Days Of Absence Research Articles

Long-term sickness absence in a working population: development and validation of a risk prediction model in a large Dutch prospective cohort

BackgroundSocietal expenditures on work-disability benefits is high in most Western countries. As a precursor of long-term work restrictions, long-term sickness absence (LTSA) is under continuous attention of policy makers. Different healthcare professionals can play a role in identification of persons at risk of LTSA but are not well trained. A risk prediction model can support risk stratification to initiate preventative interventions. Unfortunately, current models lack generalizability or do not include a comprehensive set of potential predictors for LTSA. This study is set out to develop and validate a multivariable risk prediction model for LTSA in the coming year in a working population aged 45–64 years.MethodsData from 11,221 working persons included in the prospective Study on Transitions in Employment, Ability and Motivation (STREAM) conducted in the Netherlands were used to develop a multivariable risk prediction model for LTSA lasting ≥28 accumulated working days in the coming year. Missing data were imputed using multiple imputation. A full statistical model including 27 pre-selected predictors was reduced to a practical model using backward stepwise elimination in a logistic regression analysis across all imputed datasets. Predictive performance of the final model was evaluated using the Area Under the Curve (AUC), calibration plots and the Hosmer-Lemeshow (H&L) test. External validation was performed in a second cohort of 5604 newly recruited working persons.ResultsEleven variables in the final model predicted LTSA: older age, female gender, lower level of education, poor self-rated physical health, low weekly physical activity, high self-rated physical job load, knowledge and skills not matching the job, high number of major life events in the previous year, poor self-rated work ability, high number of sickness absence days in the previous year and being self-employed. The model showed good discrimination (AUC 0.76 (interquartile range 0.75–0.76)) and good calibration in the external validation cohort (H&L test: p = 0.41).ConclusionsThis multivariable risk prediction model distinguishes well between older workers with high- and low-risk for LTSA in the coming year. Being easy to administer, it can support healthcare professionals in determining which persons should be targeted for tailored preventative interventions.

PND45 PARKINSON'S DISEASE COSTS IN MEXICAN PATIENTS FROM A COHORT OF THE NATIONAL INSTITUTE OF NEUROLOGY AND NEUROSURGERY

The main aim is to evaluate the out-of-pocket expenses in Parkinson’s disease patients. A hospital registry data with 75 Mexican patients was provided by The National Institute of Neurology & Neurosurgery (National medical institutional reference which attends patients without social healthcare), which contains clinical and economic data (direct and indirect cost data for each patient). The cost estimation was the price average obtained from private Mexican market. The total direct cost was estimated based on healthcare resource use either monthly or annually (medication, specialized mobility equipment and improvement in domestic facilities). The loss of productivity was considered as the number of work absenteeism days multiplied by Mexican minimum salary (5.47 USD). An estimation of cost average by functional stage, according to Hoehn & Yahr scale (1-5), was performed in order to identify association between severity and costs. The age average was 63 years old 52% female, their current occupation is in 44% domestic issues, 21% are retired and % 37 percent are either unemployed or informal employees whose incomes could variate. More than the half count with social health care. Total out-of-pocket annual average cost is 3,683.19 USD, expenses distribution is as shown: 66 % medication (2,362.88 USD) and 22 % exclusively for productivity losses (803.07 USD) the out-of-pocket increase with Hoehn & Yahr stage, stage 2 (936.08 USD) and stage 4 (3,142.54 USD). The productivity loss in stages 3 & 4 is due to the patient needs for a caregiver. The total cost for annual out-of-pocket expenses in general is 25,408.79 USD. There is a tendency to increasing costs of the disease and its progression through stages, especially due for the caregivers and polypharmacy expenses. Additionally, costs are relatively high notwithstanding patients are part of a low to medium socioeconomic level.

PMS35 REAL-WORLD HEALTHCARE RESOURCE UTILIZATION AND ECONOMIC BURDEN IN PARTIAL TEAR PATIENTS MANAGED ON CONSERVATIVE THERAPY

First-line conservative treatment (e.g: physiotherapy and/or pain medications) for partial thickness rotator cuff tears (pRCT) often fails to control symptoms or prevent disease progression. This study aims to understand healthcare resource utilization (HRU) and direct and indirect economic burden in pRCT non-repair patients. Adult (aged ≥18 years) conservatively managed (without mention of surgical repair) pRCT patients from 2013-2017 with at least 12-months of continuous enrollment prior to and following the index date were identified from the IBM Watson Health MarketScan® Commercial healthcare claims database using ICD-9/10-CM codes. Total and RCT-related healthcare costs (plan paid and patient out-of-pocket payment) and HRU information were reported descriptively within 12 months of pRCT diagnosis. Mean days missed from work, and absenteeism (ABS) or short-term disability (STD) attributable productivity costs (indirect costs) were also estimated. 29,774 patients were included, representing 64% of pRCT patients. On average, 75.7% of the patients had at least one physiotherapy visit (average visits: all-cause:26, RCT-related:11.4). 14.2% and 9.1% of the patients had at least one claim for physician administered opioid and non-opioid pain medications and 53.9% and 44.3% of the patients had at least one claim for opioid and non-opioid pain medicine prescription for management of RCT symptoms. 42% of the patients received at least one cortisone injection (average: 0.8 (±1.1.) injections). RCT-related cost accounted for around 13% of all-cause spending per patient [Total Healthcare costs: $22,693.67 (±$48,682.30); RCT-related costs: $2,841.16 (±6,180.12)]. Physiotherapy and outpatient pharmacy accounted for 21% and 9% of the RCT-related spending. Patients had more ABS days (33 days ±24) than STD days (13 days ±35) resulting in higher indirect costs (ABS:$5,559 ±$4,179, STD:$1,574 ±$4,138). Conservative management of pRCT patients represents a significant direct and indirect healthcare burden. Given that these patients are managed and not repaired, studies with longer-term cost-implication are warranted.

Sickness absence and sickness presence in relation to office type: An observational study of employer-recorded and self-reported data from Sweden.

ObjectivesPrevious research suggesting that open-plan office environments are associated with higher rates of sickness absence rely on self-reports which can be affected by recall bias. This paper investigates the associations of sickness absence, obtained from employer records as well as self-reports, with office type (cell offices and different sizes of open-plan offices). It additionally studies whether office type is associated with sickness presence.MethodsEmployees from two private and one public sector organization were recruited to the study. Office type was ascertained by direct observation or from employee responses to an online survey. Control variables were gender, age, public/private sector and education level. Number of days and episodes of sickness absence were calculated from employer absence records and regressed on office type using negative binomial regression (n = 988). Self-reports of sickness absence and presence were regressed on office type using ordered logistic regression (n = 1237).ResultsOffice type was generally not associated with employer records of number of episodes or days of sickness absence, except that the total number of days of leave was higher in flex offices compared to cell offices (IRR = 2.46, p = 0.007). In general, office type was not associated with self-reported days of sickness absence, apart from participants working in medium-sized open-plan offices who had 0.42 higher log-odds of absence than those working in cell offices (p = 0.004). Office type was not associated with self-reported sickness presence.ConclusionsOffice type was not associated with sickness presence nor, in general, with sickness absence, whether obtained from self-reports or company records. It is not possible to conclude from this study that open-plan offices are associated with greater sickness absence or sickness presence compared to cell offices.

Workplace absenteeism amongst patients undergoing open vs. robotic radical prostatectomy, hysterectomy, and partial colectomy.

There is controversy regarding the widespread uptake of robotic surgery across several surgical disciplines. While it has been shown to confer clinical benefits such as decreased blood loss and shorter hospital stays, some argue that the benefits of this technology do not outweigh its high cost. We performed a retrospective insurance-based analysis to investigate how undergoing robotic surgery, compared to open surgery, may impact the time in which an employed individual returns to work after undergoing major surgery. We identified a cohort of US adults with employer-sponsored insurance using claims data from the MarketScan database who underwent either open or robotic radical prostatectomy, hysterectomy/myomectomy, and partial colectomy from 2012 to 2016. We performed multiple regression models incorporating propensity scores to assess the effect of robotic vs. open surgery on the number of absent days from work, adjusting for demographic characteristics and baseline absenteeism. In a cohort of 1157 individuals with employer-sponsored insurance, those undergoing open surgery, compared to robotic surgery, had 9.9 more absent workdays for radical prostatectomy (95%CI 5.0 to 14.7, p < 0.001), 25.3 for hysterectomy/myomectomy (95%CI 11.0-39.6, p < 0.001), and 29.8 for partial colectomy (95%CI 14.8-44.8, p < 0.001) CONCLUSION: For the three major procedures studied, robotic surgery was associated with fewer missed days from work compared to open surgery. This information helps payers, patients, and providers better understand some of the indirect benefits of robotic surgery relative to its cost.

"Divorce burnout" among recently divorced individuals.

Traditionally, the concept of burnout has been applied to the workspace but recent research suggests its applicability to more general contexts such as the family sphere. The present study applies burnout to the divorce context and (a) proposes and statistically tests the Divorce Burnout Model (DBM), (b) investigates the contribution of sociodemographic variables and divorce characteristics to burnout scores, and (c) investigates the relationship between burnout scores and the number of sick days and days of absence from work. Using a cross-sectional design and a sample of 1,856 recently divorced Danish citizens, multigroup confirmatory factor analysis verified the DBM´s good fit to data. Using this model, for men, it was found that fewer previous divorces, former spouse initiation of divorce, not having a new partner and a higher degree of conflict significantly predicted higher levels of divorce burnout. For women, lower income, former spouse divorce initiation, not having a new partner, and a higher level of conflict significantly predicted higher levels of divorce burnout. Across gender, burnout scores were found to significantly predict number of sick days and days of absence from work in the past 3 months over and above sociodemographic variables, divorce related characteristics, and depressive symptoms.

Sick leave and return to work after surgery for type II SLAP lesions of the shoulder: a secondary analysis of a randomised sham-controlled study

ObjectivesTo compare days on sick leave and assess predictors of return to work following shoulder surgery.DesignA secondary analysis of a randomised controlled trial.SettingOrthopaedic department.Participants114 patients with type II superior labral...

Infrared Thermography Protocol on Reducing the Incidence of Soccer Injuries.

Infrared thermography has been used to detect skeletal muscle overload and fatigue in athletes, but its use in injury prevention in professional soccer has not been studied to date. To establish a novel injury prevention program based on infrared thermography and to determine its influence on the injury incidence in professional soccer players in the preseason. A cross-sectional, prospective study design was used to compare a conventional injury prevention program (CPP) applied over the first preseason and an infrared thermography injury prevention program (IRTPP) carried out in the following preseason. Soccer training ground. Twenty-four players belonging to a first division soccer team from Spain. Injury incidences of each player were recorded according to the Orchard Sports Injury Classification System (version 10.0) convention to determine the injury classification, location, and type. The incidence of injuries decreased from 15 injuries in the CPP preseason (0.63 [0.77] injuries per player) to 6 injuries in the second preseason when the IRTPP was applied (0.25 [0.53] injuries per player). The days of absence due to injuries also decreased from the CPP preseason (156d, 10.4 [11.0]d per injury) to the IRTPP preseason (14 d, 2.3 [2.8]d per injury). The injury severity also decreased from the first preseason to the second preseason, and fewer musculoskeletal injuries in the thigh, hip, and groin were reported. The implementation of an IRTPP can reduce the presence of injuries by identifying players potentially at risk and as a result, reducing the injury severity and days lost as a consequence.

Trajectories of sickness absence and disability pension in the 2 years before and 3 years after breast cancer diagnosis: A Swedish longitudinal population-based cohort study.

After breast cancer (BC) diagnosis, work incapacity often occurs among working-age women. We investigated the trajectories of previous and subsequent sickness absence and/or disability pension (SA/DP) days, and risk factors for consistently high levels of future SA/DP among these women. This longitudinal cohort study included all 3536 women in Sweden aged 19-64years who received a first BC diagnosis in 2010. Their annual SA/DP net days from 2years before to 3years after diagnosis were calculated. SA/DP patterns were depicted by a group-based trajectory model. Logistic regressions were used to calculate odds ratios (ORs) with 95% CIs of >90 or >180 SA/DP days/year. Three trajectories of SA/DP days/year were identified: increasing only in year+1 (61% of all), increasing then decreasing in year+3 (30%), and constantly very high (9%). The risk factors associated with annual SA/DP days >90 (long) and >180days (extreme long) were similar. Factors associated with having >90 SA/DP days for years 1-3 were: stage II (OR, 4.59; 95% CI, 2.98-7.07), stage III+IV (OR, 26.57; 95% CI, 13.52-52.22), prediagnosis SA 1-30days (OR, 2.73; 95% CI, 1.30-5.70), prediagnosis SA >90days (OR, 24.52; 95% CI, 12.25-49.08), and prediagnosis DP (OR, 659.97; 95% CI, 292.52->999.99). Conversely, adjusting for prediagnosis SA/DP and stage, sociodemographic factors were not associated with high levels of SA/DP. After BC diagnosis, SA/DP increased significantly but then decreased. The absolute majority had no SA/DP during year 3. Advanced cancer stage and previous high SA/DP rendered the greatest risk for future high SA/DP. More knowledge is needed for applying the information in rehabilitation and return-to-work planning.

Impact of Psychosocial Stress on the Morbidity of Healthcare Professionals

Abstract We have analysed the impact of psychosocial risks on the health of hospital staff, in an attempt to determine whether there is a correlation between the risk level assessed and the number of days of medical absenteeism through diseases with psychosocial stress as a contributory or aggravating factor. There is a strong correlation between the risk level assessed by sectors of activity and the number of days of medical absenteeism through diseases caused or favoured, potentially aggravated by occupational psychosocial stress.

A Longitudinal Investigation of Muscle Injuries in an Elite Spanish Male Academy Soccer Club: A Hamstring Injuries Approach

The aims of this study were to analyze the muscle injury incidence in an elite Spanish soccer academy during three consecutive seasons attending to different chronological age groups (i.e., U14, U16, U19 and senior) and to examine the hamstring injury incidence in this elite soccer academy. Elite male youth soccer players (227) participated in this study. A total of 207 time-loss injuries (i.e., injuries that involve at least one absence day) were observed during this study period. The overall incidence rate of muscle injury was 1.74 muscle injuries/1000 h. In addition, higher muscle injury incidence was observed during match play in comparison to training sessions (6.78 vs. 3.20 muscle injuries/1000 h, p &lt; 0.05). The oldest age group presented the highest injury rate (2.73 muscle injuries/1000 h, p &lt; 0.05), with the burden (i.e., number of absence days per 1000 h of exposure) peak values recorded in the U16 age group (26.45 absence days/1000 h). In addition, muscle tears accounted for the greatest percentage of muscle injuries (43.5%), and the most frequent anatomical site of injury was the hamstring (30.4%). Muscle tear was the most common type of hamstring injury (49.2%), with the biceps femoris the most commonly injured muscle of the hamstring complex (39.7%). Fullbacks (FB), wide midfielders (WM) and forwards (F) suffered a greater number of hamstring injuries. Hamstring injury incidence showed a seasonal variation, as indicated by peaks in August and October. Specifically, the highest injury incidence was observed in the final part of each period during match play. These results reinforce the necessity to implement individual preventive strategies according to each specific injury profile across the youth soccer development phase.

Neurodevelopmental disorders among young adults and the risk of sickness absence and disability pension: a nationwide register linkage study.

ObjectivesAttention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and learning disabilities (LD) have an early onset and often persist into adulthood, although their relative contribution to incapacity for work is unclear. We examined this issue among young adults with ADHD, ASD or LD taking into account socioeconomic factors and comorbid mental disorders.MethodsRecorded diagnoses between the ages of 10–35 years between 2001 and 2010 were derived from nationwide inpatient and specialized outpatient hospital registers in Sweden. We identified 15 632 individuals with a main diagnosis of ADHD, 8238 with ASD, and 1038 with LD, and the matched control group without recorded mental disorders (N=124 536). The outcome was the number of register-based sickness absence and work disability pension (SA-DP) days during a maximum of three years follow-up.ResultsAmong men, the rate ratio (RR) of SA-DP was 11.17 [95% confidence interval (CI) 9.89–12.60] for ADHD, 35.59 (95% CI 30.30–41.81) for ASD, and 9.20 (95% CI 5.76–14.70) for LD, in comparison to those in the reference group. The corresponding risks among women were RR 12.05 (95% CI 10.30–14.09) for ADHD, RR 28.36 (95% CI 22.96–35.02) for ASD, and RR 9.60 (95% CI 5.83–15.81) for LD. The findings were, to a large extent, similar when individuals on DP at baseline were excluded. Comorbid mental disorders further increased the risk of SA-DP. Educational differences were smaller among the patients than in the reference group.ConclusionsEarly-onset neurodevelopmental disorders, particularly with comorbidity, have a far-reaching impact on adult life in terms of SA and DP.

Sickness absence and disability pension days in patients with cluster headache and matched references

To determine whether patients with cluster headache have more sickness absence and disability pension days compared to matched references and possible associations with sociodemographic characteristics. We performed a registry study of all patients who had received specialized health care for cluster headache (ICD-10 code G44.0) aged 16-64 years and living in Sweden in 2010 (n = 3,240; 34% women) and matched references from the total population (n = 16,200) regarding their sickness absence and disability pension days in 2010. Mean number of sickness absence days in 2010 was 16.13 (95% confidence interval, 14.05-18.20) among patients with cluster headache and 6.54 (5.97-7.11) among references. When combining sickness absence and disability pension days, patients with cluster headache had 63.15 (58.84-67.45) days, references 34.08 (32.59-35.57) days. Among patients, women had twice as many sickness absence days than men: 23.71 (19.36-28.06) vs 12.41 (10.19-14.63). When adding disability pension days, those numbers were 83.71 (75.57-91.84) vs 52.56 (47.62-57.51). Patients with cluster headache had significantly more sickness absence days in all ages compared to the reference group. Patients with elementary education had more sickness absence/disability pension days (85.88 [75.34-96.42]) compared to those with high school (64.89 [58.82-70.97]) and college/university (41.42 [34.70-48.15]) education. This nationwide study shows that patients with cluster headache have significantly more sickness absence and disability pension days compared to matched references. Furthermore, among patients, women had more sickness absence and disability pension days than men.

Two definitions of presenteeism: sickness presenteeism and impaired work function

Two major definitions exist for presenteeism: sickness presenteeism and impaired work function. The evidence for comparing previous studies on presenteeism is insufficient because of the different definitions of presenteeism used. To assess the relationship between the two major definitions of presenteeism. This cross-sectional study analysed secondary data on 5334 respondents to an employee survey administered in a construction company in Japan. Impaired work function was measured using the Work Functioning Impairment Scale (WFun). Multiple logistic regression was performed. A strong linear association was observed between the number of days of sickness presenteeism and impaired work function (all P < 0.001). In contrast, the number of days of sickness absence was only partially positively associated with impaired work function. All choices for most frequent health problem were positively associated with impaired work function, beginning with mental problems (adjusted odds ratio [OR] = 20.45, 95% confidence interval [CI]: 14.94-28.01), followed by malaise (adjusted OR = 11.91, 95% CI: 9.08-15.62) and sleeping problems (adjusted OR = 8.62, 95% CI: 6.57-11.33). A strong relationship was observed between the two major definitions of presenteeism, even after adjusting for a variety of chronic health conditions. Although a consensus on the definition of presenteeism is yet to be reached, this study provides insight on comparing existing studies on presenteeism.

Influenza vaccination and absenteeism among healthy working adults: a cost-benefit analysis.

Seasonal influenza is a highly contagious infection that might lead to serious clinical complications and incurs a conspicuous socio-economic impact. Influenza vaccination is currently recommended only for specific groups of healthy adults (such as healthcare workers) even though it was demonstrated to be effective in reducing absenteeism and decreased workers' productivity during flu epidemic period. The main purpose of this study is to analyse the extent of absences due to illness following a voluntary flu immunization program among the Komatsu Italia Manufacturing company's personnel during the flu season 2017-2018. Secondly, we aimed at performing a cost-benefit analysis of the vaccination campaign from the company's perspective. This is an observational cohort study conducted during the period between the 14th week of 2017 and the 13th week of 2018 (from 03/04/2017 to 01/04/2018). The study population was the personnel of Komatsu Italia Manufacturing S.p.A. on duty during the study period. For each subject the following data were collected: sex, date of birth, professional profile, seasonal influenza immunization status and sick-leave days. Sick-leave days were compared among the influenza epidemic period and the previous one between vaccinated and unvaccinated and any difference in days of absence was considered to be caused by seasonal influenza. Out of 408 employees, 60 (14.7%) accepted the voluntary influenza vaccination. In multivariate analysis (logistic model) an age ≥ 50 years was the only predictor for vaccination acceptance (ORM 3.11 p<0.001). During the flu period, the monthly mean of sick-leave days per employee was significantly lower among the vaccinated than the unvaccinated, respectively of 0.328 days/person vs 0.752 days/person (p = 0.022). Unvaccinated employees reported a higher average of sick-leave days during the flu period compared to the previous non-influenza period (0.752 days/month/person vs 0.337 days/month/person p <0.001). The monthly mean cost for sickness absences per employee was significantly higher for an unvaccinated subject compared to one vaccinated, respectively € 129.00 and € 54.00 (p = 0.028). The overall net saving estimated was € 314.00 per person vaccinated. Influenza vaccination proved to be an extraordinary preventive tool and a cost-effective intervention. However, influenza immunization seems to be unappealing among healthy adults and higher flu vaccination coverages could be achieved through educational interventions possibly addressing young employees who showed little interest in vaccination. Finally, among health promotion interventions, companies should point out the importance of flu vaccination both for the individual wellbeing and the company environment.

Post-traumatic stress reactions and doctor-certified sick leave after a workplace terrorist attack: Norwegian cohort study

ObjectiveTo explore the association between the psychosocial work environment and the risk of sick leave among governmental employees with symptom-defined post-traumatic stress disorder (PTSD) after a workplace bomb attack.DesignA prospective...

Diagnosis-Specific Sickness Absence and Subsequent Common Mental Disorders: A Register-Linkage Cohort Study among Finnish Public Sector Employees

Sickness absence is associated with poor health outcomes, but little is known about its consequences for general mental health. This study examined the associations between diagnosis-specific sickness absence and subsequent common mental disorders (CMD). Register data on medically certified all-cause sickness absence and sickness absence due to mental disorders and musculoskeletal diseases from 2004–2007 were linked to the Helsinki Health Study 2007 and 2012 survey data on City of Helsinki employees in Finland (N = 3560). Using logistic regression and multinomial logistic regression, we analysed the associations between the total number of reimbursed sickness absence days in 2004-7 and CMD General Health Questionnaire 12) in 2007 and 2012 and CMD changes. Sickness absence due to mental disorders (age- and sex-adjusted odds ratio (OR)range: 2.16 to 2.93), musculoskeletal diseases (OR range: 2.79 to 2.93) and all-cause sickness absence (OR range: 1.48 to 3.20) were associated with CMD in 2007. In 2012, associations with lower ORs were observed. Associations were also found with changing and especially repeated (OR range: 1.49 to 3.40) CMD. The associations remained after adjusting for work-related covariates and health behaviours. Diagnosis-specific sickness absence showed persistent associations with subsequent CMD and their changes. Attention should be paid to both the short- and long-term consequences of sickness absence for employee mental health.

Evaluation of first-line therapies for the treatment of candidemia in ICU patients: A propensity score analysis

BackgroundCandidemia is a major cause of mortality in the intensive care unit (ICU). According to the Infectious Diseases Society of America (IDSA), an echinocandin is recommended as initial therapy and fluconazole as an alternative. In a context of echinocandin resistance development, the question arising is whether azoles are a suitable alternative to echinocandins for the treatment of candidemia in critically ill patients. MethodsA 3-year (2015–2017) retrospective multicentric cohort study was conducted. Adult patients with a diagnosis of candidemia during the ICU stay and treated with echinocandins or azoles were included. Demographic, clinical data, mycological data, and antifungal treatments were collected. Kaplan–Meier survival analysis, univariate analysis, and a multivariate logistic regression analysis using a propensity score with the inverse probability of treatment weighting method were performed. FindingsSeventy-nine patients (n = 79) were analyzed. Treatment success, as well as survival on day 90 (Kaplan–Meier survival analysis, log rank test, p = 0.542), were comparable between patients who received echinocandins (caspofungin (n = 47)) or azoles (fluconazole (n = 29) or voriconazole (n = 3)). A multivariable analysis demonstrated that higher SOFA score on the day of candidemia diagnosis and absence of adequate Candida source control were independently associated with a greater risk of 90-day mortality, whereas azoles treatment was not associated with an excess 90-day mortality. InterpretationThis study confirms that the use of azoles recommended for candidemia, mostly fluconazole, as a first-line therapy is a reasonable alternative to caspofungin for ICU patients in our institution. This needs to be included in local guidelines through antifungal stewardship programs.

The socioeconomic impact of orthopaedic trauma: A systematic review and meta-analysis.

The overall objective of this study was to determine the patient-level socioeconomic impact resulting from orthopaedic trauma in the available literature. The MEDLINE, Embase, and Scopus databases were searched in December 2019. Studies were eligible for inclusion if more than 75% of the study population sustained an appendicular fracture due to an acute trauma, the mean age was 18 through 65 years, and the study included a socioeconomic outcome, defined as a measure of income, employment status, or educational status. Two independent reviewers performed data extraction and quality assessment. Pooled estimates of the socioeconomic outcome measures were calculated using random-effects models with inverse variance weighting. Two-hundred-five studies met the eligibility criteria. These studies utilized five different socioeconomic outcomes, including return to work (n = 119), absenteeism days from work (n = 104), productivity loss (n = 11), income loss (n = 11), and new unemployment (n = 10). Pooled estimates for return to work remained relatively consistent across the 6-, 12-, and 24-month timepoint estimates of 58.7%, 67.7%, and 60.9%, respectively. The pooled estimate for mean days absent from work was 102.3 days (95% CI: 94.8-109.8). Thirteen-percent had lost employment at one-year post-injury (95% CI: 4.8-30.7). Tremendous heterogeneity (I2>89%) was observed for all pooled socioeconomic outcomes. These results suggest that orthopaedic injury can have a substantial impact on the patient's socioeconomic well-being, which may negatively affect a person's psychological wellbeing and happiness. However, socioeconomic recovery following injury can be very nuanced, and using only a single socioeconomic outcome yields inherent bias. Informative and accurate socioeconomic outcome assessment requires a multifaceted approach and further standardization.

Modelling the annual NHS costs and outcomes attributable to healthcare-associated infections in England

ObjectivesTo estimate the annual health economic impact of healthcare-associated infections (HCAIs) to the National Health Service (NHS) in England.DesignA modelling study based on a combination of published data and clinical...