***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives This article investigates various reasons for sickness presenteeism ( SP ) , that is , going to work despite illness . The research questions asked is : What are the main reported reasons for SP in Norway and Sweden ? Design Cross-sectional survey in Norway and Sweden . Use of binomial logistic regression analysis . Participants A r and om sample of people aged between 20 and 60 years was obtained from complete and up date d data bases of the Norwegian and Swedish population s. A postal question naire was sent to the selected individuals , with response rate 33 % ( n=2843 ) . 2533 workers responded to questions about SP during the last 12 months . Primary and secondary outcome measures The article informs about the distribution of reasons for SP in Norway and Sweden , selected by the respondents from a closed list . The article also examines which factors influence the most often reported reasons for SP . Results 56 % of the Norwegian and Swedish respondents experienced SP in the previous year . The most frequently reported reasons for SP include not burden colleagues ( 43 % ) , enjoy work ( 37 % ) and feeling indispensable ( 35 % ) . A lower proportion of Norwegians state that they can not afford taking sick leave adjusted OR ( aOR 0.16 ( 95 % CI 0.10 to 0.22 ) ) , while a higher proportion of Norwegians refer to that they enjoy their work ( aOR=1.64 ( 95 % CI 1.28 to 2.09 ) ) . Women and young workers more often report that they do not want to burden their colleagues . Managers ( aOR=2.19 ( 95 % CI 1.67 to 2.86 ) ) , highly educated persons and the self-employed more often report that they are indispensable . Conclusions Positive and negative reasons for SP are reported , and there are significant differences between respondents from the two countries . The response rate is low and results must be interpreted with caution . Study design Cross-sectional study Background Burnout in healthcare is a worldwide problem . However , most studies focus narrowly on work-related factors and outcomes in one health profession or speciality . Aims To investigate the prevalence of burnout and its association with job dem and s , job re sources , individual well-being , work-related attitudes and behaviour in physicians and nurses across different specialties . Methods Multi-centre cross-sectional study of physicians and nurses working in Belgian hospitals . An electronic question naire was used to assess job dem and s ( e.g.  workload )  , job re sources ( e.g.  autonomy )  and indicators of well-being , work-related attitudes and behaviours . Structural equation modelling was used to examine interrelationships between explanatory variables and outcomes . Results 1169 physicians and 4531 nurses participated ; response rate 26 % . High scores ( > 75th percentile in reference group of Dutch health care workers ) were seen in 6 % of the sample on three burnout dimensions ( i.e. emotional exhaustion , depersonalization and personal competence ) and in 13 % for at least two dimensions . In contrast to the other dimensions , emotional exhaustion strongly related to almost all variables examined in the model . Positive associations were seen with workload , role conflicts , emotional burden and work-home interference and negative associations with learning and development opportunities and co-worker support . Emotional exhaustion correlated negatively with well-being , turnover intention , being prepared and able to work until retirement age , medication use , absenteeism and presenteeism . Conclusions Work-related factors were critical correlates of emotional exhaustion , which strongly related to poor health and turnover intention . R and omized controlled trials are suggested to underpin the effectiveness of interventions tackling job stressors and promoting job re sources OBJECTIVES Nurses are at elevated risk of burnout , anxiety and depressive disorders , and may then become less productive . This begs the question if a preventive intervention in the work setting might be cost-saving from a business perspective . MATERIAL AND METHODS A cost-benefit analysis was conducted to evaluate the balance between the costs of a  preventive intervention among nurses at elevated risk of mental health complaints and the cost offsets stemming from improved productivity . This evaluation was conducted alongside a cluster-r and omized trial in a Dutch academic hospital . The control condition consisted of screening without feedback and unrestricted access to usual care  ( N = 206 ) . In the experimental condition screen-positive nurses received personalized feedback and referral to the occupational physician ( N = 207 ) . RESULTS Subtracting intervention costs from the cost offsets due to reduced absenteeism and presenteeism result ed in net-savings of 244 euros per nurse when only absenteeism is regarded , and 651 euros when presenteeism is also taken into account . This corresponds to a return-on-investment of 5 euros up to 11 euros for every euro invested . CONCLUSIONS Within half a year , the cost of offering the preventive intervention was more than recouped . Offering the preventive intervention represents a favorable business case as seen from the employer 's perspective The aim of this study is to assess the impact of a broad range of possible factors relating to work , personal circumstances and attitudes towards sickness absence on a person 's  decision to go  to work  despite feeling ill , a phenomenon that has been termed sickness presence ( SP ) , or ' presenteeism ' , in the literature . Using data from a r and om sample of 12,935 members from the core Danish work force the hypotheses were tested in a cross-sectional design utilising ordered logistic regression models . The results indicate that more than 70 % of the core work force goes ill to work at least once during a 12-month period . This means that SP is just as prevalent a phenomenon as sickness absence . Many of the results from earlier studies of SP were replicated and new factors were discovered : for example time pressure ( having a supervisory role and /or working more than 45 h per week ) and relationship with colleagues ( measured by working in a small company , having non-st and ard hours and degree of cooperation ) both increase the likelihood of SP . However , personal circumstances and attitudes , e.g. treating work as home ( cf . Hochschild 's thesis ) and being over-committed to work , were also found to lead to higher levels of SP . Finally , we found that those with a conservative attitude to absence were most likely to turn up ill at work . Overall , work-related factors seem to be slightly more important than personal circumstances or attitudes in determining people 's ' decision ' to go ill at work . However , the relatively low explanatory power of these combined factors suggests that there are still many unknowns in this field of research Objective Although research has been conducted on how nurse staffing levels affect outcomes , there has been little investigation into how the health-related productivity of nurses is related to quality of care . Two major causes of worker presenteeism ( reduced on-the-job productivity as a result of health problems ) are musculoskeletal pain and mental health issues , particularly depression . This study sought to investigate the extent to which musculoskeletal pain or depression ( or both ) in RNs affects their work productivity and self-reported quality of care and considered the associated costs . Methods Using a cross-sectional survey design , a r and om sample of 2,500 hospital-employed RNs licensed in North Carolina were surveyed using a survey instrument sent by postal mail . Specific measures included questions on individual and workplace characteristics , self-reported quality of care , and patient safety ; a  numeric pain rating scale  , a  depression tool ( the Patient Health Question naire ) , and a  presenteeism tool ( the Work Productivity and Activity Impairment Question naire : General Health ) were also incorporated . A total of 1,171 completed surveys were returned and used for analysis . Results Among respondents , the prevalence of musculoskeletal pain was 71 % ; that of depression was 18 % . The majority of respondents ( 62 % ) reported a presenteeism score of at least 1 on a 0-to-10 scale , indicating that health problems had affected work productivity at least “ a little . ” Pain and depression were significantly associated with presenteeism . Presenteeism was significantly associated with a higher number of patient falls , a higher number of medication errors , and lower quality -of-care scores . Baseline cost estimates indicate that the increased falls and medication errors caused by presenteeism are expected to cost $ 1,346 per North Carolina RN and just under $ 2 billion for the United States annually . Upper-boundary estimates exceed $ 9,000 per North Carolina RN and $ 13 billion for the nation annually . Conclusion More attention must be paid to the health of the nursing workforce to positively influence the quality of patient care and patient safety and to control costs We examined the effect of interview characteristics ( ie , recall interval , interview version ) on estimates of health-related lost productive work time ( LPT ) .  Three versions of a telephone interview were administered using 7-day and 4-week recall periods . In a population -based survey , 7674 workers r and omly were assigned to one of six interviews at contact ; 615 participants received a follow-up interview . We found strong evidence of under-reporting using a 4-week recall period and a not significant trend in over-reporting LPT using a 7-day recall period . Of the three interviews , version 3 could be administered most quickly , on average , and yielded the most discriminating estimates of LPT by health condition ( ie , headache , allergic rhinitis , and cold/flu ) . Our data suggest that variation in relatively short recall periods influences estimates of health-related LPT . A 2-week recall period may be optimal for minimizing overall reporting error but requires additional research to verify OBJECTIVE Although major depression is thought to have substantial negative effects on work performance , the possibility of recall bias limits self-report studies of these effects . The authors used the experience sampling method to address this problem by collecting comparative data on moment-in-time work performance among service workers who were depressed and those who were not depressed . METHOD The group studied included 105 airline reservation agents and 181 telephone customer service representatives selected from a larger baseline sample ; depressed workers were deliberately over sample d. Respondents were given pagers and experience sampling method diaries for each day of the study . A computerized autodialer paged respondents at r and om time points . When paged , respondents reported on their work performance in the diary . Moment-in-time work performance was assessed at five r and om times each day over a 7-day data collection period ( 35 data points for each respondent ) . RESULTS Seven conditions ( allergies , arthritis , back pain , headaches , high blood pressure , asthma , and major depression ) occurred often enough in this group of respondents to be studied . Major depression was the only condition significantly related to decrements in both of the dimensions of work performance assessed in the diaries : task focus and productivity . These effects were equivalent to approximately 2.3 days absent because of sickness per depressed worker per month of being depressed . CONCLUSIONS Previous studies based on days missed from work significantly underestimate the adverse economic effects associated with depression . Productivity losses related to depression appear to exceed the costs of effective treatment BACKGROUND The specific job dem and s of working in a hospital may place nurses at elevated risk for developing distress , anxiety and depression . Screening followed by referral to early interventions may reduce the incidence of these health problems and promote work functioning . OBJECTIVE To evaluate the comparative cost-effectiveness of two strategies to promote work functioning among nurses by reducing symptoms of mental health complaints . Three conditions were compared : the control condition consisted of online screening for mental health problems without feedback about the screening results . The occupational physician condition consisted of screening , feedback and referral to the occupational physician for screen-positive nurses . The third condition included screening , feedback , and referral to e-mental health . DESIGN The study was design ed as an economic evaluation alongside a pragmatic cluster r and omised controlled trial with r and omisation at hospital-ward level . SETTING AND PARTICIPANTS The study included 617 nurses in one academic medical centre in the Netherl and s. METHODS Treatment response was defined as an improvement on the Nurses Work Functioning Question naire of at least 40 % between baseline and follow-up . Total per-participant costs encompassed intervention costs , direct medical and non-medical costs , and indirect costs stemming from lost productivity due to absenteeism and presenteeism . All costs were indexed for the year 2011 . RESULTS At 6 months follow-up , significant improvement in work functioning occurred in 20 % , 24 % and 16 % of the participating nurses in the control condition , the occupational physician condition and the e-mental health condition , respectively . In these conditions the total average annualised costs were € 1752 , € 1266 and € 1375 per nurse . The median incremental cost-effectiveness ratio for the occupational physician condition versus the control condition was dominant , suggesting cost savings of € 5049 per treatment responder . The incremental cost-effectiveness ratio  for the e-mental health condition versus the control condition was estimated at € 4054 ( added costs ) per treatment responder . Sensitivity analyses attested to the robustness of these findings . CONCLUSIONS The occupational physician condition result ed in greater treatment responses for less costs relative to the control condition and can therefore be recommended . The e-mental health condition produced less treatment response than the control condition and can not be recommended as an intervention to improve work functioning among nurses AIM This paper is a report of a cohort study of healthcare workers ' work attendance , and its long-term consequences ' on health , burnout , work ability and performance . BACKGROUND Concepts and measures of work attendance have varied in the scientific literature . Attending work in spite of being sick can have serious consequences on health . There is little knowledge on which individual and work-related conditions that increase work attendance and the long-term impact on health and performance . METHOD Prospect i ve analyses of three measures of work attendance i.e.  sickness attendance  , uninterrupted long-term attendance  and  balanced attendance ( ≤7 days of sick leave per year and no sickness attendance ) were done using question naire data from a 2-year cohort 
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Conclusion The heterogeneity of published research and limited quality of measurement tools yielded no conclusive evidence on the association of presenteeism with hypothesized exposures , economic costs , or interventions amongst hospital healthcare workers .