Sickness Benefits Research Articles

Daily life coping—Helping stress-afflicted people manage everyday activities

Background Symptoms of stress are widespread in the working population and associated with long-term sickness absence and poor work functioning. Occupational therapy (OT)-based interventions are effective in improving return-to-work (RTW)-rates in stress-afflicted long-term sickness benefit beneficiaries (SBBs). No Danish standard on OT-RTW for stress-afflicted SSBs exists. Aims To describe and evaluate the feasibility of a seven-week OT-RTW intervention for stress-afflicted SBBs. Materials and methods Daily Life Coping (DLC) utilizes peer-learning and salutogenetic perspectives to address occupational imbalances experienced by long-term SBBs. Stress-afflicted SBBs (n = 54) in the municipality of Hilleroed were enrolled. Self-efficacy and well-being were measured before and after intervention using the general self-efficacy (GSE) scale and WHO-5 Well-Being Index (WHO-5). RTW-rates were measured at one-year follow-up. Participant feedback was collected using standardized evaluation forms. Results Following the intervention, WHO-5 improved by 13.7 ± 16.5 points and GSE improved by 4.3 ± 4.8 points. Participant feedback was positive. At one-year follow-up, employment status data were available for 51 SSBs of these 58.8% achieved employment. High post-test GSE and WHO-5 scores were associated with employment at follow-up. Conclusion DLC led to significant improvements in self-efficacy and well-being. Preliminary results indicate benefits on RTW-rates. Significance This study provides evidence of the feasibility of DLC in a municipal setting.

What is the effect of independent medical evaluation on days on sickness benefits for long-term sick listed employees in Norway? A pragmatic randomised controlled trial, the NIME-trial

BackgroundIndependent medical evaluations are used to evaluate degree and reason for work disability, uncertainty around the functional status, and/or the employee’s rehabilitation potential in several jurisdictions, but not in Norway. The main aim of this trial was to test the return to work effect of independent medical evaluation (IME) (summoning and consultation) compared to treatment as usual (TAU) in Norway, for workers who have been on continuous sick leave for 6 months.MethodsThis was a pragmatic randomised controlled trial including all employees aged 18–65 years, sick-listed by their general practitioner and on full or partial sick leave for the past 26 weeks in Hordaland County, Norway in 2015/16. Trial candidates were drawn from a central register at the Norwegian Labour and Welfare Administration at 22 weeks of sick leave. Pregnant women, individuals with cancer or dementia diagnoses, those with secret address, employed by NAV or sick listed by the specialist health services were excluded. Separate regression analyses were conducted to investigate the “intention-to-treat” and “treatment on the treated” effects, using the ordinary least squares and instrumental variable methods, respectively.ResultsAfter exemption based on predefined exclusion criteria, 5888 individuals were randomised to either IME (n = 2616) or TAU (n = 2599). The final intervention group constitutes 1698 individuals, of which 937 attended the IME consultation. No baseline differences were found between the IME and TAU group regarding gender, age, and previous sick leave. Individuals attending the IME were older than those who cancelled the appointment ((47/45), p = 0.006) and those who did not show up without cancelling ((47/42), p < 0.001). Mainly the IME physician agreed with the regular GP upon level of sick leave. In cases with different assessments, the difference tended to be towards a lower sick leave level. There were no intention to treat or treatment on the treated effect on days of sick leave after randomisation during follow up.ConclusionsOverall, the analyses showed no effect of IME on changes in sick leave for sick listed employees. This result was consistent for those who were offered an IME consultation (intention to treat) and those who undertook an IME consultation (treatment on the treated).Trial registrationClinicalTirals.gov trial number NCT02524392 first registration 14.08.2015.

Overview of recent cases before the Court of Justice of the European Union (September 2021-December 2021)

The concept of ‘working time’ for a period of stand-by time according to a stand-by system applicable to firefighters was interpreted by the Court in MG (C-214/20). In the Y case (C-636/19), the Court interpreted the concept of ‘insured person’ for the purpose of reimbursement of healthcare costs under Directive 2011/24. In the TS case (C-538/19), the Court dealt with another cross-border healthcare case. This time the question was whether a Member State can require an authorisation for cross-border healthcare to be subject to the submission of a medical report drawn up by a doctor from its national public health insurance system in light of Article 20 of Regulation 883/2004 and Article 56 TFEU. In ASGI and APN (C-462/20), the exclusion of third-country nationals from the eligibility to the Italian family card was under scrutiny. In SC (C-866/19), the Court clarified that the principle of aggregation applies to the calculation of the theoretical amount of benefit but not to the calculation of the actual amount of benefit under Article 52(1)(b) of Regulation 883/2004. In K (C-285/20), the Court held that being on sick leave and receiving sickness benefits can be considered as equivalent to the pursuit of an economic activity for the purpose of applying the rules on unemployment benefits for wholly unemployed frontier workers under Article 65(2) and (5) of Regulation 883/2004.

Who loses more? Identifying the relationship between hospitalization and income loss: prediction of hospitalization duration and differences of gender and employment status

BackgroundThe major determinants of health and well-being include wider socio-economic and political responses to poverty alleviation. To data, however, South Korea has no related social protection policies to replace income loss or prevent non-preferable health conditions for workers. In particular, there are several differences in social protection policies by gender or occupational groups. This study aimed to investigate how hospitalization affects income loss among workers in South Korea.MethodsThe study sample included 4876 Korean workers who responded to the Korean Welfare Panel Study (KoWePS) for all eight years from 2009 to 2016. We conducted a receiver operating characteristics (ROC) analysis to determine the cut-off point for the length of hospitalization that corresponded to the greatest loss of income. We used panel multi-linear regression to examine the relationship between hospitalization and income loss by gender and employment arrangement.ResultsThe greatest income loss for women in non-standard employment and self-employed men was observed when the length of hospitalization was seven days or less. When they were hospitalized for more than 14 days, income loss also occurred among men in non-standard employment. In addition, when workers were hospitalized for more than 14 days, the impact of the loss of income was felt into the subsequent year.ConclusionNon-standard and self-employed workers, and even female standard workers, are typically excluded from public insurance coverage in South Korea, and social security is insufficient when they are injured. To protect workers from the vicious circle of the poverty-health trap, national social protections such as sickness benefits are needed.

Economic evaluation of return-to-work interventions for mental disorder-related sickness absence: two years follow-up of a randomized clinical trial.

ObjectiveThe objective was to (i) assess the long-term cost-effectiveness of acceptance and commitment therapy (ACT), a workplace dialog intervention (WDI), and ACT+WDI compared to treatment as usual (TAU) for common mental disorders and (ii) investigate any differences in cost-effectiveness between diagnostic groups.MethodsAn economic evaluation from the healthcare and limited welfare perspectives was conducted alongside a randomized clinical trial with a two-year follow-up period. Persons with common mental disorders receiving sickness benefits were invited to the trial. We used registry data for cost analysis alongside participant data collected during the trial and the reduction in sickness absence days as treatment effect. A total of 264 participants with a diagnosis of depression, anxiety, or stress-induced exhaustion disorder participated in a two-year follow-up of a four-arm trial: ACT (N=74), WDI (N=60), ACT+WDI (N=70), and TAU (N=60).ResultsFor all patients in general, there were no statistically significant differences between interventions in terms of costs or effect. The subgroup analyses suggested that from a healthcare perspective, ACT was a cost-effective option for depression or anxiety disorders and ACT+WDI for stress-induced exhaustion disorder. With a two-year time horizon, the probability of WDI to be cost-saving in terms of sickness benefits costs was 80% compared with TAU.ConclusionsACT had a high probability of cost-effectiveness from a healthcare perspective for employees on sick leave due to depression or anxiety disorders. For participants with stress-induced exhaustion disorder, adding WDI to ACT seems to reduce healthcare costs, while WDI as a stand-alone intervention seems to reduce welfare costs.

Rights to enjoy benefit from social insurance of the femalelabor

Social insurance is the mainstay of the social security policy associated with the employee. The right to have social insurance is the basic and specific right associated with a female worker. This group right includes the right to enjoy the sickness benefit, maternity benefit, Work Injury, Occupational Disease Benefit, Old-age Benefit, Survivor’s Benefit, Medical Benefit (Health Insurance). The state has promulgated the Labor Code, the Law on Social Insurance, and other legal documents to create an implementation guide in order to build an effective legal corridor to protect the rights of female employees in enjoying social insurance. However, in reality, the right to enjoy social insurance of female employees is violated, and there is a gap between legal provisions and practical applications. This scientific paper evaluates the current status of legal provisions on the right to enjoy social insurance of female employees and the practical application of the law. From there, this paper proposes some solutions to improve the law on the right to enjoy social insurance of female employees.

Disruption in Supply Chain due to Covid-19 in Jordanian Economy

Disruption in Supply Chain due to Covid-19 in Jordanian Economy

FORMATION AND IMPLEMENTATION OF STATE POLICY OF SOCIO-ECONOMIC DEVELOPMENT TO ENSURE SOCIAL WELFARE AND HEALTH OF CITIZENS

The article defines that the health of citizens and public well-being is a key factor in economic and social development and is of the utmost importance for every state. Giving citizens the opportunity to control their health contributes to the improvement of the quality of life, without the active participation of the people themselves, many opportunities to strengthen and protect their health and increase the level of well-being are lost. The factors underlying the well-being of society also determine strategies that take this principle into account are more effective, because fair access to education, employment, and a decent level of income contribute to maintaining health. It is substantiated that health contributes to the increase of labor productivity, the formation of more effective labor resources, as well as the reduction of costs for sickness benefits and social assistance. The most effective way to ensure the health and social well-being of the population is the coordinated work of all sectors of the state, aimed at the social determinants of health. The effectiveness of the health care system and economic productivity are interconnected in the context of optimizing the use of resources in the field of public welfare. There are both direct and indirect effects of the health sector on socio-economic development, this is important in relation to how these activities affect people's health and their work productivity. It has been proven that many segments of the population lag behind in terms of health indicators, and often, in the event of socio-economic instability, these inequalities deepen. Changes in the social characteristics of morbidity, demographics and migration can slow down progress in improving health indicators, and solving this problem requires improving governance mechanisms and public policy as a whole. The insufficient level of social cohesion and financial uncertainty further complicate activities aimed at improving the health of citizens and their social security. It has been found that a number of state authorities cannot contain costs in modern conditions, when financial constraints make it increasingly difficult to find the necessary means for health care and social protection. Before developing the reform of the health care system, it is necessary to carefully analyze the economic and social interests, which are deeply transformed, as well as the possibility of a public and civil position. The formation of management strategies allows you to get a real effect on public well-being at acceptable costs in conditions of limited resources.

An assessment of the return to professional activity of patients aged ≤30 years after hip replacement surgery.

The study evaluated the professional activity of patients after a total cementless hip replacement surgery performed at the age of ≤30 years. The study group comprised 87 patients, with 95 total cementless hip replacements. The mean age was 25.7 years. The youngest patient was 17 years old, and the oldest 30 years old. The mean length of observation was 20.1 years, ranging 5-33 years. All patients underwent clinical and radiological evaluations before the surgery, and again in the third, sixth and twelfth months after the surgery. Further follow-up visits were performed every year. The tests were scored according to the Merle d'Aubigné and Postel (MAP) classification, as recommended by the Polish Society of Orthopaedics and Traumatology. Postoperative radiographs were used to assess the position of the endoprosthesis, and the degree of implant healing in the bone tissue. The data was subjected to statistical analysis. Of the surveyed group, 67 patients were professionally active before the surgery: 34 were white-collar workers, 29 manual workers, and 4 students or school pupils. The remaining 20 had not worked for many years, and were receiving sickness or disability benefits. An excellent result, according to the Kellgren-Lawrence classification, was noted in 22 cases, a good result in 42 cases, and a satisfactory result in 6 cases. In 25 cases, a poor result was observed. All of the patients professionally active before the surgery returned to work following the procedure. A further analysis found that 15 previously-unemployed patients commenced employment following the procedure. The mean length of the sick leave was 196.2 days, and rehabilitation payments were granted in 5 cases. Total cementless hip replacement is a valuable method of treating osteoarthritis in young patients. All of the patients who worked before the surgery returned to work in the same position and on the same employment conditions. Most of the previously-unemployed patients commenced employment following the procedure. Int J Occup Med Environ Health. 2021;34(6):747-54.

The dynamics of disability and benefit receipt in Britain

Abstract This article provides a comprehensive analysis of the dynamic relationship between disability and welfare benefit receipt in Britain. Exploiting rarely used longitudinal data, it examines the impact of disability onset and disability exit on receipt of a range of beneficial outcomes, utilizing differences in the timing of onset/exit for identification. Disability onset increases receipt of disability insurance (DI), sickness benefits, and non-sickness benefits by 6, 8, and 9 percentage points in the onset year, although almost 70% of those experiencing onset remain independent of the welfare system in the short-run. DI reforms that toughened screening, reduced generosity, and increased conditionality appear to have substantially reduced DI inflows following onset, but without affecting the overall probability of welfare receipt. Disability exit, although neglected in the literature, is common during working-age and leads to a decrease in DI (and total welfare receipt), suggesting DI is not an absorbing state.

Sickness absence during the COVID-19 pandemic

The aim of this research was to perform comparative analysis of the publicly avaiable data of the Social Insurance Institution (ZUS) on sickness absence of insured persons in Poland in 2016-2021 (before the outbreak and during the COVID-19 pandemic).&#x0D; Materials and methods. The research material consisted of data from the Social Insurance Institution for the years 2016-2021 (Q1) concerning the sickness absence of the insured. Due to the publication of data in an aggregated form, quantitative analysis was performed instead of statistical analysis. The data used in the analysis included the number of insured persons, the number of people receiving sickness benefits, the number of issued medical certificates on temporary incapacity to work and the reasons for the incapacity to work.&#x0D; Results and Conclusion. Since the beginning of the COVID-19 pandemic, following numbers have increased compared to 2019: the number of people receiving sickness benefit in Poland (by 10%), the number of days of sickness absence (by 7%) and the number of issued medical certificates of temporary incapacity for work (by 4%). The largest increase in the number of beneficiaries, the number of days of sickness absence and the number of medical certificates was recorded in the Q4 of 2020 (respectively by 21%, 16% and 24% compared to Q4 of 2019). Due to COVID-19, 4.84 million days of sickness absence were used in 2020 – it was the tenth cause of absence.&#x0D; The largest changes in the number of people receiving sickness benefit and the number of days of sickness absence can be observed in Q1 and Q4, which may result from the seasonality of COVID-19 and the subsequent wave of infections. Importantly, COVID-19 is not the only factor contributing overall increase in the number of days of sickness absence in Poland – absence due to non-communicable diseases also increased during the pandemic.

Disrupted everyday life in the trajectory of low back pain: A longitudinal qualitative study of the cross-sectorial pathways of individuals with low back pain over time.

Low back pain is a leading cause of disability and sick days worldwide. This type of pain has a fluctuating and recurrent nature, and affects all aspects of a person's life, with profound psychosocial consequences. This study aims to explore the everyday life of individuals with low back pain over time and across various contexts. A longitudinal Grounded Theory study with the concept, conduct of everyday life, as the theoretical framework. The study was conducted in Denmark, and participants were sampled from a regional spine centre in a hospital context. Twenty-seven individuals with low back pain referred to a hospital for assessment and treatment for herniated discs were sampled. Participants were divided equally between women and men 37-71 years old. Participants were followed through interviews and participant observation for 6-18 months. They were interviewed at least twice, at the beginning and end of the study period. The interviews took place in participants' homes. Data consisted of transcribed interviews and field notes. Two themes, "When 'support' systems become disrupters" and "Adapting to a new life", describe important elements of the participants' conduct of everyday life through a period of low back pain and the time after. The first theme explains how healthcare and sickness benefit systems play an existential role in the individual's life during a period of low back pain. These systems made extensive, often conflicting, demands on participants, which challenged their everyday lives. The systems and their diverse needs could take precedence over other concerns, challenging participants' social self-understanding. In the second theme, we identified three typical patterns of how participants adapt to living with a potential exacerbation of low back pain over time: 1) Resignation, 2) Balancing and 3) Ignoring. From the participants' perspectives, healthcare and sickness benefits systems are supportive, but they often disrupt everyday life due to extensive and conflicting demands. Individuals with low back pain must continually adapt to everyday life. Therefore, professionals should support a balanced pattern of adapting to life with recurrent and fluctuating low back pain.

Recurrent sick leave after COVID-19: investigating the first wave of the pandemic in a comprehensive Swedish registry-based study

BackgroundSick-leave due to COVID-19 vary in length and might lead to re-current episodes. The aim was to investigate recurrent sick leave due to COVID-19 during the first wave.MethodsThis is a registry-based cohort study. The study comprises all people with sickness benefit due to COVID-19 in Sweden in March 1–August 31, 2020. Data from the Swedish Social Insurance Agency, the Swedish National Board of Health and Welfare, and Statistics Sweden were merged.ResultsWithin the follow-up period of 4 months, 11,955 people were subject to sickness benefit due to COVID-19, whereof 242 people (2.0%) took recurrent sick leave due to COVID-19, and of those 136 (56.2%) remained on sick leave at the end of follow-up. People with recurrent sick leave were older, more often women, and more likely to have been on sick leave prior to the COVID-19 pandemic.ConclusionA group of people presented with recurrent sick leave due to COVID-19. For half of them, the second sick leave lasted throughout the follow-up. People with recurrent sick leave differ in several aspects from those with shorter sick leave. To capture long-term sick-leave patterns due to COVID-19, a longer period of follow-up is needed.

Occupational welfare en segmentatie: een onderzoek naar variatie tussen (en binnen) sectoren in Duitsland en België

The paper uses a qualitative comparative case study design to examine across (and within) sectoral variation in occupational welfare outcomes (i.e. flexible working hours, occupational pensions and health and sickness benefits, fringe benefits complementing wages) for different groups of workers in food and chemical manufacturing in Germany and Belgium. Findings indicate that common national challenges can yield different occupational welfare outcomes across (and within) different sectors, which in turn affect workforce segmentation. The integration between local and sector-level power dynamics explains the extent to which and how negotiation on occupational welfare can entail segmentation.

Decreasing time on sick leave for patients with heart failure in Sweden during two decades

Abstract Background Heart failure (HF) is increasing in people of working age in Sweden (1). Given high morbidity and reduced quality of life among HF patients (2, 3), working capacity could be greatly affected, however, studies are scarce. Purpose To determine trends in sick leave rates following a first hospitalization for HF in Sweden 1995–2015 compared to controls matched by age and sex. Methods In Sweden, people who cannot work receive sickness benefit. Sickness benefit pay days are registered by Statistics Sweden. We identified all patients aged 18–60 years with a first hospitalization for HF in Sweden 1995–2012 in the National Patient Register (NPR). For each case we selected 2 controls matched for age and sex. Cases and controls were split into age groups, &amp;lt;45 years and 45–60 years. Age, sex and comorbidities were recorded. Paid sickness benefit days were recorded during the index year and the two subsequent years. Results A total of 24,677 cases and 65,923 controls were included, mean age for the younger and older age group 36.6 and 54.5 years, and proportion of women 35.3% and 23.8%, respectively. In 1995, the proportion of time on sickness benefit in patients &amp;lt;45 years was on average 28%, decreasing to 15% in 2012, with corresponding estimates for patients 45–60 29% and 17%, shown by index year for cases and controls for patients &amp;lt;45 years in Figure 1 and for patients 45–60 years in Figure 2. Conclusion Patients had a longer time on sick leave than controls over the study period. Time on sickness benefit initially declined over the course of the study period for both patients and controls, but the last years of the study period this decline stalled for both patients and controls. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was supported by the Swedish state under an agreement between the Swedish government and the County Councils Concerning Economic Support of Research and Education of Doctors [ALFGBG-717211, ALFGBG-433211, ALFGBG-725081]; the Swedish Heart and Lung Foundation [2013-0307, 2018-0419, 2018-0589]. Figure 1Figure 2

Mental health economics: A prospective study on psychological flourishing and associations with healthcare costs and sickness benefit transfers in Denmark

BackgroundEscalating healthcare expenditures highlight the need to identify modifiable predictors of the use and costs of healthcare and sickness benefit transfers. We conducted a prospective analysis on Danish data to determine the costs associated with flourishing as compared to the below threshold level of flourishing. MethodsWe used data from a 2016 Danish survey of 3508 adults, which was linked to Danish register data. Flourishing was assessed with a validated psychological well-being scale. A two-part regression model was used to predict 2017 costs while adjusting for 2016 costs, demographic variables, and health status, including psychiatric morbidity and health behaviours. Costs are expressed in USD PPP. ResultsApplying criteria from prior literature, the prevalence of flourishing in Denmark (measured in 2016) was 34.7%. Flourishing was associated with significantly lower healthcare costs ($-687.7, 95% CI = $-1295.0, $-80.4) and sickness benefit transfers ($-297.8, 95% CI = $-551.5, $-44.0) per person in 2017, as compared to the below threshold level of flourishing. Extrapolated to the Danish population (4.1 M people aged 16+ years), flourishing was associated with lower healthcare costs and sickness benefit transfers amounting to $-1.2bn (95% CI = $-2.3 bn, $-149.0 M). ConclusionsFlourishing is associated with considerably lower health-related government expenditure. Substantial reductions could potentially be achieved by increasing the number of people who are flourishing in the population.

Social validity of work ability evaluations and official decisions within the sickness insurance system: A client perspective.

BACKGROUND:Studies of the social validity of work ability evaluations are rare, although the concept can provide valuable information about the acceptability, comprehensibility and importance of procedures.OBJECTIVE:The aim of this study was to explore clients’ perceptions of social validity of work ability evaluations and the following official decisions concerning sickness benefits within the Swedish sickness insurance system.METHODS:This was a longitudinal qualitative study based on interviews with 30 clients on sick leave, analyzed through deductive content analysis.RESULTS:Clients’ understanding of the evaluation was dependent on whether the specific tests were perceived as clearly related to the clients’ situation and what information they received. For a fair description of their work ability, clients state that the strict structure in the evaluation is not relevant to everyone.CONCLUSION:The work ability evaluations indicate low acceptability due to lack of individual adaptation, the comprehensibility varied depending on the applicability of the evaluation and information provided, while the dimension ‘importance’ indicated as higher degree of social validity. The official decision about sickness benefits however was considered unrelated to the evaluation results, lacking solid arguments and sometimes contradictory to other stakeholders’ recommendations indicating poor social validity.

Effect of Health Shocks on Poverty Status in South Korea: Exploring the Mechanism of Medical Impoverishment.

South Korea has the highest out-of-pocket burden for medical expenses among the Organisation for Economic Co-operation and Development (OECD) member countries and has no formal sickness benefit system, along with United States and Switzerland, greatly increasing the risk of poverty due to a sudden illness. We identify the causal effect of health shocks on poverty status and explore the mechanisms of medical impoverishment by analyzing longitudinal data from 13 670 households that participated in the representative Korean Welfare Panel Study (KOWEPS) from 2007 to 2016. In this study, we define a health shock as a case in which no household members were hospitalized in the previous year, but together they had more than 30 days of hospitalization in this year. The propensity score matching method was combined with a mediation analysis in this work. The proportion of households in absolute poverty increased by 4.6-8.0 percentage points among households that experienced a health shock compared with matched controls. The selection effects due to health shock were estimated to be 5.6-8.2 percentage points. On average, a sudden hospitalization reduces annual non-medical expenditures and equivalized disposable income by just over 3.2 million KRW (2500 USD) and 1.2 million KRW (1000 USD), respectively. Health shock induces impoverishment after one year through both the medical expense and work capacity pathways, which explain 12.8% and 12.8% of the total effect, respectively. However, when we decompose the mediation effect of a health shock on poverty status after two years, we find that a health shock leads to poverty mainly through labor force nonparticipation (9.9%). Income stabilizing scheme to protect households that experience a health shock should be introduced as a policy alternative to confront the issue of medical impoverishment.

Single-bicycle crashes: An in-depth analysis of self-reported crashes and estimation of attributable hospital cost

Cyclists’ awareness of their risk of single-bicycle crashes is limited. Thus, knowledge of the most common contributory factors of single-bicycle crashes is required. Similarly, single-bicycle crashes and their costs to society are under-recognized by the public. The aim of this study was to conduct an analysis of single-bicycle crashes occurring in a cohort of cyclists in Denmark and supplement it with estimation of some attributable costs of single-bicycle crashes among all injured cyclists during one year treated in a hospital or emergency room in Denmark. We conducted a one-year follow-up of 6,793 active cyclists (mean age: 45.8 years) encountering 349 single-bicycle crashes (single-bicycle crash rate: 55 per 1,000 person-years). An in-depth analysis of the crashes suggested that daily winter road maintenance is crucial in colder climates and that the current cyclist infrastructure design gives rise to many single-bicycle crashes. Further analysis of the co-occurrence of the factors contributing to the crashes indicated that when the weather is warmer, the factors pertaining to the individual cyclist (and not the road authorities) dominate. The risk of sustaining a more severe injury (i.e. other than light bruises) once in a single-bicycle crash was 18 %. However, for cyclists above 50 years, this risk doubled compared with their younger counterparts, wholly due to a 4.7 times higher risk during the warm season. Among cyclists treated in hospital or emergency room, we estimated the attributable hospital cost of single-bicycle crashes at €1,701 and the attributable cost of municipality care at €417 in the first year after the injury (2019 prices). In cyclists aged 18–60 years and treated in hospital or emergency room, the estimated attributable risk of sickness benefit was 5.2 percentage points in the first year after the injury. We concluded that to increase cyclist safety, the road authorities should improve winter road maintenance and redesign cyclist infrastructure.

"My Cancer Is Worth Only Fifteen Weeks"? A Critical Analysis of the Lived Experiences of Financial Toxicity and Cancer in Canada.

Cancer patients experience financial hardship due to rising expenses related to cancer treatment and declining income levels associated with reduced employability. Employment Insurance Sick Benefits (EI-SB) is a social income support program which provides temporary income replacement to Canadians when they fall ill. Although EI-SB is designed to maintain continuity of income during an illness, little is known about the perspectives of cancer patients who receive EI-SB. This knowledge can inform the development of public policies which are responsive to the needs and priorities of cancer patients. We conducted a theory-informed thematic analysis of data collected from twenty semi-structured interviews with participants who were receiving care in a cancer centre in Cape Breton, Nova Scotia and had received EI-SB. A coding framework was developed using Taplin and colleagues' intermediate outcomes of patient care across the cancer care continuum. Interpretation of findings was guided by the synergies of oppression theoretical lens. Three overarching themes describe the experiences of cancer patients receiving social income support: Economic exclusion, in which the structure of the labour market and social welfare system determine access to workplace benefits and continuity of reasonable income; financial toxicity, a vicious cycle of financial burden and increasing financial distress; and constrained choices, where cancer influences employability and lowered income influences the need to be employed. Cancer patients need income support programs that are tailored to match their healthcare priorities. In addition, policies which strengthen working conditions and facilitate a reintegration to work when possible will be important in addressing the structural drivers of income insecurity experienced by cancer patients.