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Biomedical subjects

E Yelin

Publications and source records attributed to E Yelin.

33 records · Page 2Linked to original sources
PubMed1995

Work disability in adults with cystic fibrosis.

Greater numbers of persons with cystic fibrosis (CF) reach adulthood and, therefore, actively participate in the labor force. In this study, we estimated labor force participation rates and determined risk factors for work disability among persons with CF. We recruited 49 (73%) of 67 adults followed at one of two hospital-based CF centers. We ascertained employment history and CF-attributed work disability by structured questionnaire. Independently, we reviewed medical records for demographics and illness severity indicators. We analyzed potential risk factors for work disability by logistic regression analysis. All of those studied reported past or present labor force participation, consistent with high work motivation. Complete cessation of work attributed to CF was reported by 17 (35%; 95% CI, 21 to 49%). Although 23 (47%; 95% CI, 32 to 60%) of those surveyed stated that CF had affected career choice, only nine respondents had ever received career counselling and 16 had ever discussed job choice with their physicians. After adjusting for standard measures of disease severity by multiple logistic regression, age, adult diagnosis of CF, female gender, and single marital status, analyzed as a group, provided significant additional explanatory power to a predictive model of disability risk (model chi square [4 d.f.] = 11.5, p < 0.05). Health care professionals who design interventions targeted at work disability among persons with CF should address demographic factors as well as illness severity and should assess the vocational needs of persons with CF and the potential benefit of career counselling.

Adult↗
PubMed1994

Mortality risk among elderly workers.

We analyzed population-based data for respondents aged 70 and older from the Longitudinal Study on Aging. We compared mortality risk among 358 baseline-year working with 4,373 nonworking respondents. Including other demographic and health status predictors in a multiple logistic regression model, employment remained a significant predictor of survival (mortality odds ratio (OR) = 0.4). Diabetes mellitus was the only factor that displayed a mortality risk that was significantly interactive with work (OR = 3.5). These data suggest that a healthy worker effect persists in older age groups, but that within the working stratum, patterns of risk may differ as compared to those among the nonworking.

Aged↗
PubMed1993

Work disability among adults with asthma.

OBJECTIVE: To estimate the incidence of work disability among adults with asthma and to evaluate a clinically based illness severity score as a predictor of such disability. DESIGN: Baseline and follow-up telephone interviews and medical record review. SETTING: University-based outpatient pulmonary specialty practice. PATIENTS: Fifty-six patients interviewed at baseline; 42 reinterviewed 2 years later. MEASUREMENTS: Work disability ascertained by interview report and defined as change in job duties, reduction in pay, or change in job or employment status attributed to asthma. Severity of asthma score derived from medical records and based on respiratory symptom frequency, asthma history, and prescribed medications. Pulmonary function by routine testing. Logistic regression analysis of the 5-year incidence of work disability on severity score and forced expiratory volume in 1 s (FEV1). RESULTS: The 5-year work disability cumulative incidence was 19 percent for change in duties, 17 percent for reduction in pay, 20 percent for change in job or work status, and 36 percent for any of these measures. The median asthma score was 10 (range, 2 to 26). The mean FEV1 as a percent predicted (FEV1 percent) was 88 +/- 25 percent. Score and FEV1 percent were statistically correlated (r = -0.6, p < 0.0001). Severity of asthma score statistically predicted each measure of work disability (p < 0.01). Addition of FEV1 percent added little additional explanatory power to the logistic regression model (maximum chi 2 = 1.3, p > 0.2). CONCLUSIONS: Work disability is common among adults with asthma. A severity of asthma score based on clinical variables is statistically correlated with lung function but appears to be a stronger predictor of disability than airflow measured at one point in time.

Adolescent↗
PubMed1993

Impact of the American Health Security Act of 1993.

In the months to come, opponents of President Clinton's proposal will focus on issues of choice among physicians and health plans and on estimates of the economic impact of reform. Others will raise the issue of the efficiency of the administrative structures necessary to implement the Act. These important concerns notwithstanding, people with rheumatic diseases stand to gain much from the passage of the American Health Security Act of 1993, principally the knowledge that they always will have insurance, that their out-of-pocket costs will be limited, that they will have access to a standard set of benefits, and that these benefits are more comprehensive than the current Medicare and Medicaid programs and all but a small percentage of private health insurance plans.

Health Care Reform↗
PubMed1992

Health policy and musculoskeletal conditions.

This paper reviews two strains of research within rheumatology relevant to contemporary health policy debates. The first concerns studies of the effectiveness of medical care on outcomes among persons with musculoskeletal conditions; the second, studies of functional status and disability among such persons. The studies of the effectiveness of medical care, largely funded by the Agency for Health Care Policy and Research, are designed to assist in the development of practice guidelines concerning lower back pain, knee replacement, hip disease, and other conditions for use by physicians and other providers as well as third party payers. The studies of functional status and disability in arthritis, largely funded by the National Institute of Arthritis, Musculoskeletal, and Skin Diseases as part of its Multipurpose Arthritis Center Program, are designed to provide measures of outcome for use in studies of medical effectiveness and to assess the societal impacts of musculoskeletal conditions.

Disability Evaluation↗
PubMed1992

Arthritis. The cumulative impact of a common chronic condition.

OBJECTIVE: To document the extent of disability related to arthritis among working-age (18-64-year-old) and elderly (greater than or equal to 70-year-old) individuals. METHODS: Data from the 1970-1987 National Health Interview Surveys were used to determine the prevalence of arthritis-related disability among working-age adults. The Longitudinal Study on Aging was used to determine the prevalence of arthritis-related disability among the elderly. RESULTS: Among working-age persons, 3.734 million men and 5.649 million women reported having arthritis, of whom in excess of 2 million and 3 million, respectively, reported activity limitation (the definition of disability in the National Health Interview Survey). Labor force participation among men with arthritis was approximately 20% lower than among those without arthritis and approximately 25% lower among women with arthritis than among those without. Among elderly individuals, 55% reported having arthritis and, of these, more than three-quarters were limited in a physical activity and more than one-third were limited in an activity of daily living. Moreover, disability rates for persons with arthritis were found to be increasing, even on an age-adjusted basis. CONCLUSION: The impact of arthritis in terms of disability was shown to be high and was probably underestimated, given the high prevalence of the disease among women and elderly persons, and the limitations in the methods used in contemporary social surveys to establish the extent of disability, in these 2 population groups in particular.

Activities of Daily Living↗
PubMed1989

The economic impact of the rheumatic diseases in the United States.

We review the literature and analyze data from the National Health Interview Survey to provide estimates of the economic cost and social impacts of the rheumatic diseases in the United States. Rheumatic diseases had an economic impact in 1980 of 21 billion dollars due to expenditures for health care and lost wages, an amount equal to 1% of gross national product. These conditions are responsible for 5% of all hospital discharges, 10% of all hospital procedures, and 9% of all physician visits. They are also responsible for over 2 million persons being unable to do major activities, for 5 million being limited in other ways, and for at least 1 million being severely limited in the ability to perform activities of daily living. As great these impacts would appear to be, they are likely to grow since the aging of the population increases both the prevalence and severity of impact of the rheumatic diseases.

Absenteeism↗
PubMed1989

Displaced concern: the social context of the work-disability problem.

The Social Security disability insurance program benefits were reduced in the early 1980s, in the belief that income supports induced people to stop working. The action failed to stem the number of program participants from rising, as older men with activity limitations due to chronic disease continued to withdraw from the labor force. Attention paid in this and other instances to work disability derives from the problem's social context, displacing concerns about work loss itself and its effects on workers' lives. While slow growth in the economy as a whole may be a root cause of the problem, policies to address the nature and scope of work disability directly remain adrift.

Adolescent↗
PubMed1987

The work dynamics of the person with rheumatoid arthritis.

This paper traces the work history of patients with rheumatoid arthritis (RA) from the year of diagnosis to 1985. The paper also describes the risk factors for work loss among patients with RA. It uses data from a panel of 698 RA patients, observed for 4 years, from the practices of a random sample of northern California rheumatologists. Of these 698, 353 had worked for pay at some point in their lives. Three hundred six of the 353 had worked when diagnosed as having RA. Of these 306, 157 (51%) were no longer working in 1985. Forty-seven individuals started working after the onset of illness, but of these, approximately one-third had stopped working by 1985. In all, 50% of RA patients with some work experience stopped working within a decade of diagnosis, 60% within 15 years, and 90% within 30 years. We found that the probability of work loss is lessened among persons in jobs that have few physical requirements, among those with high levels of discretion over the pace and activities of work, and among those who were able to stay on the job held when the diagnosis was made. The probability of work loss is increased among service workers. The findings of this longitudinal study, showing that work characteristics profoundly alter the probability of work loss among persons with RA, are consistent with the findings of our earlier cross-sectional studies of work outcome and RA.

Adult↗
PubMed1987

The impact of rheumatoid arthritis and osteoarthritis: the activities of patients with rheumatoid arthritis and osteoarthritis compared to controls.

We measured the impact of rheumatoid arthritis (RA) and osteoarthritis (OA) by comparing the activities of patients with these illnesses to controls matched for age, sex, and community of residence. Our results indicate that patients with RA experience more losses than controls in every domain of human activity and that patients with OA experience more losses in the performance of household chores, shopping and errands, and leisure activities. The methods described here provide a simple, reliable way to assess the impacts of illness in the same terms for all dimensions of human activity.

Activities of Daily Living↗
PubMed1986

The myth of malingering: why individuals withdraw from work in the presence of illness.

Federal policy to provide income to workers disabled by chronic illness has been under attack. Data from the Social Security Administration Survey of Disability and Work reveal that anticipation of higher levels of disability income does not correlate with cessation of work; the nature of illness and the structure of work do. Policies predicated on the myth of malingering will hurt millions of the disabled chronically ill.

Adult↗
PubMed1980

Work disability in rheumatoid arthritis: effects of disease, social, and work factors.

We explore here the relative contribution of selected disease, social, and work-related factors to disability status in a population of persons with rheumatoid arthritis. Our study differs from previous studies in that it is limited to one diagnostic entity, yet at the same time evaluates a broad range of social and work-related factors in disability. One hundred-eighty persons with rheumatoid arthritis sampled from 19 socially diverse practice settings were given a structured survey about their medical and work histories and social backgrounds. We found significant effects of stage and duration of illness on continued employment but no positive effect of selected therapies. Social and work factors combined had a far larger effect on work disability than all disease factors. Among work factors, control over the pace and activities of work and self-employment status had the greatest effect on continued employment, suggesting that time control issues are crucial to the maintenance of one's job after onset of this illness.

Absenteeism↗
PubMed1980

Toward an epidemiology of work disability.

The indirect cost of illness due to lost wages exceeds the cost of medical services by a large margin. Social characteristics of persons with physical impairment are more important than the characteristics of their medical condition in predicting whether disability will lead to work loss. Public policy toward disability currently emphasizes the "human capital" with which persons with impairments confront the labor market; this study suggests a new emphasis on social characteristics of the workplace.

Arthritis, Rheumatoid↗
PubMedDate not supplied

Resources for the care of arthritics in a nonmetropolitan community. Redding, California.

All professional, institutional, and administrative resources available to persons with musculoskeletal disabilities, including arthritis, were surveyed in a large nonmetropolitan community. Access to such resources and their residual capacity to serve local arthritics was determined. The resources appeared adequate as was the access, but the referral pattern was poorly developed. Most of the physicians in the community did not perceive a need for a trained rheumatologist practicing in the community.

Arthritis, Rheumatoid↗