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Treatments of depression and the functional capacity to work.

This study evaluated the effects of antidepressants and psychotherapy on work impairment in depressed patients. Original databases from 10 published treatment studies were compiled and analyzed (N = 827). Functional work impairment was common at baseline, manifested by unemployment (11%) or on-the-job performance problems (absenteeism, decreased productivity, interpersonal problems, 44%). Generally, work outcomes were good when treatment was symptomatically effective, but the trajectories of work restoration and symptom remission were different, with work recovery appearing to take considerably longer. Relapse was an important determinant of long-term occupational outcome, particularly for seriously ill patients for whom relapse meant rehospitalization or other profound social disruption. Affective impairment was distinguished from functional impairment, with the former characterizing milder depression and the latter characterizing moderate to severe depression. Some methodological recommendations are discussed.

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Health economic benefits and quality of life during improved glycemic control in patients with type 2 diabetes mellitus: a randomized, controlled, double-blind trial.

CONTEXT: Although the long-term health benefits of good glycemic control in patients with diabetes are well documented, shorter-term quality of life (QOL) and economic savings generally have been reported to be minimal or absent. OBJECTIVE: To examine short-term outcomes of glycemic control in type 2 diabetes mellitus (DM). DESIGN: Double-blind, randomized, placebo-controlled, parallel trial. SETTING: Sixty-two sites in the United States. PARTICIPANTS: A total of 569 male and female volunteers with type 2 DM. INTERVENTION: After a 3-week, single-blind placebo-washout period, participants were randomized to diet and titration with either 5 to 20 mg of glipizide gastrointestinal therapeutic system (GITS) (n = 377) or placebo (n = 192) for 12 weeks. MAIN OUTCOME MEASURES: Change from baseline in glucose and hemoglobin A1c (HbA1c) levels and symptom distress, QOL, and health economic indicators by questionnaires and diaries. RESULTS: After 12 weeks, mean (+/-SE) HbA1c and fasting blood glucose levels decreased with active therapy (glipizide GITS) vs placebo (7.5% 0.1% vs 9.3%+/-0.1% and 7.0+/-0.1 mmol/L [126+/-2 mg/dL] vs 9.3+/-0.2 mmol/L [168+/-4 mg/ dL], respectively; P<.001). Quality-of-life treatment differences (SD units) for symptom distress (+0.59; P<.001), general perceived health (+0.36; P= .004), cognitive functioning (+0.34; P=.005), and the overall visual analog scale (VAS) (+0.24; P=.04) were significantly more favorable for active therapy. Subscales of acuity (+0.38; P=.002), VAS emotional health (+0.35; P=.003), general health (+0.27; P=.01), sleep (+0.26; P=.04), depression (+0.25; P=.05), disorientation and detachment (+0.23; P= .05), and vitality (+0.22; P=.04) were most affected. Favorable health economic outcomes for glipizide GITS included higher retained employment (97% vs 85%; P<.001), greater productive capacity (99% vs 87%; P<.001), less absenteeism (losses = $24 vs $115 per worker per month; P<.001), fewer bed-days (losses = $1539 vs $1843 per 1000 person-days; P=.05), and fewer restricted-activity days (losses = $2660 vs $4275 per 1000 person-days; P=.01). CONCLUSIONS: Improved glycemic control of type 2 DM is associated with substantial short-term symptomatic, QOL, and health economic benefits.

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Effectiveness and cost-benefit of influenza vaccination of healthy working adults: A randomized controlled trial.

CONTEXT: Although the cost-effectiveness and cost-benefit of influenza vaccination are well established for persons aged 65 years or older, the benefits for healthy adults younger than 65 years are less clear. OBJECTIVE: To evaluate the effectiveness and cost-benefit of influenza vaccine in preventing influenza-like illness (ILI) and reducing societal costs of ILI among healthy working adults. DESIGN: Double-blind, randomized, placebo-controlled trial conducted during 2 influenza seasons. SETTING AND PARTICIPANTS: Healthy adults aged 18 to 64 years and employed full-time by a US manufacturing company (for 1997-1998 season, n = 1184; for 1998-1999 season, n = 1191). INTERVENTIONS: For each season, participants were randomly assigned to receive either trivalent inactivated influenza vaccine (n = 595 in 1997-1998 and n = 587 in 1998-1999) or sterile saline injection (placebo; n = 589 in 1997-1998 and n = 604 in 1998-1999). Participants in 1997-1998 were rerandomized if they participated in 1998-1999. MAIN OUTCOME MEASURES: Influenza-like illnesses and associated physician visits and work absenteeism reported in biweekly questionnaires by all participants, and serologically confirmed influenza illness among 23% of participants in each year (n = 275 in 1997-1998; n = 278 in 1998-1999); societal cost of ILI per vaccinated vs unvaccinated person. RESULTS: For 1997-1998 and 1998-1999, respectively, 95% (1130/1184) and 99% (1178/1191) of participants had complete follow-up, and 23% in each year had serologic testing. In 1997-1998, when the vaccine virus differed from the predominant circulating viruses, vaccine efficacy against serologically confirmed influenza illness was 50% (P =.33). In this season, vaccination did not reduce ILI, physician visits, or lost workdays; the net societal cost was $65.59 per person compared with no vaccination. In 1998-1999, the vaccine and predominant circulating viruses were well matched. Vaccine efficacy was 86% (P =.001), and vaccination reduced ILI, physician visits, and lost workdays by 34%, 42%, and 32%, respectively. However, vaccination resulted in a net societal cost of $11.17 per person compared with no vaccination. CONCLUSION: Influenza vaccination of healthy working adults younger than 65 years can reduce the rates of ILI, lost workdays, and physician visits during years when the vaccine and circulating viruses are similar, but vaccination may not provide overall economic benefits in most years. JAMA. 2000;284:1655-1663.

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Family predictors of the incidence of children's asthma symptoms: expressed emotion, medication, parent contact, and life events.

Self-report measures of both parents' expressed emotion, their time spent with their children, family life events, and children's medication compliance were obtained from 32 pairs of parents with a 5- to 12-year-old child with asthma and used to predict the number of the children's asthma-related medical contacts and school absences in the preceding year. Higher levels of fathers' expressed emotion, specifically critical comments, were associated with higher school absenteeism, and the amount of time fathers reported spending with their children on weekends was inversely related to the number of times children had an asthma-related medical contact. These findings were interpreted as reflecting the father's reactions to his child's asthma. Implications for intervention are discussed.

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Labour productivity effects of prescribed medicines for chronically ill workers.

Previous work on the labour productivity effects of chronic illness has not separated the effects of chronic illnesses from the effects of prescription medications taken to alleviate these conditions. Using nationally representative observational data, this study estimates the pure effect of chronic illness, and the marginal effect of prescription medicines, on labour productivity. As Americans continue to scrutinize health care expenditures, such estimates will play an increasing role in determining the allocation of resources for medical treatments. Estimates are presented of the costs and benefits to employers of covering prescription medications for workers aged 18-64 years afflicted with specific chronic illnesses. The effects of prescription medicines on hourly wages and days lost from work are examined for four major chronic illnesses: hypertension, heart disease, non-insulin dependent (type II) diabetes and depression. The net benefits to employers from having workers take prescription medicines for their chronic illnesses are substantial. Assuming average compliance rates are achieved, net benefits to employers in 1987 amounted to $286 per hypertensive employee, $633 per employee with heart disease; $822 per depressed employee, and $1475 per type II diabetic employee under medication from a physician. These estimated benefits accrue because prescription medications substantially lower absenteeism among chronically ill workers.

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Prevalence of building-related symptoms as an indicator of health and productivity.

BACKGROUND: The prevalence of building-related symptoms (BRS) is commonly used to characterize the indoor air quality in office buildings. To analyze the costs of building renovation and the improvement of the indoor environment, it is useful to quantitatively relate the prevalence or intensity of BRS to productivity. The intent of this study is to summarize the links between the BRS and productivity, and demonstrate this linkage in two case buildings. MATERIAL AND METHODS: A literature was surveyed for studies that measured simultaneously the prevalence or intensity of BRS and subjectively reported or objectively measured productivity. Case studies in two office environments were performed. An association between the prevalence of BRS and productivity of workers in a call center and in an insurance office were investigated. In the first case study, the productivity was expressed using the direct productivity metrics, namely the number of telephone contacts during active working hours while in the second case, the productivity was assessed by using the data concerning sick leave rates. RESULTS: Employees who report more BRS also have more often absences which relate to indoor environment quality (IEQ). Their productivity is lower than those who have better IEQ in their offices. Despite uncertainties related to the data concerning recorded sick leave and self-reported productivity, the number of studies showing an association between BRS and productivity or sick leave suggests that such a relationship exists. The present case studies also demonstrated an association between the BRS and the direct productivity. Based on the data from the call center, a reduction of 10%-units in the prevalence of general symptoms (such as fatigue, headache, nausea, etc.) corresponded with a gain of 1.5% in performance. Based on the findings in the insurance company, a reduction of 10%-units in the prevalence of irritation symptoms corresponded with a decrease of 0.7% in the short-term absenteeism. CONCLUSIONS: A review of 23 studies suggests that a linkage exists between typical BRS and productivity indicators such as task or work performance or absence from work. Quantitative associations between BRS and productivity were demonstrated in two office environments. Quantitative associations between BRS and economic metrics enable cost-benefits analysis.

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Functional disability due to back pain. A population-based study indicating the importance of socioeconomic factors.

Using national survey data, we examined correlates of disability due to low back pain in 1,516 persons who had back pain. Greater education level correlated significantly (P less than 0.001) with fewer disability days (i.e., days of activity limitation, absence from work, confinement to bed, or reduced housework), even after controlling for severity, sciatica, occupation, and age. Findings in men differed from those in women; education level was a strong correlate for men only. For work absenteeism, low income was a stronger correlate than education. These data support the importance of social factors in the prognosis of some musculoskeletal diseases.

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Medical and productivity costs of anxiety disorders: case control study.

This retrospective case-control study examines the medical and productivity costs associated with a diagnosis of anxiety. The study used a data set from a large employer database that collected medical, pharmaceutical, absenteeism, short-term disability, and worker compensation records during 2000 from 6 major employers. Patients diagnosed with anxiety disorders (n= 1917) were matched at a 1:1 ratio to patients not diagnosed with anxiety disorders (n= 1917) based on age, sex, metropolitan statistical area, and type of insurance coverage. Paired-difference t tests, McNemer's test, and analyses of covariance were used to compare the anxiety population with the control group. Employees diagnosed with anxiety disorders were significantly more likely to have additional diagnoses, use more services, require hospitalization, or visit the emergency room compared with the control group. Furthermore, after controlling for differences in comorbidities, employees diagnosed with anxiety disorders had significantly higher medical costs [$1555; 95% confidence interval (CI) $1066-2043], productivity costs ($1366; 95% CI $708-2023), and total costs ($2920; 95% CI $2035-3805) compared with the control group. Results indicate that anxiety disorders are associated with significant medical and productivity costs.

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A three-level model for binary time-series data: the effects of air pollution on school absences in the Southern California Children's Health Study.

A three-level model is proposed to simultaneously examine the effects of daily exposure to air pollution and individual risk factors on health outcomes without aggregating over subjects or time. We used a logistic transition model with random effects to take into account heterogeneity and overdispersion of the observations. A distributed lag structure for pollution has been included, assuming that the event on day t for a subject depends on the levels of air pollution for several preceding days. We illustrate this proposed model via detailed analysis of the effect of air pollution on school absenteeism based on data from the Southern California Children's Health Study.

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Five years of sentinel surveillance of acute respiratory infections (1985-1990): the benefits of an influenza early warning system.

For the last five years, the Brussels Institute of Hygiene and Epidemiology has been involved in the surveillance of acute respiratory infections (ARI). The four indicators used (number of encounters of ARI by GP's/100 encounters, virus isolations, absenteeism and mortality) are discussed. A regression procedure is applied to the data collected by a sentinel network of general practitioners (GP's). This procedure permits the baseline to be visualized and an epidemic threshold to be determined in order to recognize early an influenza outbreak. The traditional use of flu-like illnesses as an indicator might be improved by the addition of non-specific ARI which are more precocious, especially in children. The criteria for an accurate definition of an influenza epidemic are discussed. The same mathematical model can be used for the analysis of mortality linked with an outbreak. It shows that the last epidemic in the winter 1989-1990 was responsible for about 4900 deaths directly or indirectly related to influenza.

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Physical health correlates of type A behavior in children and adolescents.

A physical examination including resting blood pressure, heart rate, Tanner scales, height, and weight was administered to 184 students in the fifth, seventh, and ninth grades. They completed the Physical Symptoms of Stress Inventory, Health Habits Inventory, and two self-monitoring logs of physical symptoms. School absenteeism, medical records, physician ratings, and family health history data were collected. No significant differences between high- and low-Type A behavior pattern (TABP) subjects were found on any of the physical measurements. However, retrospective and prospective reports of physical symptoms revealed a consistent pattern: high TABP subjects reported significantly more physical symptoms than low-TABP subjects. Self-ratings of stress and tension were significantly higher for high-TABP subjects. High-TABP subjects, however, neither missed more school because of illness nor used physician services more often than low subjects. Further, expected relationships between physical symptoms and illness behavior, including school absence, were evident only for low subjects.

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Methods for evaluating a mature substance abuse prevention/early intervention program.

The authors describe methods for work in progress to evaluate four workplace prevention and/or early intervention programs designed to change occupational norms and reduce substance abuse at a major U.S. transportation company. The four programs are an employee assistance program, random drug testing, managed behavioral health care, and a peer-led intervention program. An elaborate mixed-methods evaluation combines data collection and analysis techniques from several traditions. A process-improvement evaluation focuses on the peer-led component to describe its evolution, document the implementation process for those interested in replicating it, and provide information for program improvement. An outcome-assessment evaluation examines impacts of the four programs on job performance measures (e.g., absenteeism, turnover, injury, and disability rates) and includes a cost-offset and employer cost-savings analysis. Issues related to using archival data, combining qualitative and quantitative designs, and working in a corporate environment are discussed.

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Sleep problems and their correlates in a working population.

OBJECTIVE: To measure the prevalence of sleep problems in a working population and examine their association with health problems, health-related quality-of-life measures, work-related problems, and medical expenditures. Also, to explore the usefulness of a sleep-problems screen for mental health conditions and underlying sleep disorders. DESIGN: Cross-sectional survey administered via voice mail and telephone interview. SETTING: A San Francisco Bay Area telecommunications firm. PARTICIPANTS: Volunteer sample of 588 employees who worked for a minimum of six months at the company and were enrolled in its fee-for-service health plan. MEASUREMENTS AND MAIN RESULTS: Thirty percent of respondents reported currently experiencing sleep problems and were found to have worse functioning and well-being (general health, cognitive functioning, energy), more work-related problems (decreased job performance and lower satisfaction, increased absenteeism), and a greater likelihood of comorbid physical and mental health conditions than were the respondents who did not have sleep problems. They also demonstrated a trend toward higher medical expenditures. CONCLUSIONS: Self-perceived sleep problems were common among the respondents and were associated with poorer health and health-related quality of life. A single question about sleep problems may serve as an effective screen for identifying primary care patients with mental health problems, as well as underlying sleep disorders.

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[Chronic course and psychosocial disability caused by depressive illnesses in general practice patients during a one year period. Results of a study by the World Health Organization].

As part of an international WHO study on psychological disorders in primary health care, patients were examined for mental disorders and especially depression and social disability in the course of 1 year. Depression is common in primary care (8.6%) and frequently associated with recurring or chronic courses (33.3%). Depression at baseline leads to a 100% increase of lost working days (3.2 per month) 1 year later as compared to patients without depression (1.7). The diagnosis of depression at baseline poses a greater risk for a relevant and lasting psychosocial disability (28.2%) than e.g. chronic somatic illnesses (8.6%). Even the diagnosis of a subthreshold depression leads comparatively to a higher degree of psychosocial disability (15.6% of patients) and days of absenteeism at work during the last month (2.9 days).

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At-risk high school students in the "Gaining Early Awareness and Readiness" Program (GEAR UP): academic and behavioral outcomes.

The purpose of this study was to assess the effects of a GEAR UP intervention with at-risk high school students at a large urban high school in Florida. The goals of the GEAR UP program were to improve academic performance, decrease behavior-related problems, and reduce truancy and absenteeism. The study design consisted of a three-group comparison of the 447 students in GEAR UP: the No Participation Group, the Low Participation Group, and the High Participation Group. Participation levels were calculated for each category of activity (academic, behavior-related, and social), and propensity scoring was used to match the groups on sociodemographic characteristics and other differentiating variables. Results indicated that race (i.e., African American) and sex (i.e., female) are associated with high participation in program activities. Also, students who spent a substantial amount of time on academic activities improved their GPAs over a semester, and students who took advantage of behavior-related services and participated in social activities significantly reduced disciplinary referrals (p < .05). Suggestions for program refinement resulting from the study are discussed.

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The relationship between productivity and health-related quality of life: an empirical exploration in persons with low back pain.

OBJECTIVE: In economic evaluation of health care programmes normally health-related quality of life is part of measurement of a programme's effectiveness and productivity part of its costs. In this paper the relationship between quality of life and productivity is highlighted and empirically assessed in persons suffering from low back pain. METHODS: A secondary analysis was performed on data from a sample of 483 patients treated for low back pain. Periodically, both quality of life (EQ-5D) and productivity indicators for both paid and unpaid work were measured. Mean EQ-5D scores were compared for groups of patients classified by level of productivity. The relationship between quality of life and productivity was also assessed using Spearman rank correlation coefficients. RESULTS: Mean EQ-5D scores for patients without productivity losses were a half to a full standard deviation higher than for patients with the lowest levels of productivity. The correlation between quality of life and productivity was moderate. CONCLUSION: Lower levels of quality of life were associated with efficiency loss and absenteeism. However, due to the moderate strength of the relation the use of information on quality of life to model productivity costs in case of absence of productivity data was not recommended.

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Current issues in the economics of depression management.

In this paper, we present a systematic review of the literature on current issues in the economics of depression management, focusing on studies within three distinct areas of interest: 1) the clinical and economic outcomes of alternative patterns of antidepressant use; 2) the impact of depression and antidepressant therapy on the costs of general medical-care services; and 3) the effects of depression and associated benefits of antidepressant therapy on worker productivity. Our review suggests that 1) patterns of antidepressant use are important predictors of symptom improvement, relapse/recurrence, and costs of care, and that use patterns vary according to the antidepressant received as initial therapy; 2) patients with depression have higher costs of general medical-care services compared with their nondepressed peers, and that treatment of depression may reduce these costs; and 3) depression can result in productivity losses via increased rates of absenteeism and short-term disability as well as via impaired on-the-job performance.

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Working on the hot seat: urban bus operators.

City bus operators suffer elevated health risks and striking levels of absenteeism and medical disability that may be related to occupational stress. This article provides a critical overview of findings on urban bus drivers' health status, paying particular attention to aspects of the physical and psychosocial job environment that may cause ill health. Methodological shortcomings in the research are discussed and preliminary ideas for salutagenic interventions are proposed.

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