Disability Costs Research Articles

Antihypertensive Medication Adherence and Medical Costs, Health Care Use, and Labor Productivity Among People With Hypertension.

Hypertension affects nearly half of US adults yet remains inadequately controlled in over three-quarters of these cases. This study aimed to assess the association between adherence to antihypertensive medications and total medical costs, health care use, and productivity-related outcomes. We conducted cross-sectional analyses using MarketScan databases, which included individuals aged 18 to 64 years with noncapitated health insurance plans in 2019. Adherence was defined as ≥80% medication possession ratio for prescribed antihypertensive medications. We used a generalized linear model to estimate total medical costs, a negative binomial model to estimate health care use (emergency department visits and inpatient admissions), an exponential hurdle model to estimate productivity-related outcomes (number of sick absences, short-term disability, long-term disability), and a 2-part model to estimate productivity-related costs in 2019 US dollars. All models were adjusted for age, sex, urbanicity, census region, and comorbidities. We reported average marginal effects for outcomes related to antihypertensive medication adherence. Among 379 503 individuals with hypertension in 2019, 54.4% adhered to antihypertensives. Per person, antihypertensive medication adherence was associated with $1441 lower total medical costs, $11 lower sick absence costs, $291 lower short-term disability costs, and $69 lower long-term disability costs. Per 1000 individuals, medication adherence was associated with lower health care use, including 200 fewer emergency department visits and 90 fewer inpatient admissions, and productivity-related outcomes, including 20 fewer sick absence days and 442 fewer short-term disability days. Adherence to antihypertensives was consistently associated with lower total medical costs, reduced health care use, and improved productivity-related outcomes.

Multiple Sclerosis Disease-Modifying Therapy Use in the Department of Veteran Affairs and Medicare: A Comparative Analysis

BackgroundHigh-cost disease-modifying therapies (DMT) for multiple sclerosis (MS) have created affordability challenges for people with MS (PwMS) and payers. The Department of Veterans Affairs (VA) is the largest integrated healthcare system in the US and uses a variety of approaches to manage utilization and cost of MS DMT. The objective of this paper is to compare national utilization trends in the VA to the US Medicare program, another large federal public healthcare program. MethodsCounts of PwMS prescribed DMT from 2012 to 2021 in the VA and Medicare programs were used to estimate changes utilization over this period. For each DMT, we estimated the proportion of all DMT users treated in each year. Trends in utilization were compared to identify differences in how these systems manage DMT use. We compared demographics and DMT use between PwMS in the VA to previously published estimates from a Medicare cohort of PwMS. ResultsDMT use in PwMS was comparable in VA and Medicare programs (65.9% vs 69.7%). In younger (<50 years) PwMS, DMT use was more prevalent in the VA compared to Medicare (85.8% vs 76.9%). Between 2012 and 2021, the proportion of patients on DMT using a lower-efficacy agent (interferon beta and glatiramer) declined in both the VA (90% to 32%) and Medicare (81% to 38%). Oral DMT use (primarily fumarates and sphingosine 1-phosphate [S1P] modulators) increased to a similar degree such that by 2021, 39% of patients in both systems were receiving oral DMT. Use of high-efficacy B cell depleting DMT (ocrelizumab, ofatumumab, and rituximab) was consistently higher in the VA than in Medicare. Despite the approval of generic glatiramer and dimethyl fumarate in 2015 and 2020 respectively, 49% of glatiramer and 58% of fumarate utilization in the Medicare program continued to be for a branded product in 2021. ConclusionsGreater DMT use among younger PwMS along with more frequent use of high-efficacy B cell depleting DMT in VA has the potential to reduce disability and attendant healthcare system costs. Generic DMT adoption in the Medicare program was lower than might be expected. Future studies should evaluate the relationship between DMT utilization, costs, and health outcomes in these populations.

Visualizing the landscape of urolithiasis research from 1979-2023: a global bibliometric analysis of randomized clinical trials.

Urolithiasis is the most prevalent benign urological condition, imposing a significant burden on morbidity, disability, and healthcare costs globally. Despite its impact, comprehensive bibliometric analyses of randomized clinical trials (RCTs) related to urolithiasis, which are essential for advancing evidence-based medical practices, are lacking. This study aimed to examine the global research landscape and trends in RCTs focused on urolithiasis. This study used bibliometric techniques to analyze a selection of RCTs on urolithiasis published between 1979 and 2023. VOSviewer software version 1.6.20 was used to visualize international collaborations and perform a keyword analysis of the included articles. The main objective was to identify key research areas and focal points within the field of urolithiasis RCTs. Between 1979 and 2023, a comprehensive search identified 16,716 research articles on urolithiasis. A total of 693 relevant RCTs were found in the Scopus database. The number of publications has significantly increased over time, indicating a strong positive correlation (R² = 0.9303; P < 0.001). China was the top contributor, with 166 publications (23.95%), followed by the United States, with 130 publications (18.76%). Turkey and Iran contributed 44 (6.35%) and 62 (8.95%) publications, respectively. Citation analysis revealed an average of 28.13 citations per article, an h-index of 70, and a total of 19,493 citations. The co-occurrence analysis highlighted current research trends and key topics in urolithiasis RCTs, including 'comparative effectiveness of surgical and laser techniques and patient outcomes', 'medical expulsive therapy (MET) for ureteral calculi and clinical outcomes', 'systematic reviews and meta-analyses of RCTs investigating urolithiasis', and 'dietary interventions and correlations between stone composition and the risk of recurrence.' The bibliometric analysis provides an overview of research on urolithiasis RCTs. It examines global research trends and identifies new developments in the field. Our review identified key research themes, including systematic reviews and meta-analyses, dietary interventions, medical therapy for the expulsion of ureteral stones, and comparisons of surgical techniques-areas that will remain focal points in future research. This bibliometric analysis is an invaluable resource for researchers, clinicians, and policymakers, providing a complete overview of past and present research trends. Informed decision making can be promoted and guided in future research, ultimately improving management and understanding.

Biomarker identification and risk assessment of cardiovascular disease based on untargeted metabolomics and machine learning

Cardiovascular disease (CVD) is the leading cause of mortality, disability, and healthcare costs, with a significant impact on the elderly and contributing to premature deaths across various age groups, including those below age 70. Despite decades of transformative discoveries and clinical efforts, the challenges of diagnosis, prevention, and treatment of CVD persist on a massive scale. This study aimed to unravel potential CVD-associated biomarkers and establish a machine learning model for the risk assessment of CVD. Untargeted metabolic assay with ultra-high performance liquid chromatography-tandem mass spectrometry and routine clinical biochemistry test were undertaken on the fasting venous blood specimens from 57 subjects. Four relevant clinical traits and 164 CVD-associated metabolites were identified, especially those related to glycerophospholipid metabolism and biosynthesis of unsaturated fatty acids. The machine learning model achieved from an integrated biomarker panel of palmitic amide, oleic acid, 138-pos (the 138th detected metabolomic feature in positive ion mode), phosphatidylcholine, linoleic acid, age, direct bilirubin, and inorganic phosphate, was able to improve the accuracy of CVD risk assessment up to a high satisfactory value of 0.91. The findings indicate that disorders in the metabolic processes of biological membranes and energy are significantly associated with increased risk of vascular damage in CVD patients. With machine learning methods, the pivotal metabolites and clinical biomarkers offer a promising potential for the efficient risk assessment and diagnosis of CVD.

Predictors of non-adherence to an early in-hospital rehabilitation program after surgery for hip fracture in a co-managed orthogeriatric unit

BackgroundHip fracture is a common event in older adults, leading to an increased risk of mortality, disability, and higher healthcare costs. Early in-hospital rehabilitation after surgery within orthogeriatric units may improve outcomes with limited incident complications even in the oldest old. We aimed to determine the prevalence and predictors of non-adherence to early rehabilitation in the orthogeriatric unit of an Italian tertiary hospital and its impact on outcomes and setting at discharge.MethodsRetrospective observational single-centered cohort study. Patients aged ≥ 65 years admitted to the orthogeriatric unit for hip fracture who underwent surgery between April 2019 and October 2020 were considered eligible if able to walk autonomously or with assistance and independent in at least 2 Basic Activities of Daily Living. Along with sociodemographic and geriatric variables, characteristics of surgery and rehabilitation, in-hospital complications and functional outcomes at discharge were collected. The primary outcome was non-adherence to the early in-hospital rehabilitation program.ResultsAmong 283 older patients (mean age 82.7 years, 28.6% male), non-compliance with physical therapy was assessed in 49 cases (17.3%), characterized by worse pre-fracture clinical, cognitive, and functional status and showing worse outcomes in terms of mobilization at discharge. After multivariable analysis, non-adherence was independently associated with the onset of delirium (OR 5.26, 95%CI 2.46–11.26; p < 0.001) or infections after surgery (OR 3.26, 95%CI 1.54–6.89; p < 0.001) and a systolic blood pressure at admission < 120 mmHg (OR 4.52, 95%CI 1.96–10.43, p < 0.001).ConclusionsPre-fracture poor cognitive and functional status, along with lower systolic blood pressure, seem to make some patients more vulnerable to in-hospital complications (mainly delirium and infections) and negatively affect the adherence to physical therapy and, by consequence, clinical outcomes of rehabilitation.

Fatal road traffic accidents and injuries: a preliminary study.

Road traffic accidents (RTAs) are a major public health problem globally and cause deaths, disability, and significant economic costs. In Italy, there was an increased number of road accidents, deaths, and injuries in 2022 compared to 2021, although still below pre-pandemic levels. A retrospective observational study was performed on a case series of 53 consecutive fatal RTAs examined by the Section of Forensic Medicine of Verona. The case series was divided, according to the type of victims involved, into pedestrians, car drivers, car passengers, and motorcyclists. For each, the times and causes of death, the distribution of external and internal injuries, and toxicological data were analysed, and the results were compared with those in the literature. Although this is a preliminary study on a small case series and lacks statistical validation, so more cases are needed, the preliminary results seem to provide a useful tool for assessing injuries in complex fatal road accidents.

Some risk factors for recurrent ischemic stroke caused by middle cerebral artery damage

Background and Purpose: Recurrent ischemic stroke due to damage to the middle cerebral artery causes deterioration of neurological function and increases the rate of disability, death, and treatment costs many times compared to the first ischemic stroke. Assessing risk factors plays an extremely important role in preventing recurrent ischemic stroke. We have discuss some risk factors for recurrent ischemic stroke caused by middle cerebral artery damage. Research subjects and methods: Cross-sectional descriptive study on 77 patients with recurrent ischemic stroke due to middle cerebral artery damage at the Neurology Center - Bach Mai Hospital from July 2021 to August 2022. Summary of review: There were 22 female patients and 55 male patients with an average age of 65 ± 11 years old, predominantly in the age group of 61 - 70 years old (making up 44.2% of the total). The majority of patients experienced their first recurrence (64.9%). The timeframe between the most recent ischemic stroke and the recurrent event ranged from 12 months to 5 years, with the highest occurrence rate at 33.8%. Hypertension has the highest rate among risk factors (88.3%); Hyperlipidemia follows as the second leading risk factor (49.4%). Patients with recurrent ischemic stroke caused by middle cerebral artery damage showed limited effectiveness in recurrence prevention treatment: 68.8% did not adhere to antiplatelet medication or had recently stopped taking them. 81.8% did not consistently receive statin treatment as prescribed. There is a significant difference in clinical recovery levels based on the mRS among patients with and without hypertension (p=0.023); with and without hyperlipidemia (p=0.044); among patients receiving regular and irregular antithrombotic therapy (p &lt; 0.005); among patients receiving regular and irregular statin therapy (p = 0.01). Conclusion: Our research indicates that recurrent ischemic stroke resulting from middle cerebral artery damage presents a higher number of risk factors, and the efficacy of recurrence prevention treatment is suboptimal.

Hubungan Dukungan Suami Terhadap Sikap Ibu Untuk Imunisasi Bayi di Puskesmas Peureulak Barat Aceh Timur Tahun 2024

One reason for the lack of information regarding the economic costs of disability or death and the benefits of immunisation when children in the vicinity are not fully immunised is the discovery of signatures. Many people are confused by the terms vaccination and immunisation. Immunisation is given to neonates as soon as possible because it can avoid primary diseases through vaccination. If the baby receives the right vaccination, he will be protected from dangerous diseases such as disabilities. Basic immunisation of infants and toddlers is a routine immunisation programme as well as an additional immunisation programme to prevent communicable diseases (PD3I) such as tuberculosis, diphtheria, pertussis, tetanus, polio, hepatitis B, and measles to reduce morbidity, mortality and disability in infants and children. BCG once, DPT-HB three times, Polio four times, HB Uniject once, and measles once are the basic vaccines. These vaccines must be given to all infants to prevent diseases from entering the body. The method used was analytical survey research. Exploration of how and why this phenomenon occurs is the goal of the analytical survey research approach.

Cost-effectiveness analysis of proximal femoral nail versus bipolar hemiarthroplasty for femoral neck fracture

BackgroundHip fractures are a serious public health problem with high rates of morbidity, mortality, disability and care costs. The aim of the research was to perform cost effectiveness analysis of hip fracture treatments using proximal femoral nail and bipolar hemiarthroplasty surgeries.MethodsThe analysis was completed based on the perspectives of the paying institution and patient. A decision tree model was used to determine whether proximal femoral nail or bipolar arthroplasty was most cost effective for the management of a femoral neck fracture in this patient population.ResultsThe findings from the decision tree model suggested that ICERs for BHP were TRY 43,164.53 TL/QALY based on reimbursement and TRY 3,977.35 TL/QALY based on patient expenditures. Compared to the calculated threshold value of TRY 60.575 TL, we concluded BHP to be a cost-effective option. Moreover, all parameter changes yielded stable results on the one-way sensitivity analysis. When it comes to the probabilistic sensitivity analysis, BHP with specified threshold value was found to be cost-effective in all the comparisons. Currently available data the use of bipolar hemiarthroplasty as the more cost- effective treatment strategy in this specific population.ConclusionOverall, our findings showed HA as a cost-effective surgical technique at the calculated threshold in a population over 60 years of age. The impacts of HA on patients’ quality of life and costs are remarkable.

Adherence, Persistence, Healthcare Resource Use, and Costs in Tofacitinib-Treated Patients with Psoriatic Arthritis: Data from Two United States Claims Databases.

Associations between increased functional disability and higher healthcare resource utilization (HCRU) and costs were reported in patients with psoriatic arthritis (PsA). We assessed characteristics/outcomes of patients with PsA receiving tofacitinib monotherapy vs combination therapy with conventional synthetic disease-modifying antirheumatic drugs. Claims data from Optum® Clinformatics® Data Mart (OC) and Merative™ MarketScan® (MS) databases between December 2017 and February 2020 were analyzed. Outcomes assessed were adherence/persistence by therapy type (monotherapy/combination therapy); HCRU/costs (per patient per month) by periods on-treatment (sum time on tofacitinib) and off-treatment (sum time off tofacitinib [gap of > 60days]) plus therapy type. This analysis included 274 and 395 tofacitinib-treated patients in OC (70.4% female, mean age 54.4years) and MS (68.9% female, mean age 51.4years), respectively. Percentages of patients with a proportion of days covered ≥ 0.8 at 12months for monotherapy vs combination therapy were OC, 44.5% vs 53.8%; MS, 36.4% vs 45.7%. Generally similar trends were seen over 24months and for medication possession ratio ≥ 0.8. Median (95%confidence interval) times to treatment discontinuation for monotherapy vs combination therapy were OC, 10.1 (7.4-11.8) vs 16.7 (8.3-26.6) months; MS, 6.9(5.6-9.4) vs 11.0(6.1-13.9) months. During off-treatment vs on-treatment periods, numerical decreases were observedfor all-cause (OC, $5383 vs $6149; MS, $4145 vs $5180) and PsA-related costs (OC, $3237 vs $4515; MS, $2703 vs $3907) regardless of therapy type. During off-treatment vs on-treatment periods, numerical increases in outpatient visits for all-cause (OC, 2.37 vs 2.05; MS, 2.15 vs 1.99) and PsA-related visits (OC, 0.60 vs 0.46; MS, 0.47 vs 0.44) were observed, and PsA-related medications numerically decreased (OC, 1.21 vs 1.53; MS, 1.05 vs 1.48). In this USA-based claims analysis, tofacitinib adherence was numerically lower for patients with PsA receiving monotherapy vs combination therapy. Costs numerically decreased off-treatment vs on-treatment, irrespective of therapy type, driven by lower medication costs.

Education in Laparoscopic Cholecystectomy: Design and Feasibility Study of the LapBot Safe Chole Mobile Game.

Major bile duct injuries during laparoscopic cholecystectomy (LC), often stemming from errors in surgical judgment and visual misperception of critical anatomy, significantly impact morbidity, mortality, disability, and health care costs. To enhance safe LC learning, we developed an educational mobile game, LapBot Safe Chole, which uses an artificial intelligence (AI) model to provide real-time coaching and feedback, improving intraoperative decision-making. LapBot Safe Chole offers a free, accessible simulated learning experience with real-time AI feedback. Players engage with intraoperative LC scenarios (short video clips) and identify ideal dissection zones. After the response, users receive an accuracy score from a validated AI algorithm. The game consists of 5 levels of increasing difficulty based on the Parkland grading scale for cholecystitis. Beta testing (n=29) showed score improvements with each round, with attendings and senior trainees achieving top scores faster than junior residents. Learning curves and progression distinguished candidates, with a significant association between user level and scores (P=.003). Players found LapBot enjoyable and educational. LapBot Safe Chole effectively integrates safe LC principles into a fun, accessible, and educational game using AI-generated feedback. Initial beta testing supports the validity of the assessment scores and suggests high adoption and engagement potential among surgical trainees.

Predictors of hip fracture in 15 European countries: a longitudinal study of 48,533 geriatric adults using SHARE dataset.

Hip fracture is a major cause of functional disability, mortality, and health costs. However, the identification and characterization of its causative factors remain poor. We investigated demography, handgrip strength (HGS), depression, and multiple age-associated comorbidities for predicting future hip fracture in individuals aged 50 or above from 15 European countries (n = 48,533). All participants were evaluated from 2013 to 2020 using four successive waves of the Survey of Health, Aging, and Retirement in Europe (SHARE). Altogether, 1130 participants developed hip fractures during the study period. We identified female gender, an advancing age from quinquagenarians onward, and a poor socioeconomic status as critical risk factors for future hip fracture. Having mobility difficulty, a low HGS (< 27kg in men, < 16kg in women) and higher scores on Euro-D depression scales were also significant risk factors for hip fracture. Summated scales of hypertension, diabetes mellitus, cancer, Alzheimer's disease, and stroke did not appear as risk factors. Collectively, we report advancing age, female gender, low HGS, and depression as independent risk factors for hip fracture. Our findings are useful in identifying high-risk populations for hip fractures in pre-clinical settings before rigorous evaluation and treatment in clinics.

Association between Dietary total antioxidant capacity and knee osteoarthritis: a case-control study in the Iranian Population

AimKnee osteoarthritis (KOA) is a prevalent chronic condition associated with significant pain, disability, and healthcare costs, particularly among the elderly population. Despite the considerable burden of KOA, effective treatment options for managing the condition’s underlying causes remain limited. This case-control study aims to investigate the relationship between dietary total antioxidant capacity (DTAC) and knee osteoarthritis.MethodsThis case-control study was conducted on 105 patients with confirmed KOA and 210 controls. KOA was diagnosed based on the American College of Rheumatology criteria. Dietary total antioxidant capacity (DTAC) was calculated based on the ferric-reducing antioxidant power method.ResultsThe mean age and BMI of the participants were 53.6 ± 8.8 years old and 27.3 ± 2.7 kg/m2, respectively. The study participant’s DTAC score ranged from 3.56 to 25.32 with a mean and SD of 12.46 ± 5.12. In the crude model, individuals in the highest quartile of DTAC score had 71% lower odds of having knee osteoarthritis compared to those in the first quartile (OR: 0.29, 95%CI: 0.15 to 0.58, P-trend < 0.001). These associations remained significant after adjustment for potential confounders including age, sex, energy intake, family history of osteoarthritis, vitamin D and calcium use, physical activity level, cigarette smoking and BMI. Although the odds of having knee osteoarthritis decreased with increasing quartiles of DTAC in both sexes, this relationship was stronger among males than females.ConclusionThe results of this study showed that there was an inverse correlation between DTAC and KOA among the Iranian patients with KOA.

Work-Related Musculoskeletal Disorders: A Systematic Review and Meta-Analysis.

Background: Musculoskeletal disorders (MSDs) involve muscles, nerves, tendons, joints, cartilage, and spinal discs. These conditions can be triggered by both the work environment and the type of work performed, factors that, in some cases, can also exacerbate pre-existing conditions. This systematic review aims to provide an overview of the impact that different work-related activities have on the musculoskeletal system. Methods: A global search of publications was conducted using the following international bibliographic web databases: PubMed and Web of Science. The search strategies combined terms for musculoskeletal disorders and workers. In addition, a meta-analysis was conducted to estimate the prevalence of MSDs within the healthcare sector. Results: A total of 10,805 non-duplicated articles were identified, and finally, 32 studies were reviewed in this article. Once the literature search was completed, occupational figures were categorized into healthcare, farming, industrial, and computer sectors. In the healthcare sector, the prevalence estimate for degenerative diseases of the lumbar spine was 21% (497 out of 2547 physicians and dentists) (95% CI, 17-26%), while for osteoarthritis of the hand, it was 37% (382 out of 1013 dentists) (95% CI, 23-51%). Conclusions: Musculoskeletal disorders significantly impair workers' quality of life, especially in healthcare sector. These conditions are also associated with high costs for employers, such as absenteeism, lost productivity, and increased costs for healthcare, disability, and workers' compensation.

Assessment of knowledge, and practices of urban women towards folic acid fortified maize meal in Zimbabwe

Neural tube defects (NTDs) are the second most common birth defects in humans and are associated with high rates of neonatal mortality, morbidity, disability, psychological and economic costs. Roughly 200,000 neonates are born with NTDs in low- and middle-income countries. To reduce the risks associated with NTDs, pregnant women are recommended to supplement their diets with folate tablets or to consume foods fortified with folic acid. Despite the introduction of a mandatory fortification program of maize meal with folic acid, in Zimbabwe, there is a paucity of literature about the perceptions of individuals towards fortified foods, as well as the storage and processing practices of fortified maize meal. This study aimed to assess the knowledge, as well as, storage and processing practices of folic acid-fortified maize meal in urban poor women. Data on knowledge and practices on fortified maize was gathered using a structured questionnaire from 630 women of childbearing age from low-income suburbs in Kwekwe town, Zimbabwe. The results showed that a paltry 26.3% of the respondents knew about folic acid, 22.5% knew about the effects of folic acid deficiency, 13.8% knew foodstuffs containing folic acid, 4% knew about food fortification and 35.6% had bought and used folic acid fortified maize meal before. Availability and accessibility were the main drivers to purchasing fortified maize meal (90%). There was no significant relationship (p &lt; 0.05) between age and folic acid knowledge as well as between level of education and folic acid knowledge. Furthermore, the result indicates that the households were engaged in poor storage practices of the folic acid fortified maize meal. There was a significant relationship between the level of education and knowledge about food fortification. In conclusion, urban women's knowledge regarding folic acid and fortified maize meal is very low in Zimbabwe and households also store the folic acid fortified maize meal under conditions that speed deterioration of the folic acid. Folic acid awareness campaigns are recommended for people to benefit from the government of Zimbabwe's fortification programme. Key words: Neural tube defects, maize, folate, deficiency, fortification, women

Association between clinical biomechanical metrics of cervical spine function and pain or disability in people with neuromusculoskeletal neck pain: Protocol for a systematic review and planned meta-analysis.

Neck pain is a burdensome condition associated with pain, disability, and economic cost. Neck pain has been associated with observable changes in neuromuscular function and biomechanics. Prior research shows impairments in kinematic control, including reduced mobility, velocity, and smoothness of cervical motion. However, the strength of association between these impairments and patient-reported pain and disability is unclear rendering development of novel and relevant rehabilitation strategies difficult. The aim of this systematic review is to synthesize existing evidence on the strength of association between clinical biomechanical metrics of neck function (ROM, strength, acceleration, accuracy, smoothness, etc.) and patient-reported neck pain and disability. This protocol follows Cochrane guidelines and adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P). MEDLINE, EMBASE, CINAHL, SPORTDiscus, Web of Science and Scopus will be searched, along with the gray literature, up to 20 November 2023, using terms and keywords derived from initial scoping searches. Observational studies, including cohorts and cross-sectional studies, that explore associations between clinical biomechanics of the neck and patient-reported outcomes of neck pain or disability will be included. Two reviewers will independently perform study selection, data extraction, and risk of bias assessment (National Institute of Health tool). Data will be synthesized using either a random effects meta-analytic approach or qualitatively using a modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, dependent on the homogeneity of data available. This review addresses a gap in the literature by systematically synthesizing findings on the relationship between neck function impairments and patient-reported outcomes. It will identify priorities for neck pain rehabilitation and gaps in current knowledge. The results of this review will be disseminated through a peer-reviewed publication, conference presentation, and lay language summaries posted on an open-access website. PROSPERO Registration number: CRD42023417317. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023417317.

From Alzheimer's Disease to Anxiety, Epilepsy to Schizophrenia: A Comprehensive Dive Into Neuro-Psychiatric Disorders.

This comprehensive narrative review endeavors to dissect the intricate web of neuropsychiatric disorders that significantly impact cognition, emotion regulation, behavior, and mental health. With a keen focus on Alzheimer's disease (AD), anxiety disorders, epilepsy, schizophrenia, and autism spectrum disorder (ASD), this article delves into their underlying mechanisms, clinical presentations, diagnostic challenges, and therapeutic interventions. Highlighting the considerable disability and societal costs that these conditions impose, it reflects on the over six million individuals grappling with Alzheimer's, the 19 million American adults living with anxiety disorders, the three million with epilepsy, and the global reach of schizophrenia affecting approximately 20 million people. Furthermore, it examines the emerging landscape of ASD, noting the escalating diagnosis rates and the pressing need for innovative treatments and equitable healthcare access. Through a detailed exploration of current research, technological innovations, and the promise of personalized medicine, this review aims to illuminate the complexities of these conditions, advocate for early intervention strategies, and call for a unified approach to tackling the multifaceted challenges they present. The ultimate goal is to inform and inspire healthcare professionals, researchers, and policymakers to foster advancements that improve outcomes and quality of life for individuals affected by these profound neuropsychiatric disorders, steering towards a future where these conditions are no longer insurmountable.

An urgent call to address work-related psychosocial hazards and improve worker well-being.

Work-related psychosocial hazards are on the verge of surpassing many other occupational hazards in their contribution to ill-health, injury, disability, direct and indirect costs, and impact on business and national productivity. The risks associated with exposure to psychosocial hazards at work are compounded by the increasing background prevalence of mental health disorders in the working-age population. The extensive and cumulative impacts of these exposures represent an alarming public health problem that merits immediate, increased attention. In this paper, we review the linkage between work-related psychosocial hazards and adverse effects, their economic burden, and interventions to prevent and control these hazards. We identify six crucial societal actions: (1) increase awareness of this critical issue through a comprehensive public campaign; (2) increase etiologic, intervention, and implementation research; (3) initiate or augment surveillance efforts; (4) increase translation of research findings into guidance for employers and workers; (5) increase the number and diversity of professionals skilled in preventing and addressing psychosocial hazards; and (6) develop a national regulatory or consensus standard to prevent and control work-related psychosocial hazards.

Reducing the Impact of Headache and Allodynia Score in Chronic Migraine: An Exploratory Analysis from the Real-World Effectiveness of Anti-CGRP Monoclonal Antibodies Compared to Onabotulinum Toxin A (RAMO) Study.

Chronic migraine (CM) is a disabling and hard-to-treat condition, associated with high disability and high cost. Among the preventive treatments, botulinum toxin A (BoNT-a) and monoclonal antibodies against the calcitonin gene-related protein (anti-CGRP mAbs) are the only disease-specific ones. The assessment of the disease burden is complex, and among others, tools such as the allodynia symptoms checklist (ASC-12) and headache impact test (HIT-6) are very useful. This exploratory study analysed the impact of these two therapies on migraine burden. The RAMO study was a multicentre, observational, retrospective investigation conducted in two headache centres: the Fondazione IRCCS Istituto Neurologico Carlo Besta (Milan) and the Fondazione Policlinico Campus Bio-Medico (Rome). This study involved patients with chronic migraine treated with mAbs or BoNT-A. We conducted a subgroup exploratory analysis on HIT-6 and ASC-12 scores in the two groups. The Wilcoxon rank-sum test, Fisher's exact test, and ANOVA were performed. Of 126 patients, 36 on mAbs and 90 on BoNT-A had at least one available follow-up. mAbs resulted in a mean reduction of -11.1 and -11.4 points, respectively, in the HIT-6 at 6 and 12 months, while BoNT-A was reduced -3.2 and -3.6 points, respectively; the mAbs arm resulted in mean reductions in ASC-12 at 6 and 12 months of follow-up of -5.2 and -6.0 points, respectively, while BoNT-A showed lesser mean changes of -0.5 and -0.9 points, respectively. The adjusted analysis confirmed our results. In this exploratory analysis, anti-CGRP mAbs showed superior effectiveness for HIT-6 and ASC12 compared to BoNT-A. Reductions in terms of month headache days (MHD), migraine disability assessment test (MIDAS), and migraine acute medications (MAM) were clinically relevant for both treatments.

Poverty, work intensity, and disability: evidence from European countries.

We use 2015-2018 European Union Statistics on Income and Living Conditions longitudinal data for four European countries (the UK, Germany, France, and Italy) and a dynamic trivariate panel data model to analyze the complex relationship between poverty, work intensity, and disability. We find evidence of genuine state dependence in the three processes and feedback effects from past poverty to work intensity in all countries and from past poverty to disability in the UK, Germany, and Italy. Disability is detrimental to poverty, despite the mitigating role played by disability cash benefits. The magnitude of this effect seems to be associated with the average expenditure on social protection benefits and its distribution across functions. We stress the importance of accounting for the extra costs of disability and the key role work intensity plays in the disability-poverty connection. Finally, adopting a joint estimation strategy appears crucial to consistently estimating the relationship between the three processes.