Patients Of Working Age Research Articles

An overview of post COVID sequelae.

After healing from COVID-19, patients often experience a slew of symptoms known as post COVID-19 sequelae. Despite the fact that the SARS-CoV-2 pandemic is still ongoing, post-Covid-19 syndrome is already a difficult problem to address: long-term multiorgan sequelae, while frequently described, have yet to be systematized. As a result, post-Covid-19 syndrome can have a major influence on surviving patients' working capacity as well as their personal lives. The clinical spectrum and long-term course of this clinical entity must be better understood. Post-Covid syndrome affects a wide spectrum of individuals (16-87%), with pneumological and cognitive symptoms being the most common. Pulmonary fibrosis was the most common organic consequence seen in post-Covid patients. In conclusion, post-Covid-19 syndrome can have a major impact on the health of survivors. Working-age patients should seek rehabilitation and follow-up in interdisciplinary rehabilitation programmes. Given the pandemic's global extent, it's obvious that COVID-19-related healthcare demands will continue to climb for the foreseeable future. For COVID-19 survivors' long-term mental and physical health, present outpatient infrastructure will be utilised, scalable healthcare models will be built, and cross-disciplinary collaboration will be required.

560 A National Analysis of Discharge Disposition in Older Adults with Burns Estimating Independence at Discharge

IntroductionWhereas older age strongly predicts higher burn mortality, the impact of age on discharge disposition is less well defined. Both providers and patients need a better understanding of the likelihood of discharge to non-independent living, as this factor may matter most to older patients. This investigation assesses the relationship between older age and discharge disposition after burns, in a nationally representative sample.MethodsWe queried the 2007-2015 National Trauma Data Bank (NTDB) for burn hospitalizations in older adults. Pre-defined age categories were 55-64 years (working age group), 65-74 years (young-old), 75-84 years (middle-old), and 85+ years (old-old). Covariables included inhalation injury, comorbidities, burn total body surface area (TBSA), injury mechanism, and race. Discharge to non-independent living (nursing home, rehabilitation, and other facilities) was the primary outcome. Logistic regression was used to assess the association between older age and discharge to non-independent living, adjusting for covariables.ResultsThere were 25,840 burn hospitalizations in older adults with complete data during the study period. Working-age patients comprised 13,563 (53%) of admissions. Young-old accounted for 7,342 (28%), while middle-old comprised 3,876 (15%), and 1,059 (4%) were classified as old-old. Discharge to non-independent living steadily increased with burn TBSA and older age in survivors (Table). Beginning in the 65-74 age group (young-old), most patients with burns ≥20% TBSA were discharged to non-independent living. After adjusting for patient and injury factors, odd ratios for discharge to non-independent living were 2.1 for young-old, 3.5 for middle-old and 7.6 for old-old patients, when compared to working-age patients (all p< 0.001).ConclusionsOlder age is a strong predictor of discharge to non-independent living after burns. These findings provide a realistic discharge framework for providers and older adults with acute burns.

Impact of the treatment of chronic myeloid leukaemia by tyrosine-kinase inhibitors on sick leaves refund: a nationwide cohort study.

The advent of chronic myeloid leukaemia (CML) tyrosine-kinase inhibitors (TKI) has led to new paradigms including occupational rehabilitation. This study aimed to characterize the impact of CML treatment on sick leaves within the 2years following diagnosis in working-age patients. A cohort of all 18-60-year-old newly diagnosed CML patients initiating a TKI between January 1st 2011 and December 31st 2014 in France was identified in the French National Healthcare database (Système National des Données de Santé [SNDS]). Patients with a sick leave identified in the 24months after TKI initiation were compared with sex and initiation date matched controls in a nested case-control design. Factors associated with sick leaves were identified through a conditional logistic regression model, providing adjusted odds-ratio (OR) with their 95% confidence interval (CI). Among 646 18-60-year-old patients, 268 were prescribed at least one sick leave in the study period, with 176 (27.2%) having their first sick leave prescribed after TKI initiation. The median number of sick days over the 2-years period was 115 per patient (interquartile range 25.5-384.5). In the nested case-control study (176 cases and 176 matched controls), sick leaves were more likely observed with second generation TKI (OR 4.11 [1.80-9.38]), whereas they were less likely observed in case if social deprivation (OR 0.07 [0.02-0.28]. More than 25% of working-age CML patients had at least one sick leave within 2years of TKI initiation, with a higher impact of second generation TKI, and with a median duration of 115days.

The Burden of Vertebral Osteomyelitis-An Analysis of the Workforce before and after Treatment.

Although vertebral osteomyelitis (VO) has a major impact on morbidity, functional status, and quality of life, data concerning the influence on the patient’s ability to work (ATW) are lacking. Therefore, the aim of this study was to analyze the work status after VO-treatment as well as risk factors associated with loss of the ATW. We conducted a post-hoc analysis of data from a prospective VO-registry (2008–2019) supplemented by workforce data. Primary endpoint was the work status after one year (T1). Univariate analysis comparing patients’ characteristics “at-work” versus “not-at-work” at T1 was performed. Of a total of 335 VO-patients, n = 52 (16%) were part of the workforce at time of diagnosis (T0), of which 22 (42%) failed to be part of the workforce at T1. A higher number of comorbidities and a body mass index (BMI) < 25 kg/m2 were associated with a reduced ATW. VO in working age patients is a debilitating condition and associated with reduced patients’ ATW. Patients engaged in heavy physical work mostly had a BMI < 25 kg/m2 and therefore were more severely affected and no longer able to keep their workforce. More support in retraining should be offered after successful treatment to maintain ATW and reduce the socio-economic burden.

Overstretching Expectations May Endanger the Success of the "Millennium Surgery".

Total hip arthroplasty (THA) is an extremely successful treatment strategy. Patient expectations, however, have increased; if not properly guided by surgeons, at present, patients expect next to pain-free restoration of the joint and a fast return to work and sports. While the revision rates after THA also increased in younger patients, knowledge on musculoskeletal loads still remains sparse, and the current recommendations on postoperative rehabilitation are based on expert opinions only. The aim of this study was to unravel biomechanical contact conditions in “working age” (<60 years, 53.5 ± 3.0 years) and “retirement age” (>60 years, 67.7 ± 8.6 years) patients during activities recommended post-THA. We hypothesized that working age patients would show substantially increased hip contact loads compared to older patients. The in vivo joint contact force (F res) and torsion torque (M tors), reflecting the main contact load situation, experienced during activities of daily living and sports activities were measured in a unique group of 16 patients with instrumented THA. We summarized patient activities and sports recommendations after THA mentioned within the literature using PubMed (without claim of completeness). The measurements showed that younger working age patients experienced significant (p = 0.050) increased M tors (21.52 ± 9.11 Nm) than older retirement age patients (13.99 ± 7.89 Nm) by walking. Bowling, as a recommended low-impact sport, was associated with F res of up to 5436 N and M tors of up to 108 Nm in the working age group, which were higher than the F res (5276 N) and M tors (71 Nm) during high-impact soccer. Based on our results, age was proven to be a discriminator in joint loading, with working age patients presenting with increased loads compared to retirement age patients, already during daily activities. The current patient recommendations have led to further increased joint loadings. If THA cannot be delayed in a patient, we propose counselling patients on a carefully considered return to sports, focusing on low-impact activities, as indicated hereby. The findings from this work illustrate the need to provide critical feedback to patient expectations when returning to work and sports activities. Patients returning to more intensive sports activities should be carefully monitored and advised to avoid as much overloading as possible.

Prevalent migraine as a predictor of incident hypertension.

BackgroundMigraine has been associated with several diseases. This population-based prospective Finnish postal survey Health and Social Support Study explored whether self-reported migraine predicted incident hypertension independently in a working-age population by utilizing two data sources: the baseline survey from the year 1998 in combination with the follow-up survey data from the years 2003 and 2012 with linkage to the national Social Insurance Institution registry data of the special reimbursement medication for hypertension from 1999 to 2013. The survey follow-up reached until the second follow-up in the year 2012. The register follow-up also included the year 2013.MethodsThe present population-based prospective cohort study, utilizing two different data sources, included 8593 respondents (22.7% response rate) who participated in 1998, 2003, and 2012 but who did not report hypertension at the baseline in 1998, and whose responses could be linked with the Social Insurance Institution registry data from the beginning of 1999 to the end of 2013. The multivariable logistic regression analysis was based on the combined two data sets.ResultsA significant association of self-reported migraine and incident hypertension (odds ratio 1.37; 95% confidence interval 1.20–1.57) prevailed in the multiple logistic regression analysis adjusted for central socio-demographic and health behaviour variables.ConclusionExtra attention should be paid to prevention and control of hypertension in working-age migraine patients.

Cardiomyopathy. Risk factors. Modern representation

The article is a review of the literature, which deals with the classifi cation, etiology, pathogenesis and risk factors of cardiomyopathies, analyzes the results of diagnostics with the use of modern technologies. The presence of cardiomyopathy always means a diffi cult life prognosis in patients. It determines the social signifi cance of the problem connected with this pathology, which is the cause of disability and mortality of most active working age patients.

Return to work among elderly patients with acquired brain injuries

Objectives: Generally, it is difficult for elderly patients with acquired brain injuries (ABI) to return to work (RTW). To assess whether elderly patients with ABI can return to their workplace, like working-age patients, we investigated medical and support records and compared the rates of RTW between the working-age and elderly groups. Methods: A prospective cohort study on RTW among inpatients with ABI was conducted. We collected the clinical data of inpatients who were admitted to the Department of Neurosurgery for acute treatment and participation in a health and employment support program; follow-ups were conducted after discharge. Participants with almost independent activities of daily living (ADL) were enrolled. A χ2 test was used to examine factors influencing RTW and successful RTW by groups stratified by white-collar and blue-collar occupations and hemiplegia. The Kaplan-Meier method was used to calculate the RTW proportion curves. Results: The RTW rates were 74% for the working-age group and 89% for the elderly group (χ2 test, p=0.149); age was not a significant factor. Occupation type was the only significant factor for RTW (χ2 test, p=0.014). The RTW proportion curves of both the working age and elderly groups showed early RTW, and the elderly group had a significantly higher RTW profile than the working-age group (log-rank test, p<0.039). Almost all elderly participants were engaged in white-collar or less physical jobs, to which it is easy to return. Conclusions: In participants with almost independent ADL, the elderly group had a higher RTW rate than the working-age group.

The Economic Burden of Recurrence in Triple-Negative Breast Cancer Among Working Age Patients in the United States.

Triple-negative breast cancer (TNBC) is associated with a high recurrence risk. However, the magnitude of direct and indirect costs associated with recurrence is lacking in the literature. Adults 18-65years old diagnosed with TNBC were identified from the OptumHealth Reporting and Insights claims database (1999-2017) and stratified by recurrence. For patients with recurrence, theindex date was defined as 30days before recurrence; for patients without recurrence, it was randomly assigned based on the distribution of time between first treatments and index dates of the recurrence cohort. All-cause and breast cancer-related healthcare resource utilization (HRU), direct and indirect costs, and work loss up to 1 year were compared between cohorts using generalized linear models. Kaplan-Meier analyses and Cox proportional hazards models compared the risk of leaving the workforce. Among the 2340 patients analyzed, mean age was 54years and > 75% of patients had stage 0-2 cancer. Among the 1170 patients with recurrence, 236 were categorized as having metastatic recurrence and 934 as having locoregional recurrence. Relative to patients without recurrence, those with recurrence had significantly higher all-cause and breast cancer-related HRU. For instance, adjusted incidence rates (IRs) for all-cause inpatient admissions were 3.67 and 10.19 times higher for patients with locoregional and metastatic recurrence, respectively (p < 0.001). Adjusted all-cause healthcare costs were $8575/month higher for metastatic recurrence and $3609/month higher for locoregional recurrence vs. patients without recurrence (p < 0.001). Adjusted IRs for work loss days were approximately two times higher for locoregional and metastatic recurrence vs. without recurrence (p < 0.001). Patients with locoregional recurrence incurred $335/month more indirect costs vs. patients without recurrence; those with metastatic recurrence incurred $769/month more (p < 0.05). Patients with recurrence had a 63% higher rate of leaving the work force (p = 0.003). The incremental direct and indirect economic burden associated with recurrent TNBC is substantial relative to non-recurrence.

Echocardiographic assessment of right ventricular systolic function in acute inferior myocardial infarction

Purpose . To assess the systolic function of the right ventricle in patients with acute inferior myocardial infarction after percutaneous coronary intervention according to the results of echocardiographic examination. Materials and methods . Echocardiographic data of 72 working-age patients with acute inferior myocardial infarction were analyzed. RV systolic function was assessed by TAPSE, S’TV, longitudinal strain of RV. Results . In 37.5% of patients with AMI of the inferior wall, in 96% of cases by ECG (elevation of the ST segment in the first hours of the disease) and in 4% by echocardiography (impaired local contractility after PCI), RV AMI was diagnosed. After PCI, the medians of TAPSE and S’TV obtained in M- and pulsed- wave modes of tissue Doppler between the groups with isolated AMI (n=45) and RV involvement (n=27) did not differ from the control. Analysis of all walls of the RV and three segments its free wall obtained by speckle tracking technology demonstrates large changes in the longitudinal deformity of the RV with a combination of AMI of both ventricles. The minimum longitudinal deformity in the groups with AMI, statistically significantly different from the control group, was observed at the basal level of the free wall of the RV and the interventricular septum. Changes in the parameters of deformity of the apical segment were present only in AMI of both ventricles. Conclusion . According to the results of echocardiographic examination in M-mode and pulsed-wave mode of tissue Doppler, the systolic function of the right ventricle in patients with acute inferior myocardial infarction both in combination with right ventricular infarction and in an isolated course a week after percutaneous coronary intervention corresponds to normal values. Using speckle tracking technology, the global longitudinal deformity of the right ventricle is not restored, remaining below the recommended norms and values of the control group in both AMI variants. The median of longitudinal deformity of the basal and median inferior septal segments had a minimum value (-9 and -12%) with combined lesions of both ventricles.

Long-term subjective results and radiologic prognosis of a distal radius fracture in working-aged patients - a prognostic cohort study of 201 patients.

ObjectiveTo investigate long-term outcomes associated with distal radius fracture (DRF) in working-aged patients. The authors hypothesized that the majority of patients experience no permanent loss of function when measured with patient-rated wrist evaluation (PRWE).MethodsThis was a retrospective cohort study of patients with a DRF aged between 18 and 65 years. The primary outcome measure was PRWE score at a minimum of 4 years after DRF. Secondary outcome measures were pain catastrophizing scale (PCS) and radiographic measurements.ResultsOf 201 patients included, 179 were primarily treated non-operatively with a 5-week cast treatment and 22 were primarily operated. The mean follow-up duration was 5 years. The mean PRWE score was 10.9 (95% confidence interval 8.4, 13.4) and median PRWE was 3.5 (interquartile range, 0.0–13.0). There was minor correlation between PCS and PRWE score (correlation coefficient [CC] 0.3), and between PRWE score and dorsal angulation of the fracture measured after closed reduction (CC 0.2) and in one-week follow-up radiographs (CC 0.2).ConclusionsWorking-aged patients seem to gain nearly normal wrist function after DRF in longer follow-up. Pain catastrophizing appears to correlate with long-term treatment outcome.

Return to work after primary total hip or knee arthroplasty. First French study. Retrospective study of 241 cases

IntroductionThe quality and reliability of the results of primary total hip or knee arthroplasty (THA, TKA) have allowed indications to be extended to younger, working-age patients, raising the issue of return to work. This question has never been specifically addressed in THA and TKA in a French population. We therefore conducted a retrospective study to determine: (1) the rates and intervals of return to work, and (2) factors affecting return to work and reasons for non-return. HypothesisRates and intervals of return to work are comparable to those in Western countries as a whole: 1.1–10.5 weeks in THA and 8–12 weeks in TKA. Material and methodA single-center retrospective study included patients aged under 65 at surgery, between 2009 and 2013. A questionnaire collected population and occupational data. The patients’ occupational situation was collected at a minimum 1 year postoperatively. During the study period, 289 TKAs or THAs were performed; 241 patients were recontacted, 144 of whom had been working at the time of surgery: 72 THAs and 72 TKAs. The sex-ratio was well balanced: 69 males, 75 females. Mean age was 55.8±8 years (range, 18.6–65.7 years). The mean time from surgery to data collection was 34.5 months (95% CI, 32.2–36.8 months). ResultsIn all, 86 patients (57.6%) returned to work, at a mean 124 days (range, 15–540 days; 95% CI, 102.8–144.4 days). At 3 months, 55.4% of patients (n=46) had returned to work, and 97.6% (n=81) at 12 months. In most cases, patients returned to the same occupation. ConclusionThe study hypothesis was not confirmed. French primary THA or TKA patients returned to work later and less frequently than in other Western countries. Level of evidenceIV, retrospective study without control group.

Quality of Life and Professional Activity of Working-Age Patients after Stroke

Background &amp;objectives:Stroke is one of the most common and severe diseases in terms of the economic burden on society. The aim of this study was to assess the quality of life of people after stroke in the context of professional activity, considering the time since stroke. Material &amp; methods:To assess the quality of life, ashortened Polish version of the World Health Organization Quality of Life Questionnaire (WHOQOL-Bref) was used. The study was conducted on agroup of 279 people with the first stroke diag- nosed. Results:The statistically significant relationship was observed, considering the period after stroke in groups: 6-12 months; 13 months-2 years; 2-5 years from the onset of stroke. The corre- lation between professional activity of people after stroke and their quality of life was statistically significant in: the somatic sphere; the social sphere; the environmental sphere. Conclusions:Undertaking professional activity by people who had astroke significantly affected the self-assessment of their quality of life and satisfaction with the quality of health, re- gardless of the period since the onset of the stroke.

Factors Affecting the Viability of Disabled COVID-19 Patients

The present research featured patients with disabilities who survived COVID-19 and had to undergo a course of comprehensive rehabilitation. Foreign scientists proved that COVID-19 can affect viability, although it does not necessarily triggers mental and psychological health disorders. The research objective was to define the main factors that affect the viability of clients of a medical rehabilitation center. The article contains a review of various approaches to the concept of viability and introduces an authentic definition. The analysis was based on the International Classification of Functioning, Disability, and Health (ICF) and revealed both positive and negative factors that affect the viability of disabled patients after COVID-19. The positive factors included harmonious or anosognosic attitude to the disease, i.e. unwillingness to consider oneself "sick" or "disabled" in working-age patients with short disease history and high rehabilitation potential, optimistic life attitude, and good family support. The negative factors included anosognosic attitude to the disease in retired patients with a long disease history. They demonstrated diffuse and mixed types of attitude to the disease, with inconsistent components, poor chances for successful rehabilitation and social adaptation, pessimism, and cynicism about rehabilitation. The research results can help specialists of medical centers to adapt their rehabilitation roadmaps to the needs of disabled COVID-19 survivors.

Professional Status of Persistent Spinal Pain Syndrome Patients after Spinal Surgery (PSPS-T2): What Really Matters? A Prospective Study Introducing the Concept of "Adapted Professional Activity" Inferred from Clinical, Psychological and Social Influence.

Persistent Spinal Pain Syndrome Type 2 (PSPS-T2) represents a main cause of work disruption. Beyond its societal consequences, occupational inactivity is responsible for a major decrease in physical/mental health in individuals but remains poorly analyzed. We designed a study to prospectively examine Professional Status (PS) evolution and its association with key bio-psychological markers. Data from 151 consecutively included working-age PSPS-T2 patients were analyzed to determine the proportion of professional inactivity and the relationships between PS and Social Gradient of Health (SGH), Numeric Pain Rating Scale (NPRS), EuroQol 5-Dimensional 5-Level (EQ-5D-5L), Oswestry Disability Index (ODI), Hospital Anxiety and Depression Scale (HADS), and Fear-Avoidance Belief Questionnaire work subscale (FABQ-W). Despite optimized medical management, 73.5% of PSPS-T2 patients remained inactive after 1 year of follow-up/p = 0.18. Inactive patients presented a low SGH/p = 0.002, higher NPRS/p = 0.048, lower EQ-5D-5L/p < 0.001, higher ODI/p = 0.018, higher HADS-D/p = 0.019 and higher FABQ-W/p < 0.001. No significant mediation effect of FABQ-W on SGH consequences regarding PS was observed in our structural model/p = 0.057. The link between unemployment and bio-psycho-social pain dimensions appears bidirectional and justifies intense collaboration with social workers. Optimizing therapeutical sequencing towards personalized professional plans implies restoring “Adapted Physical Function” as an initial goal, and tailoring an “Adapted Professional Activity”, matching with patient expectations and capabilities, as a final objective.

Covid-19 sequelae in working age patients: A systematic review.

Despite the SARS‐CoV‐2 pandemic not yet being under control, post‐Covid‐19 syndrome is already a challenging topic: long‐term multiorgan sequelae, although increasingly described, have not yet been systematized. As post‐Covid‐19 syndrome can significantly impact both the working capacity and the relationship life of surviving patients, we performed a systematic review of the evidence published over the last year and currently available in medical literature search databases (MEDLINE/Pubmed) and searching clinical trial registries, to evaluate the available evidence among workers. From 31 publications that initially matched inclusion criteria, 13 studies have been considered suitable for relevance and age of subjects. A wide range of patients (16%–87%) have post‐Covid syndrome; pneumological and neuropsychological symptoms were the most common disorders reported. The most frequent organic sequel found in post‐Covid patients was pulmonary fibrosis. The number of symptoms during acute SARS‐CoV‐2 infection, severity of the disease, and high serum levels of d‐dimer were related to high risk of post‐Covid syndrome. In conclusion, post‐Covid‐19 syndrome can significantly impact the health conditions of surviving patients. Rehabilitation and follow‐up in multidisciplinary rehabilitation programs should be considered for working‐age patients.

Employment status three years after percutaneous coronary intervention – a nationwide prospective cohort study

Abstract Background Return to work plays an important part in social readjustment after an acute coronary event, and has important implications for both the individual and the society. Updated knowledge is lacking regarding losng-term employment after percutaneous coronary intervention (PCI). Aims The aims of this study were to determine employment status three years after PCI and to assess predictors for return to work stratified by gender. Methods We included first-time PCI patients from the NorStent Trial, who were of working age (&amp;lt;60 years; n=2488) at a three-year follow-up. Employment status were assessed using self-report. Results Fifty-seven percent of females and 73% of males who were &amp;lt;60 years of age at the index event were employed at follow-up (p&amp;lt;0.001). Living with a partner, higher levels of education, and living in the western part of Norway were associated with a higher chance of being employed in males, while higher levels of education were associated with a higher chance of being employed in females. Prior cardiovascular morbidity and former smoking were associated with lower chance of being employed in males, while being older was associated with lower chance of being employed in females. Conclusion A significant number of working-age coronary heart disease patients are unemployed three years after coronary revascularization. Our findings indicate a need for revised and gender specific initiatives to promote vocational support. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): The Northern Norway Regional Health Authority

Optical reconstructive treatment of a patient with essential mesodermal dystrophy of the iris

Essentially mesodermal iris dystrophy (EMID) is a type of iridocorneal endothelial syndrome and has a chronic progressing character. It is observable after a local fibrosis is formed in the outer border of the iris, which subsequently causes the peripheral iris to pull up and leads to pupil deformation.Purpose: to evaluate the outcome of modern high-tech surgical treatment, which improves visual functions, prevents the decompensation of intraocular pressure and ensures a cosmetic effect.Materials and methods. Patient R., 48 yrs, was diagnosed with OU EMID, low hyperopia, astigmatism, and presbyopia. In order to prevent the development of secondary glaucoma and correct refractive anomalies, the patient was subjected to phacoemulsification with implantation of a multifocal toric IOL, synechiotomy, and iris plastic surgery. MTIOL was calculated using the VERION™ Image Guided System navigation computing complex (Alcon, USA) and the IOLMaster® 700 optical biometer (Carl ZEISS, Germany).Results. In early post-surgery period, the patient noted an increase in visual acuity, stabilized by the 6th month, a significant decrease of undesirable optical phenomena (glare, halo) and was satisfied with the postoperative cosmetic result. The level of intraocular pressure also stabilized by the 6th month after surgery and remained within the reference range by the 9th month. No intraoperative complications were observed. Control UBM scans showed transparent OU cornea, anterior chamber being shallower than the average depth, exfoliated stroma of the iris, moderate anterior chamber angle, intact ciliary body, centrally located pupil, IOL in capsule bag.Conclusion. The case describes a successful outcome of surgical treatment of a rare variety of iridocorneal endothelial syndrome, increase in visual functions, achievement of the desired cosmetic effect, and improvement in the quality of life of the working age patient.

Work Loss in Patients With Celiac Disease: A Population-based Longitudinal Study

Celiac disease (CD) affects around 1% of the population worldwide. Data on work disability in patients with CD remain scarce. We estimated work loss in patients with CD, including its temporal relationship to diagnosis. Through biopsy reports from Sweden's 28 pathology departments, we identified 16,005 working-aged patients with prevalent CD (villus atrophy) as of January 1, 2015, and 4936 incident patients diagnosed with CD in 2008 to 2015. Each patient was matched to up to 5 general-population comparators. Using nationwide social insurance registers, we retrieved prospectively recorded data on compensation for sick leave and disability leave to assess work loss in patients and comparators. In 2015, patients with prevalent CD had a mean of 42.5 lost work days as compared with 28.6 in comparators (mean difference, 14.7; 95% confidence interval [CI], 13.2-16.2), corresponding to a relative increase of 49%. More than one-half of the work loss (60.1%) in patients with CD was derived from a small subgroup (7%), whereas 75.4% had no work loss. Among incident patients, the annual mean difference between patients and comparators was 8.0 days (range, 5.4-10.6 days) of lost work 5 years before CD diagnosis, which grew to 13.7 days (range, 9.1-18.3 days) 5 years after diagnosis. No difference in work loss was observed between patients with or without mucosal healing at follow-up. Patients with CD lost more work days than comparators before their diagnosis, and this loss increased after diagnosis. Identifying patients with an increased risk of work loss may serve as a target to mitigate work disability, and thereby reduce work loss, in patients with CD.

Transdermal Fentanyl Usage in Working-age Patients Undergoing Cancer Treatment: Prescription Pattern Analysis Using Large Claims Data in Japan

The number of working-age individuals undergoing cancer treatment has been increasing. In these patients, transdermal fentanyl is the preferred treatment. However, it is known to have (1) pharmacodynamic interactions with benzodiazepines and (2) fever-induced pharmacokinetic variations. The aim of this study is to clarify the frequency of co-administration of benzodiazepine and the predictors for fever among working-age patients with cancer using transdermal fentanyl. We used a large claims data source including over 3.6 million patients. Finally, 759 working-age patients aged 20 to 60 years undergoing cancer treatment, in whom transdermal fentanyl was initiated, were analyzed. The proportion of patients receiving co-administration of benzodiazepines with the first administration of transdermal fentanyl was 16.5% (n = 125). This increased to 39.3% (n = 298) within 30 days. Predictive factors for fever using patients’ baseline characteristics were male sex, gastrointestinal cancer, hematological cancer, and renal disease. To provide adequate pharmacotherapy to working-age patients undergoing cancer treatment with transdermal fentanyl, medical staff should pay attention to (1) avoid adding benzodiazepines easily and (2) monitor patients having predictors for fever to avoid fentanyl-related adverse events.