Disability and workers' compensation trends for employees with mental disorders and SUDs in the United States

Introduction: US employee absence benefits may include workers' compensation (WC) for work-related injuries/illnesses, short- and long-term disability (STD and LTD, respectively) for non–work-related injuries/illnesses, and discretionary sick leave (SL). Absences can significantly impact business performance, and employers are intensifying efforts to manage benefits and connections with employee health. This research compares all-cause STD/LTD/WC/SL use and variation from baseline (2002) for eligible employees (EMPs) with mental disorders (MDs) and SUDs to determine if use/payments varied over time. Methods: Employees incurring medical claims with Agency for Healthcare Research and Quality MD and SUD ICD-9/10 codes were identified in the WorkPartners database (January 1, 2002 to December 31, 2019). Retrospective analysis was performed on annual prevalence, benefit use, mean days of leave, and median payments as a percent of salary (including lump-sum distributions and potentially extending beyond initiation year). WC claims without work absences were excluded. For each benefit, annual outcomes were calculated as a percent of baseline to show variability. Results: Use was 48.1% to 202.2% (median, 102.8%) of baseline rates for SL (SUD-EMPs), and 87.3% to 108.4% (median, 97.3%) for STD (MD-EMPs). Days of LTD leaves were 21.5% to 657.8% (median, 359.2%) of baseline days (MD-EMPs), and 122.7% to 1042.2% (median, 460.0%) of baseline days for (SUD-EMPs). Median payments for WC were 78.6% to 253.6% (median, 114.6%) of baseline (MD-EMPs) and 97.9% to 481.6% (median, 104.0%) for SUD-EMPs. Discussion: Employees with MD/SUD used absence benefits at differing rates over time with varying days of leave and payments as a percent of salary. Using a constant cost or salary replacement factor over time for all benefits is not accurate or appropriate

The Clinical and Economic Impact of Employees Who Are Care Partners of Patients with Multiple Sclerosis by Disease Severity

**Background:** Research on employee care partners of patients with multiple sclerosis (MS) is limited. **Objectives:** The clinical and economic impact on employee care partners was evaluated by MS disease severity. **Methods:** Employees with spouses/domestic partners with MS from the Workpartners database (Jan. 1, 2010–Dec. 31, 2019) were eligible if: spouse/partner had at least 3 MS-related (ICD-9-CM/ICD-10-CM:340.xx/G35) inpatient/outpatient/disease-modifying therapy claims within 1 year (latest claim = index date); 6-month pre-index/1-year post-index enrollment; and age 18 to 64 years. Employee care partners’ demographic/clinical characteristics and direct/indirect costs were compared across predetermined MS severity categories. Logistic and generalized linear regression modeled the costs. **Results:** Among 1041 employee care partners of patients with MS, 358 (34.4%) patients had mild MS, 491 (47.2%) moderate, and 192 (18.4%) severe. Mean (standard error [SE]) employee care partner age was 49.0 (0.5) for patients with mild disease, 50.5 (0.4) for moderate, 51.7 (0.6) for severe; percent female care partners was 24.6% [2.3%] mild, 19.8% [1.8%] moderate, 27.6% [3.2%] severe; and mean care partner Charlson Comorbidity Index scores 0.28 (0.05) mild, 0.30 (0.04) moderate, 0.27 (0.06) severe. More care partners of patients with moderate/severe vs mild MS had hyperlipidemia (32.6%/31.8% vs 21.2%), hypertension (29.5%/29.7% vs 19.3%), gastrointestinal disease (20.8%/22.9% vs 13.1%), depression (9.2%/10.9% vs 3.9%), and anxiety 10.6%/8.9% vs 4.2%). Adjusted mean medical costs were greater for employee care partners of patients with moderate vs mild/severe disease (_P_<.001). Pharmacy costs (SE) were lower for employee care partners of mild vs severe/moderate patients (_P_<.005). Sick leave costs (SE) were greater for employee care partners of mild/severe vs moderate patients (_P_<.05). **Discussion:** Employee care partners of patients with moderate/severe vs mild MS had more comorbidities (ie, hypertension, gastrointestinal disease, depression, and anxiety) and higher pharmacy costs. Employee care partners of patients with moderate vs mild/severe MS had higher medical and lower sick leave costs. Treatment strategies that improve patient outcomes may reduce employee care partner burden and lower costs for employers in some instances. **Conclusions:** Comorbidities and direct/indirect costs of employees whose spouses/partners have MS were considerable and varied with MS severity

Sociocultural considerations in aging men's health: implications and recommendations for the clinician

http://dx.doi.org/10.1016/j.jomh.2009.07.00

Association studies of up to 1.2 million individuals yield new insights into the genetic etiology of tobacco and alcohol use

Tobacco and alcohol use are leading causes of mortality that influence risk for many complex diseases and disorders 1 . They are heritable 2,3 and etiologically related 4,5 behaviors that have been resistant to gene discovery efforts 6–11 . In sample sizes up to 1.2 million individuals, we discovered 566 genetic variants in 406 loci associated with multiple stages of tobacco use (initiation, cessation, and heaviness) as well as alcohol use, with 150 loci evidencing pleiotropic association. Smoking phenotypes were positively genetically correlated with many health conditions, whereas alcohol use was negatively correlated with these conditions, such that increased genetic risk for alcohol use is associated with lower disease risk. We report evidence for the involvement of many systems in tobacco and alcohol use, including genes involved in nicotinic, dopaminergic, and glutamatergic neurotransmission. The results provide a solid starting point to evaluate the effects of these loci in model organisms and more precise substance use measures

2019 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations

The International Liaison Committee on Resuscitation has initiated a continuous review of new, peer-reviewed, published cardiopulmonary resuscitation science. This is the third annual summary of the International Liaison Committee on Resuscitation International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. It addresses the most recent published resuscitation evidence reviewed by International Liaison Committee on Resuscitation Task Force science experts. This summary addresses the role of cardiac arrest centers and dispatcher-assisted cardiopulmonary resuscitation, the role of extracorporeal cardiopulmonary resuscitation in adults and children, vasopressors in adults, advanced airway interventions in adults and children, targeted temperature management in children after cardiac arrest, initial oxygen concentration during resuscitation of newborns, and interventions for presyncope by first aid providers. Members from 6 International Liaison Committee on Resuscitation task forces have assessed, discussed, and debated the certainty of the evidence on the basis of the Grading of Recommendations, Assessment, Development, and Evaluation criteria, and their statements include consensus treatment recommendations. Insights into the deliberations of the task forces are provided in the Justification and Evidence to Decision Framework Highlights sections. The task forces also listed priority knowledge gaps for further research

Proceedings of the 1998 Winter Simulation Conference

The cost of delay is a serious and increasing problem in the airline industry. Air travel is increasing, and already domestic airports incur thousands of hours of delay daily, costing the industry $2 billion a year. One strategy for reducing total delay costs is to hold planes for a short time at the gate in order to reduce costly airborne congestion. In a network of airports involving thousands of flights, it is difficult to determine the amount to hold each flight at the gate. This paper discusses how the optimization procedure simultaneous perturbation stochastic approximation (SPSA) can be used to process delay cost measurements from air traffic simulation packages and produce an optimal gate holding strategy. As a test case, the SIMMOD air traffic simulation package was used to model a simple four-airport network

SPSA/SIMMOD Optimization of Air Traffic Delay Cost

The cost of delay isa serious and increasing problem in the airline industry. Air travel is increasing, and already domestic airports incur thousands of hours of delay daily, costing the industry $2 billion a year. One strategy for reducing total delay costs is to hold planes for a short time at the gate in order to reduce costly airborne congestion. In a network of airports involving hundreds of flights, it is difficult to determine the amount to hold each flight at the gate. This paper discusses how the optimization procedure simultaneous perturbation stochastic approximation (SPSA) can be used to process delay cost measurements from air traffic simulation packages and produce an optimal gate holding schedule. As a test case, the SIMMOD air traffic simulation package was used to model a simple four-airport network. Initial delay costs are reduced up to 10.3%

Simulation-Based Optimization with Stochastic Approximation Using Common Random Numbers

The method of Common Random Numbers is a technique used to reduce the variance of difference estimates in simulation optimization problems. These differences are commonly used to estimate gradients of objective functions as part of the process of determining optimal values for parameters of a simulated system. Asymptotic results exist which show that using the Common Random Numbers method in the iterative Finite Difference Stochastic Approximation optimization algorithm (FDSA) can increase the optimal rate of convergence of the algorithm from the typical rate of k -1/3 to the faster k -1/2 , where k is the algorithm's iteration number. Simultaneous Perturbation Stochastic Approximation (SPSA) is a newer and often much more efficient optimization algorithm, and we will show that this algorithm, too, converges faster when the Common Random Numbers method is used. We will also provide multivariate asymptotic covariance matrices for both the SPSA and FDSA errors.Common Random Numbers, Simultaneous Perturbation Stochastic Approximation (SPSA), Finite Difference Stochastic Approximation (FDSA), discrete event dynamic systems