Design of a randomized controlled trial on the effects of Counseling of mental health problems by Occupational Physicians on return to work: the CO-OP-study Effectiveness of an Intervention to Enhance Occupational Physicians’ Guideline Adherence on Sickness Absence Duration in Workers with Common Mental Disorders: A Cluster-Randomized Controlled Trial Facilitated bone mineral density testing versus hospital-based case management to improve osteoporosis treatment for hip fracture patients: additional results from a randomized trial. A knowledge translation tool improved osteoporosis disease management in primary care: an interrupted time series analysis Improving compliance to osteoporosis workup and treatment in postmenopausal patients after a distal radius fracture. Effects of Antibiotics on Dental Implants: A Review Effect of intrapartum oropharyngeal (IP-OP) suction on meconium aspiration syndrome (MAS) in developing country: A RCT. Guideline-Based Care of Common Mental Disorders by Occupational Physicians (CO-OP study): A Randomized Controlled Trial Multidisciplinary Collaborative Care for Depressive Disorder in the Occupational Health Setting: design of a randomised controlled trial and cost-effectiveness study Cost-Effectiveness of Guideline-Based Care for Workers with Mental Health Problems The impact of osteoporosis on quality-of-life: the OFELY cohort. Osteoporosis among older Saudis: risk of fractures and unmet needs Improving Discharge Instructions in a Pediatric Emergency Department: Impact of a Quality Initiative Economic Evaluation of an Occupational Health Care Guideline for Prevention of Weight Gain Among Employees Effectiveness of e-learning in continuing medical education for occupational physicians Process evaluation of a problem solving intervention to prevent recurrent sickness absence in workers with common mental disorders. UK clinical guideline for the prevention and treatment of osteoporosis Return to work and occupational physicians' management of common mental health problems--process evaluation of a randomized controlled trial. Randomised controlled trial of a psychiatric consultation model for treatment of common mental disorder in the occupational health setting Cohort profile: research on Osteoarthritis/Osteoporosis Against Disability study. A feasibility pilot study on the use of complementary therapies delivered via mobile technologies on Icelandic surgical patients’ reports of anxiety, pain, and self-efficacy in healing A Randomized Clinical Trial of Aquatic versus Land Exercise to Improve Balance, Function, and Quality of Life in Older Women with Osteoporosis. Effectiveness and cost-effectiveness of an exposure-based return-to-work programme for patients on sick leave due to common mental disorders: design of a cluster-randomized controlled trial
Background Mental health problems often lead to prolonged sick leave . In primary care , the usual approach towards these patients was the advice to take rest and not return to work before all complaints had disappeared . When complaints persist , these patients are often referred to psychologists from primary and specialized secondary care . As an alternative , ways have been sought to activate the Dutch occupational physician ( OP ) in primary care . Early 2000 , the Dutch Association of Occupational Physicians ( NVAB ) published a guideline concerning the management by OPs of employees with mental health problems . The guideline received positive reactions from employees , employers and Dutch OPs . This manuscript describes the design of a study , which aims to assess the effects of the guideline , compared with usual care . Methods / Design In a r and omized controlled trial ( RCT ) , subjects in the intervention group were treated according to the guideline . The control group received usual care , with minimal involvement of the OP and easy access to a psychologist .  Subjects were recruited from two Dutch police departments . The primary outcomes of the study are return to work and treatment satisfaction by the employee , employer , and OP . A secondary outcome is cost-effectiveness of the intervention , compared with usual care . Furthermore , prognostic measures are taken into account as potential confounders . A process evaluation will be done by means of performance indicators , based on the guideline . Discussion In this pragmatic trial , effectiveness instead of efficacy is studied . We will evaluate what is possible in real clinical practice , rather than under ideal circumstances . Many requirements for a high quality trial are being met . Results of this study will contribute to treatment options in occupational health practice for employees on sick leave due to mental health problems . Additionally , they may contribute to new and better-suited guidelines and stepped care . Results will become available during 2007.Trial registration Current Controlled Trials IS RCT Purpose Evidence -based guidelines in occupational health care improve the quality of care and may reduce sickness absence duration . Notwithst and ing that , guideline adherence of occupational physicians ( OPs ) is limited . Based on the literature on guideline implementation , an intervention was developed that was shown to effectively improve self-reported adherence in OPs . The aim of present study was to evaluate whether this intervention leads to earlier return to work ( RTW ) in workers with common mental disorders ( CMD ) . Methods In a two-armed cluster r and omized controlled trial , 66 OPs were r and omized . The trial included 3379 workers , with 1493 in the intervention group and 1886 in the control group . The outcome measures were : time to full RTW , time to first RTW , and total hours of sickness absence . Cox regression analyses and generalized linear mixed model analyses were used for the evaluations . Results The median time to RTW was 154 days among the 3228 workers with CMD . No significant differences occurred in ( time to ) full RTW between intervention and control group HR 0.96 ( 95 % CI 0.81–1.15 ) nor for first RTW HR 0.96 ( 95 % CI 0.80–1.15 ) . The mean total hours of sickness absence was 478 h in the intervention group and 483 h in the control group . Conclusions The intervention to enhance OPs ’ guideline adherence did not lead to earlier RTW in workers with CMD guided by the OPs . Possible explanations are the remaining external barriers for guideline use , and that perceived guideline adherence might not represent actual guideline adherence and improved care . Trail registration : IS RCT N86605310 OBJECTIVE We previously demonstrated that a case manager intervention improved  osteoporosis  ( OP ) treatment within 6 months of hip fracture compared with usual care . The second phase of the r and omized trial compared a less intensive intervention , facilitated bone mineral density ( BMD  )  testing , with usual care and the case manager intervention . METHODS We initially r and omized 220 hip fracture patients to either an OP case manager intervention or usual care . After completing the original trial at 6 months postfracture , usual care patients were reallocated to facilitated BMD testing ; BMD tests were arranged and results sent to primary care physicians . Main outcomes ( bisphosphonate treatment , BMD tests , receipt of appropriate care ) were reascertained 1 year following hip fracture and compared with outcomes achieved by the OP case manager intervention and usual care . RESULTS Compared with usual care , facilitated BMD testing increased testing from 29 % to 68 % ( P < 0.001 ) , bisphosphonate use from 22 % to 38 % ( P < 0.001 ) , and receipt of appropriate care from 26 % to 45 % ( P < 0.001 ) . The more intensive ( 70 versus 30 minutes ) and expensive ( $ 56 versus $ 24 Canadian per patient ) OP case manager intervention led to significantly higher bisphosphonate use ( 54 % versus 38 % ; P = 0.03 ) , receipt of appropriate care ( 71 % versus 45 % ; P < 0.001 ) , and more BMD testing ( 80 % versus 68 % ; P = 0.06 ) than usual care followed by facilitated BMD testing . CONCLUSION Compared with usual care , 2 different inexpensive interventions result ed in significant increases in appropriate management of OP after hip fracture . The magnitude of improvements achieved was directly related to the intensity of the interventions Background Osteoporosis affects over 200 million people worldwide at a high cost to healthcare systems , yet gaps in management still exist . In response , we developed a multi-component osteoporosis knowledge translation ( Op-KT ) tool involving a patient-initiated risk assessment question naire ( RAQ ) , which generates individualized best practice recommendations for physicians and customized education for patients at the point of care . The objective of this study was to evaluate the effectiveness of the Op-KT tool  for appropriate disease management by physicians . Methods The Op-KT tool was evaluated using an interrupted time series design . This involved multiple assessment s of the outcomes 12 months before ( baseline ) and 12 months after tool implementation ( 52 data points in total ) . Inclusion criteria were family physicians and their patients at risk for osteoporosis ( women aged ≥50 years , men aged ≥65 years ) . Primary outcomes were the initiation of appropriate osteoporosis screening and treatment . Analyses included segmented linear regression modeling and analysis of variance . Results The Op-KT tool was implemented in three family practice s in Ontario , Canada representing 5 family physicians with 2840 age eligible patients ( mean age 67 years ; 76 % women ) . Time series regression models showed an overall increase from baseline in the initiation of screening ( 3.4 % ; P < 0.001 ) , any osteoporosis medications ( 0.5 % ; P = 0.006 ) , and calcium or vitamin D ( 1.2 % ; P = 0.001 ) . Improvements were also observed at site level for all the three sites considered , but these results varied across the sites . Of 351 patients who completed the RAQ unprompted ( mean age 64 years , 77 % women ) , the mean time for completing the RAQ was 3.43 minutes , and 56 % had any disease management addressed by their physician . Study limitations included the inherent susceptibility of our design compared with a r and omized trial . Conclusions The multicomponent Op-KT tool significantly increased osteoporosis investigations in three family practice s , and highlights its potential to facilitate patient self-management . Next steps include wider implementation and evaluation of the tool in primary care OBJECTIVE Distal radius fracture ( DRF ) in postmenopausal women is often the first clinical sign of osteoporosis ( OP ) . Despite the availability of effective treatments , only a minority of patients who sustain a fragility fracture are tested for OP . The purpose of this study was to examine whether a simple intervention by the hospital staff increases rates of OP workup . MATERIAL S AND METHODS We conducted a prospect i ve r and omized clinical trial . Ninety nine patients after DRF were r and omized to two groups . Both groups were contacted after their fracture and were asked to answer a question naire and were informed about the possible relationship between DRF and OP . In the intervention group , patients were sent an explanatory pamphlet and a letter to their primary care physician . An additional survey was conducted to establish whether the intervention improved the number of patients who undergo OP workup . RESULTS The intervention increased the proportion of patients who turned to their primary care physician from 22.9 % to 68.6 % , and increased the proportion of patients undergoing OP workup from 14.3 % to 40 % ( p < 0.001 ) . CONCLUSION Women with DRF who receive an explanation about possible OP implication s and are sent explanatory material s are more likely to undergo OP workup There are many reasons for dental implant failure , the development of bacteremia is concern for dentists . This is due to the possibility of unfavorable result such as implant loss or the need for re-treatment . In general , antibiotic prophylaxis is recommended for high risk patients such as individuals with an immunodeficiency , infectious endocarditis , or previous prosthetic instrumentation . However regarding clinical ly healthy , low and moderate risk individuals the use of antibiotics in implant dentistry is controversial . Another major concern regarding the over prescription of antibiotics is the selection of antibiotic resistant bacteria . A better underst and ing of the efficacy of prophylactic treatments regarding dental implantation is crucial . Thus a literature review and comparison of survival rates of dental implants with regimens of no , pre or post prophylaxis was performed using systematic literature review using reliable electronic data bases . Retrospective or prospect i ve controlled studies were examined for the influence of preoperative and /or postoperative or no antibiosis on dental implant success rate . Of the 11406 implants used in this literature review , cases with no antibiotics had a 92 % success rate , cases with pre-op antibiotic alone had a 96 % success rate , cases with post-op antibiotic alone had a 97 % success rate and cases with both pre and post-op antibiotic had a success rate of 96 % . Thus , the results from this literature review show a > 90 % success rate when antibiotics are used compared to when they are not used . Thus , no benefit is seen from the use of antibiotic prophylaxis in low and moderate risk dental implant patients . Keywords Dental implants ; Pre-operative prophylactics ; Post-operative prophylactics ; Success OBJECTIVE Evidence about IP-OP suction and selective tracheal intubation in meconium stained neonates is from developed countries . Little information is available about their role in developing countries with high incidence of meconium staining and MAS . This r and omized trial was planned to evaluate the effectiveness of IP-OP suction in meconium stained term neonates on prevention of MAS and reduction of its severity . PATIENTS AND METHODS Out of 540 meconium stained full term , cephalic presentation , singleton neonates without major congenital malformations born from June'08 to January'09 , 31 were excluded and 509 r and omized . In the intervention group IP-OP suction was done at the time of delivery of head using a 10 Fr suction catheter with a negative pressure of 100 mmHg . No IP-OP suction was performed in control group . All neonates with MSAF were assessed as vigorous or non-vigorous after birth and provided care as per NRP guidelines 2005 . RESULTS Two hundred and fifty three neonates were r and omized to IP-OP suction and 256 to no IP-OP suction . Eighty-two neonates ( 16 % ) developed MAS , the primary outcome parameter , with 40 infants in the intervention group ( 15.8 % ) and 42 ( 16.4 % ) in the non-intervention group ( RR 0.86 , 95 % CI 0.60 - 1.54 ) . Incidence of severe MAS was comparable ( 3.55 % vs. 2.34 % ) ( P value=0.40 ) . Other variables like requirement of oxygen > 48 h ( 9.8 % vs. 10.5 % ) and mortality ( 2.7 % vs. 1.7 % ) were also comparable . CONCLUSIONS IP-OP suctioning did not reduce the incidence or severity of MAS even in a setting of high incidence of MAS in a developing country . The mortality in two groups was comparable Objective : To evaluate the effectiveness of guideline -based care ( GBC ) of workers with mental health problems , which promotes counseling by the occupational physician ( OP ) facilitating return to work ( RTW ) . Methods : In a r and omized controlled trial with police workers on sick leave due to mental health problems ( n = 240 ) , trained OPs delivered GBC in the intervention group .  Time to RTW and recurrences during 1-year follow-up , analyzed using Cox proportional hazards models , were compared with usual care ( UC ) with easy access to a psychologist . Results : GBC by OPs did not result in earlier RTW than UC . Subgroup analysis showed a small effect in favor of GBC for workers with administrative functions and /or “ minor ” stress-related symptoms . Conclusions : GBC did not differ in RTW compared with UC , but may be beneficial for the majority of workers with minor stress-related disorders Background Major depressive disorder ( MDD ) has major consequences for both patients and society , particularly in terms of needlessly long sick leave and reduced functioning . Although evidence -based treatments for MDD are available , they show disappointing results when implemented in daily practice . A focus on work is also lacking in the treatment of depressive disorder as well as communication of general practitioners ( GPs ) and other health care professionals with occupational physicians ( OPs ) . The OP may play a more important role in the recovery of patients with MDD . Purpose of the present study is to tackle these obstacles by applying a collaborative care model , which has proven to be effective in the USA , with a focus on return to work ( RTW ) . From a societal perspective , the (cost)effectiveness of this collaborative care treatment , as a way of transmural care , will be evaluated in depressed patients on sick leave in the occupational health setting . Methods / Design A r and omised controlled trial in which the treatment of MDD in the occupational health setting will be evaluated in the Netherl and s. A transmural collaborative care model , including Problem Solving Treatment ( PST ) , a workplace intervention , antidepressant medication and manual guided self-help will be compared with care as usual ( CAU ) .  126 Patients with MDD on sick leave between 4 and 12 weeks will be included in the study .  Care in the intervention group will be provided by a multidisciplinary team of a trained OP-care manager and a consultant psychiatrist . The treatment is separated from the sickness certification . Data will be collected by means of question naires at baseline and at 3 , 6 , 9 and 12 months after baseline . Primary outcome measure is reduction of depressive symptoms , secondary outcome measure is time to RTW , tertiary outcome measure is the cost effectiveness . Discussion The high burden of MDD and the high level of sickness absence among people with MDD contribute to the relevance of this study . The intervention is an innovative approach , with trained OPs in a new role as care managers in the treatment of MDD . If this intervention proves to be cost-effective , implementation will be very relevant for individual patients as well as for society . Trial registration IS RCT Objective : To evaluate the cost-effectiveness of an activating guideline -based care ( GBC ) by occupational physicians ( OPs ) . Methods : An economic evaluation was conducted in a r and omized controlled trial with police workers on sick leave due to mental health problems ( n = 240 ) . In the intervention group trained OPs provided GBC , compared with usual care with easy access to a psychologist .  Sick leave data and health care costs were gathered after 1-year follow-up . Analyses comprised bootstrap techniques , cost-effectiveness planes , and acceptability curves . Results : Health care utilization costs ( & U20AC;574.532 in total ) were significantly lower in the intervention group ( mean difference −&U20AC;520 ; 95 % CI −&U20AC;980 to & U20AC;59 ) , whereas there were no significant differences in days of sick leave and productivity loss costs . Conclusions : GBC could be cost-effective , as lower direct costs lead to equal treatment outcomes of workers with common mental disorders Although the long-term outcomes of osteoporosis ( Op ) such as fracture , kyphosis , and pain are well known , the physical , psychological , and social consequences , beyond fracture and pain , are less clear . The Osteoporosis-targeted Quality -of-life ( OPTQoL ) question naire aim ed at assessing the physical difficulty , fears , and adaptations to one 's daily life was developed as a cross-sectional instrument to characterize the burden of Op within a community . The purpose of this study was to assess the impact of Op and related factors on community women participating in the OFELY study in France .  Femoral neck bone mineral density ( BMD ) and  OPTQoL question  naire data were collected from women r and omly selected from a large insurance company . Data were obtained for 756 women ( mean age 59 years , range 36 - 92 ) , most of whom were white . Women were classified into five groups based on the extent of physical manifestations and family history of Op . Women who had prior fractures , height loss , and /or kyphosis or both reported greater physical difficulty , more adaptations to their lives , and greater fears than women reporting no such changes . Scores on the Physical Difficulty domain , however , did not differ significantly based on BMD alone ( BMD T score < or=2.5 ) , after controlling for age and self-reported arthritis . The negative impact of Op on quality -of-life ( QoL ) seems to be more related to the physical manifestations of Op than to bone density levels . Recognition of the impact of Op-related factors on QoL may help health-care providers more fully appreciate the importance of prevention and treatment Summary Using FRAX ® , this study aim ed at estimating 10-years probability of osteoporosis (OP)-related fractures and identifies those in need of OP treatment among primary care attendees in Saudi Arabia . Of those aged ≥ 60 years , 14.4 and 18.4 % scored probabilities for major and hip fractures respectively suggesting OP treatment . Predictors for receiving OP screening included the presence of multiple clinical risk factors , occurrence of fragility fractures and physicians recommendation . Purpose This study aim ed at estimating the 10-years probability of osteoporosis (OP)-related fractures and identifying those in need of OP treatment among Saudi adults attending primary care centers ( PHCs ) in Al Hassa , Saudi Arabia , using FRAX ® calculator and to determine factors possibly influence receiving of OP screening among them . Subjects and Methods A total of 1,251 Saudi aged ≥ 40 years , of both genders , were recruited from four urban and three rural r and omly selected PHCs . All were subjected to anthropometric measurements followed by a personal interview with structured question naire to asses OP clinical risk factors ( CRFs ) and possible correlates for receiving OP screening .  Ten-year probabilities for major osteoporotic and hip fractures were calculated using the Lebanese version of FRAX ® calculator . Results Of participants aged ≥ 60 years , 14.4 and 18.4 % were identified with probability scores for major osteoporotic and hip fractures respectively , suggesting OP treatment . Out of sample d population , 16.1 % received OP screening . The presence of ≥two OP CRFs ( odds ratio OR = 4.45 ) , being aware of OP ( OR = 2.89 ) , physician recommendation of OP screening  ( OR = 2.01 ) , and history of fragility fracture ( OR = 1.92 ) were all possible positive predictors for receiving OP screening . Conclusion A sizable portion of the sample d older Saudis especially those aged ≥ 60 years are at high risk for OP-related fractures indicative to receive OP treatment . Occurrence of fragility fractures , multiplicity of CRFs and physician ’s recommendations are significant positive predictors to receive OP screening among them Background Effective communication between physician and patient is essential to optimize care after discharge from the emergency department ( ED ) . Written discharge care instructions ( DCI ) complement verbal instructions and have been shown to improve communication and patient management . In 2012 , Centers for Medicare and Medicaid Services proposed a quality measure ( OP-19 ) that assesses compliance with key elements considered essential for high- quality written DCI . Objective To evaluate the impact of a QI intervention on improving quality of written DCI in a pediatric emergency department ( PED ) . Methods A QI initiative was conducted at a tertiary PED with greater than 60,000 annual visits . Based on Centers for Medicare and Medicaid Services OP-19 measure and group consensus , 8 elements were defined a priori as requisites for good quality DCI . These elements are : Customized noteExplanation of presenting complaint/diagnosisTest(s ) performedTest(s ) results New medication(s)Reason for medication(s ) Reasons to follow-upFollow-up physician's/specialty name Providers review ed a r and om sample of DCI of patients . Proportion of DCI that had each element documented was compared between preintervention phase ( PRE ) and postintervention phase ( POST ) . Results Three hundred twenty-nine DCI ( PRE ) and 1434 DCI ( POST ) were review ed . The POST DCI showed statistically significant improvement for each of the 8 elements . The bundle measure ( proportion containing all 8 elements ) increased from 23 % ( PRE ) to 79 % ( POST ) ( P < 0.001 ) . Conclusions The ED DCI improved in all 8 elements after a QI intervention . A detailed DCI at ED discharge enhances the patient 's ability to comply with postdischarge treatment plan . Further studies are needed to evaluate the impact of improving DCI on ED return rates and other outcomes Objective : To determine the cost-effectiveness and the financial return of a guideline for occupational physicians ( OPs ) , aim ed at the prevention of weight gain among employees . Methods : The guideline consisted of a company-environment scan and up to five individual sessions with an OP . Sixteen OPs r and omized to the guideline ( n = 7 ) or usual care group ( n = 9 ) recruited 275 and 249 employees . Costs were collected by using 3-monthly retrospective question naires . Quality -adjusted life-years gained were determined with 6-monthly administered EuroQol-5D . Waist circumference and body weight were measured at baseline and 18 months . Results : Unfavorable differences were found on waist circumference ( + 1.6 cm ; 95 % confidence interval [ CI ] , 0.27 to 2.90 ) and weight ( + 1.1 kg ; 95 % CI , 0.01 to 2.15 ) . Probabilities of cost-effectiveness were consistently less than 55 % . Net employer loss was & OV0556;−158 ( 95 % CI , −2865 to 2672 ) . Conclusions : The occupational health care guideline was not cost-effective and no financial return was shown Background Within a clinical context e-learning is comparable to traditional approaches of continuing medical education ( CME ) . However , the occupational health context differs and until now the effect of postgraduate e-learning among occupational physicians ( OPs ) has not been evaluated . Aim To evaluate the effect of e-learning on knowledge on mental health issues as compared to lecture-based learning in a CME programme for OPs . Methods Within the context of a postgraduate meeting for 74 OPs , a r and omized controlled trial was conducted . Test assessment s of knowledge were made before and immediately after an educational session with either e-learning or lecture-based learning . Results In both groups , a significant gain in knowledge on mental health care was found ( P < 0.05 ) . However , there was no significant difference between the two educational approaches . Conclusion The effect of e-learning on OPs ' mental health care knowledge is comparable to a lecture-based approach . Therefore , e-learning can be beneficial for the CME of OPs Common mental disorders ( CMDs ) are a major cause of sickness absence . Twenty to 30 % of the workers who return to work after sickness absence due to CMDs experience recurrent sickness absence . We developed the Stimulating Healthy participation And Relapse Prevention (SHARP)-at work intervention , a problem solving intervention delivered by occupational physicians ( OPs ) , to prevent recurrent sickness absence in this worker population in The Netherl and s. A process evaluation was conducted alongside a cluster-r and omised controlled trial to ( 1 ) evaluate whether the SHARP-at work intervention was implemented according to the protocol and differed from treatment in the control group , and ( 2 ) to investigate the relationship between the key elements of the intervention and the effect outcome ( i.e. recurrent sickness absence ) . We collected process data for both the intervention and control group on recruitment , reach , dose delivered , dose received , fidelity , context and satisfaction . Data on recurrent sickness absence was collected through the registry system of the collaborating occupational health service . The study was performed in the Netherl and s , and between 2010 and 2012 , 154 OPs and 158 participants participated . Compared to the control group , participants in the intervention group more frequently had two or more consultations with the OP  ( odds ratio [ OR ] = 3.2 , 95 % confidence interval [ CI ] = 1.2 - 8.8 ) and completed more assignments ( OR = 33.8 , 95 % CI = 10.4 - 109.5 ) as recommended in the intervention protocol . OPs and participants were satisfied with the intervention and rated it as applicable . Several individual intervention components were linked to the effect outcome . The process evaluation showed that the SHARP-at work intervention was conducted according to the protocol for the majority of the participants and well-received by OPs and participants . Furthermore , the intervention differed from treatment in the control group . Overall , the results provide support for implementing the intervention in practice Introduction In 2008 , the UK National Osteoporosis Guideline Group ( NOGG ) produced a guideline on the prevention and treatment of osteoporosis , with an up date in 2013 . This paper presents a major up date of the guideline , the scope of which is to review the assessment and management of osteoporosis and the prevention of fragility fractures in postmenopausal women and men age 50 years or over . Methods Where available , systematic review s , meta-analyses and r and omised controlled trials were used to provide the evidence base . Conclusions and recommendations were systematic ally grade d according to the strength of the available evidence . Results Review of the evidence and recommendations are provided for the diagnosis of osteoporosis , fracture-risk assessment , lifestyle measures and pharmacological interventions , duration and monitoring of bisphosphonate therapy , glucocorticoid-induced osteoporosis , osteoporosis in men , postfracture care and intervention thresholds . Conclusion The guideline , which has received accreditation from the National Institute of Health and Care Excellence ( NICE ) , provides a comprehensive overview of the assessment and management of osteoporosis for all healthcare professionals who are involved in its management OBJECTIVE The aim of this study was to examine the adherence of occupational physicians ( OP ) to the Dutch guideline on the management of common mental health problems and its effect on return to work as part of the process evaluation of a trial comparing adherence to the guideline to care as usual . The first hypothesis was that guideline adherence among the " guideline group " will be higher compared to the " usual care group " . The second hypothesis was that better guideline adherence by the occupational physician will be associated with earlier return to work . METHODS In a r and omized controlled trial , five participating OP had to provide care based on the Dutch guideline to 240 police workers with common mental health problems ( the " guideline group " ) . The same OP had to provide usual care to the participants in the control group ( the " usual care " group ) , including minimal involvement and easy access to a psychologist . In evaluating the process , we assessed guideline adherence via an audit of medical files , using 20 guideline -based performance indicators . Mean rates of guideline adherence were related to the duration until first and full return to work , using a Cox proportional hazards model . RESULTS The mean rate of the sum score of guideline adherence was 10 in a range of 0 - 20 [ st and ard deviation ( SD ) 1.8 ] and did not significantly differ between the intervention and control group . Mean better guideline adherence showed a statistically significant association with a shorter time to first and full return to work [ hazard ratio 1.1 ; 95 % confidence interval ( 95 % CI ) 1.0 - 1.2 ] , which was explained by keeping more regular contact with the worker and the work system and better monitoring of stagnation or return to work . CONCLUSIONS No contrast in guideline adherence was found between guideline -based versus usual care . This can be explained by contamination between the guideline and usual care group . Even though guideline adherence was only average , better adherence predicted earlier return to work . Guidelines for management of common mental health problems and return to work should focus on regular contact with the worker and the work organisation Background Common mental disorders are the most prevalent of all mental disorders , with the highest burden in terms of work absenteeism and utilization of health care services . Evidence -based treatments are available , but recognition and treatment could be improved , especially in the occupational health setting . The situation in this setting has recently changed in the Netherl and s because of new legislation , which has result ed in reduced sickness absence . Severe mental disorder has now become one of the main causes of work absenteeism . Occupational physicians ( OPs ) are expected to take an active role in diagnosis and treatment , and seem to be in need of support for a new approach to h and le cases of more complex mental disorders . Psychiatric consultation can be a collaborative care model to achieve this . Methods / design This is a two-armed cluster-r and omized clinical trial , with r and omization among OPs . Forty OPs in two big companies providing medical care for multiple companies will be r and omized to either the intervention group , i.e. psychiatric consultation embedded in a training programme , or the control group , i.e. only training aim ed at recognition and providing Care As Usual .  60 patients will be included who have been absent from work for 6–52 weeks and who , after screening and a MINI interview , are diagnosed with depressive disorder , anxiety disorder or somatoform disorder based on DSM-IV criteria . Baseline measurements and follow up measurements ( at 3 months and 6 months ) will be assessed with question naires and an interview . The primary outcome measure is level of general functioning according to the SF-20 . Secondary measures are severity of the mental disorder according to the PHQ and the SCL-90 , quality of life ( EQ-D5 ) , measures of Return To Work and cost-effectiveness of the treatment assessed with the TiC-P. Process measures will be adherence to the treatment plan and assessment of the treatment provided by the Psychiatric Consultant ( PC ) in both groups . Discussion In the current study , a psychiatric consultation model that has already proved to be effective in the primary care setting , and aim ed to enhance evidence -based care for patients with work absenteeism and common mental disorder will be evaluated for its efficacy and cost-effectiveness in the occupational health setting Since the proportion of the ageing population in Japan is increasing , a comprehensive and evidence based strategy is urgently required for the prevention of musculoskeletal diseases , including osteoarthritis ( OA ) and osteoporosis ( OP ) , both of which affect the activities of daily living ( ADL ) and quality of life ( QOL ) and increase morbidity and mortality . However , few prospect i ve , longitudinal studies for the purpose of developing such a strategy have been conducted , and little information is available regarding the prevalence and incidence of musculoskeletal disorders , including OA and OP , as well as pain and disability in the Japanese population . It is difficult to design rational clinical and public health approaches for the diagnosis , evaluation and prevention of OA and OP without such epidemiological data . The Research on Osteoarthritis/osteoporosis Against Disability ( ROAD ) study was established in 2005 by N.Y. , T.A. , H.O. , S.M. , H.K. and K.N. ( principal investigators ) . The principal investigators are affiliated with the 22nd Century Medical and Research Center , University of Tokyo Background Complementary therapies ( CT ) , such as relaxation technique , massage , guided imagery , and accupuncture have shown to benefit patients undergoing surgery . The aim of this study was to determine the feasibility of using audio relaxation technique ( ART ) , music intervention ( MI ) , nature video application with music ( NVAM ) , and nature video application without music ( NVA ) delivered via mobile technologies in a clinical setting . Secondary , the effects of ART , MI , NVAM and NVA on patients ’ state anxiety , pain perception , and perceived self-efficacy in healing were determined . Methods A r and omized clinical trial ( RCT ) involving 105 same day surgery ( SDS ) patients , who were assigned to an ART ( n = 25 ) , MI ( n = 25 ) , NVAM ( n = 15 ) , NVA ( n = 16 ) , or a control group ( n = 24 ) were assessed for state anxiety , self-reported pain , and self-efficacy four days prior to surgery , immediately prior and following a surgical intervention , and day five post-operative . Results ANOVA found no statistically significant differences in anxiety scores ; pain , or perceived self-efficacy between the five groups . Matched pairs t-Test revealed all participants had an increase in anxiety from pre-op to day 10 follow-up ; a significant change in pain levels from pre-op to day 10 follow-up ; and all participants had a significant increase in general self-efficacy from pre-op to day 10 follow-up . Mean pain level scores from day 1 to pre-op showed a significant decrease in pain for the ART group and NVAM group . Matched pairs t-Test for self-efficacy scores indicated the MI group and the NVA group had significant increases in self-efficacy . A significant decrease in anxiety from pre-op to day 10 for participants reporting a prior history of anxiety and for those reporting prior history of taking anti-anxiety medications . Conclusions Despite the non-significant findings between the five groups , at any measurement point , there were valuable trends toward significance and confirmed feasibility in a clinical setting . Among the groups there were statistically significant findings for all interventions on anxiety , pain , and self-efficacy . The feasability of the implementation of novel interventions of NVAM and NVAM adds to clinical practice and the CT literature .Trial registration Clinical Trials.gov Identifier : NCT02236455 ( September 4 , 2014 PURPOSE Despite the decreased gravitational loading that is experienced in an aquatic environment , little research has been conducted on this exercise medium for women with osteoporosis ( OP ) .  Aquatic exercise ( AE ) may improve function and balance , thus ultimately decreasing fall risk and the potential for hip fractures in this high-risk population . METHOD A total of 68 women with OP , aged 60 years or older , were recruited into a r and omized clinical trial evaluating the impact of AE , l and exercise ( LE ) , and no exercise ( NE ) on balance , functional mobility , and quality of life ( QOL ) . RESULTS Only one balance measure ( backward t and em walk ) significantly improved with AE compared to LE , but this did not translate into a greater improvement in self-report function . There were no significant differences between the exercise interventions and NE , except for in ratings of global change , where participants in the AE group were three times more likely to report improvement than those in the NE group . CONCLUSION There were no differences in balance , function , or QOL in women with OP who followed an AE or LE programme compared to those in an NE control group . However , the significant differences in backward t and em walk between the AE and LE groups and self-reported global change between the AE and NE groups warrant further investigation . Significant improvements in balance and global change suggest that AE is a viable alternative for older women with OP who have difficulty exercising on l and Background To reduce the duration of sick leave and loss of productivity due to common mental disorders ( CMDs ) , we developed a return-to-work programme to be provided by occupational physicians ( OPs ) based on the principles of exposure in vivo ( RTW-E programme ) . This study evaluates this programme 's effectiveness and cost-effectiveness by comparing it with care as usual ( CAU ) . The three research questions we have are : 1 ) Is an RTW-E programme more effective in reducing the sick leave of employees with common mental disorders , compared with care as usual ? 2 ) Is an RTW-E programme more effective in reducing sick leave for employees with anxiety disorders compared with employees with other common mental disorders ? 3 ) From a societal perspective , is an RTW-E programme cost-effective compared with care as usual ? Methods / design This study was design ed as a pragmatic cluster-r and omized controlled trial with a one-year follow-up and r and omization on the level of OPs . We aim ed for 60 OPs in order to include 200 patients . Patients in the intervention group received the RTW-E programme .  Patients in the control group received care as usual .  Eligible patients had been on sick leave due to common mental disorders for at least two weeks and no longer than eight weeks . As primary outcome measures , we calculated the time until full return to work and the duration of sick leave . Secondary outcome measures were time until partial return to work , prevalence rate of sick leave at 3 , 6 , 9 , and 12 months ' follow-up , and scores of symptoms of distress , anxiety , depression , somatization , and fatigue ; work capacity ; perceived working conditions ; self-efficacy for return to work ; coping behaviour ; avoidance behaviour ; patient satisfaction ; and work adaptations . As process measures , we used indices of compliance with the intervention in the intervention group and employee-supervisor communication in both groups . Economic costs were calculated from a societal perspective . The total costs consisted of the costs of consuming health care , costs of production loss due to sick leave and reduced productivity , and out-of-pocket costs of patients for travelling to their OP . Discussion The results will be published in 2009 . The strengths and weaknesses of the study protocol are discussed . Trial registration IS RCT
Interventions to improve OP management had a significant positive impact on prescription of BMD measurement but a more limited impact on treatment prescription
Osteoporosis ( OP ) is a major public health concern , but still OP care does not meet guidelines .
Interventions have been developed to improve appropriate OP management .
The objective of the present study was to systematic ally review the current literature to ascertain the efficacy of interventions to improve OP care and characterize interventions taking into account elements related to their potential cost and feasibility .