Importance of an Integrated Assessment of Functional Disability and Work Ability in Workers Affected by Low Back Pain.

Background: This study examines the relationship between functional disability and work ability in workers affected by low back pain (LBP) through an analysis of correlations between the Oswestry Disability Index (ODI) and Work Ability Index (WAI). The role of personal and work factors on functional disability/work ability levels has also been studied. LBP is the most common musculoskeletal problem and a major disabling health problem worldwide. Its etiology is multifactorial. Multidisciplinary approaches may help reduce the burden of pain and disability and improve job continuity and reintegration at work. Methods: A cohort of 264 patients affected by LBP from an Italian outpatient clinic were included in a clinical diagnostic/therapeutic trial aiming at rehabilitation and return to work through an integrated investigation protocol. Data were collected during the first medical examination using anamnestic and clinical tools. The final sample is composed of 252 patients, 57.1% man, 44.0 % blue collars, 46.4% with the high school degree, 45.6% married. Results: WAI and ODI reported a negative and fair correlation (r = -0.454; p = .000). Workers with acute LBP symptoms have a higher probability of severe disability than those with chronic LBP symptoms. White collars without depressive symptoms reported higher work ability - even in chronic disability conditions-than those with depressive symptoms. Conclusion: The study found that ODI and WAI have a convergent validity and this suggests that the two tools measure capture distinctive aspects of disability related to personal, environmental, and occupational characteristics. The most important and modifiable prognostic factors found for ODI and WAI were depressive symptoms, workday absence, and intensity of back pain. The study also found a mild association between age and ODI. The study's findings highlight the importance of using a multidisciplinary approach to manage and prevent disability due to LBP.

Developing a cost-estimation model for work-related stress: An absence-based estimation using data from two Italian case studies.

OBJECTIVES: This paper discusses the development of a cost-estimation model for work-related stress based on psychosocial risk exposure and absence from work. It presents findings from its implementation and evaluation in two organizations in Italy, using national-level tools developed by the Italian Workers' Compensation Authority (INAIL). It also provides recommendations for the development of similar cost-calculation methods in other countries. METHODS: The cost-estimation model was based on the human capital approach using an indirect cost indicator: loss of productivity due to days of absence attributable to work-related stress. Furthermore, the population attributable fraction (PAF) epidemiological measure was used to calculate the impact of exposure to work-related stress on the basis of data collected through validated tools developed by INAIL and salary cost data. RESULTS: The developed model was implemented and evaluated in two organizations, the first in healthcare (N=1014) and the second in public administration (N=534). In the first case, it was found that absence related to work-related stress cost the organization €445 000. In the second case, the cost was €360 000. CONCLUSIONS: The proposed model provides an example of how organizations can incorporate well-established indicators associated with work-related stress (eg, various types of absence, psychosocial risk perception, loss of productivity on the basis of salary costs) in a practical way in cost estimations of work-related stress. Such cost estimation can be applied in other countries and organizations to establish the economic and business case of managing work-related stress.

Half a degree and rapid socioeconomic development matter for heatwave risk.

While every society can be exposed to heatwaves, some people suffer far less harm and recover more quickly than others from their occurrence. Here we project indicators of global heatwave risk associated with global warming of 1.5 and 2 °C, specified by the Paris agreement, for two future pathways of societal development representing low and high vulnerability conditions. Results suggest that at the 1.5 °C warming level, heatwave exposure in 2075 estimated for the population living in low development countries is expected to be greater than exposure at the warming level of 2 °C for the population living in very high development countries. A similar result holds for an illustrative heatwave risk index. However, the projected difference in heatwave exposure and the illustrative risk index for the low and very high development countries will be significantly reduced if global warming is stabilized below 1.5 °C, and in the presence of rapid social development.

Global assessment of heat wave magnitudes from 1901 to 2010 and implications for the river discharge of the Alps.

Heat waves represent one of the most significant climatic stressors for ecosystems, economies and societies. A main topic of debate is whether they have increased or not in intensity and/or their duration due to the observed climate change. Firstly, this is because of the lack of reliable long-term daily temperature data at the global scale; secondly, because of the intermittent nature of such phenomena. Long datasets are required to produce a reliable and meaningful assessment. In this study, we provide a global estimate of heat wave magnitudes based on the three most appropriate datasets currently available, derived from models and observations (i.e. the 20th Century Reanalyses from NOAA and ECMWF), spanning the last century and before. The magnitude of the heat waves is calculated by means of the Heat Wave Magnitude Index daily (HWMId), taking into account both duration and amplitude. We compare the magnitude of the most severe heat waves occurred across different regions of the world and we discuss the decadal variability of the larger events since the 1850s. We concentrate our analysis from 1901 onwards, where all datasets overlap. Our results agree with other studies focusing on heat waves that have occurred in the recent decades, but using different data. In addition, we found that the percentage of global area covered by heat wave exceeding a given magnitude has increased almost three times, in the last decades, with respect to that measured in the early 20th century. Finally, we discuss the specific implications of the heat waves on the river runoff generated in the Alps, for which comparatively long datasets exist, affecting the water quality and availability in a significant portion of the European region in summer.

Early Treatment in HIV Patients: A Cost-Utility Analysis from the Italian Perspective.

BACKGROUND AND OBJECTIVE: Highly active antiretroviral therapy (HAART) has modified the clinical course of human immunodeficiency virus (HIV) infection, reducing the rate of disease progression, the incidence of opportunistic infections and mortality. Several recent studies show early antiretroviral therapy reduces the risk of AIDS and HIV-related disease. The aim of this study was to perform an economic analysis to estimate the cost-utility of early antiretroviral therapy in Italy for managing HIV-infected patients. METHODS: The incremental cost-utility analysis was carried out to quantify the benefits of the early-treatment approach in HIV subjects. A Markov simulation model including direct costs and health outcomes was developed from a third-party (Italian National Healthcare Service) payer's perspective for four CD4 strata. 5000 Monte Carlo simulations were performed on two distinct scenarios: Standard of care (SoC) in which 30% of patients started HAART with a CD4 count ≥500 cells/mm(3) versus the early-treatment scenario (ETS), where the number of patients starting HAART with a CD4 count ≥500 cells/mm(3) increased to 70%. A systematic literature review was carried out to identify epidemiological and economic data, which were subsequently used to inform the model. In addition, a one-way probabilistic sensitivity analysis was performed in order to measure the relationship between the effectiveness of the treatments and the number of patients to undergo early treatment. RESULTS: The model shows, in terms of the incremental cost-effectiveness ratio (ICER) per quality-adjusted life years (QALY) gained, that early treatment appeared to be the most cost-effective option compared to SoC (ICER = €13,625) over a time horizon of 10 years. The cost effectiveness of ETS is more sustainable as it extends the time horizon analysis (ICER = €7526 per QALY to 20 years and €8382 per QALY to 30 years). The one-way sensitivity analysis on the main variables confirmed the robustness of the model for the early-treatment approach. CONCLUSION: Our model represents a tool for policy makers and health-care professionals to provide information on the cost effectiveness of the early-treatment approach in HIV-infected patients in Italy. Starting HAART earlier keeps HIV-infected patients in better health and reduces the incidence of AIDS- and non-AIDS-related events, generating a gain in terms of both patients' health and correct resource allocation.

Economic effects of treatment of chronic kidney disease with low-protein diet.

OBJECTIVE: The most recent literature has shown extensively that a low-protein diet in patients with chronic kidney disease (CKD) delays the natural progression of end-stage renal disease and the necessary treatment of chronic dialysis. The aim of this study was to estimate the cost-effectiveness of a very low-protein diet compared with a moderate low-protein diet. DESIGN: Markov model. SETTING: The study was conducted from the perspective of the Italian National Health Service. SUBJECTS: Patients with CKD stages 4 and 5. Seven hundred and two patients were considered, and half were treated with a very low-protein diet and the other half with a moderate low-protein diet. INTERVENTION: The Markov model estimates the costs and the quality-adjusted life years (QALYs) associated with a very low-protein diet versus a moderate low-protein diet for patients with CKD Stages 4 and 5. The transition probability was estimated on data from 7 studies, which determined the efficacy of very low-protein diets in delaying the need to start maintenance dialysis. Utilities and cost were estimated from literature review and projected for the lifespan considered in the model. The annual cost of dialysis per patient was approximately €34,072. The cost of a very low-protein diet was €1,440 per patient per year in the Lazio region (conservative assumptions). Probabilistic and deterministic sensitivity analyses were performed. MAIN OUTCOME MEASURE: QALY, cost of treatment, incremental cost-effectiveness ratio. RESULTS: The model estimates that a very low-protein diet should be more effective. Dietary treatment improved 0.09 QALYs after 2 years, 0.16 after 3 years, 0.36 after 5 years, and up to 0.93 incremental QALYs after the first 10 years. After 2 years, the model estimated increment cost in favor of the most restrictive dietary treatment of €826, €2,146, €5,203, and €10,375 for 2, 3, 5, and 10 years of follow-up respectively. CONCLUSIONS: The results of these simulations indicate that the treatment of CKD patients with a very low-protein diet is cost-effective relative to a moderate low-protein diet in an Italian setting. Further studies should test this model in other countries with different dialysis costs and dietary support.

[The INSuLa Project: a knowledge survey of employers]. / Progetto INSuLa: I'indagine conoscitiva sui Datori di Lavoro.

In the framework of the INSuLa project, supported by Italian Ministry of Health, a national survey was conducted to evaluate the perceptions of employers about Occupational Safety and Health (OSH) activities. Main findings of this survey are presented in this paper. The survey was conducted on a sample of 1,010 employers weighted by economic activity sector, company size and geographic area. An ad hoc questionnaire was administered through Computer Assisted Telephone Interviewing methodology. Most of employers "mostly" or "completely" agree with the usefulness of OSH activities and the efficacy of specific prevention and protection measures. Around 37.7% of employers consider OSH management a shared responsibility with workers and 56.1% of them feel the OSH level to be increased following the implementation of Legislative Decree no. 81/08. The findings of this survey provide a picture of Italian employers' point of view about OSH and identify gaps and needs, thus contributing to choose proper actions for the improvement of OSH