2013-11-01 12:00 - Messages

How much do preexisting chronic conditions contribute to age differences in health care expenditures after a work-related musculoskeletal injury?

OBJECTIVES: To estimate the contribution of preexisting chronic conditions on age differences in health care expenditures for the management of work-related musculoskeletal injuries in British Columbia. METHODS: A secondary analysis of workers' compensation claims submitted over the 5-year period between January 1, 2002 and December 31, 2006 (N=55,827 claims among men and 32,141 claims among women). Path models examined the relationships between age and health care expenditures, and the extent to which age differences in health care expenditures were mediated by preexisting chronic conditions. Models were adjusted for individual, injury, occupational, and industrial covariates. RESULTS: The relationship between age and health care expenditures differed for men and women, with a stronger age gradient observed among men. Preexisting osteoarthritis and coronary heart disease were associated with elevated health care expenditures among men and women. Diabetes was associated with elevated health care expenditures among men only, and depression was associated with elevated health care expenditures among women only. The percentage of the age effect on health care expenditures that was mediated through preexisting chronic conditions increased from 12.4% among 25-34-year-old men (compared with 15-24 y) to 26.6% among 55+-year-old men; and 14.6% among 25-34-year-old women to 35.9% among women 55 and older. CONCLUSIONS: The results of this study demonstrate that differences in preexisting chronic conditions have an impact on the relationship between older age and greater health care expenditures after a work-related musculoskeletal injury. The differing prevalence of preexisting osteoarthritis, coronary heart disease, and to a lesser extent diabetes (among men) and depression (among women) across age groups explain a nontrivial proportion of the age effect in health care expenditures after injury. However, approximately two thirds or more of the age effect in health care expenditures remains unexplained.

Source : Smith PM, Bielecky A, Ibrahim S, Mustard C, Scott-Marshall H, Saunders R, Beaton D. Med. Care. 2013.
http://dx.doi.org/10.1097/MLR.0000000000000017

Determinants of limitations in unpaid work after major trauma

A prospective cohort study with 15 months follow-up
OBJECTIVE: To identify determinants of limitations in unpaid work (household work, shopping, caring for children and odd jobs around the house) in patients who had suffered major trauma (ISS≥16) and who were in full-time employment (≥80%) at the time of injury. DESIGN: Prospective cohort study. SETTING: University Medical Centre Utrecht, a level 1 trauma centre in the Netherlands. METHOD: All severely injured (ISS≥16) adult (age≥16) trauma survivors admitted from January 1999 to December 2000 who were full-time employed at time of the injury were invited for follow-up (n=214). Outcome was assessed with the 'Health and Labour Questionnaire' (HLQ) at a mean of 15 months (SD=1.5) after injury. The HLQ was completed by 211 patients. RESULTS: Response rate was 93%. Logistic regression analyses identified the percentage of permanent impairment (% PI), level of participation (RtW), co-morbidity, lower extremity injury (LEI) and female gender as determinants of limitations in unpaid work. Patients with a post-injury status of part-time or no return to work experienced more limitations in unpaid work than those who returned to full-time employment. CONCLUSIONS: Resuming paid work after major trauma is not associated with reductions in unpaid activities. To assess the long-term outcome of rehabilitation programmes, we recommend a measure that combines patient's satisfaction in their post-injury jobs with a satisfactory level of activities in their private lives.

Source : Van Erp S, Holtslag HR, Van Beeck EF. Injury, 2013.
http://dx.doi.org/10.1016/j.injury.2013.10.019

Guide soutenir le retour au travail et favoriser le maintien en emploi

Faciliter le retour au travail d'un employé à la suite d'une absence liée à un problème de santé psychologique
Ce guide a été conçu pour vous aider à élaborer une démarche d'accompagnement et de soutien au retour au travail d'un employé à la suite d'une absence liée à un problème de santé psychologique, afin de faciliter son rétablissement et son retour au travail.
Il s'agit d'un outil pratique, qui allie l'accompagnement individuel et les changements organisationnels. Ce guide s'adresse aux dirigeants d'entreprises, aux services de ressources humaines et aux groupes syndicaux préoccupés par la santé des travailleurs et leur maintien en emploi, mais aussi aux praticiens en milieu de travail, notamment les médecins et les intervenants en santé au travail, les psychologues organisationnels et les conseillers en réadaptation.

Source : http://www.irsst.qc.ca/-publication-irsst-guide-soutenir-le-retour-au-travail-et-favoriser-le-maintien-en-emploi-liee-a-un-probleme-de-sante-psychologique-rg-758.html

Impact of pre-existing chronic conditions on age differences in sickness absence after a musculoskeletal work injury

A path analysis approach
Objectives: This study aims to examine the extent to which a greater prevalence of pre-existing chronic conditions among older workers explains why older age is associated with longer duration of sickness absence (SA) following a musculoskeletal work-related injury in British Columbia.
Methods: A secondary analysis of workers' compensation claims in British Columbia over three time periods (1997–1998; 2001–2002, and 2005–2006), the study comprised 102 997 and 53 882 claims among men and women, respectively. Path models examined the relationships between age and days of absence and the relative contribution of eight different pre-existing chronic conditions (osteoarthritis, rheumatoid arthritis, hypertension, coronary heart disease, diabetes, thyroid conditions, hearing problems, and depression) to this relationship. Models were adjusted for individual, injury, occupational, and industrial covariates.
Results: The relationship between age and length of SA was stronger for men than women. A statistically significant indirect effect was present between older age, diabetes, and longer days of SA among both men and women. Indirect effects between age and days of SA were also present through osteoarthritis, among men but not women, and coronary heart disease, among women but not men. Depression was associated with longer duration of SA but was most prevalent among middle-aged claimants. Approximately 70–78% of the effect of age on days of SA remained unexplained after accounting for pre-existing conditions.
Conclusions: Pre-existing chronic conditions, specifically diabetes, osteoarthritis and coronary heart disease, represent important factors that explain why older age is associated with more days of SA following a musculoskeletal injury. Given the increasing prevalence of chronic conditions among labor market participants (and subsequently injured workers) moderate reductions in age differences in SA could be gained by better understanding the mechanisms linking these conditions to longer durations of SA.

Source : Smith P, Bielecky A, Ibrahim S, Mustard C, Saunders R, Beaton D, Koehoorn M, McLeod C, Scott-Marshall H, Hogg-Johnson S. Scand J Work Environ Health. 2013.
http://dx.doi.org/10.5271/sjweh.3397

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