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PubMed2005

Sudden unexplained death in children with epilepsy: a cohort study with an eighteen-year follow-up.

AIM: Sudden unexplained death is a significant cause of mortality in adults with epilepsy. Only a few data exist about this risk in childhood. METHODS: Cases of sudden unexplained death in epilepsy (SUDEP) up to the age of 18 y occurring at our hospital between 1984 and 2001 were identified. The incidence rate was calculated on the basis of diagnosed epileptics registered with a statutory disability insurance scheme. RESULTS: Four cases of SUDEP were identified during the 18-y period. The incidence of SUDEP was 4.3 per 10,000 patient-years. All children showed polytherapy-refractory epilepsy, developmental retardation and early-onset epilepsy. Two witnessed cases had shown no previous signs of seizure. CONCLUSION: SUDEP is rare in childhood. Children with uncomplicated epilepsy seem not to be at risk.

Anticonvulsants↗
PubMed2002

Applicability of the ADA to "Ticket to Work" employment networks. Americans with Disabilities Act.

This article examines the applicability of the antidiscrimination provisions of the Americans with Disabilities Act (ADA) of 1990 to The Ticket to Work and Work Incentives Improvement Act (TWWIIA) passed in 1999. Among other policy changes, under the Ticket to Work program, eligible recipients of disability insurance (SSDI) and supplemental income (SSI) receive a voucher or "ticket" to obtain services from qualified employment networks (ENs). ENs provide employment services and supports to designated beneficiaries and must meet certain qualification requirements. The ADA is applicable to ENs in several ways: primarily, in the EN's responsibility to provide appropriate access and services to program participants. This article discusses application of the ADA to the Ticket Program as ENs begin to serve program beneficiaries.

Consumer Advocacy↗
PubMed2000

Outcomes after initial receipt of social security benefits among homeless veterans with mental illness.

OBJECTIVE: This study examined the relationship between receiving disability payments and changes in health status, community adjustment, and subjective quality of life. METHODS: The study evaluated outcomes among homeless mentally ill veterans who applied for Social Security Disability Insurance or Supplemental Security Income through a special outreach program. Veterans who were awarded benefits were compared with those who were denied benefits; their sociodemographic characteristics, clinical status, and social adjustment were evaluated just before receiving the initial award decision and again three months later. RESULTS: Beneficiaries (N=50) did not differ from those were denied benefits (N=123) on any baseline sociodemographic or clinical characteristics. However, beneficiaries were more willing to delay gratification, as reflected in scores on a time preference measure. Three months after the initial decision, beneficiaries had significantly higher total incomes and reported a higher quality of life. They spent more on housing, food, clothing, transportation, and tobacco products but not on alcohol or illegal drugs. No differences were found between groups on standardized measures of psychiatric status or substance abuse. CONCLUSIONS: Receipt of disability payments is associated with improved subjective quality of life and is not associated with increased alcohol or drug use.

Adult↗
PubMed1980

Demographic factors in the disability determination process: a logistic approach.

Identifying the demographic factors that affect the likelihood of being allowed disability insurance benefits under the social security program is important in assessing the operation of that program and has been the focus of continuing research. Previous studies in this area, which have been limited to cross-tabular analyses of aggregated data and the examination of a few variables at a time, have uncovered apparently sizable differences in the probability of allowance by age, sex, race, and other demographic characteristics. This article uses a much more rigorous statistical technique--a logit maximum likelihood procedure--to examine the same question. That technique permits exploration of the relationship between a particular characteristic and the probability of allowance while controlling for the effect of other characteristics considered in the analysis. The findings show that cardiovascular primary diagnoses had a higher probability of allowance than did almost all other primary diagnoses. Mobility restrictions, older age at the onset of disability, and residence in States with temporary disability programs also were associated with a higher probability of allowance. Applicants who were black or from the South were found to have a lower probability of allowance. In general, those results applied to both men and women.

Demography↗
PubMed1983

The 1982 New Beneficiary Survey: an introduction.

This article introduces the 1982 New Beneficiary Survey, the latest survey of new beneficiaries sponsored by the Social Security Administration. This national, cross-sectional survey was fielded from October through December 1982 using a sample drawn from the Social Security Administration's Master Beneficiary Record. The sample includes retired workers, disabled workers, and aged wives and widows who received a first benefit payment from mid-1980 through mid-1981. Exactly 18,600 personal interviews were conducted with these categories of noninstitutionalized Old-Age, Survivor, and Disability Insurance beneficiaries and a comparison group who enrolled in Medicare but had not yet filed for monthly cash payments. This article describes the history of the survey's development, the sample selection procedures, the sample characteristics, the questionnaire, and the field procedures. Data from this survey of new program beneficiaries will be used to estimate the effects on future beneficiaries of changes in the Social Security program during the 1980's. The survey work was performed by the Institute for Survey Research at Temple University under contract with the Social Security Administration.

Cross-Sectional Studies↗
PubMed1984

Occupational illness. The issue of causality.

Following European precedents, workers' compensation statutes and the Social Security Disability Insurance program were developed in the United States to deal with the problem of work incapacity. The former was designed to insure for loss of wages consequent to workplace injury, the latter to insure against poverty consequent to work incapacity. Issues such as employer or product culpability, quantification of the magnitude of work incapacity, and insurance for partially restricted work capacity have greatly distorted the intent of these programs; both now provide financial awards based more on damage and disease rather than on the illness of work incapacity. Understanding this evolution will allow physicians to offer more appropriate guidance to their patients, to contribute their voices and perspective to the sociopolitical ethos, and to distinguish the legal issue of culpability from the clinical issues of pathogenesis of disease and of the role of human and work-place factors in causing the disease to be manifest as the illness of work capacity.

Accidents, Occupational↗
PubMed1983

Actuarial cost estimates for OASDI and HI and for various possible changes in OASDI.

This article, Appendix K to the Report of the National Commission on Social Security Reform, presents actuarial cost estimates for possible revisions to the Old-Age, Survivors, and Disability Insurance (OASDI) and Health Insurance (HI) programs. These projected alternatives cover major options for resolving both the short-range and long-range financing problems of the OASDI program. Long-range costs are expressed as percentages of taxable payroll. (Pages 1 through 55 of Appendix K are reprinted here. Space constraints do not permit the inclusion of the last 34 pages, which are tables of historical data for the OASDI and HI programs. Tables containing much the same information can be found in annual OASDI and HI Trustees Reports and in the 1981 Annual Statistical Supplement to the Social Security Bulletin.)

Aged↗
PubMed1995

The effect of vocational rehabilitation and work incentives on helping the disabled-worker beneficiary back to work.

This article is the second in a series of articles that use data from the New Beneficiary Followup survey to analyze the work efforts of the Social Security Administration's Disability Insurance beneficiaries. Survival analysis techniques are used to determine the effect of vocational rehabilitation efforts and work incentive program provisions on actual work outcomes. The findings indicate that the demographic variables of age, gender, race, education, and marital status affect the tendency to return to work in the expected way. The results suggest a possible disincentive effect may be built into certain work incentive provisions of the program. The encouraging news is that the vocational rehabilitation efforts seem to have a positive effect on the tendency to return to work. Physical therapy, vocational training, general education, and job placement efforts all seem to increase the tendency to go back to work.

Age Factors↗
PubMed1995

[Severe epilepsy and mental handicap in young adults. Epidemiological survey].

This study of prevalence is based in a population of 34,577 people aged from 15 to 19 resident in the canton of Vaud (Switzerland) and on the Swiss Federal Disability Insurance files (AI, AVS, IV), a compulsory insurance for all young residents. The study had two aims: firstly, to evaluate the necessary number of institutional beds for people needing multidisciplinary management because of medical, social and educational problems related to severe epilepsy, secondly, to form an idea of the number of epileptic patients needing to be considered for surgical treatment of epilepsy. In fact, we collected only 12 cases requiring multidisciplinary institutional assessment and management due to refractory epilepsy associated with mild or moderate mental handicap. Clinicians dealing with epileptic patients believe that people for whom surgical treatment needs to be considered are rare: the study confirms this rarity. We found this indication to be clearly legitimate in only 7 patients (less than 10% of all epileptic patients).

Adolescent↗
PubMedDate not supplied

Predicting outcomes of transforaminal epidural injections for sciatica.

BACKGROUND CONTEXT: Previous studies on epidural injections have focused on efficacy and have not evaluated factors predicting outcomes of epidural injections. PURPOSE: To determine which patient factors are associated with transforaminal epidural injection outcomes for sciatica. STUDY DESIGN: Cross-sectional study design at a university spine center. PATIENT SAMPLE: Consecutive patients with sciatica who have had an electromyography study and a transforaminal epidural injection between January 1999 and July 2001. OUTCOME VARIABLE: The outcome variable was a composite score of the patients' pain severity and medication use compared with their initial visit. Independent variables included demographics, previous back surgery, pain severity at initial presentation, pain medication use at initial presentation, litigation, having Social Security Disability Insurance (SSDI) or workers' compensation, electromyography results. METHODS: Medical information was gathered on the variables listed above. RESULTS: Seventy-six patients, mean age 50.4 years and 49% female, participated. At a mean follow-up of 122 days (SD 146.3), 35 (47%) were improved, 21 (28% were unchanged) and 12 (16%) were worse. Initial correlation analysis showed some relationship between outcomes and having SSDI or workers' compensation (R=.43, p<.001), lifting requirements at work (R=.44, p=.002), working status (R=-.31, p=.02), and electromyogram evidence of radiculopathy (R=-.25, p=.04). Regression analysis showed that having SSDI or workers' compensation was the primary factor associated with worse outcomes. CONCLUSIONS: When controlled for SSDI/workers' compensation, lifting requirements at work, but not working status and radiculopathy, also were associated with outcomes but the association was not as strong. This paper brings into question the utility of offering epidural injections to patients who are on SSDI/workers' compensation and require heavy lifting at work.

Adult↗
PubMed1998

Private health insurance coverage and disability among older Americans.

OBJECTIVES: This study examines the relationship between the lack of private supplemental health insurance coverage and the development of disability among adults aged 65 and older. METHODS: Data are from the baseline and six follow-up waves of the Duke Established Populations for Epidemiologic Studies of the Elderly survey (N = 4,000). Discrete-time hazard models were used to estimate the impact of insurance coverage and other risk factors on the incidence of disability among those unimpaired at baseline. RESULTS: Controlling for education, income, and other potential confounders, the odds of developing disability were 35-49% higher among those without private coverage. Insurance coverage also statistically explained part of the increased risk of disability among low-income persons. DISCUSSION: The results indicate that changes in health insurance coverage as well as in individual behaviors may be needed to reduce disability generally and disability among the socioeconomically disadvantaged, in particular.

Aged↗
PubMed1996

Barriers to return to work among persons unemployed due to arthritis and musculoskeletal disorders.

OBJECTIVE: To identify barriers to return to work (RTW) among persons likely to be seen in a clinician's practice who are unemployed due to arthritis and musculoskeletal disorders. METHODS: Two hundred eighteen persons unemployed due to arthritis and musculoskeletal disorders were interviewed at baseline and followed up for 1 year, at which time their work status was ascertained. Backward stepwise logistic regression was used to determine the association of baseline clinical, sociodemographic, and work-related factors to their work status at 1 year of followup. RESULTS: Fifty-one (24%) of 216 initially unemployed subjects had returned to permanent paid employment of > or = 20 hours/week after 1 year. Having rheumatoid arthritis, Social Security Disability Insurance (SSDI) status, a high pain level, older age, and lower education were barriers to reemployment. CONCLUSION: This study establishes the importance of chronic pain and having rheumatoid arthritis as factors independently associated with failure to RTW among persons unemployed due to arthritis and musculoskeletal disorders. The importance of SSDI beneficiary status, age, and education level in RTW is further confirmed. Duration of unemployment or previous work factors were not predictors of RTW in this group.

Adult↗
PubMed2006

Neuropsychologic aspects of post-traumatic headache and chronic daily headache.

The management of patients with chronic refractory head pain remains a treatment challenge. Treatment focus should be multidisciplinary as patients evolve into a deteriorated status with psychologic, social, vocational, and cognitive dysfunction. The neuropsychologist will gather premorbid and comorbid information, assess cognitive functioning, and be involved in every behavioral medicine and treatment decision. The patient with post-traumatic head pain copes with head injury sequelae. Issues related to worker's compensation, insurance, disability decisions, and litigation are intrinsic to these patient groups.

Craniocerebral Trauma↗
PubMed1998

Term delivery after hospitalization for preterm labor: incidence and costs in california.

Objective: To determine the incidence and costs for cases of idiopathic preterm labor followed by term delivery.Study Design: Patients hospitalized with preterm labor (N = 28,845) were identified in a dataset linking antepartum and delivery discharge abstracts of all women in California (N = 404,466) with a delivery related diagnosis from 1/1/93 to 11/19/93. Patients with multiple gestations, PROM, abruption, placenta previa, uterine anomalies, and other morbidities were excluded, leaving 19,897 study subjects. Birth outcomes were classified as term or preterm (<37 weeks). The incidence, hospital costs, and risk factors for hospitalization for preterm labor followed by term delivery were then determined using a retrospective nested case control design. Indirect costs of subsequent bedrest were estimated using data from the California Disability Insurance Fund.Results: Thirty-four percent of patients hospitalized with idiopathic preterm labor had term deliveries accounting for 2% of the pregnant population. Eighty-one percent of patients who were discharged undelivered after hospitalization delivered at term. These patients were significantly more likely to be Caucasian, privately insured, and older than patients who delivered preterm. A minimum of 45% of cases were estimated to be false diagnoses based on the relative risk of post-dates pregnancy between patients hospitalized with preterm labor and term controls. Costs totalled $4,995 per case with $2,335 in hospital costs and $2,497 in indirect costs from an average of 4 weeks of bedrest. Statewide costs for California were estimated to range from 24 to 48 million dollars annually for these potentially avertible hospitalizations.Conclusions: Hospitalization for idiopathic preterm labor with delivery at term is common, costly, and probably due to false diagnosis in a significant proportion of cases.

Journal Article↗
PubMed1981

Life effects of narcolepsy in 180 patients from North America, Asia and Europe compared to matched controls.

A questionnaire survey has been made of the life effects of narcolepsy in 180 patients, 60 each from North American, Asian and European populations, with 180 similarly distributed age and sex matched controls. Life-effects were attributed by the patients to the primary symptoms of excessive daytime drowsiness, sleep attacks, cataplexy, vivid hypnagogic hallucinations and sleep paralysis, and also to other frequent symptoms such as visual problems (blurring, diplopia) and memory impairment. Occupational problems were prevalent (over 75%) and included statistically significant deleterious effects upon performance, promotion, earning capacity, fear of or actual job loss and increased disability insurance. Driving was greatly affected and patients fell asleep at the wheel more frequently (66%), had near or actual accidents from drowsiness or falling asleep at the wheel (67%), and could experience cataplexy (29%) or sleep paralysis (12%) while driving. Work or home accidents attributed to sleepiness or sleep (49%) or related to smoking (49%) were much more common in patients. There were also deleterious effects on education, recreation and personality related to disease. Narcolepsy can produce a variety of life-effects probably more serious and pervasive than, for instance, those of epilepsy, therefore emphasizing the importance of early diagnosis and treatment.

Accidents↗