Behavioral determinants as predictors of return to work after long-term sickness absence: an application of the theory of planned behavior

Background The aim of this prospective, longitudinal cohort study was to analyze the association between the three behavioral determinants of the theory of planned behavior (TPB) model-attitude, subjective norm and self-efficacy-and the time to return-to-work (RTW) in employees on long-term sick leave. Methods The study was based on a sample of 926 employees on sickness absence (maximum duration of 12 weeks). The employees filled out a baseline questionnaire and were subsequently followed until the tenth month after listing sick. The TPB-determinants were measured at baseline. Work attitude was measured with a Dutch language version of the Work Involvement Scale. Subjective norm was measured with a self-structured scale reflecting a person's perception of social support and social pressure. Self-efficacy was measured with the three subscales of a standardised Dutch version of the general self-efficacy scale (ALCOS): willingness to expend effort in completing the behavior, persistence in the face of adversity, and willingness to initiate behavior. Cox proportional hazards regression analyses were used to identify behavioral determinants of the time to RTW. Results Median time to RTW was 160 days. In the univariate analysis, all potential prognostic factors were significantly associated (P < 0.15) with time to RTW: work attitude, social support, and the three subscales of self-efficacy. The final multivariate model with time to RTW as the predicted outcome included work attitude, social support and willingness to expend effort in completing the behavior as significant predictive factors. Conclusions This prospective, longitudinal cohort-study showed that work attitude, social support and willingness to expend effort in completing the behavior are significantly associated with a shorter time to RTW in employees on long-term sickness absence. This provides suggestive evidence for the relevance of behavioral characteristics in the prediction of duration of sickness absence. It may be a promising approach to address the behavioral determinants in the development of interventions focusing on RTW in employees on long-term sick leave

A Method for Clustering Surgical Cases to Allow Master Surgical Scheduling

Master surgical scheduling can improve the manageability and efficiency of operating room departments. This approach cyclically executes a master surgical schedule of surgery types. Surgery types need to be constructed with low variability to be efficient. Each surgery type is scheduled based upon its frequency per cycle. Surgery types that cannot be scheduled repetitively are put together in so-called dummy surgeries. Narrowly defined surgery types, with low variability, lead to many of such dummy surgeries, which reduces the benefits of a master surgical scheduling approach. In this paper we propose a method, based on Ward's hierarchical cluster method, to obtain surgery types that minimize the weighted sum of the dummy surgery volume and the variability in resource demand of surgery types. The resulting surgery types (clusters) are thus based on logical features and can be used in master surgical scheduling. The approach is successfully tested on a case study in a regional hospital

Wit-Russisch-Nederlands Gezondheids Informatie Centrum, Gomel, Wit-Rusland. Wit-Russisch-Nederlands Humanitair Hulp Project &apos;Gomel project&apos;

In het kader van het Wit-Russisch-Nederlands Humanitair Hulpproject, naar aanleiding van het ongeval met de kernreactor van Tsjernobyl in 1986 werd een Gezondheidsinformatie- centrum opgericht in Gomel. Hier werd een nieuw communicatieconcept gelanceerd. Preventieve gezondheidszorg programma's werden gestart ; het centrum vervult een kernfunctie bij de gezondheidscommunicatie voor de bevolking en voor werkers in het beroepsveld. Gedurende 1993 werden de bevolkingsvragen zorgvuldig genoteerd en geanalyseerd. De resultaten van de analyse gaven aan dat het Centrum een belangrijke functie bekleedt bij het verwijzen van patienten naar de juiste specialisten of ziekenhuizen en als laag-drempelige informatiebron dient voor degenen die een "second opinion" verlangen. Tevens functioneert het als informatiebron met betrekking tot j vragen van sociale, psycho-sociale en sociaal-economische aard. Verder dient het centrum als informatiebank voor het publiek en de beroepsgroepen voor vragen met betrekking tot straling. Het nieuwe communicatieconcept (met als belangrijke component het persoonlijk contact) is goed ontvangen door de bevolking van Gomel goed ontvangen. Het ontwikkelen van preventieve gezondheidszorg programma's voor specifieke doelgroepen werd een hoeksteen van het beleid van het Centrum. Aanbevelingen voor de toekomst besluiten dit rapport.This report describes the launching and the implementation of the Belarussian-Dutch Health Information Centre, an objective in a project aimed to alleviate the negative consequences of the Chernobyl nuclear power plant accident on April 26, 1986. In a newly established Health Information Centre in Gomel a new communication strategy was introduced in which trainings on health care programmes for professionals were performed concerning health communication with the population. During 1993 questions put to the medical consultants were extensively analysed and it was concluded that the Centre is developing a pivotal function in referring people to the relevant medical specialists or hospitals. It serves as a low-barrier source of information for patients who seek a second opinion and for questions on general health care and health education and it is developing towards a main centre for questions on social, psycho-social and socio-economic problems of the population. Furthermore, the Centre serves as a centre for information about radiation matters for the general public and professionals. Recommendations for the future management strategy conclude this report.VW