The impact of poor psychosocial work environment on non-work-related sickness absence.

PURPOSE: We aimed to analyse the impact of psychosocial work environment on non-work-related sickness absence (NWRSA) among a prospective cohort study, stratified using a random sampling technique. METHODS: Psychosocial variables were assessed among 15,643 healthy workers using a brief version of the Spanish adaptation of Copenhagen Psychosocial Questionnaire. A one year follow-up assessed the total count of NWRSA days. Zero-inflated negative binomial regression was used for multivariate analyses. RESULTS: After adjusting for covariates, low levels of job control and possibilities for development (Odds Ratio [OR]: 1.17; 95% CI: 1.01-1.36 [men]; OR: 1.39 95% CI: 1.09-1.77 [women]), poor social support and quality of leadership (OR: 1.29; 95% CI: 1.11-1.50 [men]; OR: 1.28; 95% CI: 1.01-1.63 [women]), and poor rewards (OR: 1.34; 95% CI: 1.14-1.57 [men]; OR: 1.30; 95% CI: 1.01-1.66 [women]) predicted a total count of sickness absence greater than zero, in both men and women. Double presence was also significantly associated with NWRSA different than 0, but only among women (OR: 1.40; 95% CI: 1.08-1.81). Analyses found no association between psychosocial risk factors at work and the total count (i.e., number of days) of sickness absences. CONCLUSIONS: The results suggest that work-related psychosocial factors may increase the likelihood of initiating an NWRSA episode, but were not associated with the length of the sickness absence episode. Among our large cohort we observed that some associations were gender-dependent, suggesting that future research should consider gender when designing psychosocial interventions aimed at decreasing sickness absences.

Tratamiento farmacológico del trastorno de estrés agudo con propanolol e hipnóticos / Pharmacological treatment of acute stress disorder with propranolol and hypnotics

Introducción. El tratamiento farmacológico de la patología asociada a los traumas no presenta ni la eficacia ni la especifidad deseada, por lo que se realizan intentos constantes de añadir nuevos fármacos al arsenal terapéutico, en este caso con propranolol e hipnóticos. Método. Se ofreció dicho tratamiento a las víctimas del atentado del 11 de marzo de 2004 recibidas la siguiente semana por causa psiquiátrica (n=21) que cumplieran criterios de trastorno de estrés agudo (TEA) (n=15) y que no presentaran contraindicaciones para ello (n = 3). Asimismo se evaluó la intensidad del trauma a través de la Escala de Intensidad de Horowitz (EIH) y se recogieron los datos clínicos principales de los pacientes. Resultados. Los pacientes tratados con propranolol presentaron remisión de los síntomas diana en el 63,6% de los casos, respuesta parcial en el 27,3 % y falta de respuesta en el 9,1 %. Por su parte, el tratamiento con hipnóticos presenta una remisión de los síntomas en el 61,5 % de los casos y una respuesta parcial en el 38,5 %. Se encuentran correlaciones significativas estadísticamente para la EIH al inicio con el tiempo de incapacidad y al mes con la respuesta al propranolol y a los hipnóticos en las distintas subescalas. Conclusiones. El tratamiento con propranolol y con hipnóticos resulta útil en la disminución de la sintomatología del TEA. La EIH resulta de gran interés como predictor de incapacidad, así como la mala respuesta a propranolol y a hipnóticos. Son necesarios más estudios al respecto queconfirmen los hallazgos de esta muestra

Introduction. Pharmacological treatment of traumarelated mobidity has neither the efficacy nor specificity desired. Thus, several attempts have been made to add new drugs to the usual treatments, in this case with propranolol and hypnotic drugs. Method. We offered this treatment to the victims of the March 11, 2004 terrorism attack who were attended within the first week of this attack for psychiatric reasons (n = 21) and who also fulfilled criteria for acute stress disorder (ASD) (n = 15) and had no contraindications for the treatment (n=3). Trauma intensity was measured with Horowitz Impact of Events Scale (IES). Significant clinical data were collected. Results. Propranolol treatment was associated with clinical remission of target symptoms in 63.6 % of the cases, partial response in 27.3 % and no response in 9.1%. Hypnotic treatment was also associated with clinical remission in 61.5 % and partial response in 38.5 %. Statistically significant correlations were found at the beginning for IES with disability, and after the first month with the propranolol and hypnotic responses. Conclusions. Propranolol and hypnotic treatments are useful in the decrease of ASD symptoms. IES is very useful to predict disability as well as poor response to propranolol or hypnotic drugs. More studies are needed to confirm the data obtained in our sample

Pharmacological treatment of acute stress disorder with propranolol and hypnotics.

INTRODUCTION: Pharmacological treatment of traumarelated mobidity has neither the efficacy nor specificity desired. Thus, several attempts have been made to add new drugs to the usual treatments, in this case with propranolol and hypnotic drugs. METHOD: We offered this treatment to the victims of the March 11, 2004 terrorism attack who were attended within the first week of this attack for psychiatric reasons (n=21) and who also fulfilled criteria for acute stress disorder (ASD) (n=15) and had no contraindications for the treatment (n=3). Trauma intensity was measured with Horowitz impact of events scale (IES). Significant clinical data were collected. RESULTS: Propranolol treatment was associated with clinical remission of target symptoms in 63.6 % of the cases, partial response in 27.3 % and no response in 9.1%. Hypnotic treatment was also associated with clinical remission in 61.5 % and partial response in 38.5 %. Statistically significant correlations were found at the beginning for IES with disability, and after the first month with the propranolol and hypnotic responses. CONCLUSIONS: Propranolol and hypnotic treatments are useful in the decrease of ASD symptoms. IES is very useful to predict disability as well as poor response to propranolol or hypnotic drugs. More studies are needed to confirm the data obtained in our sample.