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PubMed2005

[Disability caused by essential hypertension complications in Sarajevo Canton in the period 1998-1999].

The aim of this study was to assess working ability of persons suffering from some of essential hypertension (EH) complications in Canton Sarajevo in the period of two years (01.01.1998-31.12.1999). Recorded complications included: congestive heart failure (CHF), heart attack (HA), angina pectoris (AP) and cerebrovascular disease (CVD). The study included 606 persons with EH with clinically verified complications, out of whom there were 416 males of average age of 53.4 (+/- 14.7) years, and 190 females of average age of 50.3 (+/- 12.8) years. There were 377 (62.2%) persons assessed with complete loss of working capability, 126 (20.8%) with limited working capability and only 103 (16.9%) were found without disability in regard to the tasks required in their job description. It was confirmed that EH complications have significant impact to disability among insurants in their most productive working age. CHF is the leading cause of complete loss of working capability, particularly in the group of labour workers with low qualification structure, followed by CVD, HA and AP. Disability-loss and limited working capability was dependant on sex, age, type of complication, qualification structure and the type of occupation. The results of this study indicate urgent need for establishing a more efficient concept of primary prevention as well as better and comprehensive treatment of the EH in order to reduce morbidity and disability among the working age population.

Adult↗
PubMed2001

Predictive factors for disability pension--an 11-year follow up of young persons on sick leave due to neck, shoulder, or back diagnoses.

AIMS: Although back diagnoses are recurrent and the main diagnoses behind sickness absence and disability pension surprisingly few longitudinal studies have been performed. This study identifies predictive factors for disability pension among young persons initially sick-listed with back diagnoses. METHODS: An 11-year prospective cohort study was conducted, including all individuals in a Swedish city who, in 1985, were aged 25-34 and sick-listed > or =28 days owing to neck, shoulder, or back diagnoses (n = 213). The following data was obtained: disability pension, emigration, and death for 1985-96, sickness absence for 1982-84, and demographics in 1985 regarding sex, income, occupation, marital status, diagnosis, socioeconomic group, and citizenship. Cox regression and life tables were used in the analyses. RESULTS: In 1996, i.e. within 11 years, 22% of the individuals (27% of the women and 14% of the men) had been granted disability pension. The relative risk for disability pension was higher for women (2.4; p = 0.010), persons with foreign citizenship (3.6; p=0.009), and those who had had >14 sick-leave days per spell during the three years before inclusion, compared to those with <7 days/spell (3.1; p=0.003). CONCLUSIONS: This cohort of young persons proved to be a high-risk group for disability pension. Some of the factors known to predict long-time sickness absence also predict disability pension in a cohort of already sick-listed persons.

Adult↗
PubMed1993

[Need for nursing care--severely disabled patients. Problems in determining disability prerequisites in legal health insurance].

The report describes the legal and administrative regulations concerning the medical examination of the new Leistungstatbestand "Schwerpflegebedürftigkeit" (i.e. a situation characterized by "urgent need of nursing care"). The numbers of applicants and the results of the medical examinations during the period 1989-1992 are also reported. The main difficulties consist in clarifying the meaning of some important legal terms and the relatively vague formulations of the administrative guidelines. Another important aspect is seen in the fact that the result of the medical examination is largely dependent on the informations supplied by the patients or their relatives. Two case reports are presented for the purpose of demonstrating these difficulties. Finally short reports of the first few judgements regarding the definition of situations with "urgent need of care" by different social-courts of appeal are presented.

Aged↗
PubMed1996

Body mass index and disability pension in middle-aged men--non-linear relations.

BACKGROUND: Obesity has, in a number of studies, been found to correlate to disability and mortality, primarily due to diseases of the circulatory and musculoskeletal systems. In addition, an excess mortality among underweight subjects has been observed in previous studies. METHODS: Five complete birth-year cohorts (1926-1930) of male residents in Malmö (n = 7697) were invited to the survey at the Department of Preventive Medicine, Malmö General Hospital, and 5926 (77%) attended with complete data. Each subject was followed from inclusion, defined by the date of examination, until the end of the calendar year when he turned 58, a total study period of approximately 11 years. Data on about 300 questionnaire items and laboratory tests were determined at the health survey visit. Nationwide Swedish data registers were used for surveillance. RESULTS: Of the participants, 4.7% were underweight, 37.7% overweight, 7.3% obese and 50.3% normal weight; 849 (14.3%) had been granted disability pension at the end of follow-up, 717 after screening. After adjustment for smoking there was a J-shaped relation between body mass index (BMI) and incidence of disability pension, the relative risk ( with the normal group as reference) among underweight men being 1.9. For the overweight subjects it was 1.3 and for the obese 2.8, all differences were significant. Disease of the musculoskeletal and circulatory systems and mental disorders accounted for 67.2% of all main diagnoses resulting in disability pensions during follow-up. A total of 377 (6.4%) men died during follow-up. Diseases of the circulatory system, neoplasms, injury/poisoning and diseases of the respiratory system accounted for 91.8% of the deaths. CONCLUSIONS: Both underweight, overweight and obesity were related to risk of disability pension, with a J-shaped risk relationship.

Body Mass Index↗
PubMed2002

Assessment and treatment of depression in disability claimants: a cost-benefit simulation study.

The economic burden of depression includes direct costs of treatment, as well as absenteeism and reduced productivity. In this study, we consider the costs and benefits of an intervention to assess and treat depressive symptoms in long-term disability claimants with nonpsychiatric medical illnesses. Cost-benefit simulations were conducted using data from a study sample of long-term disability claimants (N = 1229) and estimates of both the costs of treatment of depressive symptoms and the savings in claims payments for those who return to work as a result of treatment. We show that the savings that stem from returning a very few claimants to work can offset the assumed cost of a comprehensive program for the assessment of depressive symptoms in all claimants and intensive treatment of those with depressive symptoms. The economic and public health benefits both point toward the value of such an intervention for disability claimants.

Comorbidity↗
PubMed1999

[Sources of income after being denied disability pension].

Restrictions in eligibility criteria for disability pension were introduced in Norway in 1991. The effect of these restrictions on sources of income is an important question in social policy. 157 first time applicants from two counties who were denied disability pension before (1990) and after (1993) the restrictions were studied three years later. Sources of income were established through searches in registers of wages and social security benefits. NOK 3,000 per month was set as the lowest income allowing economic independence. Of the applicants in 1990, 14% were in the workforce three years later. In the post-restriction 1993 sample, this proportion was 21% (p = 0.29). The proportions receiving disability pension were 25% and 22% respectively. The spouse supported 33% of the 1990 applicants, and 22% in the 1993 sample (p = 0.13). Social welfare was the main source of income for 6% and 10% (p = 0.25). Changes in main sources of income following the restriction were relatively small. The main result of this study is that family support is the most prevalent source of income when disability benefits are denied. This is not in accordance with the Government's policy of promoting gainful employment.

Adult↗
PubMed1998

Length of disability and cost of work-related musculoskeletal disorders of the upper extremity.

There is little information on the length of disability (LOD) reported for work-related musculoskeletal disorders of the upper extremity (WMSDUE). For this study, LOD, cost, and the relationship between LOD and cost were derived from a large workers' compensation company's claims data for 1994 WMSDUE (n = 21,338). The average LOD was 87 days, with a median of zero days. For those claims with at least one day of compensable disability (25.2%), the average and median LOD were 294 and 99 days, respectively. The distribution of cost was skewed, with the average cost of a claim being 13 times higher than its median. Approximately 60% of the claims cost $1000 or less. Additionally, the 6.8% of the claims with an LOD greater than one year accounted for 59.9% of the cost and 75% of the total disability days. The majority of WMSDUE claimants did not lose sufficient time to qualify for indemnity. For those who did receive lost time wages, a disability duration of more than three months was typical.

Adult↗
PubMed2004

Disability plans--treating physician rule. Black & Decker Disability Plan v. Nord.

ERISA does not require the administrator of an employee welfare plan to give special deference to a claimant's treating physician's opinion for purposes of determining eligibility for disability benefits. Nevertheless, administrators may not arbitrarily refuse to credit a claimant's treating physician's opinion or any other reliable evidence.

Eligibility Determination↗
PubMed1987

Health insurance coverage and physician use among children with disabilities: findings from probability samples in five metropolitan areas.

The effect of insurance coverage on physician use for children in the United States who have been identified as disabled by their schools under the provisions of the Education for All Handicapped Children Act (PL 94-142) is examined. The research is based on identically drawn stratified random samples of children from the elementary school special education populations of five large metropolitan school systems. It was found that health insurance coverage was a predictor of whether a disabled child had seen a doctor in the past year even after adjustment for site, family background characteristics, type and severity of childhood disability, and structural access factors (adjusted odds ratio, 1.76, P less than .05); Hispanic children with disabilities were more likely than white children to be without any health insurance (adjusted odds ratio, 3.63; P less than .001), but there was no similar statistically significant difference between blacks and whites; and wide variations persist in scope of insurance payment for care, such that parents of publicly insured children paid out of pocket for only 5% of all physician visits as compared to 30% of visits for the privately insured. Even for children with various low-prevalence disabilities, when privately insured, parents paid out of pocket for 23% of all physician visits. These data help clarify the extent of health insurance coverage among children with disabilities and indicate that insurance remains an important predictor of physician use even though it continues to pay for only certain elements of care.

Child↗
PubMed1998

[Work capacity evaluation within Social Security].

Incapacity for work is not a medical but an economic concept. The difference between the earnings somebody could have had without health problems, and the possible earnings with health problems determine the degree of incapacity for work. Social security physicians and vocational experts together judge the degree of incapacity for work in discussion with the client. The physician judges the general possibilities of the client. The vocational expert selects possible jobs the client should be able to do. The disability allowances are relatively low. Treating physicians should take into account this and other negative aspects of incapacity for work.

Adult↗
PubMed2004

Variations in the risk of disability pension in Norway 1970-99. A gender-specific age-period-cohort analysis.

AIMS: A study was undertaken to investigate whether cohort or period effects could explain the varying and generally increasing incidence of disability pension in Norway between 1970 and 1999. METHODS: The study used data from a complete national register of new disability cases in Norway, including all cases of disability pension in the 16-60 age group categorized according to age and gender for each year from 1970 to 1999. The population at risk was defined for each year from census data and number of individuals already receiving disability pension. Data were organized in five-year age groups, five-year time periods and corresponding overlapping nine-year birth cohorts. Age- and gender-specific rates were displayed graphically for periods and cohorts. Separate Poisson regression models were fitted for age periods and age cohorts. Finally a combined age, period, and cohort model was applied. RESULTS: The overall incidence was 7.4/1,000 non-disabled persons per year for women and 6.0/1,000 for men. For women 52.1% of the cases were in the 51-60 age group, whereas the corresponding figure for men was 57.6%. Statistical analysis showed an increasing trend for both genders, more pronounced for women than men. All time periods deviated significantly from the trend, either upwards or downwards. Age-cohort models showed less variation, but recent cohorts had higher than expected rates, especially for men. CONCLUSIONS: Further studies should investigate why Norwegian women were more affected by the period effects than men. An increasing incidence of disability pension among recent cohorts is a major challenge for the Norwegian welfare system.

Adolescent↗
PubMed1998

Sick leave and disability pension among passenger car occupants injured in urban traffic.

STUDY DESIGN: A follow-up cohort study of passenger car occupants injured in car crashes in an urban area in Sweden. OBJECTIVES: To analyze the injuries, injury events, and long-term consequences of injuries in car crashes. SUMMARY OF BACKGROUND DATA: The consequences of car crashes usually are described in terms of the number of people injured, the severity of injuries, or the number of inpatient days. Certain types of crash injuries can results in long-term sick leave and granting of disability pension. The increased socioeconomic significance of these outcomes is not always indicated by analysis of commonly used variables. METHODS: Two hundred fifty-five passenger car occupants aged 16-64 years who were injured in car crashes in urban traffic were analyzed in terms of length of sick leave and receipt of disability pension. RESULTS: Strain of the cervical spine was the most common type of injury (55%, 141 injuries), and these injuries accounted for 82% of all sick leave taken within 2.5 years after the injury event. Injury to the cervical spine in 16 of 18 cases resulted in long-term sick leave or dependence on disability pension. The most common injury mechanism was rear-end collisions (39%). This type of crash resulted in 64% of all sick-leave days within 2.5 years after the injury event. Twelve out of 18 injured people on long-term sick leave or receiving disability pension had been in cars struck from behind. CONCLUSIONS: It is important to include long-term consequences in the form of sick leave and disability pension when describing the consequences of different types of car crashes and injuries.

Accidents, Traffic↗
PubMed1997

[The occupational injury act--an improvement for persons with occupational diseases?].

The aim of the study was to find out what degree employees with occupational injuries and diseases knew about the new Act, and had received compensation in accordance with the provisions. In 1994, 6,755 questionnaires were sent to persons reported to the Labour Inspection as suffering from occupational injury or disease, 3,762 (56%) responded. The study shows that at the time of the investigation only a small minority of the persons who had been reported as having occupational injuries or diseases had received compensation. Even among those who had experienced loss of income, actual expenses, or medical disability, only one subject in four had filed a claim. A number of claims may have been rejected on unlawful grounds.

Adult↗
PubMed2003

Diagnosis and duration of sickness absence as predictors for disability pension: results from a three-year, multi-register based* and prospective study.

AIM: A study was undertaken to identify predictors for the transition from long-term sickness absence into disability pension with special emphasis on routinely collected medical information (e.g. diagnoses on sickness certificates) and the duration of sickness-absence spells. METHODS: The study used a 10% random sample of the Norwegian population of working age (the KIRUT database). Individuals below 60 years of age, with spells of long-term sickness absence starting in 1990-91, where the medical diagnoses on the sickness certificates were known, were identified. This group (4,432 men and 5,645 women) was followed up for three years after the end of sickness absence with regard to disability pension and working status. RESULTS: In logistic regression the following predictors significantly increased the risk of obtaining disability pension during the first three years after the long-term sickness spell: age, part-time employment, and duration of absence > 197 days. Higher education and having children < 11 years significantly decreased the risk. Having the medical diagnoses "mental problems" and diseases in the nervous system, respiratory system, and circulatory systems indicated high risk (compared with musculoskeletal disease). The diagnostic groups "pregnancy-related disease" and "injuries" implied low risk for disability pension. In separate regressions for both genders the "protective effect" of having small children remained only for women. High risk for sickness absence caused by "mental problems" reached significance only for men. CONCLUSIONS AND IMPLICATIONS: Several risk factors for transition from long-term sickness absence into disability pension were identified. The finding that spells of sickness absence with duration up to seven months did not imply increased risk of disability during the first three years may have implications for interventions aimed at long-term sickness absentees.

Adolescent↗
PubMed1998

Employment, attitudes toward work, and quality of life among people with schizophrenia in three countries.

This study examines attitudes toward work, work incentives, and the impact of work on quality of life for people with schizophrenia, and investigates whether these findings differ among Western countries. We interviewed 24 randomly selected subjects with schizophrenia and schizoaffective disorder (12 employed and 12 unemployed) at each of three sites: Boulder, Colorado, United States; Berlin, Germany; and Berne, Switzerland. No significant differences were found in the subjects' attitudes toward work or subjective well-being, although Swiss patients had a higher cost-of-living-adjusted income. Unemployed subjects reported a lower subjective reservation (minimum financially worthwhile) wage than employed subjects in Berlin and Berne, whereas the reverse was true in Boulder. When subjects from all sites were combined, employed patients displayed less psychopathology and significant advantages in terms of objective and subjective measures of income and well-being: They were also more likely to stress the importance of work. The results suggest that work is associated with a markedly better quality of life for people with schizophrenia, but that disability pension programs in the United States might introduce work disincentives.

Adult↗
PubMed1999

Managed care and physician disability.

The number of disability claims by physicians has skyrocketed during the last decade. One of the primary reasons for this escalation is decreased job satisfaction brought about by managed care. Certain physician groups are more vulnerable to the stress of advanced managed care: solo practitioners, specialists and subspecialists, certain generalists, doctors with independent personalities, middle-aged or near-retirement physicians, impaired physicians, and those whose practices are almost solely contract driven. Based on analysis of physician disability claims, certain protective measures are recommended to relieve stress and promote survival in today's health care market.

Community Networks↗
PubMed1998

Traumatic brain injury in children in Denmark: a national 15-year study.

Demographic trends are reported concerning three types of traumatic brain injury (concussions, cranial fractures, and intracranial contusions/haemorrhages) among children in Denmark of ages up to and including 14 years, for a fifteen year period from 1979 through 1993. The data were derived from a national computer-based hospitalization register and include 49,594 children, of whom 60% were boys and 89% had suffered a concussion. Virtually all injuries were the result of accidents. A major finding was that there has been a general decline in the incidence of traumatic brain injuries, especially for boys from 5 to 14 years old, suggesting a degree of success in preventive measures, particularly regarding road safety. The incidence of fatal cases of intracranial contusions/haemorrhages approximately halved over the 15 year period. However, as a proportion of all diagnosed cases, mortality from intracranial contusions/haemorrhages remained fairly constant at about 22%, perhaps because there have been no markedly successful innovations in acute care. Among children surviving a intracranial contusions/haemorrhages, rather considerable numbers were found to have been awarded disability pension at ages under 30.

Accidents↗