Missed Work Days Research Articles

Healthcare Utilization and Missed Workdays for Parents of Children With Traumatic Brain Injury.

We enrolled patients in a prospective study in which we obtained estimates of the direct and indirect burden for families of children with traumatic brain injury (TBI) relative to a control group of families of children with orthopedic injury (OI). Parents were surveyed at 3 time points following injury: 3, 6, and 12 months. At each follow-up contact, we asked parents to list the number of workdays missed, number of miles traveled, amount of travel-related costs, and whether their child had an emergency department (ED) visit, hospital admission, any over-the-counter (OTC) medications, and any prescription medications during that time period. We assessed the difference in these outcomes between the TBI and OI groups using multivariable logistic and 2-part regression models to account for high concentrations of zero values. Children with TBI had significantly greater odds of having an ED visit (3.04; 95% CI, 1.12-8.24), OTC medications (1.98; 95% CI, 1.34-2.94), and prescription medications (2.34; 95% CI, 1.19-4.59) than those with OI. In addition, parents of children with TBI missed significantly more days of work (19.91 days; 95% CI, 11.64-28.17) overall during the 12 months following injury than their OI counterparts. Extrapolating our results to the entire country, we estimate that pediatric TBI is associated with more than 670 000 lost workdays annually over the 12 months following injury, which translates into more than $150 million in lost productivity. These missed workdays and lost productivity may be prevented through safety efforts to reduce pediatric TBI.

Ambulatory Management of Childhood Asthma Using a Novel Self-management Application.

Pediatric ambulatory asthma control is suboptimal, reducing quality of life (QoL) and causing emergency department (ED) and hospital admissions. We assessed the impact of the electronic-AsthmaTracker (e-AT), a self-monitoring application for children with asthma. Prospective cohort study with matched controls. Participants were enrolled January 2014 to December 2015 in 11 pediatric clinics for weekly e-AT use for 1 year. Analyses included: (1) longitudinal changes for the child (QoL, asthma control, and interrupted and missed school days) and parents (interrupted and missed work days and satisfaction), (2) comparing ED and hospital admissions and oral corticosteroid (OCS) use pre- and postintervention, and (3) comparing ED and hospital admissions and OCS use between e-AT users and matched controls. A total of 327 children and parents enrolled; e-AT adherence at 12 months was 65%. Compared with baseline, participants had significantly (P < .001) increased QoL, asthma control, and reduced interrupted and missed school and work days at all assessment times. Compared with 1 year preintervention, they had reduced ED and hospital admissions (rate ratio [RR]: 0.68; 95% confidence interval [CI]: 0.49-0.95) and OCS use (RR: 0.74; 95% CI: 0.61-0.91). Parent satisfaction remained high. Compared with matched controls, participants had reduced ED and hospital admissions (RR: 0.41; 95% CI: 0.22-0.75) and OCS use (RR: 0.65; 95% CI: 0.46-0.93). e-AT use led to high and sustained participation in self-monitoring and improved asthma outcomes. Dissemination of this care model has potential to broadly improve pediatric ambulatory asthma care.

The transmission of the influenza virus from patient to emergency physician: No flu for you

BackgroundSignificant morbidity and mortality is attributed to infection with the influenza virus annually and care is often sought in Emergency Departments (ED). The exposure of Emergency Department healthcare personnel and subsequent illness is speculated to be high but has not been quantified. MethodsAll physicians and mid-level providers in a large tertiary care ED who cared for an Influenza-positive patient were identified and surveyed. Information was gathered regarding each provider's report of an Influenza-like illness during the study period as well as laboratory testing results, sick contacts and subsequent missed work. General descriptive information of Influenza-positive patients was extracted through a retrospective chart review. Results1020 Influenza-positive patients were cared for by 106 physicians and advanced practice nurses. Patients testing positive for Influenza-A were more likely to be admitted (p = .003). The majority of patients (83%) were cared for by an attending only. Our provider survey response rate was 87%. 1 in 4 providers reported suffering from an Influenza-like illness during the study period and no providers subsequently missed work days. Only 4 (5%) of those providers sought medical care to receive testing. Overall, 2% of ED providers tested positive for Influenza. ConclusionsAmong Emergency Department providers, transmission of clinically significant Influenza illness was low.

Report looks at MH challenges in the workplace

A new report from Unum, a leading provider of employee benefits, reveals that just 25 percent of managers in the United States have received training on how to refer employees to mental health resources, and more than half of people are unsure how they would help a colleague who came to them with a mental health issue, Business Wire reported March 27. Among its key findings, the report noted that mental illness is one of the top causes of worker disability in the United States, and 62 percent of missed work days can be attributed to mental health conditions. Additionally, 55 percent of employees said their employer did not have, or they were unsure if their employer had, a specific program, initiative or policy in place to address mental health. “Creating a workplace culture that promotes mental health resources and encourages employees to take advantage of them helps to destigmatize mental health issues and leads to a happier, more productive workforce,” said Michelle Jackson, assistant vice president of market development at Unum.

Abstract 73: The True Cost of Stroke: Assessment of Direct and Indirect Cost of Stroke Among All Age Groups in United States of America From 2003 to 2014

Introduction: Researchers have looked at medical expenses directly associated with stroke care, however, there is a paucity of data regarding indirect costs associated with productivity loss, especially in young adults. Methods: Direct and indirect medical costs were compared between stroke and non-stroke patients using the 2003-2014 Medical Expenditure Panel Survey-Household components. Direct costs include expenditures from hospitalizations, emergency room/clinic visits, medications, home health services etc. Indirect costs depend on employment, wages, missed work days (limited to 18-64 age group), and productivity loss from premature death. Two-part econometric models were used to estimate the adjusted incremental direct expenditure for patients with stroke. We used a generalized linear model with family gamma, log link for the adjusted analysis of annual wage and a negative binomial regression model for the adjusted analysis of missed work day. Loss of productivity due to premature death was computed across all age groups using Present value of one life and annual number of deaths obtained from the 2014 National Vital Statistics. Results: We identified 8,101,160 stroke and 245,133,892 non-stroke patients of all age groups. Weighted samples of 10,175 stroke and 314,694 non-stroke patients were compared. Total adjusted incremental direct cost for a stroke patient (vs. non-stroke) was $4,317 (95% CI $3,828-4,807) causing a $35 billion increment in total direct cost annually. Stroke patients had $14,254 (95% CI $16,023-12,485) lower adjusted annual wage, 4.2 (95% CI 2.9-5.6) more missed workdays and nearly 60% (OR 0.41; 95% CI 0.36-0.46) lower employment compared to non-stroke patients yielding an estimated annual $38.1 billion indirect-cost due to productivity loss. Indirect-cost from premature death was estimated to be $30.4 billion. Total (direct + indirect) annual cost for stroke patients was $103.5 billion. Conclusion: Two-thirds of the estimated $103.5 billion annual cost involved with stroke patients is attributed to indirect expenditures. Loss of productivity due to premature death is heavily concentrated in the economically productive age group. Our findings renew the call for greater emphasis on stroke prevention strategies.

Cost of Severe Chronic Obstructive Pulmonary Disease Exacerbations in a High Burden Region in North India.

Background:Data on costs of acute exacerbations of COPD (AECOPD) in low-income countries are sparse. We conducted a prospective survey to assess direct and indirect costs of severe AECOPD in a tertiary care setting in a high prevalence area of North India.Methods:We conducted face-to-face surveys using a semi-structured questionnaire among a convenience sample of 129 consenting patients admitted with AECOPD. Data were collected on out-of-pocket costs of hospitalization, consultation, medications, diagnostics, transportation, lodging, and missed work days for self and their attendants. Out-of-pocket costs were supplemented with World Health Organization-CHOICE estimates. Missed work-days were valued on per capita national income (Indian Rupees [INR] 68,748, US$1,145.8). Median total cost per exacerbation episode was INR 44,390 (Inter-quartile range [IQR]: INR 33,354–63,642; US$739.8, IQR: 555.9–1060.7). Hospital costs constituted the largest component of the costs (71%) followed by other costs directly borne by the patient himself (29%), medicine costs (14%), transportation charges (2%) and diagnostic tests (3%). Indirect costs to caregivers (median INR 1,544, IQR: INR 0–17,370 INR; US$25.7, IQR: US$0–289.5), calculated as financial loss due to missed work days, accounted for 4% of the total cost. Expenses were covered by family members in all but 11 patients.Conclusions:AECOPD in India are associated with substantial costs and strategies to reduce the burden of disease such as smoking cessation, influenza and pneumococcal vaccination, etc should be aggressively pursued.

Musculoskeletal complaints, absenteeism and associated factors among cytotechnologists: cross-sectional study.

Cytotechnologists are laboratory professionals who analyze cytology slides under optical microscopes. Static postures, speed and repetitive movements are associated with occurrence of musculoskeletal complaints. To establish the main musculoskeletal complaints among cytotechnologists at the National Cancer Institute, Brazil, test associations between absenteeism due to musculoskeletal complaints and individual and occupational variables, and characterize absenteeism related to diseases of the musculoskeletal system in 2016 and 2017. Cross-sectional study in which we administered the Nordic Musculoskeletal Questionnaire and tested associations between exposure variables and absenteeism. We also analyzed morbidity records kept at the Occupational Health Division (OHD) to establish the main disorders related to absenteeism. Associations were investigated by means of Fisher's test using SPSS version 20.0. The significance level was set to p<0.05. 34.4% of the sample required sick leave due to musculoskeletal complaints. The most affected body site was the neck (18%). As per the OHD records, sickness absenteeism was mainly due to diseases of the musculoskeletal system and connective tissue (25%). We found statistically significant association of absenteeism with length in the job and body mass index. Diseases of the musculoskeletal system and connective tissue were the main reason for missing work days. Absenteeism was associated with length in the job and high body mass index.

Sickness absenteeism among outsourced hygiene and cleaning workers at a university hospital in São Paulo, Brazil, 2015-2017.

ABSTRACT |Background: Absenteeism refers to frequent absences from work without producing a medical certificate or having been granted sick leave.Objective: To establish the rate of short-term sickness absenteeism (1 to 15 days) among outsourced hygiene and cleaning workers at a university hospital.Methods: Retrospective analysis of all medical and dental certificates collected by the contractor along two years (2015 through 2017). Descriptive statistics analysis was performed according to the nature of variables (absolute and relative frequencies and measures of central tendency and variability for categorical and numerical variables respectively) followed by Pearson’s χ2 test.Results: The study population consisted of 370 workers, most of whom were female (n=333, 91.4%), aged 30 to 50 and with low educational level. The monthly absenteeism rate was 5.2%, on average, and the sickness absenteeism rate 37.9%. The most prevalent reasons for sick leave were musculoskeletal disorders (n=271, 20.7%) and diseases of the digestive system (n=141, 10.8%). The total number of missed work days along the analyzed period was 8,788.Conclusion: The epidemiological profile of sick leave spells included both occupational diseases (musculoskeletal disorders) and conditions without direct or indirect relationship to work. The proportion of sickness absence was low relative to the overall absenteeism rate.

The Role of School Environments and Occupational Stressors for Michigan Public School Teachers: An Assessment of Stress and Health

School teachers experience tremendous occupational stress, which can lead to low retention, missed work days, and lower quality of life. Teachers working in low-resource school districts face unique challenges and stressors, with some experiencing poor indoor air quality, crowding, and biological exposures. The objective of this pilot research was to assess cumulative stressors in low and high-resource public school districts, and the influence these stressors have on perceived stress and biological stress response for teachers. Teachers were recruited from four low- and high-resource school districts in southeast Michigan. Participants were surveyed on demographics, occupation, health, and perceived stressors. Blood pressure and heart rate were measured at the time of the survey. Individual salivary cortisol samples were collected in the afternoon (n&amp;#61;3) and evening (n&amp;#61;3) following the survey. An environmental survey of each teacher&amp;#8217;s classroom and school was conducted to assess room and school conditions, noise, and proximity to major roadways and industry. Fifty-nine (n&amp;#61;59) teachers were recruited from 26 public schools. Teachers at low-resource school districts had higher afternoon cortisol levels (4.12 nmol/L) and a higher prevalence of hypertension (54%), although not significant, compared to high-resource school district teachers (3.11 nmol/L and 45%, respectively). Low-resource school district teachers had significantly higher reported occupational stress (p&amp;#61;0.004); specifically concerning environmental quality, relationships, and demands; and were more likely to feel stressed &amp;#8220;very often&amp;#8221; and &amp;#8220;fairly often&amp;#8221; (82%) compared to high-resource school district teachers (45%). Teachers&amp;#8217; classrooms and schools were less likely to be classified as well-maintained in low-resource school districts. This research will support priority-setting for reducing occupational and environmental stressors for school districts to improve teacher health outcomes and retention.

Integrating Technology into Clinical Care to Improve Outcomes in Panic Disorder: Use of Safety Behaviors and Resulting Anxiety as Assessed by Smartphone-Based Experience Sampling Methods

Background: Research in mental health conditions such as panic disorder suffers from issues related to the means of assessing the condition and its contributing factors by self-report in the office setting. The integration of real time technologies into research is critically needed. Panic disorder is the fifth leading cause of missed work days across all chronic medical conditions, and anxiety disorders are estimated to cost more than $40 billion annually in the United States (Greenberg et al, 1999). Panic attacks occur in approximately 23% of the general population (Kessler et al, 2006) and cause substantial functional and social impairment, as well as significant financial burden on the health care system. While effective treatments for panic disorder exist, more than half of patients do not improve, remain symptomatic post-treatment, or return to treatment within two years (Brown & Barlow, 1995; Gloster et al, 2013). Very little is known about what treatment will work for each patient and why. New technologies allow us to identify individual factors that may be important to treatment outcomes. This pilot study aimed to bridge the gap between the human element and technology using smartphones to more efficiently investigate a factor that may contribute to lack of remission in panic disorder, the use of safety behaviors. Safety behaviors represent ineffective attempts to reduce or eliminate anxiety (eg, carrying a water bottle to reduce physiological sensations that arise during anxiety; Helbig-Lang & Petermann, 2010). They are hypothesized with mixed evidence to play a central role in the etiology and maintenance of anxiety disorders, including panic disorder. Existing studies are limited in their temporal conclusions and ecological validity. New technologies such as smartphones permit time-intensive investigation of these phenomena in the natural environment in which they occur, thus improving external validity.

Lifetime Economic Burden of Intimate Partner Violence Among U.S. Adults

This study estimated the U.S. lifetime per-victim cost and economic burden of intimate partner violence. Data from previous studies were combined with 2012 U.S. National Intimate Partner and Sexual Violence Survey data in a mathematical model. Intimate partner violence was defined as contact sexual violence, physical violence, or stalking victimization with related impact (e.g., missed work days). Costs included attributable impaired health, lost productivity, and criminal justice costs from the societal perspective. Mean age at first victimization was assessed as 25 years. Future costs were discounted by 3%. The main outcome measures were the mean per-victim (female and male) and total population (or economic burden) lifetime cost of intimate partner violence. Secondary outcome measures were marginal outcome probabilities among victims (e.g., anxiety disorder) and associated costs. Analysis was conducted in 2017. The estimated intimate partner violence lifetime cost was $103,767 per female victim and $23,414 per male victim, or a population economic burden of nearly $3.6 trillion (2014 US$) over victims' lifetimes, based on 43 million U.S. adults with victimization history. This estimate included $2.1 trillion (59% of total) in medical costs, $1.3 trillion (37%) in lost productivity among victims and perpetrators, $73 billion (2%) in criminal justice activities, and $62 billion (2%) in other costs, including victim property loss or damage. Government sources pay an estimated $1.3 trillion (37%) of the lifetime economic burden. Preventing intimate partner violence is possible and could avoid substantial costs. These findings can inform the potential benefit of prioritizing prevention, as well as evaluation of implemented prevention strategies.

The effectiveness of 6 versus 12-months of dialectical behaviour therapy for borderline personality disorder: the feasibility of a shorter treatment and evaluating responses (FASTER) trial protocol

BackgroundAlthough Dialectical Behaviour Therapy (DBT) is an evidence-based psychosocial treatment for borderline personality disorder (BPD), the demand for it exceeds available resources. The commonly researched 12-month version of DBT is lengthy; this can pose a barrier to its adoption in many health care settings. Further, there are no data on the optimal length of psychotherapy for BPD. The aim of this study is to examine the clinical and cost-effectiveness of 6 versus 12 months of DBT for chronically suicidal individuals with BPD. A second aim of this study is to determine which patients are as likely to benefit from shorter treatment as from longer treatment.Methods/DesignPowered for non-inferiority testing, this two-site single-blind trial involves the random assignment of 240 patients diagnosed with BPD to 6 or 12 months of standard DBT. The primary outcome is the frequency of suicidal or non-suicidal self-injurious episodes. Secondary outcomes include healthcare utilization, psychiatric and emotional symptoms, general and social functioning, and health status. Cost-effectiveness outcomes will include the cost of providing each treatment as well as health care and societal costs (e.g., missed work days and lost productivity). Assessments are scheduled at pretreatment and at 3-month intervals until 24 months.DiscussionThis is the first study to directly examine the dose-effect of psychotherapy for chronically suicidal individuals diagnosed with BPD. Examining both clinical and cost effectiveness in 6 versus 12 months of DBT will produce answers to the question of how much treatment is good enough. Information from this study will help to guide decisions about the allocation of scarce treatment resources and recommendations about the benefits of briefer treatment.Trial registrationNCT02387736. Registered February 20, 2015.

Meditation or exercise for preventing acute respiratory infection (MEPARI-2): A randomized controlled trial.

BackgroundPractice of meditation or exercise may enhance health to protect against acute infectious illness.ObjectiveTo assess preventive effects of meditation and exercise on acute respiratory infection (ARI) illness.DesignRandomized controlled prevention trial with three parallel groups.SettingMadison, Wisconsin, USA.ParticipantsCommunity-recruited adults who did not regularly exercise or meditate.Methods1) 8-week behavioral training in mindfulness-based stress reduction (MBSR); 2) matched 8-week training in moderate intensity sustained exercise (EX); or 3) observational waitlist control. Training classes occurred in September and October, with weekly ARI surveillance through May. Incidence, duration, and area-under-curve ARI global severity were measured using daily reports on the WURSS-24 during ARI illness. Viruses were identified multiplex PCR. Absenteeism, health care utilization, and psychosocial health self-report assessments were also employed.ResultsOf 413 participants randomized, 390 completed the trial. In the MBSR group, 74 experienced 112 ARI episodes with 1045 days of ARI illness. Among exercisers, 84 had 120 episodes totaling 1010 illness days. Eighty-two of the controls had 134 episodes with 1210 days of ARI illness. Mean global severity was 315 for MBSR (95% confidence interval 244, 386), 256 (193, 318) for EX, and 336 (268, 403) for controls. A prespecified multivariate zero-inflated regression model suggested reduced incidence for MBSR (p = 0.036) and lower global severity for EX (p = 0.042), compared to control, not quite attaining the p<0.025 prespecified cut-off for null hypothesis rejection. There were 73 ARI-related missed-work days and 22 ARI-related health care visits in the MBSR group, 82 days and 21 visits for exercisers, and 105 days and 24 visits among controls. Viruses were identified in 63 ARI episodes in the MBSR group, compared to 64 for EX and 72 for control. Statistically significant (p<0.05) improvements in general mental health, self-efficacy, mindful attention, sleep quality, perceived stress, and depressive symptoms were observed in the MBSR and/or EX groups, compared to control.ConclusionsTraining in mindfulness meditation or exercise may help protect against ARI illness.LimitationsThis trial was likely underpowered.Trial registrationClinicaltrials.gov NCT01654289

Chikungunya outbreak (2017) in Bangladesh: Clinical profile, economic impact and quality of life during the acute phase of the disease.

BackgroundChikungunya virus causes mosquito-transmitted infection that leads to extensive morbidity affecting substantial quality of life. Disease associated morbidity, quality of life, and financial loss are seldom reported in resources limited countries, such as Bangladesh. We reported the acute clinical profile, quality of life and consequent economic burden of the affected individuals in the recent chikungunya outbreak (May to September 2017) in Dhaka city, Bangladesh.MethodsWe conducted a cross-sectional study during the peak of chikungunya outbreak (July 24 to August 5, 2017) to document the clinical profiles of confirmed cases (laboratory test positive) and probable cases diagnosed by medical practitioners. Data related to clinical symptoms, treatment cost, loss of productivity due to missing work days, and quality of life during their first two-weeks of symptom onset were collected via face to face interview using a structured questionnaire. World Health Organization endorsed questionnaire was used to assess the quality of life.ResultsA total of 1,326 chikungunya cases were investigated. Multivariate analysis of major clinical variables showed no statistically significant differences between confirmed and probable cases. All the patients reported joint pain and fever. Other more frequently reported symptoms include headache, loss of appetite, rash, myalgia, and itching. Arthralgia was polyarticular in 56.3% of the patients. Notably, more than 70% patients reported joint pain as the first presenting symptom. About 83% of the patients reported low to very low overall quality of life. Nearly 30% of the patients lost more than 10 days of productivity due to severe arthropathy.ConclusionsThis study represents one of the largest samples studied so far around the world describing the clinical profile of chikungunya infection. Our findings would contribute to establish an effective syndromic surveillance system for early detection and timely public health intervention of future chikungunya outbreaks in resource-limited settings like Bangladesh.

Burden of Depression among Working-Age Adults with Rheumatoid Arthritis.

Objective This study estimated the excess clinical, humanistic, and economic burden associated with depression among working-age adults with Rheumatoid Arthritis (RA). Methods A retrospective cross-sectional study was conducted among working-age (18 to 64 years) RA patients with depression (N = 647) and without depression (N = 2,015) using data from the nationally representative Medical Expenditure Panel Survey for the years 2009, 2011, 2013, and 2015. Results Overall, 25.8% had depression. In adjusted analyses, adults with RA and depression compared to those without depression were significantly more likely to have pain interference with normal work (severe pain: AOR = 2.22; 95% CI = 1.55, 3.18), functional limitations (AOR = 2.17; 95% CI = 1.61, 2.94), and lower mental health HRQoL scores. Adults with RA and depression had significantly higher annual healthcare expenditures ($14,752 versus 10,541, p < .001) and out-of-pocket spending burden. Adults with RA and depression were more likely to be unemployed and among employed adults, those with depression had a significantly higher number of missed work days annually and higher lost annual wages due to missed work days. Conclusions This study highlights the importance of effectively managing depression in routine clinical practice of RA patients to reduce pain and functional limitations, improve quality of life, and lower direct and indirect healthcare costs.

Productivity loss of caregivers of schizophrenia patients: a cross-sectional survey in Japan

Background: When a family member is diagnosed with schizophrenia, it causes stress to the caregiver that can eventually result in missed work days and lower work performance.Aim: This study aims at revealing productivity costs for caregivers of schizophrenia patients in Japan.Method: A cross-sectional survey of caregivers was conducted and resulted in 171 respondents. The assessment of work productivity included calculating the costs of absenteeism, presenteeism and total productivity costs. This was accomplished using the “Work Productivity and Activity Impairment Questionnaire” (WPAI).Results: A relative majority of caregivers in the sample provided care for their spouse (47%), 18% cared for their brother or sister and 16% provided care for their child. Per capita productivity costs totaled JPY 2.42 million, with JPY 2.36 million (97%) of that amount being due to presenteeism.Conclusions: The burden on caregivers is substantial enough to warrant structured support programs aimed at maintaining careers’ physical and mental health, helping them provide more effective care to schizophrenia patients and eventually increase productivity at work.

Sickness absence among public workers in the healthcare sector of the Federal District, Brazil.

To describe the profile and indicators of sickness absence for civil servants allocated to the 18 public health units of a Federal District (Brasilia) Health Region, Brazil. Cross-sectional study of all sick leaves longer than 3 days granted in 2014. Sickness absence indicators were calculated and analyzed per sex, marital status, age, educational level, professional category, length in the job, working hours and workplace. The analyzed population (n=2,501) was granted 2,205 sick leaves in total, corresponding to 40,755 missed work days. The prevalence of sickness absence was 39%, the leave frequency index 88%, the severity index 16 days, the average sickness absence length 42 days, and the average length of leaves 18 days. More than 85% of the missed work days corresponded to workers with recurrence of sickness absence. Mental and behavioral disorders and musculoskeletal diseases were the main causes of sick leave. Planning health actions demands accurate knowledge of the characteristics and morbidity profile of this population of workers. The results of the present study express the magnitude of sickness absence in the public health sector, and point to the need for thorough change in the organization of the work process and innovative interventions in the workplace.

The national burden of poorly controlled asthma, school absence and parental work loss among school-aged children in the United States

ABSTRACTObjective: The degree of poorly controlled asthma and its association with missed school days and parental missed work days is not well understood. Methods: This was a retrospective analysis of missed school days and missed work days for school-aged children (SAC; aged 6–17) and their caregivers in the nationally representative 2007–2013 Medical Expenditure Panel Survey (MEPS). Indicators of poor asthma control included: exacerbation in previous 12 months; use of >3 canisters of short-acting beta agonist (SABA) in 3 months; and annual asthma-specific (AS) Emergency Department (ED) or inpatient (IP) visits. Negative binomial regression was used for missed school days, and a Heckman two-step selection model was used for missed work days. All analyses controlled for sociodemographics and other covariates. Results: There were 44,320 SAC in MEPS, of whom 5,890 had asthma. SAC with asthma and an indicator of poor control missed more school days than SAC without asthma: exacerbation (1.8 times more; p < 0.001); >3 canisters SABA (2.7 times more; p < 0.001) and ED/IP visit (3.8 times more; p < 0.001). The parents/caregivers of SAC with asthma and an exacerbation missed 1.2 times more work days (p < 0.05), while those with SAC with asthma and an ED/IP visit missed 1.8 times more work days (p < 0.01) than the parents of SAC without asthma. Conclusions: This study provides evidence of the significant national burden of poorly controlled asthma due to missed school and work days in the United States. More effective and creative asthma management strategies, with collaboration across clinical, community and school-based outreach, may help address this burden.

School absence and productivity outcomes associated with childhood asthma in the USA

ABSTRACTBackground: Previous studies have examined the association between childhood asthma and lost productivity; however, more data are needed to understand its impact. Methods: This was a retrospective analysis of cross-sectional data in the nationally representative 2007–2013 Medical Expenditure Panel Survey (MEPS). School-aged children (SAC), children (age 6–11), and adolescents (age 12–17) with asthma were compared to those without asthma to examine annual missed school days. Adult parents/caregivers of SAC with asthma were compared to those of SAC without asthma to examine missed work days. The cost of premature asthma mortality for SAC was also estimated. Negative binomial regression was used for missed school days, and a two-part model structure was used for missed work days. All analyses controlled for sociodemographics and other covariates. Results: There were 44,320 SAC of whom 5,890 had asthma. There were 43,496 employed adults with at least one child. SAC (6–17) with asthma missed 1.54 times the number of school days compared to SAC without asthma. Caregivers of SAC (6–17) with asthma missed 1.16 times the number of work days to care for others compared to caregivers of SAC without asthma. SAC in the USA missed an additional 7 million school days associated with asthma (3.7 million children and 3.3 million adolescent). There were 130 asthma deaths resulting in an annual cost of $211 million ($US 2015). Conclusions: Childhood asthma is associated with a significant school absence and productivity loss in the USA. Better treatment and asthma management programs are needed to alleviate this burden.

Abstract IA13: Stool DNA detection of colorectal neoplasia

Abstract IA13: Stool DNA detection of colorectal neoplasia