2010-05-01 12:00 - Messages

Daily functioning and self-management in patients with chronic low back pain after an intensive cognitive behavioral programme for pain management

Chronic low back pain (CLBP) is associated with persistent or recurrent disability which results in high costs for society. Cognitive behavioral treatments produce clinically relevant benefits for patients with CLBP. Nevertheless, no clear evidence for the most appropriate intervention is yet available. The purpose of this study is to evaluate the mid-term effects of treatment in a cohort of patients with CLBP participating in an intensive pain management programme. The programme provided by RealHealth-Netherlands is based on cognitive behavioral principles and executed in collaboration with orthopedic surgeons. Main outcome parameters were daily functioning (Roland and Morris Disability Questionnaire and Oswestry Disability Questionnaire), self-efficacy (Pain Self-Efficacy Questionnaire) and quality of life (Short Form 36 Physical Component Score). All parameters were measured at baseline, last day of residential programme and at 1 and 12 months follow-up. Repeated measures analysis was applied to examine changes over time. Clinical relevance was examined using minimal clinical important differences (MCID) estimates for main outcomes. To compare results with literature effect sizes (Cohen's d) and Standardized Morbidity Ratios (SMR) were determined. 107 patients with CLBP participated in this programme. Mean scores on outcome measures showed a similar pattern: improvement after residential programme and maintenance of results over time. Effect sizes were 0.9 for functioning, 0.8 for self-efficacy and 1.3 for physical functioning related quality of life. Clinical relevancy: 79% reached MCID on functioning, 53% on self-efficacy and 80% on quality of life. Study results on functioning were found to be 36% better and 2% worse when related to previous research on, respectively, rehabilitation programmes and spinal surgery for similar conditions (SMR 136 and 98%, respectively). The participants of this evidence-based programme learned to manage CLBP, improved in daily functioning and quality of life. The study results are meaningful and comparable with results of spinal surgery and even better than results from less intensive rehabilitation programmes.

Source: http://www.springerlink.com/content/d2282671214x01j7/

Prevalence of arm, shoulder and neck symptoms, risk factors and sick leave in computer workers

Titre complet: Effectiveness of a questionnaire based intervention programme on the prevalence of arm, shoulder and neck symptoms, risk factors and sick leave in computer workers: A cluster randomised controlled trial in an occupational setting

Arm, shoulder and neck symptoms are very prevalent among computer workers. In an attempt to reduce these symptoms, a large occupational health service in the Netherlands developed a preventive programme on exposure to risk factors, prevalence of arm, shoulder and neck symptoms, and sick leave in computer workers. The purpose of this study was to assess the effectiveness of this intervention programme. Methods: The study was a randomised controlled trial. The participants were assigned to either the intervention group or the usual care group by means of cluster randomisation. At baseline and after 12 months of follow-up, the participants completed the RSI QuickScan questionnaire on exposure to the risk factors and on the prevalence of arm, shoulder and neck symptoms. A tailor-made intervention programme was proposed to participants with a high risk profile at baseline. Examples of implemented interventions are an individual workstation check, a visit to the occupational health physician and an education programme on the prevention of arm, shoulder and neck symptoms. The primary outcome measure was the prevalence of arm, shoulder and neck symptoms. Secondary outcome measures were the scores on risk factors for arm, shoulder and neck symptoms and the number of days of sick leave. Sick leave data was obtained from the companies. Multilevel analyses were used to test the effectiveness. Results: Of the 1,673 persons invited to participate in the study, 1,183 persons (71%) completed the baseline questionnaire and 741 persons participated at baseline as well as at 12-month follow-up. At 12-month follow-up, the intervention group showed a significant positive change (OR=0.48) in receiving information on healthy computer use, as well as a significant positive change regarding risk indicators for work posture and movement, compared to the usual care group. There were no significant differences in changes in the prevalence of arm, shoulder and neck symptoms or sick leave between the intervention and usual care group. Conclusions: the effects of the RSI QuickScan intervention programme were small, possibly as a result of difficulties with the implementation process of the proposed interventions. However, some significant positive effects were found as to an increase in receiving education and a decrease in exposure to adverse postures and movements. With regard to symptoms and sick leave, only small and non-significant effects were found.

Source: http://www.biomedcentral.com/1471-2474/11/99

Adjusting Rehabilitation Costs and Benefits for Health Capital: The Case of Low Back Occupational Injuries

Case-mix adjustments for treatment/rehabilitation costs and benefits of non-traumatic injuries, such as occupational back pain, are much more difficult than adjustments for traumatic injuries. We present a new method for adjusting for severity differences in the costs and benefits of treating occupational low back injuries. Methods Using initial post-injury differences in the health capital of prospective sample of 1,831 occupational related back pain patients, we combine survey data with workers' compensation claim files and medical billing information to adjust the costs and benefits of treatment using multivariate techniques. Results We find that large differences in the net benefits of treatment between the three lowest cost provider groups virtually disappear once adjustments are made for worker's health capital (injury severity) at entry into treatment. Conclusions Once adjustments are made for initial health capital immediately after injury, the net benefits of treating occupational low back pain are virtually identical for physician only care, physician plus physical therapy care, and chiropractic care. Net benefits of care are lower for combined physician/chiropractic care, and lowest for all other forms of care (principally, treatment by orthopedic surgeons). Our method is readily adapted for comparisons among individual health care/occupational rehabilitation professionals or among group practices and other health care organizations.

Source: http://www.springerlink.com/content/v3561850775x4663/?p=9536b4fdc7ba4563b1b4f30d53b55a59&pi=9

Avoidable Sickness Absence in a Dutch Working Population

Sickness absence has an important impact on employers (e.g. reduced productivity, high costs) and employees (e.g. replacement, job loss). Therefore, we investigated possible reduction by exploring avoidable sickness absence. Methods A questionnaire was filled out by 2,954 Dutch workers (internet panel of a marketing research company, 2005). We obtained data on self reported sickness absence (6.5 months), including the main reason for each sickness absence spell (4 health and 3 non-health reasons), self-reported work-relatedness of absence and workers' opinion on whether their absence could have been shorter or prevented, and on 12 listed factors that might have contributed to sickness absence. For each of these factors we calculated the avoidable absence fraction (AAF), analogous to the epidemiological population attributable risk. Results A total of 1,233 workers reported sickness absence. The absence rate was 4.46%. For 11% of the absence rate health was not the main reason. Yet, when non-health was reported as the main reason for absence, health still contributed in half the cases. 35% of the absence rate was mainly work-related. 15% of the workers mentioned that their sickness absence could have been shorter or prevented. The AAFs of contributory factors were 0.129 for home related factors, 0.136 for work-related factors and 0.101 for (occupational) health care and guidance factors. In total, the AAF showed that 21.5% of the absence rate can be considered possibly avoidable. Conclusion According to the studied workers sickness absence rate can be reduced. In reducing the absence, one should not only consider factors from the home and work situation, but also from (occupational) health care.

Source: http://www.springerlink.com/content/d204wq341r626237/?p=9536b4fdc7ba4563b1b4f30d53b55a59&pi=8

A Prospective Study of Return to Work Across Health Conditions: Perceived Work Attitude, Self-efficacy and Perceived Social Support

The aim of the present study was to conduct subgroup-analyses in a prospective cohort of workers on long-term sickness absence to investigate whether associations between perceived work attitude, self-efficacy and perceived social support and time to RTW differ across different health conditions. Methods The study was based on a sample of 926 workers on sickness absence (6–12 weeks). The participants filled out a baseline questionnaire and were subsequently followed until the tenth month after listing sick. Perceived work attitude was measured with a Dutch language version of the Work Involvement Scale. Perceived social support was measured with a self-constructed standardized scale reflecting a person's perception of social support regarding RTW. Self-efficacy was measured with the standardised Dutch version of the General self-efficacy scale, assessing the subjects' expectations of their general capacities. The sample was divided into three subgroups: musculoskeletal health conditions, other physical health conditions and mental health conditions. Anova analyses and Cox proportional hazards regression analyses were used to identify differences in association between the three factors and the time to RTW between different subgroups. Results The associations between the perceived work attitude, self-efficacy and perceived social support and the time to RTW vary across different health condition subgroups, not only with regard to the strength of the association but also for the type of factor. In the multivariate model, hazard ratios (HRs) of 1.33 (95% CI 1.01–1.75) in the musculoskeletal subgroup, and 1.26 (95% CI 0.89–1.78) in the other physical subgroup were found in perceived work attitude. With regard to perceived social support HRs of 1.39 (95% CI 1.12–1.99) respectively 1.51 (1.05–2.17) in the same subgroups were found. Only self-efficacy remained in the multivariate model in all subgroups with HRs of 1.49 (95% CI 1.12–1.99) in the musculoskeletal subgroup, 1.53 (95% CI 1.07–2.18) in the other physical subgroup and 1.60 (1.07–2.40) in the mental subgroup. Conclusions The results of this study show that perceived work attitude, self-efficacy and perceived social support are relevant predictors with regard to the time to RTW in all types of health conditions, but that important differences are observed in type of factor and strengths of the relationships between physical and mental health conditions.

Source: http://www.springerlink.com/content/p555246qu57k2007/?p=ad83420b41ad4f3b8ac70268a81f7719&pi=10

Factors Related to Return to Work by Women with Breast Cancer in Northern France

Earlier diagnosis and better treatment have increased the survival rates of breast cancer patients. This warrants research on return to work of cancer survivors, especially about subjective factors because they affect the mental desire to return to work. Moreover, knowledge in this issue is very limited in France. Objectives This study aims to explore the objective and subjective factors that affect whether and when women with breast cancer return to work. Methods 379 women with breast cancer aged 18–60 years who were working at the time of diagnosis responded to a 45 item questionnaire. The questionnaire had personal characteristics, disease-related characteristics and work-related ones. Multivariate logistic regressions were run to determine the association of these factors and return to work and time until return to work. Results During a median follow-up of 36 months, 82.1% of the 379 women who had worked before their diagnosis returned to work after a median sick leave of 10.8 months. Older age, lower educational level, chemotherapy, radiotherapy, lymphoedema, psychological or organizational self-perceived constraints related to their former job, and the lack of moral support from work colleagues both limited and delayed return to work. Conclusion The resumption of work by women with breast cancer depends on many factors, not all of them medical. The self-perceived factors must be considered: first to help support these women during their sick leave, while taking into account elements that may hinder early return to work; second to initiate a work resumption support process which takes into account both the person and her environment.

Source: http://www.springerlink.com/content/q66r774t0456v356/?p=4d16931d16874cb6b4492762943b3198&pi=5

Development and Validation of Competencies for Return to Work Coordinators

Return to work (RTW) coordinators are a key element in programs that facilitate RTW of injured or ill workers, yet little research documents the competencies required for success in this role. Methods Competencies were defined as knowledge, skills, attitudes, and behaviors. Eight focus groups were conducted with 75 experienced RTW coordinators to identify 904 individual competencies. These were subsequently reduced to 234 unique items through affinity mapping, and sorted into eight groups: administration, individual personal attributes, information gathering, communication, professional credibility, evaluation, problem-solving, and conflict management. A subset of 100 items, including 88 items most often cited, were incorporated in an Internet-based survey that sampled a broad range of RTW coordinators from three countries. Results Eighty-three of the questionnaire items were rated 4 or 5 (very important or essential) by over half of the 148 respondents. There were no differences in affinity group mean ratings by country, employer, profession, or type of clients. The highest-rated items reflect general personal characteristics, or specific skills related to coordinating among all involved with the RTW process. RTW coordinators with nursing backgrounds provided slightly higher ratings for items related to medical knowledge, but otherwise their ratings were similar to non-nurses. Conclusions These findings indicate a consensus across a wide range of RTW coordinators, and results can be applied to improve coordinator selection, training, and development. Certain key competencies may be well-established individual attributes, and others may be best developed through mentorship. Most of these competencies are probably best evaluated by direct observation.

Source: http://www.springerlink.com/content/922338122u81628x/?p=4d16931d16874cb6b4492762943b3198&pi=4

Effectiveness of a Targeted Occupational Health Intervention in Workers with High Risk of Sickness Absence

Titre complet: "Effectiveness of a Targeted Occupational Health Intervention in Workers with High Risk of Sickness Absence: Baseline Characteristics and Adherence as Effect Modifying Factors in a Randomized Controlled Trial"

In a recently published randomized controlled trial (RCT), a targeted occupational health (OH) intervention was found effective in an intention-to-treat analysis in controlling sickness absence among workers with high risk of sickness absence, compared to usual care. We performed an exploratory subgroup analysis in order to detect possible effect modifiers and mediators. Methods Age, gender, working status, severity of physical impairment, depression score, self-rated working ability, co-morbidity, and sickness absence characteristics in the previous 12 months were identified as potential effect modifiers (n = 382). We conducted regression analyses with the potential effect modifiers and a mediator (treatment attendance as intended) as explanatory variables. The difference of sickness absence days during the previous year and the follow-up year was the dependent variable. Results The intervention was especially effective in the subgroups of workers who were certain that they will not be able to continue working in their current job due to health-related reasons (−74 days; 95% CI −105 to −43), had co-morbidities (−22.5 days; 95% CI −35.5 to −9.5), or severe physical impairment at work (−17.5 days; 95% CI −28.5 to −6.5). A modifying effect of age, gender, working status, depressive symptoms, or prior sickness absence on the effectiveness of this OH intervention was not found. Conclusions This targeted OH intervention seems especially suitable for workers who consider that they are no longer able to continue working due to health reasons and have high level of physical impairment or co-morbidities. The findings from these exploratory analyses should be tested in future RCTs.

Source: http://www.springerlink.com/content/h50545747141l715/?p=4d16931d16874cb6b4492762943b3198&pi=1

Translating questionnaire items for a multi-lingual worker population: The iterative process of translation and cognitive interviews with English-, Spanish-, and Chinese-speaking workers

BACKGROUND: The increasing ethnic diversity of the US workforce has created a need for research tools that can be used with multi-lingual worker populations. Developing multi-language questionnaire items is a complex process; however, very little has been documented in the literature. METHODS: Commonly used English items from the Job Content Questionnaire and Quality of Work Life Questionnaire were translated by two interdisciplinary bilingual teams and cognitively tested in interviews with English-, Spanish-, and Chinese-speaking workers. RESULTS: Common problems across languages mainly concerned response format. Language-specific problems required more conceptual than literal translations. Some items were better understood by non-English speakers than by English speakers. De-centering (i.e., modifying the English original to correspond with translation) produced better understanding for one item. CONCLUSIONS: Translating questionnaire items and achieving equivalence across languages require various kinds of expertise. Backward translation itself is not sufficient. More research efforts should be concentrated on qualitative approaches to developing useful research tools.

Source: http://www3.interscience.wiley.com/journal/122528202/abstract

Work and Family Characteristics as Predictors of Early Retirement in Married Men and Women

This study presents an integrative model of early retirement using data from the Wisconsin Longitudinal Study. The model extends prior work by incorporating work—family conflict to capture the interaction between the work and family domains and by assuming proximal and distal predictors of early retirement. More precisely, the model suggests that family and job demands and resources predict family-to-work and work-to-family conflict, respectively. All of these factors are presumed to have only indirect effects on retirement timing via the intervening effect of quality-of-life measures, that is, marital satisfaction, job satisfaction, and health. The authors assume that these three factors constitute predictors of early retirement in addition to socioeconomic status and the availability of a pension plan and health insurance. The model was tested with structural equation modeling techniques, and the results were supportive. Therefore, the proposed model offers a general framework for the integration of previous research findings.

Source: http://roa.sagepub.com/cgi/content/abstract/32/4/467?etoc 

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Experience of Health Complaints and Help Seeking Behavior in Employees Screened for Depressive Complaints and Risk of Future Sickness Absence

The aim of this study was to examine the associations between on the one hand depressive complaints and risk of future sickness absence and on the other hand experience of health complaints and help seeking behavior in the working population. Methods Cross-sectional data were used from employees working in the banking sector (n = 8,498). The screening instrument included measures to examine the risk of future sickness absence, depressive complaints and help seeking behavior. Results Of employees reporting health complaints, approximately 80% had already sought help for these complaints. Experience of health complaints and subsequent help seeking behavior differed between employees with mild to severe depressive complaints and employees at risk of future sickness absence. Experience of health complaints was highest in employees identified with both concepts (69%) compared with employees identified at risk of future sickness absence only (48%) and with mild to severe depressive complaints only (57%). In those employees identified with one or both concepts and who had not sought help already, intention to seek help was about 50%. Conclusions From a screening perspective, employees who do not experience health complaints or who do not have the intention to seek help may refuse participation in early intervention. This might be a bottleneck in the implementation of preventive interventions in the occupational health setting.

Source: http://www.springerlink.com/content/682458626j72m346/

What should an ideal spinal injury classification system consist of?

What should an ideal spinal injury classification system consist of? A methodological review and conceptual proposal for future classifications

Since Böhler published the first categorization of spinal injuries based on plain radiographic examinations in 1929, numerous classifications have been proposed. Despite all these efforts, however, only a few have been tested for reliability and validity. This methodological, conceptual review summarizes that a spinal injury classification system should be clinically relevant, reliable and accurate. The clinical relevance of a classification is directly related to its content validity. The ideal content of a spinal injury classification should only include injury characteristics of the vertebral column, is primarily based on the increasingly routinely performed CT imaging, and is clearly distinctive from severity scales and treatment algorithms. Clearly defined observation and conversion criteria are crucial determinants of classification systems' reliability and accuracy. Ideally, two principle spinal injury characteristics should be easy to discern on diagnostic images: the specific location and morphology of the injured spinal structure. Given the current evidence and diagnostic imaging technology, descriptions of the mechanisms of injury and ligamentous injury should not be included in a spinal injury classification. The presence of concomitant neurologic deficits can be integrated in a spinal injury severity scale, which in turn can be considered in a spinal injury treatment algorithm. Ideally, a validation pathway of a spinal injury classification system should be completed prior to its clinical and scientific implementation. This review provides a methodological concept which might be considered prior to the synthesis of new or modified spinal injury classifications.

Source: http://www.springerlink.com/content/9348k21n81362137/

Work-Anxiety and Sickness Absence After a Short Inpatient Cognitive Behavioral Group Intervention in Comparison to a Recreational Group Meeting

Objective: The aim of this study was to study the effects of a short-term cognitive behavior therapy on work-anxiety and sickness-absence in patients with work-anxiety.
Methods: Three-hundred forty-five inpatients who suffered from cardiologic, neurological, or orthopedic problems and additionally work-anxiety were randomly assigned into two different group interventions. Patients got four sessions of a group intervention, which either focused on cognitive behavior–therapy anxiety–management (work-anxiety coping group, WAG) or unspecific recreational activities (RG).
Results: No differences were found between WAG and RG for work-anxiety and subjective work ability. When looking at patients who were suffering only from work-anxiety, and no additional mental disorder, the duration of sickness absence until 6 months follow-up was shorter in the WAG (WAG: 11 weeks, RG: 16 weeks, P?=?0.050).
Conclusion: A short-term WAG may help return to work in patients with work-anxieties, as long as there is no comorbid mental disorder.

Source: Muschalla, Beate; Linden, Michael; Jöbges, Michael. Journal of Occupational & Environmental Medicine: April 2016, Volume 58, Issue 4, p. 398-406.

Self-reported cold sensitivity in normal subjects and in patients with traumatic hand injuries or hand-arm vibration syndrome

Cold sensitivity is a common and disabling complaint following hand injuries. The main purpose of this study was to describe self-reported consequences of cold sensitivity and the association with disability and health-related quality of life in patients with hand injuries or hand-arm vibration syndrome (HAVS) and in normal subjects. Responses to the Cold Intolerance Symptom Severity (CISS) questionnaire, Potential Work Exposure Scale (PWES), Disability of the Arm, Shoulder and Hand (DASH) and Short-Form 36 questionnaire (SF-36) were investigated in normal subjects (n=94), hand injured patients (amputation and nerve injuries, n=88) and patients with HAVS (n=30). The results are presented as median (range), percent and mean deviation from norms. The Kruskal Wallis Test or Mann-Whitney U-Test were used to identify significant differences between multiple groups or subgroups. The Spearman rank correlation was used to study the relationship between cold sensitivity and disability. Abnormal cold sensitivity (CISS score 50) was seen in 75% and 45% of patients with HAVS and a traumatic hand injury, respectively. Patients were significantly more exposed to cold in their work environment than the normal population, with a consequently negative effect on work ability due to cold sensitivity. Patients with abnormal cold sensitivity were more seriously disabled and had a poorer health-related quality of life than patients with normal cold sensitivity [higher DASH scores and e.g. significantly larger mean deviation from norms in the subscales Role Physical and Bodily Pain (SF-36)]. Severe and abnormal cold sensitivity may have a profound impact on work capacity, leisure, disability and health-related quality of life. It is frequently seen in patients with traumatic hand injuries and particularly apparent in patients with HAVS.

Source: http://www.biomedcentral.com/1471-2474/11/89

Comparisons of Catastrophizing, Pain Attitudes, and Cold-Pressor Pain Experience Between Chinese and European Canadian Young Adults

Experimental pain research indicates ethnic differences in pain experience. Most of the cross-cultural pain research studied African Americans and Hispanics with little data available for Asian groups. This study examined differences in pain catastrophizing, pain attitudes, and pain responses between Chinese and European Canadian young adults. Prior to completing a cold-pressor (CP) task, 80 Chinese and 80 European Canadian undergraduate students were administered measures of pain catastrophizing and pain attitudes, including stoicism and cautiousness. Pain threshold, pain tolerance, and pain intensity were measured during the CP task. The Short Form-McGill Pain Questionnaire was administered immediately postimmersion to measure sensory and affective pain. While there was no group difference in pain threshold and pain intensity, Chinese participants displayed lower pain tolerance and reported higher SF-MPQ-Affective than European Canadians. Regarding psychological variables, there was no difference in stoicism and cautiousness between groups, but Chinese participants reported greater pain catastrophizing. Mediational analysis indicated that pain catastrophizing mediated the group differences in SF-MPQ-Affective score. The implications of the findings and future research were discussed. The study found ethnic differences in cold-pressor responses, in which Chinese undergraduates reported higher levels of pain compared to their Euro-Canadian counterparts. The finding that pain catastrophizing mediated the ethnic difference in SF-MPQ-Affective scores indicated the importance of examining the role of catastrophizing in pain reports from Chinese and Euro-Canadian patients.

Source: http://www.jpain.org/article/PIIS1526590010003573/abstract?rss=yes

Salariés opérés du canal carpien : suivi professionnel pendant 3 ans

Cette étude, débutée en 2004, a permis de suivre pendant 3 ans, sur les plans médical et professionnel, 99 salariés (80 femmes et 19 hommes) opérés d'un syndrome du canal carpien avec seulement 3 salariés perdus de vue.
Les salariés sont répartis en trois grandes catégories : "emplois de bureau", "service et commerce" et "ateliers ou usines".
À l'issue de la première visite médicale du travail, 54 femmes et 12 hommes ont été déclarés aptes à leur poste antérieur à l'intervention chirurgicale. À l'issue des 3 ans, seuls 8 salariés ont vu leur parcours professionnel modifié par les conséquences du syndrome du canal carpien. Vingt-neuf salariés ont déclaré leur pathologie en maladie professionnelle, 20 ont été reconnus.

Source : http://www.dmt-prevention.fr/inrs-pub/inrs01.nsf/IntranetObject-accesParReference/TF%20185/$File/TF185.pdf

Psychological and behavioural predictors of pain management outcomes in patients with cancer

To better understand the phenomenon of patient-related barriers to cancer pain management and address them more effectively in interventional studies, a theoretical model related to psychological aspects of pain experience and pain-related behaviours was elaborated. The aim of the study was to analyse the impact of patient-related barriers on cancer pain management outcomes following this model. Thirty-three patients responded to the Brief Pain Inventory Pain scale, the Danish Barriers Questionnaire II (DBQ-II), the Hospital Anxiety and Depression scale (HADS), the Danish version of Patient Perceived Involvement in Care Scale measuring the quality of patient-physician pain communication, and the Danish version of Medication Adherence Report Scale (DMARS-4). Statistical analysis was performed with SPSS 16.00. The results of the multivariable linear regression analyses showed that pain intensity was explained by patients' emotional distress (symptoms of anxiety and depression) and that pain relief was explained by cognitive barriers. In conclusion, interventions in emotional distress and patients' concerns may supposedly result in better cancer pain management outcomes.

Source: http://www3.interscience.wiley.com/journal/123417133/abstract?CRETRY=1&SRETRY=0

The Shell Disability Management Program: A Five-Year Evaluation of the Impact on Absenteeism and Return-on-Investment

OBJECTIVE: To evaluate the impact of the Shell Disability Management Program (DMP) on U.S. manufacturing employee absenteeism. METHODS:: We estimated absence episodes and days lost per employee from 2004 to 2008 compared to pre-program values in 2002, and productivity gains from transitional duty (TD). RESULTS:: Between 2002 and 2008, absence episodes/100 employees decreased from 37.4 to 25.7 among hourly workers but increased from 9.7 to 13.1 among staff employees. Days lost per employee decreased from 7.4 to 5.2 for hourly employees and were virtually unchanged for staff employees. TD resulted in 6042 days saved in 2006 and 11,438 days in 2008, with direct cost savings of more than $4.1 million from 2006 to 2008. CONCLUSIONS:: The Shell DMP emphasizes absence tracking, timely return-to-work, and facilitation of TD. Absenteeism decreased significantly after DMP implementation, particularly among hourly employees, with an estimated 2.4:1 return-on-investment.

Source: http://journals.lww.com/joem/Abstract/publishahead/The_Shell_Disability_Management_Program__A.99809.aspx

Multicultural and Diversity Considerations in the New Code of Professional Ethics for Rehabilitation Counselors

As the demographic transformation of the U.S. population continues, the challenges of multicultural and diversity-based considerations remain a central focus, as does the need to incorporate cultural competencies into the practice of rehabilitation. The Commission on Rehabilitation Counselor Certification's 2010 Code of Professional Ethics for Rehabilitation Counselors offers guidance for the practice of professional conduct and ethical decision making when one is working with individuals from culturally diverse groups and backgrounds. The revised code sets the expectation that the culturally competent rehabilitation counselor will develop interventions and services that are congruent with the client's values and cultural context.

Source: http://rcb.sagepub.com/cgi/content/abstract/0034355210368564v1?rss=1 

 La version 2010 du Code d'éthique peut être téléchargé gratuitement sur le site de la Commission on Rehabilitation Counselor Certification (CRCC). Vous pouvez le trouver comme document attachée au présent envoi. 


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