Jensen IB, Bergstrom G, Bjorklund C, Fried I, Lisspers J, Nathell L, Hermansson U, Roos P, Bodin L, the AHAstudy group (2006). The AHA-study: Implementing evidence based measueres for retaining workability at work sites - Effcets on lifestyle, workability and firm productivity. Presented at the 9th International Congress of Behavioral Medicine. Bangkok, Thailand, Nov 29-Dec 2, 2006.

AIM:Among adult asthmatics a major proportion of the cost of illness is attributed to productivity losses and societal costs in connection with sick leave compensation. The aim of the study was to evaluate an extensive structured four-week inpatient rehabilitation programme for asthmatics.METHODS:A diagnosis of asthma was made in a structured way among people on sick leave due to a respiratory disorder. In total, 197 persons were randomized to either a rehabilitation programme, or to usual care. The main components of the rehabilitation programme were education, pharmacological optimization, physical training, and coping skill acquisition.RESULTS:At the three-year follow-up, the median number of sick leave days in the rehabilitation group was 104, and in the usual care group 167 (p = 0.12). An analysis of a subgroup consisting of persons not currently smoking with a previous diagnosis of asthma by a physician (n = 57) showed a significant effect on sick leave at three years (median number of days 63 in the rehabilitation group vs 361 in the control group, p = 0.02). All analyses were based on intention to treat.CONCLUSIONS:The long-term effects on sick leave of an extensive inpatient asthma rehabilitation programme are most evident for non-smokers and ex-smokers with a previous asthma diagnosis. It is therefore recommended that persons with asthma who are current smokers should be offered participation in smoking cessation programmes instead of asthma rehabilitation programmes.

Bronchoscopy with bronchoalveolar lavage (BAL) is an important research tool for assessing airway inflammation in a variety of inflammatory lung diseases. In chronic obstructive pulmonary disease (COPD), BAL recovery is often low, making analysis of the recovered fluid difficult to interpret. The present authors hypothesised that the degree of emphysema may predict BAL recovery. A total of 20 COPD patients (mean age 57 yrs, range 49–69) with a median (interquartile range) forced expiratory volume in one second (FEV1) of 51 (33–69)% predicted underwent BAL. Matched “healthy” smokers and nonsmokers served as controls. Emphysema index in COPD patients was calculated on computed tomography scan as the percentage of the right lung with pixels <−950 Hounsfield units. The carbon monoxide diffusing capacity of the lung (DL,CO) was determined by the single-breath method. COPD patients had lower BAL recovery than controls. COPD patients with an emphysema index <1 had higher BAL recovery than patients with an emphysema index >1. BAL recovery correlated negatively to emphysema index and positively to DL,CO. However, no correlation was found between recovery and FEV1. In conclusion, the extent of emphysema evaluated by computed tomography-scan index and carbon monoxide diffusing capacity of the lung may predict a low bronchoalveolar lavage recovery in chronic obstructive pulmonary disease patients. These parameters may, therefore, be useful when chronic obstructive pulmonary disease patients are selected for bronchoscopy with bronchoalveloar lavage. The present study underlines the importance of careful phenotyping of chronic obstructive pulmonary disease patients.

Background: The conformity between asthma diagnosed in a clinical setting and asthma from an epidemiological point of view has not been much studied.Methods: History, symptoms, and clinical findings in persons with and without a previous physician diagnosed asthma were studied among persons classified as having asthma according to an epidemiological definition.Results: Smoking was more prevalent in persons not diagnosed as having asthma prior to the study (n = 96), than in those with a previous asthma diagnosis (n = 119), (60% vs. 41%, P = 0.006). Positive skin prick test (SPT) was less common (39.6% vs. 58.0%, P = 0.009), lung function expressed as FEV1.0 in percentage of predicted was better (92.1 vs. 85.4, P = 0.018), reversibility to a bronchodilator was smaller (mean reversibility 4.0% vs. 6.2% of predicted, P = 0.003) and symptoms were less frequently reported (P < 0.001) by those who had not a physician diagnosed asthma prior to the study.Conclusion: The asthma diagnosis is often overlooked by the medical profession in patients with mild disease. Furthermore, smoking seems to worsen asthma exacerbations in patients with mild disease.

There is evidence, spanning many decades of research, that the subjective well-being (SWB) of workers, including life satisfaction, job satisfaction, and positive affect, positively correlates with the performance of workers and organizations. However, the size of the relationships is typically small to moderate. In this review we address the question of why the relationships are not stronger. We first review evidence of a relationship moving from well-being to performance through various pathways. Workers who are high in SWB are now understood to have: 1. better health, 2. lower absenteeism, 3. greater self-regulation, 4. stronger motivation, 5. enhanced creativity, 6. positive relationships, and 7. lower turnover. Each of these variables can predict individual and organizational performance. However, the sheer number of known and possible pathways means the relationships are bound to be complex, and there are mitigating conditions at every turn. Thus, second, we review the evidence of moderators of these mediators, hypothesizing when a happier workforce is a more productive one, and when not. Future research is needed to firmly establish the pathways from different types of SWB through the mediators to metrics of performance, to further establish the moderating conditions in which these relations are most likely to occur, and to evaluate how much SWB is needed to maximize effectiveness. We end by urging scholars to conduct this future research using the highest standards of scientific integrity.

Obesity and asthma are common chronic diseases in the industrialised world. The aim of the present study was to investigate a possible relationship between asthma and obesity among persons on sick leave due to respiratory disorder. The diagnosis of asthma (n = 237) was made in a three-stage model (questionnaire, telephone interview and clinical examination) in persons on sick leave due to any respiratory disorder. Persons on sick leave due to non-specific spinal pain, (n = 1231) and a general population sample (n = 5092) were used as references. Obesity (body mass index > 30 kg/m2) was found in 20.7% of the asthmatic patients on sick leave compared with 13.7% in the non-specific pain patients on sick leave and in 6.5% of the controls (P < 0.001). It is not clear whether the increased prevalence of obesity among asthmatics reflects a true increase in asthma in obese persons or whether asthma-like symptoms occur because of obesity. Weight reduction schemes and weight maintenance programmes should be important components in treatment and rehabilitation plans for persons with asthma.

OBJECTIVESThis study identified occupations with a marked impact on sick leaves due to respiratory disease.METHODSA national sick-leave register containing information on all sick leaves exceeding 14 days, physicians' diagnoses, and the occupational status of all manual and service employees in the private sector in Sweden was studied. Sick leaves during 1992-1994 (N=210,755) were analyzed with special attention to respiratory disease and occupation.RESULTSRespiratory disease accounted for 4.4% of the total number of sick leaves. The incidence of long-term (> or = 90 days) sick leaves due to respiratory disease was 3 times higher in occupations with a high incidence than in those with a low incidence. There was a high correlation (r=0.80) between the incidence of long-term sick leave due to respiratory disease and sick leave due to all other conditions; this finding suggests that market and selection factors may play an important role in determining the overall risk for sick leave in various occupations. The proportion of sick leaves due to long-term respiratory disease out of all long-term disease was compared between occupations. Agricultural workers had a 46% higher proportion of long-term respiratory disease than metal workers. Industrial workers, food industry workers, and painters were also occupations with an increased risk. These findings could not be explained by differences in age or smoking habits.CONCLUSIONSMajor differences were found among manual and service occupations regarding long-term sick leave due to respiratory disease. Several occupations, in which exposure to respiratory sensitizers and irritants are known to occur, were among those in which workers had an increased risk for long-term respiratory disease.