to burnout

The Effectiveness of Mental Health Courts in Reducing Recidivism

Mental health courts were created to help criminal defendants who do not meet not-guilty-for-reason-of-insanity criteria, but who have a mental illness that is a significant contributing factor to their arrest. A systematic review of the literature was undertaken to look at the current evidence on the effectiveness of mental health courts in reducing client recidivism and contact with police. A secondary data analysis was done on mental health court support clients to see what individual level factors were associated with positive recidivism outcomes. From the systematic review, there is some evidence that diversion to a mental health court can lead to a significant decrease in recidivism while the effect on police contact is less clear. From the secondary analysis, age and criminal history were found to be significant factors associated with recidivism. Future research should explore other demographic, socio-economic, or programmatic factors that may be associated with positive recidivism outcomes.M.Sc

A GENERAL PRESERVATION THEOREM FOR REVISED COUNTABLE SUPPORT ITERATION OF SEMIPROPER FORCING NOTIONS

Bachelor'sBACHELOR OF SCIENCE (HONOURS

The effectiveness of mental health courts in reducing recidivism and police contact: a systematic review protocol.

BackgroundMental health courts were created to help criminal defendants who have a mental illness that significantly contributes to their criminal offense. Despite the increasing number of mental health courts around the world, data about their effectiveness have only begun to emerge in the past decade. The purpose of this systematic literature review is to assess the current evidence on the effectiveness of mental health courts. Specifically, this review will address the question, "How effective are mental health courts in reducing recidivism and police contact?"Methods/designEight electronic databases will be searched, specifically PsycINFO, Medline, Medline In-Process, Embase, Web of Science, CINAHL, Social Work Abstracts, and Criminal Justice Abstracts. A multi-phase screening process will be used to identify relevant search hits. Articles that pass the three-stage screening process will then be assessed for risk of bias and have their reference lists hand searched. Full-text articles that are rated to have low to moderate risk of bias will be summarized into two tables, one containing a brief description of the study and the other reporting the results of relevant outcomes measured.DiscussionBy synthesizing the results of the studies, this systematic review will help illuminate gaps in the literature, direct future research, and inform policy makers.Systematic review registrationPROSPERO CRD42016036084

The effectiveness of mental health courts in reducing recidivism and police contact: a systematic review protocol.

BackgroundMental health courts were created to help criminal defendants who have a mental illness that significantly contributes to their criminal offense. Despite the increasing number of mental health courts around the world, data about their effectiveness have only begun to emerge in the past decade. The purpose of this systematic literature review is to assess the current evidence on the effectiveness of mental health courts. Specifically, this review will address the question, "How effective are mental health courts in reducing recidivism and police contact?"Methods/designEight electronic databases will be searched, specifically PsycINFO, Medline, Medline In-Process, Embase, Web of Science, CINAHL, Social Work Abstracts, and Criminal Justice Abstracts. A multi-phase screening process will be used to identify relevant search hits. Articles that pass the three-stage screening process will then be assessed for risk of bias and have their reference lists hand searched. Full-text articles that are rated to have low to moderate risk of bias will be summarized into two tables, one containing a brief description of the study and the other reporting the results of relevant outcomes measured.DiscussionBy synthesizing the results of the studies, this systematic review will help illuminate gaps in the literature, direct future research, and inform policy makers.Systematic review registrationPROSPERO CRD42016036084

Transition of equilibrium stochastic to unidirectional velocity vectors in a nanowire subjected to a towering electric field

The equilibrium Fermi–Dirac distribution is revealed to transform to an asymmetric distribution in a very high electric field where the energy gained (or lost) in a mean free path is of paramount importance. The equilibrium stochastic velocity vectors randomly oriented in and opposite to the quasifree direction of a nanowire are shown to streamline in the presence of an extremely high electric field. The complete velocity-field characteristics are acquired. The ultimate directed drift velocity in a towering field is shown to be limited to the appropriately averaged Fermi velocity in the strongly degenerate limit where only half of the quantum states are accessible to electrons. This unidirectional velocity does not sensitively depend on the low-field Ohmic mobility. The emission of a quantum in the form of a phonon or photon lowers the saturation velocity from its ultimate unidirectional limit

Universal velocity-field characteristics for a nanowire arbitrary degeneracy

The effects of electric field on the carrier motion and drift velocity in nanowire (NW) are presented in this paper. When the electric field is applied in NW, the electron is expected to move in anti-parallel direction to the electric field. This is so-called randomness motion is transformed into streamlined motion in extremely high electric field. The normalized Fermi energy and relative electron population as a function of electric field are examined for various degeneracies. It was found that the electric field has lesser influence on the relative electron population with the increased degeneracy. The drift velocity in NW is shown to increase with electric field until it reaches the saturation velocity. Two approximations have been made to simplify the theoretical equation. It is also shown in this paper that when the quantum emission is taken into account, the drift and saturation velocity degrades