Work Absenteeism Research Articles

Short-term effect of acupuncture dry needle in treatment of chronic mechanical low back pain: a randomized controlled clinical trial.

In today's industrialized world, between sixty and ninety percent of the working-age population experiences low back discomfort. Chronic mechanical low back pain (CMLBP), the most common ailment among working-age people in contemporary industrial society, causes a major economic burden due to the widespread use of medical services and the absence of work. For those suffering from persistent mechanical low back pain, this experiment aimed to assess the efficacy of using acupuncture dry needles in the short term. Our research included 30 individuals with nonspecific low back pain; their ages varied from 20 to 45. The participants were divided into two parallel groups using a random process: 15 individuals in group A had acupuncture treatment with a dry needle placed to specified locations on their backs, whereas 15 individuals in group B participated in muscle strengthening and stretching exercises. Both before and after therapy, researchers examined the lumbar range of motion (ROM) in four directions: flexion, extension, bilateral side bending, as well as pain intensity and functional impairment. We examined the data for normality and covariance homogeneity using the Shapiro-Wilk and Box's tests, respectively. The variables of interest that were investigated were compared across various test groups and measurement periods using a 2x2 mixed design-multivariate analysis of variance (MANOVA). We used a significance threshold of 0.05. When comparing the two groups after treatment, it was found that the flexion and extension range of motion increased significantly (p<0.05), while the pain intensity, bending to the right and left, and functional impairment decreased significantly (p<0.05). The results of multiple pairwise comparisons showed a noteworthy difference in pain severity, functional debility, and back ROM between the two groups before and after treatment (p<0.05), with group A showing an advantage over group B after treatment. Based on the study results, dry needle acupuncture may be a beneficial modality in treating chronic mechanical low back pain by relieving pain intensity, improving functional debility, and improving ROM.

Estrategias de afrontamiento al estrés en docentes:

The main objective is to analyze the strategies for coping with stress in teachers at the San Francisco de Asís Parish School (Bello, Antioquia). The research approach is qualitative, and the method is phenomenological, since it allows us to identify and analyze the subjective and dynamic realities of the context, based on the conscious experiences of the actors addressed. The techniques used for information collection and analysis were social cartography, situation murals and in-depth interviews. From this analysis, categories such as work stress, self-sabotage, emotional self-management and absence of psychosocial support emerge. The findings obtained present a humanized dimension of the teaching experience and the daily ways they find to face the stress derived from their daily functions and challenges within the educational system.

Psychosocial and mental impact of alopecia areata: Analysis of the Danish Skin Cohort

AbstractImportanceAlopecia areata (AA) carries a psychological burden for patients beyond hair loss. However, quality‐of‐life measurement tools such as EQ‐5D used in clinical trials may not adequately capture the burden of AA, the perceived stigmatization or the psychosocial impact of AA.ObjectiveTo investigate the potential association between disease severity and the degree of social isolation, perceived stigmatization, anxiety and depression, alcohol consumption and work absenteeism using multiple PRO measures in patients with AA.Design, Setting and ParticipantsUsing the Danish Skin Cohort, the study included adult patients diagnosed with AA. The study included multiple PRO measures, including Skindex‐16, EQ‐5D‐5L, Work Productivity and Activity Impairment (WPAI), Alcohol Use Disorders Identification Test‐Consumption (AUDIT‐C) and the Alopecia Areata Symptom Impact Scale (AASIS). The questionnaires were dispatched to the patients in January 2023. The severity of AA was determined based on scalp involvement using a modified Alopecia Areata Scale. Multiple multivariate linear regressions were conducted using Skindex‐16, AASIS and WPAI, while multivariate logistic regressions were applied to HADS, AUDIT‐C and EQ‐5D‐5L.ResultsA total of 376 patients were included, of which 177 (47%) had severe disease, 41 (11%) had moderate disease, 94 (25%) had mild disease, and 64 (17%) were in remission. The median age of patients was 55 (IQR, 47–66 years) and most were female (70%). Skindex‐16 and AASIS were the only PRO measures able to distinguish between severity. For these scores, moderate and severe diseases, female sex, and involvement of eyebrows increased the score and negatively impacted patient quality of life.Conclusion and RelevanceThe results indicate the importance of using the proper tool for the intended measurement of quality of life and that factors such as the severity of AA, as well as female sex and involvement of the eyebrows, may potentially increase the psychosocial burden of AA.

Clinical, economic, and societal burden of cystic fibrosis and the impact of the CFTR modulator, lumacaftor/ivacaftor: an assessment using linked registry data in Sweden

Aims We aimed to describe the clinical, economic, and societal burdens of cystic fibrosis (CF) and impact of CF transmembrane conductance regulator modulator (CFTRm) treatment on people with CF, caregivers, and healthcare systems. Material and methods This retrospective study used linked real-world data from Swedish national population-based registries and the Swedish CF Quality Registry to assess clinical, economic, and societal burden and CFTR impact in CF. Records from people with CF and a ten-fold control population without CF matched by sex, birth year, and location were compared during 2019. Outcomes for a subset aged >6 years initiating lumacaftor/ivacaftor (LUM/IVA) in 2018 were compared 12 months pre- and post-treatment initiation. Results People with CF (n = 743) had >10 times more inpatient and outpatient specialist visits annually vs controls (n = 7406). Those aged >18 had an additional 77·7 (95% CI: 70·3, 85·1) days of work absence, at a societal cost of €11,563 (95% CI: 10,463, 12,662), while caregivers of those aged <18 missed an additional 6.1 (5.0, 7.2) workdays. With LUM/IVA treatment, people with CF (n = 100) had significantly increased lung function (mean change in ppFEV1 [3·8 points; 95% CI: 1·1, 6·6]), on average 0·5 (95% CI: −0·8, −0·2) fewer pulmonary exacerbations and 45·2 (95% CI: 13·3, 77·2) fewer days of antibiotics. Days of work lost by caregivers of people with CF aged <18 decreased by 5·4 days (95% CI: 2·9, 7·9). Conclusion CF is associated with a high clinical economic and societal burden in Sweden. Improvements in clinical status observed in people with CF treated with LUM/IVA were reflected in reduced caregiver and societal burden.

An improved three factor authentication protocol for wireless body area networks

Wireless Body Area Networks (WBAN) is a concrete solution for the healthcare system, and it is paramount to ensure the sensed data by the WBAN sensors is secure against vulnerable threats and inaccessible by unauthorized entities. In light of this, highly robust authentication schemes and solutions are essential for the successful adoption of WBANs. To this end, a plethora of secure authentication solutions have been recommended by investigators over the past few decades. However, the absence of cohesive research work in view of secure mutual authentication schemes does not light on the extensive purpose of offering a bird’s-eye solution to the domain. To address the security issues in the previous schemes, we approach them in the following manner: We reviewed the Ali et al. scheme, a recently proposed authentication scheme for wireless medical sensor networks for healthcare monitoring, asserting that their scheme can withstand various attacks. Despite this, we proved that their scheme still has significant security weaknesses and is vulnerable to various attacks through rigorous cryptanalysis. Afterward, we proposed our three-factor authentication scheme to overcome the vulnerable attacks found in the Ali et al. scheme. Thereafter, we performed an extensive informal and formal analysis using Burrows-Abadi-Needham (BAN) logic to verify the robustness of the proposed scheme. From the analysis, we proved that the proposed authentication scheme is able to withstand various attacks on WBAN. Finally, a critical performance evaluation is done on our scheme. From the results, we identified that our scheme is a robust and identical solution for feature-rich WBAN health-care applications.

Flemish critical care nurses’ experiences regarding the influence of work-related demands on their health: a descriptive interpretive qualitative study

BackgroundCritical care nurses (CCNs) around the globe face other health challenges compared to their peers in general hospital nursing. Moreover, the nursing workforce grapples with persistent staffing shortages. In light of these circumstances, developing a sustainable work environment is imperative to retain the current nursing workforce. Consequently, this study aimed to gain insight into the recalled experiences of CCNs in dealing with the physical and psychosocial influences of work-related demands on their health while examining the environments in which they operate. The second aim was to explore the complex social and psychological processes through which CCNs navigate these work-related demands across various CCN wards.MethodsA qualitative study following Thorne’s interpretive descriptive approach was conducted. From October 2022 to April 2023, six focus groups were organised. Data from a diverse sample of 27 Flemish CCNs engaged in physically demanding roles from three CCN wards were collected. The Qualitative Analysis Guide of Leuven was applied to support the constant comparison process.ResultsParticipants reported being exposed to occupational physical activity, emotional, quantitative, and cognitive work-related demands, adverse patient behaviour, and poor working time quality. Exposure to these work-related demands was perceived as harmful, potentially resulting in physical, mental, and psychosomatic strain, as well as an increased turnover intention. In response to these demands, participants employed various strategies for mitigation, including seeking social support, exerting control over their work, utilising appropriate equipment, recognising rewards, and engaging in leisure-time physical activity.ConclusionsCCNs’ health is challenged by work-related demands that are not entirely covered by the traditional quantitative frameworks used in research on psychologically healthy work. Therefore, future studies should focus on improving such frameworks by exploring the role of psychosocial and organisational factors in more detail. This study has important implications for workplace health promotion with a view on preventing work absenteeism and drop-out in the long run, as it offers strong arguments to promote sufficient risk management strategies, schedule flexibility, uninterrupted off-job recovery time, and positive management, which can prolong the well-being and sustainable careers of the CCN workforce.

Patient-reported outcomes and healthcare resource utilization in systemic lupus erythematosus: impact of disease activity

BackgroundLimited real-world data exists on clinical outcomes in systemic lupus erythematosus (SLE) patients by SLE Disease Activity Index 2000 (SLEDAI-2 K), hereafter, SLEDAI. We aimed to examine the association between SLEDAI score and clinical, patient-reported and economic outcomes in patients with SLE.MethodsRheumatologists from the United States of America and Europe provided real-world demographic, clinical, and healthcare resource utilization (HCRU) data for SLE patients. Patients provided self-reported outcome data, capturing their general health status using the EuroQol 5-dimension 3-level questionnaire (EQ-5D-3 L), health-related quality of life using the Functional Assessment of Chronic Illness Therapy (FACIT) and work productivity using the Work Productivity and Activity Impairment questionnaire (WPAI). Low disease activity was defined as SLEDAI score ≤ 4 and ≤ 7.5 mg/day glucocorticoids; patients not meeting these criteria were considered to have “higher” active disease. Data were compared between patients with low and higher disease activity. Logistic regression estimated a propensity score for SLE based on demographic and clinical characteristics. Propensity score matched analyses compared HCRU, patient-reported outcomes, income loss and treatment satisfaction in patients with low disease activity versus higher active disease.ResultsData from 296 physicians reporting on 730 patients (46 low disease activity, 684 higher active disease), and from 377 patients’ self-reported questionnaires (24 low disease activity, 353 higher active disease) were analyzed. Flaring in the previous 12 months was 2.6-fold more common among patients with higher versus low active disease. Equation 5D-3 L utility index was 0.79 and 0.88 and FACIT-Fatigue scores were 34.78 and 39.79 in low versus higher active disease patients, respectively, indicating better health and less fatigue, among patients with low versus higher active disease. Absenteeism, presenteeism, overall work impairment, and total activity impairment were 47.0-, 2.0-, 2.6- and 1.5-fold greater in patients with higher versus low disease activity. In the previous 12 months there were 28% more healthcare consultations and 3.4-fold more patients hospitalized in patients with higher versus low disease activity.ConclusionCompared to SLE patients with higher active disease, patients with low disease activity experienced better health status, lower HCRU, less fatigue, and lower work productivity impairment, with work absenteeism being substantially lower in these patients.

Investigating the Dynamic Creep of Polymer Modified Hot Mix Asphalt

Abstract Jordan's road network continues to deteriorate as a consequence of the continuous increase in traffic and the absence of adequate maintenance work. The primary objective of this study was to enhance HMA performance by using polymer-modified asphalt mixtures. The polymer modifier known commercially as Eastman (EE-2) was mixed with binder penetration grade (60–70) at a ratio of 12%. In order to investigate the performance of polymer, the dynamic creep, the resilient modulus and the stability-flow tests were performed. Marshall Mix design was utilized to prepare a total of 50 samples, of which 20 were used to determine the optimal binder content, and the remaining samples were used to determine the effect of EE-2 modifier on asphalt mixtures. The results showed that the optimal asphalt content was 4.57 percent and revealed that the addition of EE-2 polymer to asphalt cement contributed to the production of a variety of desirable properties. The most important indicator of these developments is increased rutting resistance. For instance, the total permanent deformation has decreased by 87% (8500 to 1000 μm). Conversely, addition of EE-2 has resulted in a threefold increase in the resilience modulus (from 3632 to 10590 MPa). Finally, effect of the EE-2 polymer on the stability was demonstrated by increasing the stability value by about 52%

The role of familial factors and neuroticism in the association between exposure to offensive behaviors at work and long-term sickness absence due to common mental disorders - a prospective twin study

ObjectivesThe aim of this study was to investigate associations between exposure to work-related violence/threats and harassment, and future sickness absence (SA) due to common mental disorders (CMDs), taking familial factors (shared genetics and early-life environment) and neuroticism into account.MethodsThe study sample included 8795 twin individuals from the Swedish Twin Project of Disability Pension and Sickness Absence (STODS), including survey data from the Study of Twin Adults: Genes and Environment (STAGE). Self-reported work-related violence and/or threats as well as work-related harassment (including bullying) and national register data on SA due to CMDs were analyzed using standard logistic regression, and conditional logistic regression among complete twin pairs discordant on exposures. Individuals were followed for a maximum of 13 years. Interactions between neuroticism and exposures were assessed using both multiplicative and additive interaction analyses.ResultsExposure to work-related violence/threats was associated with higher odds of SA due to CMDs when adjusting for age, sex, marital status, children, education, type of living area, work characteristics, and symptoms of depression and burnout (OR 2.11, 95% CI 1.52–2.95). Higher odds of SA due to CMDs were also found for exposure to harassment (OR 1.52, 95% CI 1.10–2.11) and a combined indicator of exposure to violence/threats and/or harassment (OR 1.98, 95% CI 1.52–2.59), compared with the unexposed. Analyses of twins discordant on exposure, using the unexposed co-twin as reference, showed reduced ORs. These ORs were still elevated but no longer statistically significant, potentially due to a lack of statistical power. No multiplicative interaction was found between neuroticism and exposure to work-related violence/threats, or harassment. However, a statistically significant additive interaction was found between neuroticism and exposure to violence/threats, indicating higher odds of SA due to CMDs in the group scoring lower on neuroticism.ConclusionsExposure to work-related offensive behaviors was associated with SA due to CMDs. However, the results indicated that these associations may be partly confounded by familial factors. In addition, an interaction between exposure and neuroticism was suggested. Thus, when possible, future studies investigating associations and causality between offensive behaviors at work and mental health-related outcomes, should consider familial factors and neuroticism.

A Randomized Control Trial of Dexketoprofen/Vitamin B (Thiamine, Pyridoxine and Cyanocobalamin) Fixed-Dose Combination in Post-Traumatic Grade I-II Cervical Sprains.

Musculoskeletal disorders are an important cause of work absence. Clinical practice guidelines recommend nonsteroidal anti-inflammatory drugs (NSAIDs) for grade I-II cervical sprains. The combination of thiamine + pyridoxine + cyanocobalamin vitamins has been used, alone and in combination with NSAIDs, for pain and inflammation in musculoskeletal disorders. The objective of this study was to demonstrate the analgesic synergy of dexketoprofen, and the combination of vitamins thiamine + pyridoxine + cyanocobalamin in a fixed-dose combination (FDC) for the treatment of acute pain caused by grade I-II cervical sprains. We conducted a multicentre, prospective, randomized, double-blind, phase IIIb clinical study comparing two treatment groups: (1) dexketoprofen 25 mg/vitamin B (thiamine 100mg, pyridoxine 50mg and cyanocobalamin 0.50mg) in an FDC (two or more active ingredients combined in a single dosage form) versus (2) dexketoprofen 25mg monotherapy (single drug to treat a particular disease), one capsule or tablet orally, every 8h for 7 days. Final mean, average change, and percentage change in pain perception (measured using a visual analogue scale [VAS]) were compared with baseline between groups. A p value < 0.05 was considered statistically significant. Analyses were conducted using SPSS software, v.29.0. A statistically significant reduction in pain intensity was observed from the third day of treatment with the FDC compared with monotherapy (- 3.1±- 1.5 and - 2.6±- 1.1 cm, respectively) measured using the VAS (p=0.011). Regarding the degree of disability, using the Northwick Park Neck Pain Questionnaire (NPQ), statistical difference was observed for the final measurement (7.5%, interquartile range [IQR] 2.5, 10.5; vs. 7.9%, IQR 5.0, 13.8; p=0.028). A lower proportion of adverse events was reported when using the FDC. The FDC of dexketoprofen/thiamine + pyridoxine + cyanocobalamin vitamins demonstrated superior efficacy and a better safety profile compared with dexketoprofen monotherapy for pain treatment in patients with grade I-II cervical sprains. NCT05001555, registered 29 July 2021 ( https://clinicaltrials.gov/study/NCT05001555 ).

Comparison of morbidity and absenteeism due to COVID-19 and seasonal influenza in a large cohort of health care personnel in the 2022 to 2023 season

To compare the morbidity and work absenteeism associated with coronavirus disease 2019 (COVID-19) and influenza among health care personnel (HCP) in 2022 to 2023. We followed 5,752 hospital-based HCP in Greece from November 14, 2022 through May 28, 2023. Symptomatic HCP was tested for SARS-CoV-2 and influenza by real-time polymerase chain reaction and/or rapid antigen detection test. The association between the duration of absenteeism and the type of disease was estimated by multivariable regression models. A total of 734 COVID-19 cases and 93 influenza cases were studied. The mean duration of absence per COVID-19 case was 5.8days compared with a mean of absence of 3.6days per influenza case (P value <.001). Overall, COVID-19 accounted for 4,245days missed during the study period compared with 333days missed due to influenza. Multivariable regressionestimates indicated that HCP with COVID-19 had 1.91 more days of absenteeism (95% confidence interval 1.67-2.15) compared with those with influenza, on average. As SARS-CoV-2 becomes endemic, COVID-19 remains the prevalent cause of morbidity and absenteeism among HCP, accounting for considerably more workdays missed compared with influenza. HCP should be up-to-date with COVID-19 booster vaccinations and annual influenza vaccination in order to protect them as well as health care systems from HCP absenteeism.

A network analysis of exhaustion disorder symptoms throughout treatment

BackgroundStress-induced Exhaustion Disorder (ED) is associated with work absenteeism and adverse health outcomes. Currently, little is known regarding how the symptoms of ED are interrelated and whether the patterns of symptoms influence treatment outcomes. To this end, the current study applied network analyses on ED patients participating in a multimodal intervention.MethodsThe first aim of the study was to explore the internal relationships between exhaustion symptoms and identify symptoms that were more closely related than others. A second aim was to examine whether the baseline symptom network of non-responders to treatment was more closely connected than the baseline symptom networks of responders, by comparing the sum of all absolute partial correlations in the respective groups’ symptom network. This comparison was made based on the hypothesis that a more closely connected symptom network before treatment could indicate poorer treatment outcomes. Network models were constructed based on self-rated ED symptoms in a large sample of patients (n = 915) participating in a 24-week multimodal treatment program with a 12-month follow-up.ResultsThe internal relations between self-rated exhaustion symptoms were stable over time despite markedly decreased symptom levels throughout participation in treatment. Symptoms of limited mental stamina and negative emotional reactions to demands were consistently found to be the most closely related to other ED symptoms. Meanwhile, sleep quality and irritability were weakly related to other exhaustion symptoms. The symptom network for the full sample became significantly more closely connected from baseline to the end of treatment and 12-month follow-up. The symptom network of non-responders to treatment was not found to be more closely connected than the symptom network of responders at baseline.ConclusionsThe results of the current study suggest symptoms of limited mental stamina and negative emotional reactions to demands are central ED symptoms throughout treatment, while symptoms of irritability and sleep quality seem to have a weak relation to other symptoms of ED. The implications of these findings are discussed in relation to the conceptualization, assessment, and treatment of ED.Trial registrationThe clinical trial was registered on Clinicaltrials.gov 2017-12-02 (Identifier: NCT03360136).

Gender and educational differences in work participation and working years lost in Norway.

This study aimed to quantify the duration of work participation and reasons for working years lost, according to gender and educational attainment, among a Norwegian population. Register data on labor market attachment between 2000-2015 were obtained from Statistics Norway. We included five cohorts: individuals turning 20 (N=323 333), 30 (N=386 006), 40 (N=388 962), 50 (N=358 745), and 60 years (N=284 425) between 1 January 2000 and 31 December 2005. Individuals were followed for ten years. Data completeness allowed calculation of the average time spent in work and years lost to health-related absences and non-employment states per cohort. Changes in state probabilities over time were also depicted. Mean differences between genders and educational levels, and corresponding 95% confidence intervals were based on 1000 bootstrap samples. Both genders spent most time in work; however, per cohort, women worked approximately one year less than men. As cohorts aged, main reasons for working years lost changed from education and economic inactivity to sickness absence and disability pensioning; this trend was stronger for women than men. Individuals with a low education spent fewer years in work and more years in sickness absence and disability pensioning than highly educated peers. This difference tended to be larger for women and older cohorts. Per cohort, women participated one year less in work than men and, depending on age, spent more time in education, economic inactivity, sickness absence, and disability pensioning. Stronger educational gradients were seen for work and health-related absences for older cohorts and women.

Factors affecting return to work following arthroscopic rotator cuff repair

Background Prolonged work absence following arthroscopic rotator cuff repair (ARCR) is a major concern, yet factors influencing return to work are poorly understood. The primary aim of this study is to retrospectively assess the proportion of patients who successfully resume equivalent occupational demands after ARCR, along with the time taken for their return to work. Methods Eighty-three patients underwent ARCR. Work intensity and worker's compensation status were recorded. Patients were interviewed at ≥12 months to determine return to work rate and timing. Results In total, 83 patients were included, with a median age of 58.7 (±8.36) and a follow-up of at least 12 months. 98.8% returned to work at a median of eight weeks. Heavy manual labor significantly delayed return to work compared to light work (HR 0.15 95% CI). Receiving worker's compensation was associated with delayed return to work (HR 0.26 95% CI). Conclusion This study found that nearly all patients returned to work following ARCR, but high-intensity manual labor and worker compensation status significantly delayed their return to work. Patients with physically demanding jobs and those receiving workers’ compensation had a 60–85% lower likelihood of returning to work at any given time point compared to light work and noncompensated patients.

The impact of COVID-19 on police officer wellness

ABSTRACT Disaster policing requires considerably more effort than working under normal conditions, thereby exacerbating existing threats to employee wellness. Research suggests that such working conditions may be harmful to physical and mental health outcomes, including increasing absenteeism. This study relies on personnel records from 3,398 police officers across 12 police services to determine the extent to which the COVID-19 pandemic impacted police officer work attendance and absenteeism, controlling for officer – and community-level characteristics. Results indicate that compared to the previous time-period, work attendance decreased during the COVID-19 pandemic and absenteeism increased. Data shows that a greater proportion of officers worked fewer days during the pandemic compared to the time-period before, and a smaller proportion worked a greater number of days. Multilevel mixed effects models indicate that COVID-19 largely contributed to decreasing attendance and increasing absenteeism beyond the effects of community conditions and officer demographics.

AYURVEDIC MANAGEMENT OF CHRONIC NON-SPECIFIC LOW BACK PAIN W.S.R KATI SHOOLA – A CASE REPORT

Low back pain is the leading cause of activity limitation and work absence worldwide, including in families, communities, industries, and governments. It is a prevalent condition afflicts about 84% of people in developing countries at some point in their lifetime. An Ayurvedic classical term such as Kati Shoola describes low back pain. Low back pain is pain, tension, or rigidity between the 12th rib posteriorly and the gluteal line. Non-specific LBP (NSLBP) is defined as tension, soreness and stiffness of unknown aetiology in the lower back region with joint, disc and connective tissue involvement potentially contributing to symptoms. Treatment modalities like Snehana (oleation), Swedana (sudation), Basthi Karma (medicated enema), Agnikarma (therapeutic cauterisation), Lepa (local application) etc. In this case, Basthi, Alabu, Physiotherapy's integrative approach, along with Yogaraj Guggulu, Rasnasaptaka Kashaya, and Hingwasthaka Choorna has been selected for managing NSLBP. The present study concludes that the integrative approach of Ayurveda and Physiotherapy helps manage NSLBP.

Endoscopic Treatment of Lumbar Degenerative Disc Disease: A Narrative Review of Full-Endoscopic and Unilateral Biportal Endoscopic Spine Surgery

BackgroundDegenerative lumbar spine disease is the leading cause of disability and work absenteeism worldwide. Lumbar microdiscectomy became the standard treatment for herniated discs and stenotic disease. With the evolution of different techniques, endoscopic spinal surgery emerged to minimize the surgical footprint while providing at least non-inferior results. Currently, two different types of endoscopic spine procedures are dominating the surgical scenario: “Full-Endoscopic” (FE) and Unilateral Biportal Endoscopic”(UBE) Spine Surgery. The aim of this study is to describe and analyze their indications, their technical characteristicswithitsadvantagesanddisadvantagesofbothtechniquesandtheirfuture trends. MethodsWe performed a narrative review of the most relevant articles published up to August 2023 through a Pub Med search. The search terms "Full-Endoscopic Spine Surgery" and "Unilateral Biportal Endoscopic Spine Surgery" were used. The articles selected, were independently reviewed by 3 authors and 55 full text articles were reviewed. ResultsThe FE and UBE Spine Surgery techniques were described. The FE technique is performed with a monoportal access under constant saline irrigation. The FE comprises the transforaminal and the interlaminar approaches, and the indication depends from the pathology to treat, and still remains controversial. UBE can approach also the spine from a posterior, postero lateral,and para spinal route. It uses two different ports addressed to a target with continuous irrigation. The process of establishing these two portals is called triangulation. ConclusionFE and UBE spine surgery have demonstrated outcomes comparable to open surgery, minimizing complications and surgical footprint.

Differences between parents' and paediatricians' perceptions of mild respiratory infections in childhood: contrast study.

Mild respiratory infections are a common reason for consultation in paediatrics, both in the emergency department and in primary care clinics. These conditions, mostly viral and self-limiting, have a significant impact on the healthcare system, school and work absenteeism, and family routines. Despite being common and banal illnesses from a medical perspective, they involve a significant concern in families. The main objective of the contrast study was to compare the perceptions of parents and paediatricians regarding mild respiratory infections in childhood and their impact on family conciliation. Two online, cross-sectional surveys were conducted among Spanish paediatricians and parents with children aged 6 months to 12 years, involving 504 paediatricians and 1,447 families, with questions on attitudes towards visits to the paediatric consultation, care burden of minor pathologies, work, and family conciliation, and treatment and prevention of these illnesses. Results showed significant differences in paediatricians' and parents' perceptions in many aspects. According to 34.5% of paediatricians and 27% of parents, families regularly go to the paediatrician without a scheduled visit. Only 4% of parents report having self-medicated their child, while paediatricians raise this percentage significantly to 48%. Regarding the question: "it is normal for a child to have an average of 4 colds a year," only 25.5% of the surveyed families "strongly agree" unlike to 70.2% of paediatricians. 72.8% of paediatricians "strongly agree" with: "in my opinion, it is good for children to get sick to improve their immune system" reduced to 45.9% of parents. Consultations for minor pathologies represent a "high workload" for 60.9% of paediatricians, while this opinion is agreed by only 18.9% of the parents. Mild respiratory infections in childhood are perceived differently by paediatricians and parents. While paediatricians perceive them as a common and manageable phenomenon, parents tend to show higher concern and demand for medical attention. This study underlines the need to improve communication between paediatricians and parents to align perceptions, optimise the use of the health system resources, and improve the efficiency in the management of these common paediatric illnesses.

Implementation of the International Consortium of Health Outcomes Measurement CHD standard set in patients undergoing pulmonary valve replacement.

Despite the burden of CHD, a high cost and utilization condition, an implementation of long-term outcome measures is lacking. The objective of this study is to pilot the implementation of the International Consortium of Health Outcomes Measurement CHD standard set in patients undergoing pulmonary valve replacement, a procedure performed in mostly well patients with diverse CHD. Patients ≥ 8 years old undergoing catheterization-based pulmonary valve replacement were approached via various approaches for patient-reported outcomes, with a follow-up assessment at 3 months post-procedure. Implementation strategy analysis was performed via a hybrid type 2 design. Of the 74 patients undergoing pulmonary valve replacement, 32 completed initial patient-reported outcomes with variable response rates by strategy (email and in-person explanation 100%, email only 54%, and email followed by text/call 64%). Ages ranged 8-67 years (mean 30). Pre-procedurally, 34% had symptomatic arrhythmias, which improved post-procedure. For those in school, 43% missed ≥ 6 days per year, and over half had work absenteeism. Financial concerns were reported in 34%. Patients reported high satisfaction with life (50% [n = 16]) and health-related quality of life (90% [n = 26]). Depression symptoms were reported in 84% (n = 27) and anxiety in 62.5% (n = 18), with tendency towards improvement post-procedurally. Pilot implementation of the International Consortium of Health Outcomes Measurement CHD standard set in pulmonary valve replacement patients reveals a significant burden of disease not previously reported. Barriers to the implementation include a sustainable, automated system for patient-reported outcome collection and infrastructure to assess in real time. This provides an example of implementing cardiac outcomes set in clinical practice.

Hospital Queues, Patient Health, and Labor Supply

Long waits for health care raise concerns about the consequences of delayed treatment. We use variation in queue congestion to estimate effects of wait time for orthopedic surgery. We do not find that longer wait times lead to increased health care utilization. However, we do find persistent reductions in labor supply: long waits increase medium to long-term work absences and permanent disability receipt. Effects are driven by individuals who are on sick leave at referral. Our results are consistent with patterns of state dependence, where extended periods of temporary disability while awaiting treatment create persistent barriers to returning to work. (JEL I11, I12, I18, J22)