Methodologic issues in the use of workers' compensation databases for the study of work injuries with days away from work. I. Sensitivity of case ascertainment

Background Case ascertainment costs vary substantially between primary and secondary data sources. This review summarizes information on the sensitivity of state administrative databases in workers' compensation systems for the ascertainment of days-away-from-work (DAFW) work injuries for use in modeling studies. Methods Review of the literature supplemented by data from governmental or organizational reports or produced for this report. Results Employers currently appear to provide workers' compensation insurance coverage for 98.9% of wage and salary workers. Wage and salary jobs account for approximately 90% of jobs in the United States. In industries such as manufacturing, the fraction of covered jobs is probably closer to 98%. In Minnesota, the number of DAFW cases ascertained by the Bureau of Labor Statistics' annual survey of occupational injuries and illnesses is approximately 92–97% concordant with the number of wage compensation claims for injuries producing DAFW over the period 1992–2000, once adjustments are made to permit direct comparisons of the numbers. The workers' compensation databases provide information for more than 95% of the total DAFW resulting from work injuries. Covariate estimates are unaffected by this less than 5% loss because effects appear dependent on time from injury. Conclusions Statewide workers' compensation administrative databases can have substantial utility for epidemiologic study of work injuries with DAFW because of their size, using high sensitivity for case ascertainment as the evaluative criterion. Am. J. Ind. Med. 45:260–274, 2004. © 2004 Wiley-Liss, Inc.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/34825/1/10333_ftp.pd

Occupational safety and regulatory compliance in US commercial fishing

Author Posting. © The Author(s), 2010. This is the author's version of the work. It is posted here by permission of Taylor & Francis for personal use, not for redistribution. The definitive version was published in Archives of Environmental & Occupational Health 66 (2011): 209-216, doi:10.1080/19338244.2011.564237.This study explored occupational safety practices and regulatory compliance in a representative sample of Maine commercial fishing vessels. Data were collected on demographic characteristics, safety equipment and training, and regulatory compliance during at sea boardings of working commercial fishing vessels (n=259). Trends in safety and compliance were explored using standard comparison tests and principal component analysis. More than 40% of vessels were not in compliance with applicable safety regulations. That rate was lower for fishermen subjected to more stringent and costly safety requirements. The vast majority of fishermen were not safety trained, and many were not familiar with the proper use and maintenance of life-saving equipment. There is a clear need for better safety training in this industry. Educational efforts should be targeted at the local level at minimal cost to fishermen to encourage participation.This study was supported by funding from Maine Sea Grant and the National Oceanic and Atmospheric Administration (R/08-03 NA060AR4170108)

BMI, Physical Activity, and Health Care Utilization/Costs among Medicare Retirees

Objective : To examine the influence of physical activity (PA) and BMI on health care utilization and costs among Medicare retirees. Research Methods and Procedures : This cross‐sectional study was based on 42, 520 Medicare retirees in a U.S.‐wide manufacturing corporation who participated in indemnity/perferred provider and one health risk appraisal during the years 2001 and 2002. Participants were assigned into one of the three weight groups: normal weight, overweight, and obese. PA behavior was classified into three levels: sedentary (0 time/wk), moderately active (1 to 3 times/wk), and very active (4+ times/wk). Results : Generalized linear models revealed that the moderately active retirees had $1456,$1731, and $1177 lower total health care charges than their sedentary counterparts in the normal‐weight, overweight, and obese groups, respectively ( p < 0.01). The very active retirees had$1823, $581, and$1379 lower costs than the moderately active retirees. Health care utilization and specific costs showed similar trends with PA levels for all BMI groups. The total health care charges were lower with higher PA level for all age groups ( p < 0.01). Discussion : Regular PA has strong dose‐response effects on both health care utilization and costs for overweight/obese as well as normal‐weight people. Promoting active lifestyle in this Medicare population, especially overweight and obese groups, could potentially improve their well‐being and save a substantial amount of health care expenditures. Because those Medicare retirees are hard to reach in general, more creative approaches should be launched to address their needs and interests as well as help reduce the usage of health care system.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/93683/1/oby.2005.175.pd

Household out-of-pocket medical expenditures and national health insurance in Taiwan: income and regional inequality

BACKGROUND: Unequal geographical distribution of medical care resources and insufficient healthcare coverage have been two long-standing problems with Taiwan's public health system. The implementation of National Health Insurance (NHI) attempted to mitigate the inequality in health care use. This study examines the degree to which Taiwan's National Health Insurance (NHI) has reduced out-of-pocket medical expenditures in households in different regions and varying levels of income. METHODS: Data used in this study were drawn from the 1994 and 1996 Surveys of Family Income and Expenditure. We pooled the data from 1994 and 1996 and included a year dummy variable (NHI), equal to 1 if the household data came from 1996 in order to assess the impact of NHI on household out-of-pocket medical care expenditures shortly after its implementation in 1995. RESULTS: An individual who was older, female, married, unemployed, better educated, richer, head of a larger family household, or living in the central and eastern areas was more likely to have greater household out-of-pocket medical expenditures. NHI was found to have effectively reduced household out-of-pocket medical expenditures by 23.08%, particularly for more affluent households. With the implementation of NHI, lower and middle income quintiles had smaller decreases in out-of-pocket medical expenditure. NHI was also found to have reduced household out-of-pocket medical expenditures more for households in eastern Taiwan. CONCLUSION: Although NHI was established to create free medical care for all, further effort is needed to reduce the medical costs for certain disadvantaged groups, particularly the poor and aborigines, if equality is to be achieved

From Marginalized to Maximized Opportunities for Diverse Youths With Disabilities: A Position Paper of the Division on Career Development and Transition

Current secondary education and transition practices have created differential education and employment outcomes by gender, race and ethnicity, socioeconomic status, and disability classifications. These differential outcomes result in economic and social marginalization of far too many students with disabilities. Transition education practices need to respond to these differential outcomes and provide targeted, systematic, and long-term opportunities for all students to attain individually and family-determined postschool goals. This position paper recommends an ecological framework for considering the multiple systems that influence transition education and postschool outcomes for diverse youths with disabilities. The authors argue for educators, researchers, and policy makers to attend to social, political, economic, educational, and cultural contexts in developing effective interventions and improving postschool outcomes.Yeshttps://us.sagepub.com/en-us/nam/manuscript-submission-guideline

Ergonomic evaluation of an alternative tool for cake decorating

Aim Cake decorating involves several hand intensive steps with high grip force during the application of icing. The purpose of this laboratory study was to evaluate forearm muscle activity, discomfort, productivity, and usability of an alternative tool for cake decorating compared to decorating with the traditional piping bag. Methods Participants (n&nbsp;=&nbsp;17) performed 2&nbsp;h of cake decorating tasks using the two tools. Subjective hand and arm fatigue, usability, upper extremity posture, and muscle activity from three forearm muscles were assessed for each tool. Outcome measures were evaluated using the Wilcoxon Signed Rank test and the paired t-test. Results Less fatigue was reported in the dominant hand (p&nbsp;=&nbsp;0.001), forearm (p&nbsp;=&nbsp;0.003) and shoulder (p&nbsp;=&nbsp;0.02) for the alternative tool when compared to the piping bag. Average median (APDF 50%) and peak (APDF 90%) muscle activity was significantly less for the alternative tool across all three forearm muscles. The alternative tool significantly reduced grip force, an important risk factor for distal upper extremity pain and disorders. Participants rated usability of the alternative tool superior for refill and comfort but the traditional method was rated better for accuracy, stability, positioning and control. Conclusions The alternative tool was associated with less dominant arm fatigue, muscle activity, and grip force when compared with the piping bag. However, the alternative tool did not receive the best overall usability rating due to problems with accuracy and overflow, especially with smaller decorating tips. Recommendations were made for addressing these problems with the alternative tool

Cost-effectiveness of Implementing Low-Tidal Volume Ventilation in Patients With Acute Lung Injury

Background: Despite widespread guidelines recommending the use of lung-protective ventilation (LPV) in patients with acute lung injury (ALI), many patients do not receive this lifesaving therapy. We sought to estimate the incremental clinical and economic outcomes associated with LPV and determined the maximum cost of a hypothetical intervention to improve adherence with LPV that remained cost-effective. Methods: Adopting a societal perspective, we developed a theoretical decision model to determine the cost-effectiveness of LPV compared to non-LPV care. Model inputs were derived from the literature and a large population-based cohort of patients with ALI. Cost-effectiveness was determined as the cost per life saved and the cost per quality-adjusted life-years (QALYs) gained. Results: Application of LPV resulted in an increase in QALYs gained by 15% (4.21 years for non-LPV vs 4.83 years for LPV), and an increase in lifetime costs of $7,233 per patient with ALI ($99,588 for non-LPV vs $106,821 for LPV). The incremental cost-effectiveness ratios for LPV were$22,566 per life saved at hospital discharge and $11,690 per QALY gained. The maximum, cost-effective, per patient investment in a hypothetical program to improve LPV adherence from 50 to 90$9,482. Results were robust to a wide range of economic and patient parameter assumptions. Conclusions: Even a costly intervention to improve adherence with low-tidal volume ventilation in patients with ALI reduces death and is cost-effective by current societal standards.NIH F32HL090220.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/84154/1/Cooke - CEA LPV.pd