[Problematic sickness absence: a quantitative and qualitative analysis]. / Problematisch arbeidsverzuim.

OBJECTIVE: In the Netherlands, an occupational physician supports absence management and staff's return to work, but this role may be hampered if there is uncertainty concerning return to labour options. The return to work process may be improved when a specialized second opinion organization is called upon. Our objective was to map the potential for deployment, return to work rates, and healthcare costs for staff with problematic sickness absence profiles. METHOD: We analysed the data of problematic absentees who passed through a second opinion advisory system between 2011-2014, using pseudo-anonymized data matching from various sources. The datasets include client data from a company providing second opinions (n = 2595), a questionnaire for employees (n = 1800), a questionnaire for referrers (n = 400), additional data from one case management company (n = 564) and claims data from a health insurance company (n = 725). RESULTS: Among the problematic absentees, 49% concerned musculoskeletal problems, compared to 23% mental health problems, 14% multifactorial problems, and 16% other problems; 29% concerned limitations restricting return to work. In 51% of the cases, physicians representing the second opinion company concluded that current treatment was inadequate. Fifty-three percent of the referrers responded that the second opinion usually led to a change in treatment. In 31% of cases, employees felt that the second opinion system did not contribute to the return to work process. Average annual health costs of problematic absentees were €7800, compared to €2600 before sickness absence commenced. CONCLUSION: Many employees with problematic sickness absence are not treated adequately; opportunities to return to work are not utilized and the treatment is often not sufficiently focused on functional recovery. In principle, (partial) return to work is deemed possible for the majority of cases.

Hypercoagulability states in upper-extremity deep venous thrombosis.

Deep venous thrombosis of the upper extremity (DVTUE) is a rare thrombotic disorder that may occur spontaneously but is most often related to predisposing factors, such as an indwelling central venous catheter, malignancy, or exercise. The role of coagulation disorders, i.e., a hypercoagulable state in the pathogenesis of DVTUE is not well known. We have evaluated both genetic and acquired thrombophilia parameters in consecutive patients with DVTUE. A hypercoagulable state was found in 32% of the patients. The most frequent coagulation abnormality was the presence of lupus anticoagulant or anticardiolipin antibodies (27%). Factor V Leiden mutation was detected in two patients, antithrombin deficiency in one, and none of the patients had the prothrombin G20210A gene variant or protein C or S deficiency. The prevalence of coagulation abnormalities was not significantly different in a subgroup of patients with spontaneous DVTUE as compared to those with an obvious predisposing factor, such as an indwelling central venous catheter. We conclude that antiphospholipid antibodies are frequently found in patients with DVTUE. Factor V Leiden mutation, prothrombin 20210A gene variant, protein C deficiency, and protein S deficiency do not seem to play a major pathogenetic role in DVTUE.