Activity

BACKGROUND Patient-reported lower satisfaction with the abdomen preoperatively is a strong predictor of undergoing DIEP flap surgery. The authors evaluated physical well-being of the abdomen before and after flap-based breast reconstruction to determine potential predictors for decreased postoperative abdominal well-being. METHODS The authors retrospectively analyzed an institutional breast reconstruction registry, selecting patients who underwent abdominally based autologous flap breast reconstruction from 2010 to 2015. The authors’ primary outcome was the Physical Well-being of the Abdomen domain from the BREAST-Q, measured preoperatively and at 6- and 12-month follow-up visits after final reconstruction. The authors classified two patient groups those who experienced a clinically important worsening of Physical Well-being of the Abdomen score and those who did not. The authors used the chi-square test, t test, and Wilcoxon rank sum test, and multivariable logistic regression to identify potential predictors. RESULTS Of 142 women identified, 74 (52 percent) experienced clinically important worsening of physical well-being of the abdomen, whereas 68 (48 percent) did not. The first group experienced a 25-point (95 percent CI, 22 to 28) decrease and the latter an 8-point (95 percent CI, 5 to 10) decrease in score compared to baseline. Multivariable analysis showed an association between higher baseline score and race, with higher odds of decreased score at the 12-month follow-up. A higher baseline RAND-36 general health score, bilateral reconstruction, and a lower body mass index demonstrated a trend for clinically important worsening of physical well-being of the abdomen. CONCLUSIONS More than half of flap-based breast reconstruction patients experienced clinically important worsening of abdominal well-being after final breast reconstruction. Clinicians may use these findings to identify patients at higher risk of worsened postoperative abdominal well-being. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, III.BACKGROUND Breast cancer survival continues to improve, with women living longer after treatment. It is not well understood how long-term satisfaction and well-being differ following treatment or how types of reconstruction differ when compared to the norm. METHODS In a propensity-matched sample, the authors compared patient-reported outcomes in breast cancer patients at various time intervals from surgery with normative BREAST-Q data. All data were obtained using the Army of Women, an online community fostering breast cancer research. Breast cancer patients were stratified by surgical treatment and reconstruction type. Regression lines were estimated and differences in slope tested between cancer patients and noncancer controls. RESULTS The authors compared normative (n = 922) and breast cancer (n = 4343) cohorts in a propensity-matched analysis. Among the breast cancer patients, 49.4 percent underwent lumpectomy, 17.0 percent underwent mastectomy, 21.7 percent underwent implant reconstruction, and 11.9 percent underwent autologous reconstruction. Median time since surgery was 4.7 years, with 21.1 percent more than 10 years after surgery. At the time of survey, breast cancer patients reported higher Satisfaction with Breasts and Psychosocial Well-being scores compared to noncancer controls (p less then 0.01), with the cohorts undergoing lumpectomy and autologous reconstruction both reporting higher scores than the normative controls. After mastectomy, scores averaged lower than the noncancer controls, but improved over time. However, all breast cancer groups reported significantly lower Physical Well-being scores than the noncancer cohort (all p less then 0.01). CONCLUSIONS Breast cancer patients undergoing lumpectomy or autologous reconstruction reported higher psychosocial well-being compared to noncancer controls. These differences were influenced both by time since treatment and by choice of surgical procedure.OBJECTIVE To examine the associations between SP reported as number of days with SP reported as number of times and to evaluate their responsiveness. METHODS The study population (n = 454) consisted of employed individuals, at risk of long-term sickness absence. Correlation analyses were performed to examine associations between the two SP measures and external constructs such as work performance, general health and registered sick leave. Both SP constructs were measured several times to examine responsiveness. RESULTS The SP measures are moderately correlated. They moderately correlated with work performance and health status measures. SP reported as number of times seem to be more sensitive than number of days in detecting changes after rehabilitation. CONCLUSIONS Numerical or categorical constructs are valid sources of data on SP. However, categorized SP seem to be more responsive.OBJECTIVES To investigate why boards of directors engage in occupational health and safety (OHS) and what influences their level of engagement. GW0742 METHODS Thirty-four board members and chief executive officers at large companies from the manufacturing, construction, trade, and health/social care sectors were interviewed. An inductive thematic analysis was conducted. RESULTS Five drivers organized along a continuum explain why boards engage legal compliance, untoward events, external expectations/regulations, business drivers, and moral values. Certain factors influence the level of engagement board’s OHS competence, owner’s agenda, and competing needs. CONCLUSIONS Boards continuously prioritize among multiple foci. If a board’s total engagement is likened to a pie, the size of the OHS slice will depend on the drivers, as well as on the influencing factors. We suggest that even boards with many drivers can down-prioritize OHS under certain conditions.OBJECTIVE To evaluate the effects of Physical Activity program in healthcare workers with low back pain (LBP). METHODS A group of healthcare workers participated voluntarly to a meeting about LBP and to be accepted, were randomly allocated to workplace program or to home-based exercises, illustrated in a booklet and in a video available on the company intranet website. Both programs consisted in 7 weeks of moderate intensity exercises adapted to LBP. RESULTS Most outcomes improved in both groups, however with larger improvement of the Oswestry Disability Index in the workplace group (P = 0.02). CONCLUSIONS Regular physical exercise, at home or at the workplace among healthcare workers with LBP, represents a great opportunity to improve health and reduce disability.