Work Productivity Loss Research Articles

Spread associations of hoof pathology in donkeys in the central and eastern regions of Ukraine

Interest in keeping a donkey as a working, productive, sports and entertainment, and companion animal is constantly growing both in the countries of the world and in Ukraine. However, unlike other countries, in Ukraine, sufficient attention should have been paid to hoof diseases in donkeys for an extended period. Having studied foreign research on this problem and having conducted our research on the spread of donkey hoof pathologies in the central and eastern regions of Ukraine, we concluded that this problem requires in-depth research since hoof pathologies are primarily associated. The hoof has many anatomical components that are closely related to each other and must function in harmony. Therefore, the occurrence of a disease in one anatomical component entails pathological conditions in others. We have conducted a systematization of the data obtained during the study of the distribution of hoof pathologies in donkeys in the central and eastern regions of Ukraine, and we have discovered 59 associations of hoof pathologies with different compositions. 90 % of the donkeys in the experiment had from 2 to 9 hoof pathologies simultaneously, and there were no donkeys with a single separate hoof disease among the examined animals. It was also established that 80.6 % of examined donkeys had from 5 to 8 hoof pathologies simultaneously. Most often, associations of hoof pathologies consisted of 8 different diseases (24.3 %). Associations with two and three-hoof pathologies (2.1 and 4.2 %) were the least common. We also investigated the qualitative composition of associations of hoof pathologies in donkeys and revealed a certain regularity and dependence of the formation of hoof pathologies in donkeys. Moreover, the widest qualitative variety of hoof pathologies had 13 different associations consisting of precisely five pathologies. During our study of the mechanisms of formation of associations of hoof pathologies, we noted that overgrown hooves, various forms of hoof imbalance, and hoof onychomycosis (surface impression of the hoof horn by keratophages of fungal and bacterial origin) are among the main starting pathologies of hooves in donkeys. In advanced cases, severe pathologies of the hooves occurred, such as contracture of the superficial digital flexor, hypoplasia of the flexors, or deformation of the hoof wall. These pathologies caused inflammatory and destructive processes in various structures of the hoof, which in association led to a partial or complete loss of work capacity and productivity of donkeys and deterioration of their well-being and health.

An update on the prevalence, chronicity, and severity of atopic dermatitis and the associated epidemiological risk factors in the Singapore/Malaysia Chinese young adult population: A detailed description of the Singapore/Malaysia Cross-Sectional Genetics Epidemiology Study (SMCGES) cohort

BackgroundAtopic Dermatitis (AD) is a highly pruritic, chronic-recurrent inflammatory skin condition associated with erythematous lesions that affect a significant proportion of the population. Although AD is a non-communicable disease, it can cause pain, unbearable itchiness, sleep disturbance, loss of work productivity, and reduced quality of life. As a heterogeneous disease, AD is influenced by multiple genes and environmental triggers. As such, it is imperative to gain a deeper insight into the intricate gene-environment relationship that results in the manifestation of AD. MethodsThere are 3 objectives in our study. We first aim to update the epidemiological status of AD amongst young adults in Singapore and Malaysia, in particular amongst the Chinese ethnic background. Next, we re-evaluated the possible associated risk factors, identified in our previous meta-analysis and review studies, on the current cohort. Finally, we described here a detailed disease presentation and symptoms profile of our Singapore and Malaysia Cross-Sectional Genetics Epidemiology Study (SMCGES) cohort, which forms the base population for the discovery of associated genetic factors in relation to asthma, allergic diseases and skin conditions. Based on a skin prick test (SPT) and investigator-administered medical history responses, we assessed the AD profiles of 11 494 participants and the significant modifiable and non-modifiable factors associated with disease presentation. ResultsThe prevalence of AD in the combined population was 13.5%. Chronic and moderate/severe AD were observed in 35.5% and 40.5% of the individuals with AD, respectively. Family history of atopic diseases, prior history of drug allergies, a history of acne, increased household family monthly income, higher number of individuals in the shared household, parental education, sedentary lifestyle, physical activities, alcoholic consumption, and even quality of diet was significantly associated with AD presentation, chronicity, and severity. Among all the factors evaluated, family and personal history of atopic diseases imposed the strongest associated risk. ConclusionsThese findings supported our previous review studies and affirmed that familial history or genetic factors critically influence the development of AD in our population and environment. Environmental and other modifiable factors can also trigger AD throughout the lifetime of individuals who have especially inherited the atopic disease disposition. A better understanding of how these risk factors affect AD individuals in our population can facilitate disease surveillance, monitor disease control, and serve as a description for our future genetic epidemiology studies.

Disease burden in primary sclerosing cholangitis in the Netherlands: A long-term follow-up study.

Primary sclerosing cholangitis (PSC) is a progressive, cholestatic liver disease which greatly impacts the lives of individuals. Burden of disease due to shortened life expectancy and impaired quality of life is ill-described. The aim of this study was to assess long-term disease burden in a large population-based registry with regard to survival, clinical course, quality adjusted life years (QALYs), medical consumption and work productivity loss. All PSC patients living in a geographically defined area covering ~50% of the Netherlands were included, together with patients from the three liver transplant centres. Survival was estimated by competing risk analysis. Proportional shortfall of QALYs during disease course was measured relative to a matched reference cohort using validated questionnaires. Work productivity loss and medical consumption were evaluated over time. A total of 1208 patients were included with a median follow-up of 11.2year. Median liver transplant-free survival was 21.0 years. Proportional shortfall of QALYs increased to 48% >25 years after diagnosis. Patients had on average 12.4 hospital contact days among which 3.17 admission days per year, annual medical costs were €12 169 and mean work productivity loss was 25%. Our data quantify for the first time disease burden in terms of QALYs lost, clinical events, medical consumption, costs as well as work productivity loss, and show that all these are substantial and increase over time.

Health-Related Quality of Life and Disease Impacts in Adults with Transfusion-Dependent β-Thalassemia: Preliminary Results from the Global Longitudinal Survey

Introduction: Transfusion-dependent β-thalassemia (TDT) is a chronic inherited blood disorder requiring frequent red blood cell transfusions and daily iron chelation therapy. Health-related quality of life (HRQoL) of individuals with TDT is impacted by a multitude of factors, including iron overload-related morbidity, substantial time required to manage TDT, and work and activity impairments. Nonetheless, the HRQoL impact of TDT is not well quantified. Here, we report the preliminary findings from a prospective longitudinal study evaluating the HRQoL and work productivity impacts among adult participants with TDT. Methods: A mixed-methods study was conducted to quantify the symptoms, HRQoL, and work and education impacts of adults with TDT. The study consisted of qualitative interviews and an online longitudinal survey administered at 3 timepoints (time 0, 3 months, 6 months) in the US, the UK, France, Germany, and Italy. The survey aimed to quantify the HRQoL impacts using multiple patient-reported outcomes measures (PROMs): the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), composed of the Functional Assessment of Cancer Therapy-General (FACT-G) and a BMT subscale (BMTS); EuroQol 5-Dimension 5-Level (EQ-5D-5L); Transfusion-dependent Quality of Life (TranQoL); and Work Productivity and Activity Impairment (WPAI) questionnaire. Symptoms, comorbidities, treatment experiences, out-of-pocket costs, and time spent managing TDT were also collected and evaluated. Survey invitations were sent to patient communities via patient advocacy groups. Participants were required to meet the eligibility criteria and provide consent. Eligibility criteria included receiving ≥8 blood transfusions/year in each of the 2 years prior to enrollment. Descriptive analyses were conducted for participant characteristics and PROMs based on survey findings at time 0. Results: The survey was completed by 155 adult participants with TDT (aged ≥18 years) living in the US (n=83) and the UK, Germany, France, and Italy (n=72). Overall, 65.8% (n=102) were female, the mean age was 38.5 years (standard deviation [SD]: 10.8 years), and 32.9% (n=51) had full-time employment (32 hours/week). Participants reported a mean of 18.7 (SD: 8.2) transfusions in the previous 12 months. The mean FACT-G score was 70.1 (SD: 19.0) (0-108 scale; 108=best HRQoL), which is lower than the US general population mean of 80.1 (SD: 18.1). The largest HRQoL impact was observed on the emotional well-being domain of the FACT-G (-21.9% relative change) (mean: 14.7 [SD: 4.4] compared with the US general population (mean: 9.9 [SD: 4.8]) (0-24 scale; 24=best HRQoL). Participants reported a mean EQ-5D-5L visual analog scale score of 67.1 (SD: 20.4), with 73.2% reporting pain/discomfort, 60.8% anxiety/depression, 46.4% mobility impairment, and 24.8% self-care impairment. The mean TranQoL total score was 53.9 (SD: 18.5) (100-point scale; 100=best HRQoL). Forty percent of the participants felt that TDT limited their career opportunities "often” or "always.” Participants reported spending substantial time managing their condition in the last month, with 62.4% spending >6 hours at medical appointments and 36.1% needing >6 hours of care from family members/caregivers to manage their condition. Among those employed (n=84), 34.4% (SD: 30.9%) reported work impairment (presenteeism), 19.5% (SD: 25.5%) absenteeism, and 41.7% (SD: 32.4%) work productivity loss on the WPAI. Among all respondents (n=151), the mean activity impairment was 44.2% (SD: 31.0%). Results were consistent in a subset of 18-to-35-year-old participants. Conclusions: Adults with TDT currently receiving treatment experience significant HRQoL impacts and impaired work productivity and spend considerable time managing their disease, indicating significant humanistic burden and unmet needs in this patient population.

Health-Related Quality of Life, Disease Impacts, and Health Equity Concerns in Adults with Sickle Cell Disease with Recurrent Vaso-Occlusive Crises: Preliminary Results from a Global Longitudinal Survey

Introduction: Sickle cell disease (SCD) is characterized by vaso-occlusive crises (VOCs) and a progressive clinical course, often leading to end-organ damage and accelerated mortality. Individuals with SCD with recurrent VOCs experience disruptions to daily life due to recurrent pain crises and debilitating chronic pain and fatigue, which affect their ability to work and substantially impair their health-related quality of life (HRQoL). Nonetheless, HRQoL and disease impacts in this population are not well quantified. Here, we report preliminary findings from a prospective longitudinal study evaluating the HRQoL, work productivity impacts, and health equity concerns among adult participants with SCD with recurrent VOCs. Methods: A mixed-methods study was conducted to quantify the symptoms, HRQoL, and work impacts of adults with SCD with recurrent VOCs. The study consisted of qualitative interviews and an online longitudinal survey administered at 3 timepoints (time 0, 3 months, and 6 months) in the US, the UK, France, Germany, and Italy. The survey included multiple patient-reported outcomes measures (PROMs): the Functional Assessment of Cancer Therapy-Bone Marrow Transplant (FACT-BMT), composed of the Functional Assessment of Cancer Therapy-General (FACT-G) and a BMT subscale (BMTS); EuroQol 5-Dimension 5-Level (EQ-5D-5L); 11-point pain Numerical Rating Scale (NRS); Adult Sickle Cell Quality of Life Measurement Information System (ASCQ-Me); and Work Productivity and Activity Impairment (WPAI) questionnaire. Symptoms, comorbidities, treatment experiences, out-of-pocket costs, time spent managing SCD, and participants' health equity concerns were also collected and evaluated. Survey invitations were sent to patient communities via patient advocacy groups. Participants were required to meet the eligibility criteria and provide consent. Eligibility criteria included experiencing ≥2 VOCs/year, in each of the 2 years before study enrollment, that required interaction with a healthcare provider and administration of pain medication or a red blood cell transfusion. Descriptive analyses were conducted for participant characteristics and PROMs based on survey findings at time 0. Data are reported as mean (standard deviation [SD]), unless noted. Results: The survey was completed by 142 participants with SCD (aged ≥18 years) living in the US (n=85) and the UK, Germany, France, and Italy (n=57) at time 0. Overall, 71.8% were female (n=102), the mean age was 35.5 years (10.4), and 15.5% (n=22) had full-time employment (≥32 hours/week). In the prior 12 months, participants reported a mean of 5.9 (4.8) VOCs that required interaction with a healthcare provider and pain medication and spent a mean of 14.6 (24.7) days in the hospital. In the past month, 62.0% (n=88) were taking hydroxyurea to manage their condition. The mean FACT-G total score was 62.2 (18.5) (0-108 scale; 108=best HRQoL), which is lower than in the US general population (80.1 [18.1]). The largest impacts were observed on the physical (-23.9% relative difference) and emotional well-being domains (-16.3% relative difference) vs the US general population. Participants reported a mean EQ-5D-5L visual analog scale score of 58.7 (19.4), with 89.9% reporting pain/discomfort, 74.1% anxiety/depression, 71.2% mobility impairment, and 46.8% self-care impairment. Significant HRQoL impairments were also observed on the ASCQ-Me vs the SCD reference population, with the largest differences observed on the pain (41.5 [9.0]), stiffness (41.1 [8.2]), and emotional (43.5 [7.6]) impact domains. Among those employed (n=47), 42.0% (27.8%) reported work impairment (presenteeism), 24.7% (27.1%) absenteeism, and 53.4% (27.5%) work productivity loss on the WPAI. Among all respondents (n=137), the mean activity impairment was 52.6% (26.0%). On healthcare equity concerns, 68.3% (n=97) felt that they had been treated unfairly while seeking care, with most attributing the unfair treatment to their race/ethnic background (67.0%) and/or requesting more pain medicine (64.9%). Results were consistent in a subset of 18-to-35-year-old participants. Conclusions: Adults with SCD with recurrent VOCs currently receiving treatment experience significant HRQoL impact, impaired work productivity, and health equity concerns, indicating substantial humanistic burden and unmet needs in this patient population.

Depression in Rheumatoid Arthritis: A Narrative Review-Diagnostic Challenges, Pathogenic Mechanisms and Effects.

Depression is one of the most frequent comorbidities in rheumatoid arthritis (RA); it takes an important toll on the quality of life of these patients and also leads to a decrease in life expectancy. The current article is a narrative review on depression in RA, with the objective to emphasize and raise awareness on the high prevalence, pathogenic mechanisms, and effects that depression has on RA patients. In RA, the prevalence of depression has been shown to be 2 to 3 times higher than in the general population, with a meta-analysis reporting that 16.8% of RA patients have a major depressive disorder. Future studies are needed to determine the most accurate self-reported depression questionnaires and their ideal threshold for defining depression as compared to diagnostic interview as gold-standard for patients with RA to allow better comparisons across studies. The pathogenesis of depression remains to be fully understood, but recent specialty literature suggests that immune-mediated processes are involved and that there are similarities between the neural networks recruited in inflammation and those implicated in the pathophysiology of depression. Depression in patients with RA is associated with poor long-term outcomes. Multiple studies have shown that depression in RA is associated with increased pain, fatigue, and physical disability. It alters treatment compliance, causes more comorbidities, and leads to higher mortality, partly through increased suicide risk. Depression in RA also increases health service utilization and healthcare costs directly through hospitalization, but also indirectly through loss of work productivity. Assessing depression could be a significant psychomarker of rheumatological outcome in RA.

Burden of migraine in Brazil: A cross-sectional real-world study.

To assess the burden and consequences of migraine in Brazil in terms of health-related quality of life (HRQoL), work productivity and daily activities, and healthcare resource utilization (HRU). Despite existing data on how migraine affects populations worldwide, there are limited data on the burden of migraine in Latin America. This cross-sectional study used patient-reported data from the 2018 Brazil National Health and Wellness Survey. HRQoL scores (EuroQol 5-dimension 5-level [EQ-5D-5L]; 36-item Short Form Health Survey, version 2 [SF-36v2]; and Short Form 6-dimension [SF-6D]), impairments to work productivity and daily activities (Work Productivity and Activity Impairment questionnaire), and all-cause HRU were compared between migraine respondents and matched non-migraine controls. Of the 12,000 total respondents in the survey database, 1643 self-reported a physician diagnosis of migraine and were propensity score matched 1:1 with controls without migraine. HRQoL was lower in patients with migraine versus non-migraine controls, with significantly lower SF-36v2 physical (mean[± SD] 50.3[7.5] vs. 52.0[7.6]) and mental component (mean [± SD] 42.9[10.2] vs. 46.0[9.9]) summary scores and SF-6D (mean [± SD] 0.7[0.1] vs. 0.7[0.1]) and EQ-5D-5L (mean [± SD] 0.7[0.2] vs. 0.8[0.2]) utility scores (all p < 0.001). Patients with migraine reported higher levels of work productivity loss (mean[± SD], 40.6%[31.4%] vs. 28.6%[30.9%], including absenteeism 12.8%[19.1%] vs. 8.4%[17.1%] and presenteeism 35.0%[28.7%] vs. 24.8%[28.0%]; all p < 0.001); activity impairment (mean[± SD] 36.0%[28.8%] vs. 25.5%[28.1%]; p < 0.001); and significantly higher HRU in the past 6 months (healthcare provider and emergency department visits [mean [± SD] 7.2[9.5] vs. 4.5[6.3] and 1.7[3.8] vs. 0.9[2.2]; both p < 0.001] and hospitalizations [mean [± SD] 0.4[2.7] vs. 0.2[1.1]; p=0.002]) than controls. Migraine is associated with poorer HRQoL, higher all-cause HRU, and greater activity impairment and work productivity loss versus non-migraine controls in Brazil.

Work productivity loss among adults aged 18–64 years with Multiple Sclerosis in the United States: A propensity score matched study

Scarce data exists regarding United States (US) national-level work productivity loss among adults with Multiple Sclerosis (MS). To address this significant knowledge gap, we examined the national-level productivity loss among adults (18≤ age ≤64 years) with MS compared to propensity score matched non-MS controls. We adopted a retrospective, cross-sectional, matched cohort study design with pooled data from alternate years (2005/2007/2009/2011/2013/2015) of the Medical Expenditure Panel Survey (MEPS). We included adults who were employed and alive during the calendar year. Clinical Classification System code of "80" was used to identify individuals with MS. We matched adults with MS to non-MS adults utilizing propensity scores generated based on age, gender, and race/ethnicity using a greedy matching algorithm (8:1-digit matching). Missed workdays measured productivity loss of MEPS respondents. We selected Negative Binomial Regression (NBR) analysis as the count data model for this study. Analyses were conducted using SAS 9.4 and STATA 15.0 and accounted for the complex survey design of MEPS to generate US national-level estimates. The final propensity-score matched sample consisted of 104 and 312 (unweighted) adults with and without MS, respectively. US national-level mean [Standard Error (SE)] annual missed workdays among individuals with MS [8.94 (SE:1.59)] was significantly higher (p=0.001) compared to propensity score matched non-MS controls [3.15 (SE:0.40)]. After adjusting for several factors, NBR showed an approximately two-fold higher rate of missed work days among individuals with MS compared to propensity score matched non-MS controls (Incidence Rate Ratio: 1.98, 95% Confidence Interval: 1.18-3.33). Severity of pain, marital status, region, and hypertension also negatively impacted work productivity in this sample. Individuals with MS in the US experience significantly higher productivity loss compared to propensity score matched non-MS controls. Interventions (e.g., improved management of MS symptoms) are warranted to reduce productivity loss among individuals with MS.

Burden of enthesitis on the quality of life and work productivity in psoriatic arthritis patients

BackgroundPsoriatic arthritis (PsA) which affects 6–42% of psoriasis patients is the most common extra-cutaneous manifestation of the psoriasis disease. Enthesitis may be considered as a sign of increased disease burden due to its association with several clinical aspects. Therefore, the aim of the study was to investigate the effect of clinical enthesitis on quality of life and work productivity in PsA patients.ResultsEnthesitis was detected in 50% of patients. There was statistically significant difference between the studied groups as regard disease activity index for psoriatic arthritis (DAPSA) score, psoriatic arthritis impact of the disease 12 (PsAID-12), Health Assessment Questionnaire disability index (HAQ-DI), and Spondyloarthritis Research Consortium of Canada index (SPARCC) with higher mean score in patients with enthesitis. The majority of patients with enthesitis had a higher percentage of impairment in daily activities (95.5%) than those without enthesitis (38.6%), as well as a statistically significant positive correlation between SPARCC index and both work absenteeism and work productivity loss. Furthermore, enthesitis in both the upper and lower sites was related with worse quality of life (36.4%) and higher work impairment (45.5%) compared to patients with enthesitis in either the upper or lower sites alone.ConclusionEnthesitis was a frequent complaint among PsA patients. PsA patients with enthesitis had a significant disease burden regardless of enthesitis location, and patients with enthesitis in both the upper and lower sites have a worse quality of life and a higher work impairment.

Disease Activity and Health-related Quality of Life Relationships with Work Productivity in Patients with Ulcerative Colitis in OCTAVE Induction 1 and 2 and OCTAVE Sustain.

Tofacitinib is an oral small molecule Janus kinase inhibitor for the treatment of ulcerative colitis [UC]. We evaluated the relationship between Mayo/Inflammatory Bowel Disease Questionnaire [IBDQ] scores and Work Productivity and Activity Impairment-UC [WPAI-UC] components in patients with UC. All available pooled data from three Phase 3 tofacitinib studies [OCTAVE Induction 1 and 2 and OCTAVE Sustain] were included. Relationships were estimated using repeated measures regression models with Mayo score/subscores or IBDQ total/domain scores as a separate anchor predictor and WPAI-UC components as the outcome. Evidence for linear relationships was confirmed between Mayo/IBDQ scores and WPAI-UC components. Robust relationships between total Mayo score/IBDQ total score and WPAI-UC presenteeism, work productivity loss, and activity impairment were observed; relationships with absenteeism were weak. Total Mayo scores of 0 and 12 corresponded, on average, to WPAI-UC component scores of < 15% and ≥ 60%, respectively, and IBDQ total scores of 224 and 32 corresponded, on average, to WPAI-UC component scores of < 6% and ≥ 90%, respectively. Presenteeism, work productivity loss, and activity impairment [all 0-100%], respectively, improved on average by 14.7, 13.6, and 16.4 percentage points for every 3-point improvement in total Mayo score, and by 8.1, 7.9, and 8.8 percentage points for every 16-point improvement in IBDQ total score. Robust relationships between Mayo/IBDQ scores with WPAI-UC presenteeism, work productivity loss, and activity impairment suggest that patient productivity and non-work activities are strongly associated with disease activity and HRQoL. The weak relationships with absenteeism suggest that patients attend work regardless of their disease activity/poor HRQoL. ClinicalTrials.gov: NCT01465763;NCT01458951;NCT01458574.

Schistosomiasis control in adults: a call for action towards the goal of universal health coverage

Abstract Background Schistosomiasis is a high-burden parasitic disease and endemic in tropical climates, such as Madagascar. Recently it is emerging in Europe. Chronic infections lead to disabilities including loss in work productivity. Current control strategies focus on school-aged children, thereby systematically excluding adults. The goal to eliminate the disease as a public health problem is aligned with the Sustainable Development Goals agenda, including Universal Health Coverage (UHC). We aim at assessing the distribution of schistosomiasis among adults in Madagascar, in order to promote more targeted public health initiatives against the disease. Methods In a cross-sectional study, 1477 blood samples were collected at three primary health-care centers in Madagascar from 03.21 to 01.22. A semi quantitative PCR assay was used to assess the presence of Schistosoma. Positivity rates with 95% Confidence Intervals (CI) were reported by gender and age groups. Results Our study population had a balanced gender distribution with 54.2% [CI: 51.7;56.8] of females and a median age of 37 years (IQR: 24-48). Preliminary results show an overall Schistosome positivity rate of 59.5% [CI: 57.0;62.0]. Positivity was higher in males 62.4% [CI: 58.7;66.1], than in females 57.1% [CI: 53.5;60.5]. Highest positivity was seen in the 18-34 year age group with 66.2% [CI: 62.7;69.6]. Lowest positivity of 46.2% [CI: 39.2;53.2] was observed in adults aged over 55 years. Conclusions Our preliminary results provide evidence of high positivity rates of schistosomiasis among adults in a highly endemic country. Differently from many studies, males seem more affected than females. The youngest age group, representing the more active workforce of a population, shows a higher positivity rate. Our data suggests that, in the logic of UHC and health as a human right, public health strategies for schistosomiasis need to be re-addressed towards a universal coverage of affected individuals. Key messages

Work productivity and activity in patients with SAPHO syndrome: a cross-sectional observational study

BackgroundOur understanding of work productivity impairment among patients with synovitis, acne, pustulosis, hyperostosis, and osteitis (SAPHO) syndrome is limited. The purpose of this study was to provide an overview of work productivity loss in SAPHO syndrome patients through the use of the work productivity and activity impairment (WPAI) questionnaire, as well as to investigate the relationship between the WPAI and other disease-related indicators.MethodsPatients for this cross-sectional study were recruited from Peking Union Medical College Hospital (Beijing, China). The questionnaires incorporating the WPAI were administered, along with the inclusion of demographic data, disease-specific measures, and general health variables. The construct validity of the WPAI was evaluated via the correlations between WPAI outcomes and other measures. Wilcoxon rank-sum tests and nonparametric Kruskal‒Wallis tests were used for the comparison of the WPAI outcomes between known groups.ResultsA total of 376 patients were included, and 201 patients (53.5%) were employed. The medians (interquartile range [IQR]) of absenteeism, presenteeism, work productivity loss, and activity impairment were 0% (0–13%), 20% (0–40%), 20% (0–52%), and 30% (0–50%), respectively. All of the WPAI outcomes showed moderate to strong correlations with other generic and disease-specific measures (|r| = 0.43–0.75), except for absenteeism. Increasing disease activity and worse health status were significantly associated with increased impairments of work productivity and activity.ConclusionThis study highlights the negative effects of SAPHO syndrome on the work productivity and activity of patients, thus indicating good construct validity and discriminative ability of the WPAI. To reduce the economic burden, it is important to improve the work productivity and daily activity of patients by ameliorating clinical care.

The economic value of informal long-term care

Abstract Informal care makes up a significant share of long-term care (LTC) and is likely to become even more important in the near future because of the ageing population, rising numbers of chronic patients and shortages of formal carers. At the same time, informal care is under pressure because of societal developments (shrinking family sizes, increased participation of women on the labour market, rising retirement age and geographical dispersion of families). These developments may further enhance the effect of informal care in terms of individuals’ quality of life and opportunity costs caused by work absence and productivity losses. Against this background, Ecorys has performed studies, to empirically estimate the social value of informal LTC and increase the awareness on its importance. The results of the study, commissioned by the European Commission, demonstrate that informal caregivers represent about 80% of all caregivers (measured in FTE). If paid for, these hours would cost between 2.4 and 2.7% of EU GDP. Currently, these costs are not paid and the actual costs of informal care are estimated at 1.05% of EU GDP, mostly in lost tax revenues. European countries vary greatly in the extent to which informal carers are supported by public policies. Only some countries have cash benefit schemes to compensate for the loss of income from employment. Specific benefits and leave entitlements to support informal caregivers are often insufficient or lacking. In several studies in the Netherlands, Ecorys found that total social costs of informal care are estimated at 2.54% of NL GDP (€22 billion/year) and informal caregivers perceive increasing economic and psychological burden and are at higher risk of depression and burn out. Government policies are developed to better support informal caregivers. Key messages

Occupational stress is associated with job performance among pregnant women in Japan: comparison with similar age group of women

BackgroundPregnancy results in physical and psychological changes in women; however, pregnant women hesitate to take a break from work even when they feel the need. Since working while physically ill leads to decreased job performance, it is important to determine the factors that lead to this phenomenon.AimTo study the occupational stress associated with job performance and absenteeism of pregnant women compared with non-pregnant women.MethodsIn 2019, non-pregnant and pregnant employed women in their 20–40 s in Japan completed an online survey examining job performance (Work Limitation Questionnaire - Short Form), absenteeism, occupational stress (Brief Job Stress Questionnaire), and working situations.ResultsOf 918 respondents who met the inclusion criteria, 904 were included in the final analysis (454 non-pregnant and 450 pregnant women). Logistic regression analyses showed that absenteeism was significantly higher for pregnant women. However, for women who were absent, there was no significant difference between non-pregnant and pregnant women. After adjusting for attributes and working conditions, pregnant women had significantly higher (p < .001) work productivity losses than non-pregnant women, but only in the physical tasks domain; their physical stress response was also higher compared to non-pregnant women (p = .048). However, pregnant women reported significantly less interpersonal conflict stress (p < .001) and psychological stress (p = .026), as well as better workplace support as a buffering factor for stress (p = .021), than non-pregnant women.ConclusionClarifying the physical burden associated with pregnancy and assisting women in coordinating their work duties while considering the physical demands of pregnancy may minimize work productivity losses among pregnant women.

S798 Indirect Effects of Tofacitinib on Work Productivity in Patients with Ulcerative Colitis: A Mediation Analysis Between Work Productivity and the Inflammatory Bowel Disease Questionnaire

Introduction: Tofacitinib is an oral small molecule JAK inhibitor for the treatment of UC. Tofacitinib induction treatment has been shown to improve work productivity in patients (pts) with UC. However, it is unknown whether improvements in work productivity are fully explained by changes in the Inflammatory Bowel Disease Questionnaire (IBDQ) or if other factors not captured by these changes contribute. Methods: We evaluated the interrelationship between IBDQ domains (bowel, emotional, social, and systemic) and Work Productivity and Activity Impairment-UC (WPAI-UC) components (overall work productivity loss and activity impairment) among pts in the Phase 3, 8-week induction studies that evaluated tofacitinib as induction therapy for UC (OCTAVE Induction 1&2; NCT01465763; NCT01458951). A mediation model used IBDQ domains as mediators of the treatment effect on WPAI-UC components as outcomes. Work productivity loss and activity impairment can be viewed as complementary outcomes covering work and other daily activities, respectively. Analyses used all available pooled data from Week 8 in pts receiving tofacitinib/placebo. Results: There were 490 and 1,083 pts available for analysis in the models assessing work productivity loss and activity impairment, respectively. For the models evaluating work productivity loss (Figure a) and activity impairment (Figure b), the effects of tofacitinib were fully mediated via IBDQ domains; the largest effects were via the IBDQ social domain, which represented 57.4% and 58.4% of the effects of tofacitinib on work productivity loss and activity impairment, respectively (Figure a and Figure b, respectively). The impact of tofacitinib via the IBDQ emotional domain did not affect work productivity loss or activity impairment. Conclusion: This analysis suggests that the effects of tofacitinib induction therapy on work productivity loss and activity impairment in pts with UC were fully mediated via IBDQ bowel, social, and systemic domains. These findings provide insights into the interrelationship between IBDQ domains and WPAI-UC and may help inform healthcare providers on the impact of UC therapies on pts' work and leisure activities.Figure 1.: Summary of indirect (mediated through IBDQ domains) effects of tofacitinib vs placebo on the a) work productivity loss and b) activity impairment WPAI-UC components as a percentage of the total treatment effect. The WPAI-UC is a self-administered six-item questionnaire that generates four metrics: absenteeism (work time missed), presenteeism (impairment whilst working), productivity loss (overall work impairment from the combination of absenteeism and presenteeism), and activity impairment (non-work activity impairment). WPAI-UC component scores are expressed as percentages, with a higher percentage indicating greater impairment and less productivity. The IBDQ evaluates disease-related quality of life by 32 items over four domains: bowel (total domain score ranges from 10 to 70), emotional (total domain score ranges from 12 to 84), social (total domain score ranges from 5 to 35), and systemic (total domain score ranges from 5 to 35). For the total score (ranges from 32 to 224) and each domain, a higher score indicates a better quality of life. IBDQ, Inflammatory Bowel Disease Questionnaire; WPAI-UC, Work Productivity and Activity Impairment-Ulcerative Colitis

S883 Impact of Fatigue on Work Productivity and Activity Impairment and Health Care Utilization in Patients With Inflammatory Bowel Disease

Introduction: Fatigue often impacts daily activities in patients with IBD and is commonly reported even in patients with inactive disease. We explored the impact of fatigue on work productivity and activity impairment (WPAI) and health care utilization (HCU). Methods: Data were analyzed from the CorEvitas IBD Registry, a prospective cohort of adult patients with Crohn’s Disease (CD) or ulcerative colitis (UC). Using data collected between May 3, 2017 and April 1, 2022, we compared WPAI and HCU among 1) subjects with high fatigue (PROMIS score > 55) vs low fatigue (PROMIS score < 55) at enrollment and 2) subjects whose fatigue score worsened vs subjects with persistently high fatigue at 6 months. Disease activity was assessed with Harvey Bradshaw Index (CD) or Partial Mayo (UC). Descriptive statistics, adjusted odds ratios and 95% CIs are reported. Results: High fatigue at enrollment was reported in 47% of 640 CD and 38% of 569 UC patients with 56% and 39% in remission, respectively. For both CD and UC, patients with high fatigue reported more absenteeism, presenteeism, work productivity loss, and daily activity impairment, and higher rates of HCU at enrollment compared to those with low fatigue (Table). In adjusted analyses, 17% of CD subjects had worsened fatigue at 6 months which correlated with 2.7 increased odds of worsening presenteeism (95% CI: 1.19-6.26) and a 2.6 increased odds of worsening daily activity impairment (95% CI 1.45-4.72) compared to those with persistently high fatigue (Figure a). For UC, high fatigue correlated with 2.9 increased odds of an IBD-related hospitalization (95% CI 1.02-7.99) and 3.8 increased odds of having an ER visit (95% CI 1.28-11.01) in the following 6 months. Further, 13% of UC subjects had worsened fatigue at 6 months and were found to have 2.2 increased odds of worsening daily activity impairment (95% CI 1.06-4.59) compared to those with persistently high fatigue (Figure b). Conclusion: Our data show that fatigue is prevalent in both CD and UC and persists in the absence of active inflammation. More severe fatigue is associated with concurrent work productivity and activity impairment in both UC and CD patients and more IBD-related HCU in the UC subjects. Treatment approaches that improve fatigue in our IBD population may help to lessen further disability.Figure 1.: Adjusted Association Between Worsening Fatigue vs Persistently High Fatigue at 6 Months and Change in Employment, Work Productivity and Activity Impairment, and Health Care Utilization at 6 Months in Patients with Crohn’s Disease or Ulcerative Colitis * Adjusted odds ratios were obtained using logistic regression models adjusted for age, sex, education, marital status, current alcohol use, history of CVD, history of respiratory, history of depression, history of anxiety, number of prior biologics/JAKi/S1P, concomitant steroids, duration of current IBD therapy, Harvey Bradshaw index score (continuous), and WPAI current employment † Adjusted odds ratios and p values were obtained using logistic regression models adjusted for age, sex, BMI continuous, private insurance, marital status, history of respiratory, history of anxiety, history of other non-serious medical condition, time since IBD diagnosis, prior IST experienced, prior steroid experienced, Harvey Bradshaw Index score (continuous), and WPAI current employment ‡ Adjusted odds ratios were obtained using logistic regression models adjusted for age, sex, smoking status, current alcohol use, history of CVD, history of depression, history of anxiety, history of other non-serious medical condition, pan-colitis, concomitant biologics/JAKi/S1P, concomitant 5-ASAs, duration of current IBD therapy (years), and Partial Mayo score (continuous) ‖ Adjusted odds ratios were obtained using logistic regression models adjusted for white race, Hispanic ethnicity, BMI categorical, smoking status, history of anxiety, history of other non-serious medical conditions, proctitis, pan-colitis, prior-antibiotic experienced, concomitant biologics/JAKi/S1P, concomitant 5-ASAs, and Partial Mayo score (continuous). Table 1. - Baseline Work Projectivity and Activity Impairment and Health Care Utilization Among Patients with Crohn’s Disease or Ulcerative Colitis having High Fatigue (PROMIS score ≥ 55) versus Low Fatigue (PROMIS score < 55) at Enrollment High Fatigue Low Fatigue Unadjusted p value Crohn's disease n=299 n=341 Absenteeism 45/169 (27%) 28/209 (13%) 0.001 Presenteeism 147/174 (85%) 113/222 (51%) < 0.001 Work productivity loss 143/167 (86%) 112/208 (54%) < 0.001 Daily activity impairment 255/298 (86%) 193/339 (57%) < 0.001 IBD-related hospitalizations 206/299 (69%) 203/340 (60%) 0.016 IBD-related ER visits 193/299 (65%) 185/340 (54%) 0.009 Ulcerative Colitis n=218 n=351 Absenteeism 48/131 (37%) 23/215 (11%) < 0001 Presenteeism 102/139 (73%) 120/232 (52%) < 0001 Work productivity loss 99/130 (76%) 117/215 (54%) < 0001 Daily activity impairment 176/217 (81%) 199/351 (57%) < 0001 IBD-related hospitalizations 109/218 (50%) 144/351 (41%) 0.036 IBD-related ER visits 111/218 (51%) 132/350 (38%) 0.002

S749 Mirikizumab Improves Work Productivity and Activity Impairment Questionnaire Scores in Moderately-to-Severely Active UC: The LUCENT-1 and LUCENT-2 Randomized, Double-Blind, Placebo-Controlled Phase 3 Studies

Introduction: This analysis compares mirikizumab (miri) to placebo (PBO) for improvement in the Work Productivity and Activity Impairment Questionnaire Ulcerative Colitis (WPAI:UC) in participants of LUCENT-1 and LUCENT-2, phase 3 clinical trials who had moderately-to-severely active UC and had failed prior conventional or biologic therapies. Methods: 1162 patients (pts) in LUCENT-1 12-week induction study were randomized 3:1 to receive 300mg miri or PBO intravenously once every 4 weeks (Q4W). 544 pts who completed induction and achieved Modified Mayo Score (MMS) Clinical Response with miri were rerandomized 2:1 in LUCENT-2 to a 40W maintenance treatment of miri 200mg or PBO subcutaneously Q4W for a total of 52W treatment. Randomization was stratified by previous biologic therapy failure, baseline (BL) corticosteroid use, and region. Stratification for LUCENT-1 included BL disease activity, and LUCENT-2 included LUCENT-1 clinical remission status. WPAI:UC scores between 0%-100% were calculated from pts-reported measurements, with a higher score indicating greater impairment. Evaluations of the WPAI:UC domain of overall activity impairment included all respondents, while domains of absenteeism, presenteeism, and work productivity loss required employment at the time of the analyses. Changes from W0 BL at W12 (induction) and W40 (maintenance; 52W treatment) were evaluated by analysis of covariance. Stratification factors and BL scores were used as covariates. Results were reported as least squares mean differences (LSM diff) of miri vs PBO. Results: At BL, 60.67% (N=705) of pts reported employment. At W12 of induction, activity impairment, absenteeism, presenteeism, and work productivity loss were significantly reduced from BL in miri treated pts vs PBO (Table). Of the pts who achieved W12 MMS Clinical Response, those who continued receiving miri had sustained improvements in the WPAI:UC change from BL at W40 of maintenance vs those who received PBO, including activity impairment, presenteeism, and work productivity loss. Absenteeism was not significantly different between treatment groups at W40 (52W treatment). Conclusion: Compared to PBO, miri treatment provided statistically significant improvements in work productivity and activity impairment as measured by the WPAI:UC. Improvements were observed during induction and maintenance therapy in pts with moderately-to-severely active UC who had failed prior conventional or biologic therapies. Table 1. - Changes from Baseline in Work Productivity and Activity Impairment Questionnaire: Ulcerative Colitis Scores at Week 12 and Week 40 (52 Weeks of Continuous Treatment) Activity Impairment of All Participants Absenteeism from Work of Employed Participants Presenteeism at Work of Employed Participants Overall Work Impairment of Employed Participants LSM Change from BL (SE) LSM Diff 1 (SE) LSM Change from BL (SE) LSM Diff 1 (SE) LSM Change from BL (SE) LSM Diff 1 (SE) LSM Change from BL (SE) LSM Diff 1 (SE) Induction Period Change from Baseline (Week 12) PBO IV Q4W (N=294) −12.90 (1.41) −3.45 (1.75) −13.94 (1.75) −14.91 (1.99) Miri 300 mg IV Q4W (N=868) −20.90 (0.87) −8.01 (1.57)*** −7.88 (1.03) −4.43 (1.95)* −19.25 (1.03) −5.31 (1.95)** −20.65 (1.16) −5.74 (2.20)** Maintenance Period Change from Induction Baseline of Miri Induction Responders (Week 40; 52 Weeks of Continuous Therapy) PBO SC Q4W (N=179) −22.91 (1.77) −10.78 (1.68) −19.82 (1.98) −22.59 (2.26) Miri 200 mg SC Q4W (N=365) −32.46 (1.35) −9.55 (1.98)*** −12.85 (1.28) −2.07 (1.93) −29.42 (1.51) −9.60 (2.28)*** −31.72 (1.73) −9.13 (2.61)*** Abbreviats: BL=Baseline; IV=intravenous; LSM=least squares mean; LSM Diff=least squares mean difference; Miri=mirikizumab; N=number of participants in the analysis population; PBO=placebo; Q4W=every 4 weeks; SC=subcutaneous; SD=standard deviation; SE=standard error.1The LSM Diff is the least squares mean change from baseline in WPAI:UC scores of participants receiving mirikizumab minus the LSM change from baseline in WPAI:UC scores of participants receiving placebo. *p< 0.05, **p< 0.01, ***p< 0.001.

A Multi-component Intervention (NEXpro) Reduces Neck Pain-Related Work Productivity Loss: A Randomized Controlled Trial Among Swiss Office Workers

Purpose Neck pain is common among office workers and leads to work productivity loss. This study aimed to investigate the effect of a multi-component intervention on neck pain-related work productivity loss among Swiss office workers. Methods Office workers, aged 18–65 years, and without serious neck-related health problems were recruited from two organisations for our stepped-wedge cluster randomized controlled trial. The 12-week multi-component intervention included neck exercises, health-promotion information, and workplace ergonomics. The primary outcome of neck pain-related work productivity loss was measured using the Work Productivity and Activity Impairment Questionnaire and expressed as percentages of working time. In addition, we reported the weekly monetary value of neck pain-related work productivity loss. Data was analysed on an intention-to-treat basis using a generalized linear mixed-effects model. Results Data from 120 participants were analysed with 517 observations. At baseline, the mean age was 43.7 years (SD 9.8 years), 71.7% of participants were female (N = 86), about 80% (N = 95) reported mild to moderate neck pain, and neck pain-related work productivity loss was 12% of working time (absenteeism: 1.2%, presenteeism: 10.8%). We found an effect of our multi-component intervention on neck pain-related work productivity loss, with a marginal predicted mean reduction of 2.8 percentage points (b = −0.27; 95% CI: −0.54 to −0.001, p = 0.049). Weekly saved costs were Swiss Francs 27.40 per participant. Conclusions: Our study provides evidence for the effectiveness of a multi-component intervention to reduce neck pain-related work productivity loss with implications for employers, employees, and policy makers.Trial Registration ClinicalTrials.gov, NCT04169646. Registered 15 November 2019—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04169646.

Ankilozan spondilitte iş engelliliği ve iş verimliliği kaybı ile ilişkili faktörler

Objective: To assess the rate of employment and factors associated with work productivity loss in Ankylosing spondylitis (AS).&#x0D; Material and Method: This study was designed as a cross-sectional study that included 70 patients with AS. Fatigue, morning stiffness, and pain were assessed on a visual analogue scale (VAS). Disease activity, physical function, quality of life, anxiety and depression were assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Ankylosing Spondylitis Quality of Life (ASQoL), and Hospital Anxiety and Depression Scale (HAD), respectively. We used the Work Productivity and Activity Impairment Questionnaire (WPAI) to determine the impact of AS on work productivity. The clinical and demographic characteristics of working and not working patients were compared. Factors associated with absenteeism and presenteeism were assessed using univariable logistic and linear regression analysis, respectively.&#x0D; Results: Mean age of 70 patients (24 women, 46 men) with AS was 42.96 ± 7.83 years. The percentages of working patients was 65.7%. The percentages of presenteeism and absenteeism were 60.21% and 37%, respectively. The clinical and demographic characteristics of working and not working patients were not different (p&gt;0.05). Absenteeism was associated with low educational level (odds ratio [OR]=7.636; 95% confidence interval [CI]=1.782-32.723; p=0.006), morning stiffness (OR=1.545; 95% CI=1.118-2.134; p=0.008), BASDAI (OR=1.645; 95% CI=1.088-2.489; p=0.018), and ASQoL (OR=1.392; 95% CI=1.094-1.772; p=0.007). In the linear regression model, BASDAI (β=8.394; 95% CI=5.570-11.217; p

Direct and indirect health-related costs of systemic sclerosis in New Zealand.

To study the economic impact of systemic sclerosis (SSc) in the patients attending Rheumatology clinics in Waikato Hospital, Hamilton, New Zealand (NZ). There is currently no bottom-up data on this in NZ. This is a retrospective cross-sectional questionnaire-based study, including demographics, costs related to SSc, quality of life measures including the short-form survey (SF-36) the scleroderma health assessment questionnaire-visual analog scale (SHAQ-VAS), the NZ index of Deprivation (NZiDep), and work limitations questionnaire (WLQ). Direct health costs include patient-reported costs and costs incurred by the public health system. Indirect costs include calculated loss of work productivity. Comparisons were made between age, gender, disease duration, and disease subtype (diffuse, limited, and overlap syndromes). Participants fulfilled the 2013 ACR/EULAR criteria for SSc. The study was completed by 86 (65.5%) patients, 77 (90%) were females, 19 (22%) had diffuse cutaneous systemic sclerosis (dcSSc), 72 (83%) were NZ European (NZE), seven(8%) were Māori or NZE/Māori. Seventy-six (41.8%) were employed. The average total costs for 6months were NZ$444.50 with the highest costs in the dcSSc sub-group at NZ$598.00. The costs incurred by the Hospital for the 2018/2019 fiscal year was NZ$3091 per patient. The SF-36 score was lower compared with the general population, mean SHAQ was 0.82. Mean summative WLQ scores were: Time management 21.7, Physical demands 62.5, Interpersonal 23.6, Output demands 23.8. The calculated percentage productivity loss was 46.5%. This study has shown high health-related costs of SSc in NZ, with reduction in employment, work productivity, and quality of life. The contributors to the costs included physical disability and loss of productivity.