Disability Days Research Articles

Experience of using omalizumab in patients with severe bronchial asthma

Introduction. New insights into the complex pathophysiology of severe asthma (SA) have led to the development of personalized treatment strategies using genetically engineered drugs, which is based not only on disease severity, but also on specific patient characteristics and asthma endotypes.Aim. Evaluation of the effectiveness of omalizumab in patients with severe bronchial asthma (SBA).Materials and methods. A prospective observational study (12 months) with the participation of 39 patients with TB (20 women and 19 men, average age 47.7 ± 14.2 years) who were treated at the Ochapovsky Regional Clinic Hospital of Krasnodar Region. All patients included in the study were prescribed the drug omalizumab.Results. After 6 months of follow-up, there was an improvement in asthma control in the form of an increase in the average number of points according to the ACT questionnaire: 15.9 (1.19) vs 10.7 (3.19); a decrease in the proportion of patients with an ACT score of ≤ 19 points by 15.6% (from 32 patients to 27), a decrease in the proportion of patients with the result of the ACT is less than 15 points by 16%. Within 12 months from the start of treatment with omalizumab, there was a decrease in asthma exacerbations regardless of the initial level of IgE and eosinophils, a decrease in the number of days of disability by 68.9%, the number of emergency calls by 50%, outpatient visits to a pulmonologist by 65.2%, the number of hospitalizations by 63.6%, the number of days spent in hospital – by 49.2, there was a significant decrease in daily doses of IGCS, oral GCS, the total number of exacerbations, the average score on the ACT test in all patients (p = 0.01).Conclusions. Use of the drug omalizumab in patients with SBA, in combination with a different spectrum of sensitization, it was possible to bring the treatment of such patients to a qualitatively new level, providing a pronounced clinical effect by minimizing symptoms, stopping exacerbations, and improving the quality of life. It is important to have a good safety and portability profile, as well as a convenient application mode.

Laser Epilation as an Adjunct to Standard Care in Reducing Pilonidal Disease Recurrence in Adolescents and Young Adults

Recurrence continues to be a significant challenge in the treatment and management of pilonidal disease. To compare the effectiveness of laser epilation (LE) as an adjunct to standard care vs standard care alone in preventing recurrence of pilonidal disease in adolescents and young adults. This was a single-institution, randomized clinical trial with 1-year follow-up conducted from September 2017 to September 2022. Patients aged 11 to 21 years with pilonidal disease were recruited from a single tertiary children's hospital. LE and standard care (improved hygiene and mechanical or chemical depilation) or standard care alone. The primary outcome was the rate of recurrence of pilonidal disease at 1 year. Secondary outcomes assessed during the 1-year follow-up included disability days, health-related quality of life (HRQOL), health care satisfaction, disease-related attitudes and perceived stigma, and rates of procedures, surgical excisions, and postoperative complications. A total of 302 participants (median [IQR] age, 17 [15-18] years; 157 male [56.1%]) with pilonidal disease were enrolled; 151 participants were randomly assigned to each intervention group. One-year follow-up was available for 96 patients (63.6%) in the LE group and 134 (88.7%) in the standard care group. The proportion of patients who experienced a recurrence within 1 year was significantly lower in the LE treatment arm than in the standard care arm (-23.2%; 95% CI, -33.2 to -13.1; P < .001). Over 1 year, there were no differences between groups in either patient or caregiver disability days, or patient- or caregiver-reported HRQOL, health care satisfaction, or perceived stigma at any time point. The LE group had significantly higher Child Attitude Toward Illness Scores (CATIS) at 6 months (median [IQR], 3.8 [3.4-4.2] vs 3.6 [3.2-4.1]; P = .01). There were no differences between groups in disease-related health care utilization, disease-related procedures, or postoperative complications. LE as an adjunct to standard care significantly reduced 1-year recurrence rates of pilonidal disease compared with standard care alone. These results provide further evidence that LE is safe and well tolerated in patients with pilonidal disease. LE should be considered a standard treatment modality for patients with pilonidal disease and should be available as an initial treatment option or adjunct treatment modality for all eligible patients. ClinicalTrials.gov Identifier: NCT03276065.

Characterizing worker compensation claims in long-term care and examining the association between facility characteristics and severe injury: a repeated cross-sectional study from Alberta, Canada

BackgroundDespite the physical demands and risks inherent to working in long-term care (LTC), little is known about workplace injuries and worker compensation claims in this setting. The purpose of this study was to characterize workplace injuries in LTC and to estimate the association between worker and organizational factors on severe injury.MethodsWe used a repeated cross-sectional design to examine worker compensation claims between September 1, 2014 and September 30, 2018 from 25 LTC homes. Worker compensation claim data came from The Workers Compensation Board of Alberta. LTC facility data came from the Translating Research in Elder Care program. We used descriptive statistics to characterize the sample and multivariable logistic regression to estimate the association between staff, organizational, and resident characteristics and severe injury, measured as 31+ days of disability.ResultsWe examined 3337 compensation claims from 25 LTC facilities. Less than 10% of claims (5.1%, n = 170) resulted in severe injury and most claims did not result in any days of disability (70.9%, n = 2367). Most of the sample were women and over 40 years of age. Care aides were the largest occupational group (62.1%, n = 2072). The highest proportion of claims were made from staff working in voluntary not for profit facilities (41.9%, n = 1398) followed by public not for profit (32.9%, n = 1098), and private for profit (n = 25.2%, n = 841). Most claims identified the nature of injury as traumatic injuries to muscles, tendons, ligaments, or joints. In the multivariable logistic regression, higher staff age (50–59, aOR: 2.26, 95% CI 1.06–4.83; 60+, aOR: 2.70, 95% CI 1.20–6.08) was associated with more severe injury, controlling for resident acuity and other organizational staffing factors.ConclusionsMost claims were made by care aides and were due to musculoskeletal injuries. In LTC, few worker compensation claims were due to severe injury. More research is needed to delve into the specific features of the LTC setting that are related to worker injury.

Work absenteeism and disability days after diagnosis among patients with AML and caregivers.

e19002 Background: Treatment for acute myeloid leukemia (AML) includes intensive chemotherapy and/or hematopoietic stem cell transplant, and patients usually require extended hospital stays and absence from work. Caregivers may also take workplace absence to provide care during and after treatment. As data on the indirect burden of AML are underreported, we aimed to understand the impact of work absenteeism (ABS) and disability days among patients with AML and caregivers. Methods: This non-interventional, retrospective analysis of healthcare claims data was conducted using MarketScan Databases containing ABS data. Two cohorts were analyzed: patients newly diagnosed with AML between January 1, 2009 and December 1, 2019 (index period), and caregivers with an adult family member newly diagnosed with AML during the index period. All participants were full-time employees, aged 18–64 years, and had ≥12 months of continuous enrollment prior to index date and ≥30 days of continuous enrollment after index date. The index date was the date of first AML diagnosis for patients, or the date of the linked family member’s first AML diagnosis for caregivers. Participants were followed for ≥30 days up to 3 years, until the end of continuous enrollment, end of database eligibility, or end of the study period. Participants who were pregnant or in families with &gt; 1 member with AML were excluded. Days of work loss and associated wage loss were calculated for each work loss type: ABS, short-term disability (STD), and long-term disability (LTD). Results: This analysis included 1,037 patients with AML and 781 caregivers. From baseline to follow-up (FU) period, the proportion of patients reporting ABS numerically decreased from 72.8% to 62.7% (p = 0.054), and changes in ABS days per patient per month (PPPM) (2.21– 2.10, p = 0.735) or ABS-related wage loss PPPM ($562–$511, p = 0.516) were not statistically significant. However, the proportion of patients reporting STD and LTD significantly increased (24.6%–50.0%, p &lt; 0.001, and 4.0%–20.0%, p &lt; 0.001, respectively). The number of days PPPM lost due to STD and LTD significantly increased (0.85–4.94, p &lt; 0.001, and 0.24–1.40, p &lt; 0.001), as did STD- and LTD-related wage loss PPPM ($203–$1194, p &lt; 0.001, and $57–$330, p &lt; 0.001). Among caregivers, the proportion reporting ABS and ABS days PPPM were similar between baseline and FU periods (83.2%–83.9%, p = 0.871, and 2.41–2.64, p = 0.315). The proportion of caregivers with STD claims significantly increased (5.4%–11.8%, p &lt; 0.001), and days PPPM lost due to STD and associated wage loss PPPM numerically increased (0.15–0.25, p = 0.057 and $38–$60, p = 0.087). Conclusions: Following AML diagnosis, the proportion of patients with STD and LTD leave increased significantly, while absenteeism did not change significantly. Days of STD leave also increased among caregivers. Future research is needed to determine how work loss varies by AML treatment type and/or sequencing.

The effectiveness of essential oils in the treatment of acute viral rhinosinusitis

Introduction. Acute respiratory viral infections are the most widespread diseases, accounting for up to 90% of all infectious pathology, which supports the relevance of optimizing the treatment of acute viral rhinosinusitis.Aim. Evaluate the dynamics of clinical symptoms of acute viral rhinosinusitis, which arose as part of an acute respiratory infection, when supplementing therapy with the drug Respero Myrtol (Pol-Boskamp GmbH and Co.KG, Germany), the active ingredient of which is myrtol standardized 120 mg in 1 capsule.Materials and methods. The dynamics of clinical symptoms of 20 cases of acute viral rhinosinusitis in comparison groups was analyzed. Traditional treatment of patients included taking propionic acid derivatives, ascorbic acid, intranasal use of decongestants and irrigation of the nasal cavity with isotonic saline solutions. Patients who have received traditional treatment are defined as a “standard therapy group”. To assess the effectiveness of therapy using standardized myrtol, 20 cases of acute viral rhinosinusitis against the background of acute respiratory viral infections with a similar severity were analyzed, in which patients received outpatient therapy with Respero Myrtol 2 capsules 3 times a day for 7 days in addition to the above treatment (the “myrtol therapy” group). The dynamics of the disease assessed: the number of days of disability before recovery, the period of normalization of body temperature in feverish patients, the need for vasoconstrictive intranasal agents after the seventh day of therapy, the period of complete relief of pain syndrome, the period of normalization of night sleep, the number of cases of bacterial superinfection and the need for systemic antibacterial therapy.The results. In the observed patients, the quality of sleep was restored faster, the pain syndrome was stopped earlier, less often there was a need for systemic antibiotics and prolonged use of intranasal decongestants. The disease proceeded with fewer days of disability.Conclusion. The study results have been shown to report the clinical efficacy of Respero Myrtol essential oils in the outpatient treatment of patients with acute rhinosinusitis.

Impact of TNF inhibitor medication on working ability in axial spondyloarthritis: an observational national registry-based cohort study.

The aim was to investigate the effect of TNF inhibitor (TNFi) initiation on working ability and health-care resource utilization among axialSpA patients in a real-life setting. Patients with a clinical diagnosis of non-radiographic (nr-axSpA) or radiographic axial SpA initiating their first TNFi were identified from the National Register for Antirheumatic and Biologic Treatment in Finland. Sickness absences, including sick leave and disability pension, in- and outpatient days and rehabilitation rates, 1year before and after initiating the medication were retrieved from national registries. Factors affecting result variables were studied using multivariate regression analysis. Overall, 787 patients were identified. Rates of work disability days per year were 55.6 the year before treatment onset and 55.2 the year after, with significant differences between patient subgroups. The rate of sick leave decreased after starting TNFi treatment. However, the rate of disability pension continued to rise. Patients with a diagnosis of nr-axSpA experienced a decrease in overall work disability and, especially, fewer sick leaves. No sex differences were detected. TNFi interrupts the increase in work disabled days evident during the year before its initiation. However, the overall work disability remains high. Treating patients earlier in the nr-axSpA phase, regardless of sex, appears important in maintaining the ability to work.

Analysis of morbidity with temporary disability in social workers according to the factors of their work

Objective: to analyze the incidence of temporary disability and take into account the labor factors of workers in the social service sector of a large city. Material and methods. The initial data were the number of employees of the Center for Social Services for the Population "Central" g. o. Samara, cases and days of temporary disability for 2018-2021. According to the compiled questionnaire, a survey was conducted of 150 social workers for a subjective assessment of health disorders, factors of conditions and nature of work. Results. In 2020, compared to 2019, the number of cases of temporary disability increased by 2.8 times, in 2021 — by 2.5 times; the number of missed days increased by almost 3 times, the largest number of cases of temporary disability in 2021 was registered in the group with 5-9 years of work experience (31 out of 128 cases; 24%). When interviewing social workers for the presence of their health disorders and affecting their ability to work, the most common symptoms were those of the respiratory system (56%), the musculoskeletal system and connective tissue (16%). It was revealed that the factors of the severity of the labor process correspond to the harmful class of working conditions of degree 3.1, the factors of intensity of the labor process — the harmful class of working conditions of degree 3.2. Conclusion. The identified features of morbidity with temporary disability must be taken into account when planning and conducting treatment and preventive work with social workers.

Isolated anterior pituitary dysfunction in adulthood.

Hypopituitarism is defined as a complete or partial deficiency in one or more pituitary hormones. Anterior hypopituitarism includes secondary adrenal insufficiency, central hypothyroidism, hypogonadotropic hypogonadism, growth hormone deficiency and prolactin deficiency. Patients with hypopituitarism suffer from an increased disability and sick days, resulting in lower health status, higher cost of care and an increased mortality. In particular during adulthood, isolated pituitary deficits are not an uncommon finding; their clinical picture is represented by vague symptoms and unclear signs, which can be difficult to properly diagnose. This often becomes a challenge for the physician. Aim of this narrative review is to analyse, for each anterior pituitary deficit, the main related etiologies, the characteristic signs and symptoms, how to properly diagnose them (suggesting an easy and reproducible step-based approach), and eventually the treatment. In adulthood, the vast majority of isolated pituitary deficits are due to pituitary tumours, head trauma, pituitary surgery and brain radiotherapy. Immune-related dysfunctions represent a growing cause of isolated pituitary deficiencies, above all secondary to use of oncological drugs such as immune checkpoint inhibitors. The diagnosis of isolated pituitary deficiencies should be based on baseline hormonal assessments and/or dynamic tests. Establishing a proper diagnosis can be quite challenging: in fact, even if the diagnostic methods are becoming increasingly refined, a considerable proportion of isolated pituitary deficits still remains without a certain cause. While isolated ACTH and TSH deficiencies always require a prompt replacement treatment, gonadal replacement therapy requires a benefit-risk evaluation based on the presence of comorbidities, age and gender of the patient; finally, the need of growth hormone replacement therapies is still a matter of debate. On the other side, prolactin replacement therapy is still not available. In conclusion, our purpose is to offer a broad evaluation from causes to therapies of isolated anterior pituitary deficits in adulthood. This review will also include the evaluation of uncommon symptoms and main etiologies, the elements of suspicion of a genetic cause and protocols for diagnosis, follow-up and treatment.

Evaluation of a Group Therapy for Work-Related Mental Disorders.

Objectives: Work-related mental distress is one of the most dominant reasons for sick leave and early retirement. Specialized therapy programs for work-related mental health problems are rare, especially in a group setting. This study evaluates the severity of depression, anxiety, somatization and burnout symptoms before and after a work-related group therapy program. Methods: Patients of a psychosomatic outpatient clinic with work-related mental disorders completed 12 sessions of a manual-based group training with reference to the workplace. Data were collected using the Patient Health Questionnaire-9 (PHQ-9), Patient Health Questionnaire-15 (PHQ-15), General Anxiety Disorder Scale-7 (GAD-7) and the Maslach Burnout Inventory (MBI) before (T1) and directly after the intervention (T2). Results: Overall, 48 participants completed the intervention. The participants' symptoms of depression (T1: M = 11.06, SD = 6.19, T2: M = 8.92, SD = 8.17; p < 0.001, d = 0.53) and anxiety (T1: M = 9.94, SD = 5.18, T2: M = 7.13, SD = 5.69; p = 0.001, d = 0.49) as well as their emotional exhaustion (T1: M = 4.63, SD = 0.95, T2: M = 4.05, SD = 1.35; p < 0.001, d = 0.55) decreased significantly, and the difference was clinically relevant at T2. For cynicism (T1: M = 3.93, SD = 0.99, T2: M = 3.70, SD = 1.32; p = 0.14, d = 0.22) and personal fulfillment at work (T1: M = 4.30, SD = 0.83, T2: M = 4.41, SD = 0.94; p = 0.24, d = 0.17), the difference between T1 and T2 was not significant. Women benefited more than men (PHQ-9: p < 0.001, d = 0.96; GAD-7: p < 0.001, d = 0.91; PHQ-15: p < 0.001, d = 0.76) from the training. Conclusions: Participants' mental health symptoms were substantially reduced during the course of the work-related group therapy. As mental health problems account for the largest group of work disability days, the potential of group therapy should be better exploited in health care services.

Social and economic burden of stroke in Russian Federation

The purpose of this study was to assess the annual socio-economic burden of stroke in the Russian Federation from the position of the state. Based on official statistics on morbidity and mortality due to stroke (2019), the results of a survey of patients or caregivers (680 respondents) and cost indicators of 2022, the social and economic burden of stroke during the 1st year after the acute period is modeled. All cost estimates are made from the position of the state. In 2019 435.2 thousand cases of stroke have been registered in the Russian Federation, 30% of those patients died during the year after the acute episode, thus annually up to 1.7 million years of life are lost. According to our study, stroke accounted for 2% of all days of disability paid by Social Insurance Fund in 2019 and 9% of cases of primary receiving of disability. More than 139 thousand working people assisted their relatives who suffered a stroke, 59.2 thousand of them were forced to change jobs, 18 thousand people left work due to the need to care for a relative. The economic burden of stroke amounted to more than 490 billion rubles. or 0.3% of GDP. The average costs per 1 registered case of hemorrhagic stroke amounted to 0.93 million rubles, ischemic - 1.2 million rubles, of which about 10% are medical costs, 5% are non-medical costs and 85% are costs associated with loss of productivity. Stroke causes a significant socio-economic burden for the state in the Russian Federation, the economic losses within 1 year is equal to the 0.3% of the country's annual GDP. The main contribution to the stroke economic and social burden is not only mortality, but also disability, leading to incapacitation of patients who have suffered a stroke, as well as to a reduction in the contribution to the economy of their relatives who help and care for them.

Lifestyle, Type of Work, and Temporary Disability: An Incidence Study of the Working Population.

The objective of the study was to identify lifestyles associated with loss of health among workers. A retrospective longitudinal incidence study was carried out over a three-year period (2015, 2016, and 2017) among the working population. A total of 240 workers were analysed using information from occupational health assessments. The outcome variable was loss of health due to common illness or workplace injury, quantified by the number of days each episode lasted. Predictor variables were age, gender, type of work, tobacco use, alcohol consumption, physical activity (IPAQ), and adherence to the Mediterranean diet (AMD). An adjusted multiple linear regression was performed, determining the goodness of fit of the final model using the coefficient of determination adjusted r2. During the study, 104 men (58.8%) and 25 women (39.7%) suffered an episode of illness or workplace injury (p &lt; 0.05). The overall incidence was 17.9% people/year 95% CI [15, 21.3]. 4.6% of the workers were sedentary or engaged in light physical activity, and 59.2% maintained an adequate AMD. Workers who engaged in high levels of physical activity had an average of 36.3 days of temporary disability compared to 64.4 days for workers with low-moderate levels of physical activity (p &lt; 0.01).

УСЛОВИЯ ТРУДА И ПРОФЕССИОНАЛЬНЫЙ РИСК ЗДОРОВЬЮ РАБОТНИКОВ ЦЕХА ПО ПРОИЗВОДСТВУ ПРОТИВООПУХОЛЕВЫХ ЛЕКАРСТВЕННЫХ СРЕДСТВ

Background. Ensuring safe working conditions in the production of medicines is a guarantee of maintaining labor resources and sustainable socio-economic development of the state as a whole. Objective: to study the working conditions and morbidity rates with temporary disability of workers in the shop for the production of anticancer drugs and establish the level of occupational risk to their health. Material and methods. Based on the data of industrial laboratory control of factors of the working environment and the labor process, the results of certification of workplaces, a comprehensive hygienic assessment of working conditions was carried out at 10 main workplaces of the workshop for the production of anticancer drugs in the form of freeze-dried powders and solutions for injections. The source of information for the study of morbidity with temporary disability of workers was the certificates of incapacity for work for a five-year period. The study of morbidity with temporary disability was carried out on two formed groups of workers (the main group - shop workers and the comparison group - employees of management departments). A quantitative assessment of the magnitude of occupational risk was carried out using the results of a study of working conditions, health indicators of employees, data from checking a business entity according to a checklist. Results. The main contribution to the formation of harmful working conditions at a number of workshop workplaces is made by contact with unregulated chemicals, noise, unsatisfactory microclimate parameters in the cold season, and excessive indicators of the severity of the labor process. The level of morbidity with temporary disability of workers in the shop for the production of anticancer drugs was assessed as "medium". The integral indicator among shop workers, taking into account cases and days of temporary disability, did not have statistically significant differences with the average annual indicator in the republic, however, it was higher than in the comparison group (t=2.97, p&lt;0.05). The numerical value of the indicator of the actual level of occupational risk was 1.7. Conclusion. The value of the indicator of the level of occupational risk established in the course of the study indicates the average degree of occupational causation of health disorders among workers in the shop for the production of anticancer drugs in the form of freeze-dried powders and solutions for injections.

Differences in Modified-Return-to-Work by Immigration Characteristics Among a Cohort of Workers in British Columbia, Canada.

Introduction To investigate differences in modified-return-to work (MRTW) within the first 30 days of a work-related, short-term disability injury by immigration characteristics. This question was part of a program of research investigating differences in work and health experiences among immigrant workers and explanations for longer work disability durations. Methods Workers' compensation claims, immigration records and medical registry data were linked to identify a sample of workers in British Columbia, Canada with a short-term disability claim for a work-related back strain, concussion, limb fracture or connective tissue injury occurring between 2009 and 2015. Multivariable logistic regressions, stratified by injury type, investigated the odds of MRTW, defined as at least one day within the first 30 days on claim, associated with immigration characteristics, defined as a Canadian-born worker versus a worker who immigrated via the economic, family member or refugee/other humanitarian classification. Results Immigrant workers who arrived to Canada as a family member or as a refugee/other immigrant had a reduced odds of MRTW within the first 30 days of work disability for a back strain, concussion and limb fracture, compared to Canadian-born workers. Differences in MRTW were not observed for immigrant workers who arrived to Canada via the economic classification, or for connective tissue injuries. Conclusion The persistent and consistent finding of reduced MRTW for the same injury for different immigration classifications highlights contexts (work, health, social, language) that disadvantage some immigrants upon arrival to Canada and that persist over time even after entry into the workforce, including barriers to MRTW.

Dose-response relationship and effect modifier of stabilisation exercises in nonspecific low back pain: a project-wide individual patient data re-analysis on 1483 intervention participants.

This planned MiSpEx-Network reanalysis was designed to derive a dose-response relationship under consideration of further effect modifiers in exercises on low back pain. One thousand four hundred eighty three intervention participants with low back pain (mean age, 40.9 years [SD 14 years]) performed stabilisation exercises (3 weeks supervised, 9 weeks self-administered). Patients reported pain intensity, disability, and disability days at baseline, 3 weeks, 12 weeks, and 6 months post randomisation. Exercise characteristics and effect modifiers were prospectively monitored. Beyond the comparison to the results of the control group, linear mixed models were calculated to determine a dose-response relationship. The interventions led to small but significantly larger symptom reductions than in the control group at each measurement. Longer durations of the intervention led to larger symptom reductions. Higher exercise frequencies were associated with a decrease in pain intensity: to train once more per week led to a mean decrease of 0.93 points in pain intensity [95% CI = -1.54 to -0.32]. Disability days were also impacted (estimate = -0.07 [-0.14 to 0.00]), but disability was not (-0.09 [-0.67 to 0.48]). Adding perturbation was superior to adding stretching or a behavioural module. The relationships were robust when additional effect modifiers were considered and against the control group' effects. The odds ratio for a clinically important effect with higher exercise frequencies decreased at 3 weeks (OR = 0.71 [0.618-0.813] for >2.5*week -1 ) and increased at 12 weeks (1.13 [1.006-1.270], >1.5*week -1 ). Using longer intervention durations, adding a perturbation component to the stabilisation trainings and using higher frequencies (up to a certain point) may lead to an even more beneficial response on exercise in patients with low back pain. Developing strategies to maintain a training frequency of at least 2 times per week may be relevant in stabilisation exercises to treat low back pain.

Out-of-Pocket Spending and Work Loss after Common Surgical Procedures Among Working-Age Adults

INTRODUCTION: Half of surgical patients report financial toxicity, which results from direct out-of-pocket (OOP) cost and indirect loss of income. This study aimed to assess the economic impact of common surgical procedures on patient OOP spending and work loss among working-age adults. METHODS: We used the 2017 to 2019 MarketScan Database to identify adults ages 19 to 64 years who underwent 1 of 20 common surgical procedures. These data were linked to the Health Productivity and Management (HPM) Database, which reports work absence and disability for a subset of employers. Outcomes included spending after index operation, disability, and return to work. Multivariable regression models adjusted for patient demographics and clinical variables. To control for secular trends, we used 4:1 propensity score matching using patient and employment variables. RESULTS: We identified 135,480 patients and 541,920 matched controls. Among this cohort, 25% of patients had a nonelective presentation and 12% had an ICU admission. Spending, missed work, and disability for patients linked to the HPM database are shown in the Table. Nonelective presentation was associated with higher OOP spending and more short-term disability (p < 0.05). Patients requiring ICU stay had higher OOP spending and more missed days of work and disability (p < 0.05). Table. - Six Month Out-of-Pocket Spending and Missed Work after Common Surgical Procedures Variable Surgical patients Matched controls Difference p Value Mean OOP spending (median, IQR) $3,487 ($2,020, $749-3,597) $636 ($12, $0-422) $2,851 <0.001 Any missed work 62.1% 32.5% 29.6% <0.001 Mean total days missed (median, IQR) 23 (15,4-36) 3 (2, 0-4) 20 <0.001 Any short-term disability 36.2% 2.7% 33.5% <0.001 Mean total days of short-term disability (median, SD) 41 (32, 19-56) 35 (15, 0-54) 6 <0.001 Surgical cohorts include common cardiac, vascular, general, and orthopedic procedures. OOP spending represents coinsurance, copays, and deductibles per patient. Missed work and short-term disability outcomes are only for those linked to the HPM database and employed at time of index admission. CONCLUSION: Patients recovering from operation face high OOP payments, miss over a month of work on average, and one in three receive short-term disability benefits. These findings demonstrate the double burden of medical expense and productivity loss and can inform policies for improved financial risk protection after operation.

Too serious to ignore: The epidemiologic and economic burden of home injuries in the Southwest Region of Cameroon-A community-based study.

BackgroundHome injuries are an important cause of morbidity and mortality in high-income countries. In Sub-Saharan Africa, including Cameroon, many people live in unplanned settlements with poorly constructed houses, predisposing them to home injuries. However, little is known about the epidemiology and care-seeking behaviors of the domestically injured. In this study, our objective was to determine the epidemiology and care-seeking behaviors of home injuries in the Southwest Region of Cameroon.MethodsA sub-analyses of a larger descriptive cross-sectional community-based study on injury epidemiology in the preceding 12 months was conducted. Sampling was done using three-stage cluster sampling technique. Differences between groups were evaluated using Chi-squared and Adjusted Wald tests.ResultsOf 8065 participants, 157 suffered home injuries giving an incidence of 19.6 (16.8–23.0 95% CI) cases per 1000-person years. Home injuries comprised 31.2% of all 503 injuries and affected more females (60.8%) and younger individuals (mean age (SE) 25.1 years (2.0)) than non-home injuries. The most common activity and mechanism of home injury was leisure/play (51%) and falls (37.9%) respectively. Amongst those with home injuries, 37.6% did not seek care from any care provider (versus 25.0% of non-home injuries, p = 0.004) and were more likely to seek treatment within the family or at home (p = 0.008) or at church (p = 0.010). Those with home injuries experienced a median of 14 disability days and 22.9% of families faced difficulties affording basic expenses (p = 0.001).ConclusionHome injuries comprise about a third of the Southwest Region of Cameroon’s burden of injury and likely have a profound socioeconomic impact. Though these injuries cause severe disabilities, a large proportion of victims do not seek care from providers. Prevention efforts should address the design of homes and victims of home injury should be encouraged to utilize formal care services.

Identification de facteurs associés à un faible recours aux soins spécialisés en psychiatrie. À propos de 516 cas d’expertises psychiatriques réalisées dans le cadre du Comité médical départemental de Martinique

ObjectiveMental illness is noted for being in one of the first places in global burden of disease in terms of years lived with disability (YLDs). Notably, absences due to mental health problems greatly affect the world of work, and mental illness is one of the most economically important diseases. However, there is a high rate of those not seeking care in mental health, both in the general population but also in workers in private and public sectors with significant economic impacts. The aim of our study was to identify factors associated with low access to specialized psychiatric care among French Public Sector employees referred to a psychiatric expertise upon request from the Departmental Medical Board of Martinique (Comité médical départemental [CMD] de Martinique), between 2000 and 2013. MethodsWe carried out an observational and transversal study, analyzing sociodemographic and clinical data from psychiatric assessments done to help the CMD give notification on the medico-administrative situation of Public Sector employees, a large majority of whom had been on sick leave due to mental health for at least 6 months. The variable of interest – low access to psychiatric care – was defined as the absence of consultation at the time of the assessment provided by a psychiatrist since at least 12 months. Descriptive analyses were performed first, then univariate analysis using a non-adjusted binary logistic regression model, to identify factors associated with low access to psychiatric care. Finally, multivariate analyses using a binary logistic regression model were performed after excluding non-relevant factors (with significance level above 5%) during the univariate analysis. A significance threshold of 0.05 was adopted for all of the statistical analyses. ResultsWe retrospectively analysed the records of 516 Public Sector employees. Two hundred and ninety-three subjects (57% of the population) had a low access to psychiatric care as part of their regular clinical follow-up, even the 81% who were identified has having had psychiatric antecedents (55% with ‘mood disorders’, and 17% with ‘neurotic, stress-related and somatoform disorders’). Moreover, psychiatric expertise found a psychiatric diagnostic in 96 % of cases, mostly ‘mood disorders’, ‘neurotic, stress-related and somatoform disorders’ and ‘personality disorders’. For mood disorders, clinical characteristics of episodes were defined as ‘severe’ or ‘with psychotic symptoms’ in many cases. Suicidal thoughts were found in 96 subjects (18%) during the expertise. Fewer than half of the subjects (43%) had a specialized psychiatric care (mostly subjects with ‘mood disorders’ and ‘psychotic disorders’) and 41% only had care by a general practitioner (mostly subjects with ‘neurotic, stress-related and somatoform disorders’). In most of the cases, psychotropic drugs were insufficiently and inadequately prescribed. Using multivariate analysis, we found a significant association between low access to psychiatric care and: being masculine, having had more than two children, having had personal life events (in particular chronic somatic diseases), and having had no history of mental illness or of psychiatric hospitalization. It appears that chronic somatic diseases are frequently associated with psychiatric diseases, and the association worsens the prognosis of the two disorders. However, even if employees with mental disorders associated with chronic somatic diseases are unfit for work, many of them do not have access to mental health care and only have care by a general practitioner. ConclusionMore than half of French Public Sector employees referred to the Departmental Medical Board of Martinique for a medico-administrative decision relevant to sick leave due to mental diseases, had low access to specialized psychiatric care. By identifying barriers to care and reasons for not seeking specialized mental health care, we would be able to prevent disability claims and days off work (predicting malaise in the workplace and health-related limitations). Our results demonstrate the need to strengthen existing partnerships, and thus enhancing cooperation between public psychiatric sectors and primary healthcare players, facilitating access to mental healthcare and decreasing the stigma about mental disorders.

Sick Leave in Colombia in the 2016–2018 period: A Retrospective Cross-Sectional Observational Study

Introduction: To understand the sick leave situation and the causes and effects of a temporary loss of capacity to work allows for the strengthening of policies and management in the provision of health services. Objective: To analyze sick leave in Colombia in the 2016–2018 period. Materials and methods: A retrospective cross-sectional observational study and the relative risk was calculated. Sick leave reports were provided by the Ministry of Health and Social Protection. 12,410,837 reports from formal workers between the ages of 18–70 years and had at least one temporary disability were processed. Results: The average age of people with sick leave was 37.11 years, 53% corresponding to females. On average, sick leave was 90.6% and 5.6% for dependent and independent workers, respectively. The principal causes of disability were musculoskeletal diseases and were more likely in men and adults according to RR. Men in comparison to females and adults in comparison to youths are less likely to have sick leave due to respiratory disease. Conclusions: In Colombia, females presented more temporary sick leave, even if males had more days of disability, even though the median was three days in both genders. Youth and adults had more sick leave days.

Impact of spinal cord stimulation on sick leave and disability pension in patients with chronic neuropathic pain: a real-world evidence study in Sweden.

Current research indicates that spinal cord stimulation (SCS) has a positive short-term impact on outcomes, such as quality of life, pain, and productivity in patients with chronic neuropathic pain. However, there is a need for studies on larger population samples. This study used data from Swedish national registers to analyze change and predictors of sick leave and disability pension 2 years before and after SCS treatment. Patients with SCS implanted between 2006 and 2017, and a reference group consisting of 5 individuals matched to each SCS patient without replacement with respect to age, sex, and region of residence, were included. A difference-in-difference approach was used to compare the average change (2 years after treatment vs 2 years before treatment) in net disability days and indirect cost related to disability days for the SCS group, compared with the average change for the reference group. The results showed that SCS treatment in Sweden is associated with a decrease of 21 disability days and consequent decrease in indirect cost of €4127 in working age patients. Large work loss prior to index date was also demonstrated (average 214 days before 1 year), indicating a significant burden on the patient, employers, and the society at large. The number of disability days varied considerably depending on age, sex, socioeconomic variables, and comorbidities; however, the effect of SCS seemed to have little association with patient characteristics. This economic benefit needs to be considered, as well as the clinical outcome, when evaluating the full societal value of SCS.

Healthcare utilization, costs, and productivity losses in treatment-resistant depression in Finland – a matched cohort study

BackgroundDue to its relatively high prevalence and recurrent nature, depression causes a major burden on healthcare systems, societies and individuals. Our objective was to investigate healthcare resource utilization and costs associated with treatment-resistant depression (TRD) compared with non-treatment-resistant depression in Finland.MethodsOf all patients aged 16–65 years and diagnosed with depression in Finland during 2004–2016, persons with TRD (N = 15,405) were identified from nationwide registers and matched 1:1 with comparison persons with depression who initiated antidepressant use but did not have TRD at the time of matching. TRD was defined as initiation of a third treatment trial after having failed two pharmacological treatment trials. Follow-up period covered 5 years after TRD or corresponding matching date (until end of 2018). Health care resource utilization was studied with negative binomial regression and costs of TRD (per patient per year) with generalized estimating equations, by adjusting for baseline costs, comorbidity and baseline severity of depression.ResultsPersons with TRD (mean age 38.7, SD 13.1, 60.0% women) had more health care utilization and work disability (sick leaves and disability pensions), adjusted incidence rate ratio for work disability days was 1.72 (95% CI 1.64–1.80). This resulted in 1.9-fold higher total costs for persons with TRD (15,907 versus 8335 EUR), adjusted mean difference 7572 (95% CI 7215–7929) EUR per patient per year, higher productivity losses (due to sick leaves and disability pensions, mean difference 5296, 95% CI 5042–5550), and direct healthcare costs (2003, 95% CI 1853–2151) compared with non-TRD patients. Mean difference was the highest during the first year after TRD (total costs difference 11,760, 95% CI 11,314–12,206) and the difference decreased gradually after that.ConclusionTreatment-resistant depression is associated with about two-fold cost burden compared with non-treatment-resistant depression.