Rate Of Work Disability Research Articles

The impact of antineutrophil cytoplasmic antibody-associated vasculitis on employment and work disability in an Australian population.

Although antineutrophil cytoplasmic antibody-associated vasculitis (AAV) most commonly affects older individuals, many patients develop the disease during their most productive working years. The aim of this study was to examine the effects of AAV on employment and work disability in a cohort of Australian patients of working age. Patients attending a vasculitis clinic located in Melbourne, Australia, completed an employment questionnaire in addition to the Work Productivity and Activity Impairment Questionnaire: Specific Health Problem. The average age of the 47 respondents was 47.8±11.9years (range 22-63years), with a median disease duration of 60months (range 10.2-318.5months). There were 68.1% who were currently employed, but 20.6% of respondents employed at the time of diagnosis were no longer working and 10.6% had experienced a significant reduction in work hours since their diagnosis. There were 12.7% who were dependent on the disability support pension. The rate of work disability was 23.4%. Many participants considered themselves work impaired (41.9%), with 10.1% having missed work in the previous week. Furthermore, 44.7% of respondents reported that their financial stability had been negatively impacted by their vasculitis diagnosis. Fatigue was commonly reported. Work disabled patients were significantly more likely to be obese and less likely to have completed a tertiary education. Work disabled patients tended to be older, myeloperoxidase-antineutrophil cytoplasmic antibody positive, and have renal involvement and lung involvement. A proportion of people living with AAV in Australia experience a decline in employment and an increase in work disability when living with this condition.

Cognitive function predicts work disability among multiple sclerosis patients.

BackgroundIn multiple sclerosis various aspects of cognitive function can be detrimentally affected. More than that, patients´ employment and social functioning is likely to be impacted.ObjectiveTo determine whether work disability among multiple sclerosis patients could be predicted by the symbol digit modalities test.MethodsA register-based cohort study was conducted. Individual data on work disability, operationalised as annual net days of sickness absence and/or disability pension were retrieved at baseline, when the symbol digit modalities test was performed, after one-year and 3-year follow-up for 903 multiple sclerosis patients. The incidence rate ratios for work disability were calculated with general estimating equations using a negative binomial distribution and were adjusted for gender, age, educational level, family composition, type of living area and physical disability.ResultsAfter one year of follow-up, the patients in the lowest symbol digit modalities test quartile were estimated to have a 73% higher rate of work disability when compared to the patients in the highest symbol digit modalities test quartile (incidence rate ratio 1.73, 95% confidence interval 1.42‒2.10). This estimate after 3-year follow-up was similar (incidence rate ratio 1.68, 95% confidence interval 1.40‒2.02).ConclusionCognitive function is to a high extent associated with multiple sclerosis patients’ future work disability, even after adjusting for other factors.

Sphincter of Oddi Dysfunction: How Is It Diagnosed? How Is It Classified? How Do We Treat It Medically, Endoscopically, and Surgically?

Sphincter of Oddi dysfunction (SOD) refers to an abnormal contractility of the sphincter of Oddi, resulting in impedance to the flow of bile and pancreatic juice thru the ampulla of Vater. Under normal circumstances, the sphincter of Oddi is responsible for regulating pressures in the pancreaticobiliary tree, determines the direction and rate of bile and pancreatic juice flow into the duodenum, and diverts bile into the gallbladder. It is also responsible for preventing duodenal reflux into the liver and the pancreas. Sphincter of Oddi dysfunction is a benign noncalculous obstructive disorder occurring at the level of the sphincter of Oddi which causes pancreaticobiliary-type pain. Patients may present with cholestasis and/or pancreatitis. The etiology of SOD may be from either an anatomic stricture at the ampulla of Vater from the passage of a gallstone or may be a functional abnormality due to a congenital hypertrophic sphincter or a hypertensive sphincter that is hyper-responsive to hormonal and neuronal stimuli. Sphincter of Oddi dysfunction is more common in women than men (3:1) and usually occurs between the ages of 20 to 50 years. It is often diagnosed post cholecystectomy but can occur with the gallbladder in situ. It may coexist with other motility disorders such as gallbladder dyskinesia, gastroparesis, and small bowel or colonic dysmotility. SOD is associated with a high rate of work absenteeism, disability, and health-care use. Criteria for diagnosing SOD have been established by the Rome III conference. Patients suspected with SOD should have episodes of abdominal pain that is located in the epigastrium and right upper quadrant and is associated with the following features: (1) ≥30 min in duration, (2) recurrent symptoms occurring at variable intervals (not daily), (3) have occurred on one or more occasions in the last 12 months, (4) pain that builds up to a steady level, (5) pain that is moderate to severe enough to interrupt patient's daily activities, and (6) no evidence of structural abnormalities to explain the symptoms. Associated features include nausea and vomiting, as well as radiation of the pain to the back or shoulder. The pain may or may not be associated with meals and is not relieved by postural changes, antacids, or bowel movements. The diagnosis of SOD is often supported by elevated liver function tests (LFTs) closely related to at least two pain episodes. The Hogan–Geenan SOD classification system classifies patients with SOD into three categories. Type 1 patients have typical biliary pain, abnormal LFTs (more than two times the normal on more than two occasions), a dilated common bile duct (>12 mm), and delayed drainage of contrast from the common duct on endoscopic retrograde cholangiopancreatography (ERCP) (>45 min). Type 2 patients have biliary pain with one or two additional criteria (LFTs, CBD dilation, and delayed contrast drainage), and type 3 patients have biliary pain with no other objective criteria. The diagnostic evaluation for patients with suspected SOD includes a careful history and physical exam, measurement of liver and pancreatic chemistries, and abdominal computed tomography and/ or magnetic resonance imaging to rule out any structural abnormalities. In the past, noninvasive testing This paper has been a part of the SSAT/SAGESKelly and Carlos Pellegrini Joint Luncheon Symposium: Current Concepts and Controversies in Foregut Motility, May 22, 2012, San Diego, California.

Does primary sclerosing cholangitis impact quality of life in patients with inflammatory bowel disease?

Impairment of health-related quality of life (HRQoL) is an important concern in inflammatory bowel disease (IBD; ulcerative colitis [UC], Crohn's disease [CD]). Between 2%-10% of patients with IBD have primary sclerosing cholangitis (PSC). There has been limited examination of the disease-specific HRQoL in this population compared to non-PSC IBD controls. This was a retrospective, case-control study performed at a tertiary referral center. Cases comprised 26 patients with a known diagnosis of PSC and IBD (17 UC, 9 CD). Three random controls were selected for each case after matching for IBD type, gender, age, and duration of disease. Disease-specific HRQoL was measured using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ). Disease activity for CD was measured using the Harvey-Bradshaw index (HB) and using the UC activity index for UC. Independent predictors of HRQoL were identified. There was no significant difference in the age, gender distribution, or disease duration between PSC-IBD and controls. There was no difference in use of immunomodulators or biologics between the 2 groups. Mean SIBDQ score was comparable between PSC-IBD patients (54.5) and controls (54.1), both for UC and CD. Likewise, the disease activity scores were also similar (2.8 versus 3.1, P = 0.35). On multivariate analysis, higher disease activity score (-1.33, 95% confidence interval [CI] 95% CI -1.85 to -0.82) and shorter disease duration were predictive of lower HRQoL. Coexisting PSC did not influence IBD-related HRQoL. There was a higher proportion of permanent work disability in PSC-IBD (7.7%) compared to controls (0%). PSC does not seem to influence disease-specific HRQoL in our patients with IBD but is associated with a higher rate of work disability.

An international prospective general population-based study of respiratory work disability

Background:Previous cross-sectional studies have shown that job change due to breathing problems at the workplace (respiratory work disability) is common among adults of working age. That research indicated that occupational...

Relationship between sick leave, unemployment, disability, and health-related quality of life in patients with inflammatory bowel disease

The goal of this study was to determine the rate of work disability, unemployment, and sick leave in an unselected inflammatory bowel disease (IBD) cohort and to measure the effect of working status and disability on the patient's health-related quality of life (HRQOL). All eligible patients were clinically examined and interviewed at the 5-year follow-up visit. In addition, they completed the 2 HRQOL questionnaires, the Short Form-36 Health Survey (SF-36) and the Inflammatory Bowel Disease Questionnaire validated for use in Norway (N-IBDQ). Data regarding sick leave, unemployment, and disability pension (DP) also were collected. All together, 495 patients were or had been in the workforce during the 5-year follow-up period since diagnosis. Forty-two patients (8.5%) were on DP compared with 8.8% in the background population. Women with Crohn's disease (CD) had the highest probability of receiving DP (24.6%). A total of 58 patients (11.7%) reported they were unemployed at 5 years. This was equally distributed between men and women but was more frequent in patients with ulcerative colitis. Sick leave for all causes was reported in 47% with ulcerative colitis and 53% with CD, whereas IBD-related sick leave was reported in 18% and 23%, respectively. A majority (75%) had been sick <4 weeks, and a relatively small number of patients (25%) contributed to a large number of the total sick leave days. Both unemployment and DP reduced HRQOL scores, but the most pronounced effect on HRQOL was found in patients reporting IBD-related sick leave, measured with SF-36 and N-IBDQ. The observed differences also were highly clinically significant. Multiple regression analysis confirmed that IBD-related sick leave was the independent variable with the strongest association to the observed reduction in HRQOL scores. Unemployment or sick leave is more common in IBD patients than in the Norwegian background population. The number of patients receiving DP is significantly increased in women with CD but not in the other patient groups. Unemployment, sick leave, and DP are related to the patient's HRQOL in a negative way, but this effect is most pronounced in patients reporting IBD-related sick leave.

Work Disability and Costs Caused by Recurrence of Low Back Pain: Longer and More Costly Than in First Episodes

Retrospective analysis of workers' compensation (WC) claims data for nonspecific low back injuries (LBI) in a single jurisdiction. To examine whether recurrences, defined as post-initial episodes of work disability or medical care, substantially contribute to total medical and indemnity costs, and total duration of work disability. Previous studies have not measured the proportion of care seeking and work disability that are associated with recurrences in claims for work-related LBI. All persons with new lost-time claims for nonspecific LBI reported in New Hampshire to a large WC provider from 1996 to 1999 were selected (N = 1867). Three years of follow-up data, starting at the beginning of the first episode, were collected. Previously validated definitions of recurrence were used identify new episodes of care and new episodes of lost work time (work disability). Total duration of work disability, total medical costs, and total indemnity costs were investigated. For individuals with recurrences, these variables were separated into first-episode and recurrent period duration and costs. The rate of recurrent work disability was 17.2%, and the rate of recurrent care seeking was 33.9%. Individuals with recurrence had significantly higher total length of work disability, and higher medical and indemnity costs. For those with recurrent work disability, 69% of total lost time from work, 71% of associated indemnity costs, and 84% of total medical costs occurred during the recurrent period. For those with recurrence of care, the respective values were 48%, 47%, and 42%. Recurrences contributed disproportionately to the total burden of work-related nonspecific LBI, through both additional care seeking and work disability. Results imply that those who have recurrences may be an especially important target for secondary prevention efforts.

A health professional's guide to exercise prescription for people with arthritis: a review of aerobic fitness activities.

Inactivity and subsequent cardiovascular and musculoskeletal deconditioning superimposed on the numerous impairments associated with arthritis play a significant role in patients’ overall functional status and quality of life (1–8). Research in the past 25 years has revealed not only that people with most forms of arthritis are less fit than their nonaffected, ageand sex-matched peers, but that they, like most other adults, can safely benefit from aerobic exercise activities (4–6). Regular, aerobic exercise provides both short-term and long-term benefits for people with arthritis and related musculoskeletal conditions. These positive changes include improved cardiovascular function (8–10), increased muscular strength and flexibility (8–11), decreased depression and anxiety (3), reduced fatigue (12), improved physical and social activity levels (6,13,14), and decreased or unchanged disease activity and pain (14). In addition, there is no long-term increase in the rate of joint damage (10,15,16), and both hospitalization and work disability are lessened (10,17). Whether there are differential effects of exercise modes on these arthritis symptoms and impairments is an important question that will be addressed in this paper (18).

The Demographics of Disability

In this article, I have attempted to clarify some of the disparate estimates and ways of measuring disability that have been used in different surveys. The definitional issue has implications for the size of the population that will be covered by the ADA. I have reviewed several perspectives, including that of researchers, disability advocates, and individual self-perceptions, which need to be considered in understanding the meaning of disability. Disability involves limitations in actions and activities because of mental and physical impairments. Comparison of these different perspectives reveals that the differences lie in the range of activities that are considered. At least 36 million persons, over 14 percent of the U.S. population, are limited in selected activities. Depending on what are considered to be major life activities, the population covered by the ADA could vastly exceed that figure. Little information is available about the extent to which persons with disabilities, however defined, are affected by discrimination and unequal treatment. Limited data are available from one survey conducted by the International Center for the Disabled, which indicate that as many as 66 percent of persons with activity limitations who are not working would like a job. On the other hand, many persons with activity limitations indicate that their limitations are an important cause of their unemployment. About a quarter of persons with activity limitations due to impairments have experienced discrimination in some form. The impact of the ADA will likely vary by impairment. Because the prevalence of chronic diseases is far greater than the prevalence of physical and sensory impairments, chronic diseases are more frequently the cause of disability. The risk of disability is highest for impairments with low prevalence. Because states and local areas differ in the prevalence of disability, the impact of the ADA will also be likely to vary by geographic area. For some states, the rate of work disability is more than twice the rate of other states. Yet, research indicates that much of the variation is due to socioeconomic characteristics of areas. This reflects, at the macroeconomic level, that persons with disabilities are more likely to be poor and less educated than persons without disabilities. Because of differences in understanding what disability is and insufficient knowledge about the extent of the problem of discrimination toward persons with disabilities, assessment of the potential impact of the ADA is challenging.(ABSTRACT TRUNCATED AT 400 WORDS)

Work disability from coronary heart disease in women.

This study investigates the comparatively high rate of work disability from coronary disease in women. A sample of working women and men hospitalized for acute myocardial infarction was followed for two years to ascertain patterns of labor market withdrawal. Women were more likely than men at 24 months to have withdrawn entirely from market work. Multivariate statistical analysis suggests this greater likelihood stems from differences in behavioral responses to disease rather than from differences in disease severity. Economic incentives to resume work are shown to play an especially crucial role in these responses. Implications of these findings are discussed.