Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions: An Update of the Evidence and Messages for Practitioners.

Purpose The objective of this systematic review was to synthesize evidence on the effectiveness of workplace-based return-to-work (RTW) interventions and work disability management (DM) interventions that assist workers with musculoskeletal (MSK) and pain-related conditions and mental health (MH) conditions with RTW. Methods We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis that ranked evidence as strong, moderate, limited, or insufficient. Results Seven electronic databases were searched from January 1990 until April 2015, yielding 8898 non-duplicate references. Evidence from 36 medium and high quality studies were synthesized on 12 different intervention categories across three broad domains: health-focused, service coordination, and work modification interventions. There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains. There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes. There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW. Evidence for the effectiveness of other single-domain interventions was mixed, with some studies reporting positive effects and others reporting no effects on lost time and work functioning. Conclusions While there is substantial research literature focused on RTW, there are only a small number of quality workplace-based RTW intervention studies that involve workers with MSK or pain-related conditions and MH conditions. We recommend implementing multi-domain interventions (i.e. with healthcare provision, service coordination, and work accommodation components) to help reduce lost time for MSK or pain-related conditions and MH conditions. Practitioners should also consider implementing these programs to help improve work functioning and reduce costs associated with work disability.

The development of competency-based education for mid-level eye care professionals: a process to foster an appropriate, widely accepted and socially accountable initiative.

INTRODUCTION: The Western Pacific region has a dearth of appropriately educated eye care providers, training programs and large and increasing eye health needs. METHOD: To ensure regional eye health needs would be met, an iterative process sought triangulations between the literature and consultations with local stakeholders from various fields. This information was used to develop competencies to meet quality standards for educational outcomes. A framework for social accountability was used to evaluate the proposed educational initiative, and the subsequent eye care service the graduates could provide. RESULTS: Current human resource development and deployment is inadequate to protect and restore ocular and visual health in the region. Some of these service needs could be met by task-shifting from conventional health professionals to appropriately trained mid-level personnel. A competency-based curriculum was developed to meet eye care needs and define this new cadre of mid-level professionals in relation to other professionals. This initiative met the relevance, equity, cost effectiveness and quality criteria for social accountability. DISCUSSION: The consultative process resulted in broad acceptance of the need for an appropriately educated mid-level cadre that could be recruited, educated, deployed, supported and retained in the Western Pacific region to supplement and substitute for established eye care professionals. This process also provided validation of the initiative prior to implementation, as being appropriate to the region, meeting educational standards and social accountability criteria for outcomes. It could be replicated in other regions that wish to develop such an education for new cadres of health care professionals.

First Report of Spot Form of Net Blotch of Barley Caused by Pyrenophora teres f. maculata in Hungary.

A countrywide survey of fungal diseases of barley (Hordeum vulgare L.) was conducted from 2005 to 2009. Unusual leaf necrosis varying in shape from 1 × 2 mm necrotic flecks to 15 × 20 mm ovoid spots was found. Sometimes a chlorotic halo surrounding the dead area was observed. Lesions appeared on various cultivars in many commercial fields and experimental plots at a number of sampling sites. Symptomatic leaves were taken to the laboratory and incubated in a moist chamber at room temperature on the bench to induce sporulation of the pathogen. Conidiophores on the diseased tissues were single or in small groups, dark brown, and bore several hyaline-to-olive brown, almost cylindrical conidia with three to seven pseudosepta. Dimensions of conidia were 75.2 to 100.9 × 16.5 to 18.8 µm. Under a stereo microscope, single conidia were transferred aseptically from the leaves onto potato dextrose agar (PDA) with a sterile needle. Plates were kept in the dark at 20°C for 2 weeks. Cultures were gray to olive green, cottony, and did not form conidia and sexual structures. These characteristics indicated that the pathogens belonged to the genus Pyrenophora. Species identity was confirmed by PCR assays with specific primers developed for the barley pathogenic Pyrenophora spp. (3,4). Of 169 isolates, 41 were identified as P. teres Drechs. f. maculata Smed.-Pet., the spot form of net blotch pathogen (2), and two of them have been deposited at an international culture collection under accession nos. CBS 123929 and CBS 123930. The remaining isolates were either P. graminea or P. teres f. teres, the leaf stripe and net form of net blotch pathogens of barley, respectively. Pathogenicity of four P. teres f. maculata and two P. teres f. teres isolates from different regions was confirmed by Koch's postulates. Each isolate was grown on two 9-cm PDA plates at 22°C in darkness. After 10 days, aerial mycelia were scraped off, blended in 100 ml of sterile distilled water, and filtered through two layers of cheesecloth. Ten seedlings of cv. Botond were sprayed at the two-leaf stage with the mycelium suspension of each isolate and a water control until runoff. Seedlings were kept in a growth chamber at 100% relative humidity and 20°C in the dark for 24 h, then at 70% relative humidity and 24/20°C (day/night) with a 12-h photoperiod. Within 3 weeks, one to four brownish ovoid spots, typical of the spot form of net blotch symptoms, developed on the leaves inoculated with P. teres f. maculata. In contrast, the seedlings inoculated with P. teres f. teres exhibited characteristic net-like lesions, whereas the control plants sprayed with sterile water remained healthy. All strains were reisolated and identified by specific PCRs as described above. To our knowledge, this is the first report of the occurrence of P. teres f. maculata in Hungary. Resistance of barley against P. teres f. maculata and P. teres f. teres is inherited independently (1). Therefore, knowledge regarding the frequency and distribution of these pathogens is important for disease management and resistance breeding. References: (1) O. S. Afanasenko et al. J. Phytopathol. 143:501, 1995. (2) V. Smedegård-Petersen. Page 124 in: R. Vet. Agr. Univ. Yearbook. Copenhagen, 1971. (3) E. J. A. Taylor et al. Plant Pathol. 50:347, 2001. (4) K. J. Williams et al. Australas. Plant Pathol. 30:37, 2001.

Using assessment of willingness to pay to improve a Cambodian spectacle service.

AIMS: To assess willingness to pay for spectacles in provincial Cambodia, and use this to inform creation of a financially self-sustaining spectacle scheme within a blindness prevention programme. METHODS: An interview-based questionnaire was used to elicit willingness to pay for spectacles of all people dispensed spectacles during an outreach refraction service visit to three village health centres in Cambodia. RESULTS: Of 293 people participating in the study, 252 (86%) provided internally valid willingness-to-pay responses from which data were analysed. 76.6% (193) were willing to pay at least KHR1500 (US$0.38) for spectacles. On multivariate analysis, an increased likelihood of being unwilling to pay at least KHR1500 for spectacles in the future was significantly and independently associated with being >/=60 years old, attending Kor or Svay Teap health centres, not being an income earner in the household and having a household monthly income of less than KHR50 000. There was no association with being vision-impaired, this being the first eye examination, occupation, not having motorised transport or previous spectacle wear. If the potential willingness to pay had been converted to actual on the day, there would have been a 28.0% increase in revenue, and a greater than fivefold increase in profit, for the spectacle scheme. CONCLUSIONS: Willingness-to-pay data may be useful for price-setting and developing a subsidisation protocol for poorer consumers that will ensure financial accessibility for all and financial sustainability for the provision of spectacles.

Correction of refractive error and presbyopia in Timor-Leste.

AIM: To investigate the aspects of spectacle correction of vision-impairing refractive error and presbyopia in those aged >or=40 years in Timor-Leste. METHOD: A population-based cross-sectional survey with cluster random sampling was used to select 50 clusters of 30 people. Those who had uncorrected or undercorrected refractive error (presenting acuity worse than 6/18, but at least 6/18 with pinhole), uncorrected or undercorrected presbyopia (near vision worse than N8), and/or who were using or had used spectacles were identified. Dispensing history, willingness to wear and willingness to pay for spectacles were elicited. RESULTS: Of 1470 people enumerated, 1414 were examined (96.2%). The "met refractive error need" in the sample was 2.2%, and the "unmet refractive error need" was 11.7%. The "refractive error correction coverage" was 15.7%. The "met presbyopic need" was 11.5%, and the "unmet presbyopic need" was 32.3%. The "presbyopia correction coverage" was 26.2%. Lower correction coverage was associated with rural domicile, illiteracy and farming. Of the sample, 96.0% were willing to wear spectacles correcting impaired vision. Of these, 17.0% were willing to pay US$3 ( pound 1.52, euro 2.24) for spectacles, whereas 50.2% were unwilling to pay US$1 ( pound 0.51, euro 0.75). Women and rural dwellers were less likely to be willing to pay at least US$1 for spectacles. CONCLUSION: Refractive error and presbyopia correction coverage rates are low in Timor-Leste. There is a large need for spectacles, especially for elderly and illiterate people, farmers and rural dwellers: those least able to pay for them. An equitable cross-subsidisation spectacle system should be possible.

Analysis of genetic variability within the genus Petromyces.

Phenotypic and genotypic features of three teleomorphic species, Petromyces alliaceus, P. albertensis and P. muricartus and some related anamorphic Aspergillus species were compared. The dendrogram based on carbon source utilisation data revealed a close relationship between P. muricarus and the A. ochraceus strains examined. P. alliaceus and P. albertensis strains were very closely related to each other. A dendrogram with similar topology was obtained by analysing sequences of the intergenic transcribed spacer regions of representatives of these species. P. alliaceus and P. albertensis strains could only be distinguished by the random amplified polymorphic DNA technique. These strains possibly represent a single species closely related to Aspergillus section Flavi, while the anamorph of P. turicatus is a member of Aspergillus section Circumdati. Our results indicate that Aspergillus section Circumdati is in need of taxonomic revision.