Number Of Disability Days Research Articles

Common mental disorders and disability across cultures. Results from the WHO Collaborative Study on Psychological Problems in General Health Care.

To examine the impact of common mental illness on functional disability and the cross-cultural consistency of this relationship while controlling for physical illness. A secondary objective was to determine the level of disability associated with specific psychiatric disorders. A cross-sectional sample selected by two-stage sampling. Primary health care facilities in 14 countries covering most major cultures and languages. A total of 25,916 consecutive attenders of these facilities were screened for psychopathology using the General Health Questionnaire (96% response). Screened patients were sampled from the General Health Questionnaire score strata for the second-stage Composite International Diagnostic Interview administered to 5447 patients (62% response). Patient-reported physical disability, number of disability days, and interviewer-rated occupational role functioning. After controlling for physical disease severity, psychopathology was consistently associated with increased disability. Physical disease severity was an independent, although weaker, contributor to disability. A dose-response relationship was found between severity of mental illness and disability. Disability was most prominent among patients with major depression, panic disorder, generalized anxiety, and neurasthenia; disorder-specific differences were modest after controlling for psychiatric comorbidity. Results were consistent across disability measures and across centers. The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures. This suggests the importance of impairments of higher-order human capacities (eg, emotion, motivation, and cognition) as determinants of functional disability.

Common Mental Disorders and Disability Across Cultures

<h3>Objective.</h3> —To examine the impact of common mental illness on functional disability and the cross-cultural consistency of this relationship while controlling for physical illness. A secondary objective was to determine the level of disability associated with specific psychiatric disorders. <h3>Design.</h3> —A cross-sectional sample selected by two-stage sampling. <h3>Setting.</h3> —Primary health care facilities in 14 countries covering most major cultures and languages. <h3>Patients.</h3> —A total of 25916 consecutive attenders of these facilities were screened for psychopathology using the General Health Questionnaire (96% response). Screened patients were sampled from the General Health Questionnaire score strata for the second-stage Composite International Diagnostic Interview administered to 5447 patients (62% response). <h3>Main Outcome Measures.</h3> —Patient-reported physical disability, number of disability days, and interviewer-rated occupational role functioning. <h3>Results.</h3> —After controlling for physical disease severity, psychopathology was consistently associated with increased disability. Physical disease severity was an independent, although weaker, contributor to disability. A dose-response relationship was found between severity of mental illness and disability. Disability was most prominent among patients with major depression, panic disorder, generalized anxiety, and neurasthenia; disorder-specific differences were modest after controlling for psychiatric comorbidity. Results were consistent across disability measures and across centers. <h3>Conclusions.</h3> —The consistent relationship of psychopathology and disability indicates the compelling personal and socioeconomic impact of common mental illnesses across cultures. This suggests the importance of impairments of higher-order human capacities (eg, emotion, motivation, and cognition) as determinants of functional disability. (<i>JAMA</i>. 1994;272:1741-1748)

Effects of stressful life events on bowel symptoms: subjects with irritable bowel syndrome compared with subjects without bowel dysfunction.

A standardised inventory of stressful life events and a bowel symptom questionnaire were administered at three month intervals for one year to 383 women who were unselected with respect to bowel symptoms. A NEO Personality Inventory was given initially to assess neuroticism. Subjects who satisfied restrictive diagnostic criteria for irritable bowel syndrome were compared with those who complained of abdominal pain plus altered bowel habits but who did not meet restrictive diagnostic criteria (functional bowel disorder) and with controls without bowel dysfunction. The irritable bowel group showed significantly higher levels of stress than the other two groups even when the confounding effects of neuroticism were statistically controlled for. Time lagged correlations showed that stress in one three month interval was significantly correlated with bowel symptoms in the subsequent three month interval for all groups. The slope of the regression line relating stress to bowel symptoms was significantly steeper for the irritable bowel group than for the other two groups at three and six months, suggesting that subjects with irritable bowel syndrome show a greater reactivity to stress. Stress scores were also significantly correlated with the number of disability days and the number of medical clinic visits for bowel symptoms.

Human Illness Costs of Foodborne Bacteria

The economic costs of human illness caused by two bacterial contaminants of food (Salmonella and Listeria) have been used to extrapolate costs to other bacterial caused human illness. A bacterium-by-bacterium estimate is necessary because each enters the food chain in different ways and at different locations. Also, each bacterium and its toxins respond differently to control procedures. Future benefit/cost analyses of foodborne disease control will need to consider the costs of foodborne disease, potential benefits from control, the responsiveness of the specific bacterium and toxins to the alternative control measures, and the costs of control measures at different points in the food chain. This study provides a first approximation of human illness costs (medical costs and productivity losses) for specific bacteria contaminating the U.S. food supply. The National Academy of Sciences has called for using risk assessment in setting priorities in food safety programs. Economics can enhance the risk assessment and risk management process by providing a uniform measure for evaluating the costs and benefits to be gained from strategies to control contamination of food. From an economic efficiency perspective, too much inspection for low probability health risks or inspection not directly related to reducing health risks can be as costly as too little inspection with consequent foodborne disease costs. The key to optimal regulation is to determine when marginal social costs equal marginal social benefits. Economic cost of disease estimates assign different relative importance to diseases than other health indices. Mushkin compared rankings of economic costs with other health status measures for seventeen disease categories. The importance of the diseases varies markedly with the measure used: foodborne disease falls in the category of infectious and parasitic diseases, which ranks seventh in importance for number of disability days, eleventh for number of deaths, and fourteenth in economic costs to society of the seventeen disease categories (Mushkin). The literature on the social cost of foodborne disease is new and limited to either broad estimates (Garthright, Archer, and Kvenberg; Archer and Kvenberg; Todd 1985a, p. 159) or estimates for a specific foodborne disease outbreak (Todd 1985a, b; Cohen et al.; Shandera et al.); neither are very useful for benefit/cost analyses. The former are too general and do not permit a correlation between a specific pathogen and various control options. The latter are narrow and do not capture the wide range of outcomes (mild illness to death) for he specific bacterium. Data exist for two foodborne bacteria that take account of all known acute cases, yielding cost-of-illness estimates for the whole bacterial disease profile. Thes tw diseases represent extremes on a continuum of likely foodborne disease outc mes. Using these data in combination with epidemiological data on incidence and severity, t is paper extrapolates costs to other foodb rne bacteria to make a first approximation of the cost of all bacterial pathogens.

Reduced disability and health care costs in an industrial fitness program.

A prospective longitudinal study of a group of participants in an industrial physical fitness program during a five-year period compares the disability and major medical costs incurred by the subjects before and after entry into the program. The members of the cohort were employees of an insurance company; most were well educated and held sedentary, white-collar jobs. Participation was voluntary and without financial incentives. The group experienced 45.7% reduction in major medical costs in the postentry year, rather than the expected inflationary increase. There was a reduction of 20.1% in the average number of disability days, and a 31.7% reduction in direct disability dollar costs in the one-year postentry period. The average combined savings per participant were $353.38; the average operational cost was $120.60. Results suggest that work-site wellness programs can make a substantial contribution to the reduction of health care and disability costs.

The influence of a supportive, problem-solving, group intervention on the health status of students with great recent life change

A small randomized trial was conducted with college students to test the efficacy of a supportive, problem-solving group intervention for reducing morbidity following accumulation of numerous life changes. The two intervention groups reported declines in number of illness episodes and number of disability days over the two semesters of study; one of the intervention groups also reported a decrease in number of days on which illness was experienced. The control group did significantly worse on these measures than the intervention groups.

A causal model for physician utilization: analysis of Norwegian data.

This article contains a causal model for physician utilization in Norway. The model relates enabling factors, predisposing factors, and perceived illness to physician utilization in a linear structural equation model. Our aim has been to study the effect of variables other than perceived illness on physician utilization. The results of the analysis indicate that the number of disability days because of illness and psychologic well-being are almost exclusively the only important variables in the explanation of physician utilization in Norway.