Relationship Analysis of Injured Workers' Average Weekly Wages and Workers' Compensation Indemnity Claims in Maine, US: 1998 to 2017.

OBJECTIVE: Explore the relationship between injured workers' average weekly wages (AWW) and their workers' compensation (WC) claims outcomes in Maine, US. METHODS: A total of 29,668 indemnity (lost-time) claims categorized into three wage-based percentile groups from a 20-year period (5-year intervals) were analyzed. WC outcomes included medical costs, number of indemnity checks, claim's duration, and claim settlements. RESULTS: Generally, claims within the lower percentile group were less likely to have high medical costs, but were more likely to have an elevated number of indemnity checks when compared to those in the middle percentile group. An inverse relationship was observed for those claims within the higher percentile group. CONCLUSIONS: Generalizations about low wage earners' claims being longer-lasting and more expensive or early return to work always reducing the medical cost of claims should be avoided.

Injuries and Exposure to Time Lobstering in Northeast US Inshore Lobster Fleet.

Objectives: The study objective was to estimate a denominator of exposure to inshore lobstering in Full-Time Equivalents (FTEs), to count incident injury data from a sample cohort of this population, to use this count to calculate rates for incident injuries, and to use official counts of fatalities to estimate a fatality rate.Methods: Captains were randomly selected from those licensed to fish in Maine and Massachusetts. Data on work exposure and injuries that occurred on the boat were collected using a survey that was administered once per season via phone or face-to-face interview with the captain. Data included self-reports of the number of weeks worked during the season, average crew size, number of trips per week, and average trip length in hours. In addition, this survey captured relevant information (body segment affected, type of injury, and whether treatment was received) on all acute injuries occurring during the season. Only data on acute injuries were collected, and defined as having newly occurred within the last 3 months. Counts of fatalities were obtained from an official surveillance database at the National Institute for Occupational Health and Safety.Results: The total occupational exposure reported for the cohort was over 2 million man-hours over 4 years, resulting in an average annual FTE of 5,847. The fatality rate averaged over 4 years was 21/100,000 FTE. The incidence rates for all injuries (51.0/100 FTE) and injuries receiving treatment (17.5/100 FTE) were much higher than those reported in other studies of fishing that used US Coast Guard data. Lobstermen presented with all categories of injuries, sprains being the most frequent (7.8/100 FTE) and amputations the least (0.2/100 FTE). Wrist/hand injuries on the right side occurred most frequently of all body locations (3.6/100 FTE).Conclusion: Non-fatal injuries occur at high rates in lobstering. The impact of interventions aimed at exposure to risk for sprains and cuts has potential to affect the most lobstermen. Fatality rate appears to have been unchanging since the year 2000.

Assessment of Mortality and Smoking Rates Before and After Reduction in Community-wide Prevention Programs in Rural Maine.

Importance: It is unclear whether effective population-wide interventions that reduce risk factors and improve health result in sustained benefits to a community's health. If benefits do persist after a program is ended, interventions could be brief rather than maintained long term. Objective: To measure mortality and smoking rates in a rural community over decades before, during, and after prevention program reductions. Design, Setting, and Participants: This cross-sectional study compared smoking and mortality rates in a rural Maine county with other Maine counties over time by 5-year intervals. Multiple changes occurred between 2001 and 2015 in the physiological and behavioral risk factor reduction programs offered in the county. They included reductions in leadership, staff, institutional resources, data monitoring, and the programs themselves. Data were analyzed from May 2018 to March 2019. Intervention: Previous multifaceted interventions and outcome monitoring were withdrawn or diminished in the past decade. Main Outcomes and Measures: Smoking and age-adjusted mortality rates vs household income. Results: Reduced mortality rates in Franklin County in 1986 to 2005 reverted to those predicted by household incomes, relative to other Maine counties, by 2006 to 2015 (1986-1990 T score = -2.86 [P = .01] and 2001-2005 T score = -3.00 [P = .01] to 2006 to 2010 T score = -0.43 [P = .67] and 2011-2015 T score = -0.72 [P = .48]). Analysis of County Health Rankings data from 2010 to 2018 also showed that Franklin County's outcomes have reverted to no better than predicted by socioeconomic status. The county's T scores increased from -3.62 (P = .003) in 2010 to -0.41 (P = .69) in 2015 to 0.13 (P = .90) in 2018. Statewide association of income with mortality by analyses of variance showed that the R2 values have increased from the decades preceding 2000 (1976-1980, R2 = 0.21; P = .08; 1986-1990, R2 = 0.32; P = .02) to 2006 to 2010 (R2 = 0.73; P < .001) and 2011 to 2015 (R2 = 0.70; P < .001). Conclusions and Relevance: This study suggests that gains associated with population health interventions may be lost when the interventions are reduced. Adjusting outcome measures for socioeconomic status may allow quicker and more sensitive monitoring of intervention adequacy and success. The increasing trend of age-adjusted mortality in Maine and nationally to correlate inversely with incomes may warrant further community interventions, especially for poorer populations.

Characterizing the demographics of chronic pain patients in the state of Maine using the Maine all payer claims database.

BACKGROUND: Chronic pain is currently a significant health problem in the United States. A comprehensive strategy is needed to increase prevention of chronic pain and to improve care for chronic pain patients. However, development of a successful strategy relies, in part, on a better understanding of the demographics and socioeconomics of patients living with chronic pain conditions. The current study was designed to understand the burden of chronic pain in the state of Maine by identifying the prevalence of chronic pain and its relationship with selected demographic and socioeconomic factors in Maine. METHODS: The Maine All Payer Claims Database (MEAPCD) (2006-2011) was used in the secondary data analysis to assess the demographic characteristics (such as age, sex, insurance type, and county of residence) of chronic pain patients in Maine. Chronic pain patients were identified based on the presence of pre-identified chronic pain-associated ICD-9 code(s) and opioid prescription information. Potential associations between the prevalence of chronic pain and a number of socioeconomic factors were determined by comparisons to Maine Census data. RESULTS: More women in the state were identified as having chronic pain across all counties and all age groups (> 10 years old). Surprisingly, the majority of chronic pain patients were identified based on the diagnostic code criteria and not the opioid prescription criteria. A greater utilization of public health insurance was seen within the chronic pain patients. At the county level, although neither education level nor income were associated with the prevalence of chronic pain, these factors significantly correlated with the usage of public health insurance. CONCLUSIONS: Further detailed characterization of the chronic pain patient population in the state of Maine, using multiple data sources, can help design population-targeted strategies to prevent and manage chronic pain.

Using Controlled Substance Receipt Patterns to Predict Prescription Overdose Death.

BACKGROUND: This study evaluates complete state data from controlled substance prescribing trends in the prescription monitoring program (PMP) database and their association with the risk of prescription drug overdose death. SUMMARY: Maine PMP records of individuals who died of prescription overdose deaths between 2006 and 2010 were selected (n = 690). For each subject, an age, gender, and residence matched cohort of PMP users in a 50: 1 ratio was identified (n = 34,500). Key Messages: Prescription opioids contributed to 480 of 690 prescription deaths, many co-ingestions were noted, and OR for overdose death increased with milligram of morphine equivalent (MME)/day >100. The majority who were prescribed MME >100 per day received a prescription within 90 days of overdose matching the toxicology cause of death. CONCLUSIONS: Medication profiles available through state PMP can identify dosing of prescriptions associated with drug overdose death.

School-Based Influenza Vaccination: Health and Economic Impact of Maine's 2009 Influenza Vaccination Program.

OBJECTIVE: To estimate the societal economic and health impacts of Maine's school-based influenza vaccination (SIV) program during the 2009 A(H1N1) influenza pandemic. DATA SOURCES: Primary and secondary data covering the 2008-09 and 2009-10 influenza seasons. STUDY DESIGN: We estimated weekly monovalent influenza vaccine uptake in Maine and 15 other states, using difference-in-difference-in-differences analysis to assess the program's impact on immunization among six age groups. We also developed a health and economic Markov microsimulation model and conducted Monte Carlo sensitivity analysis. DATA COLLECTION: We used national survey data to estimate the impact of the SIV program on vaccine coverage. We used primary data and published studies to develop the microsimulation model. PRINCIPAL FINDINGS: The program was associated with higher immunization among children and lower immunization among adults aged 18-49 years and 65 and older. The program prevented 4,600 influenza infections and generated $4.9 million in net economic benefits. Cost savings from lower adult vaccination accounted for 54 percent of the economic gain. Economic benefits were positive in 98 percent of Monte Carlo simulations. CONCLUSIONS: SIV may be a cost-beneficial approach to increase immunization during pandemics, but programs should be designed to prevent lower immunization among nontargeted groups.

Trends in Nonfatal Agricultural Injury in Maine and New Hampshire: Results From a Low-Cost Passive Surveillance System.

OBJECTIVES: Agriculture is a dangerous industry, and although data on fatal injuries exist, less is known about nonfatal injuries. The purpose of this study is to describe trends in agricultural morbidity in Maine and New Hampshire from 2008 to 2010 using a newly established passive surveillance system. This passive system is supplied by injury cases gathered from prehospital care reports and hospital data. METHODS: Demographics and specifics of the event were recorded for each incident case. RESULTS: The average age of injured people in Maine and New Hampshire was 41.7. Women constituted 43.8% of all agricultural injuries. Machinery- (n = 303) and animal- (n = 523) related injuries accounted for most agricultural incidents. Of all injured women, over 60% sustained injuries due to animal-related causes. Agricultural injuries were spread across the two states, with clustering in southern New Hampshire and south central Maine, with additional injuries in the Aroostook County area, which is located in the northeast part of the state. Seasonal variation in agricultural injuries was evident with peaks in the summer months. There was some overlap between the agricultural and logging industry for tree-related work. CONCLUSIONS: Our methods are able to capture traumatic injury in agriculture in sufficient detail to prioritize interventions and to evaluate outcomes. The system is low-cost and has the potential to be sustained over a long period. Differences in rates of animal- and machinery-related injuries suggest the need for state-specific safety prioritization.

The Impact of Maternal Obesity and Excessive Gestational Weight Gain on Maternal and Infant Outcomes in Maine: Analysis of Pregnancy Risk Assessment Monitoring System Results from 2000 to 2010.

The objective of this study is to understand the relationships between prepregnancy obesity and excessive gestational weight gain (GWG) and adverse maternal and fetal outcomes. Pregnancy risk assessment monitoring system (PRAMS) data from Maine for 2000-2010 were used to determine associations between demographic, socioeconomic, and health behavioral variables and maternal and infant outcomes. Multivariate logistic regression analysis was performed on the independent variables of age, race, smoking, previous live births, marital status, education, BMI, income, rurality, alcohol use, and GWG. Dependent variables included maternal hypertension, premature birth, birth weight, infant admission to the intensive care unit (ICU), and length of hospital stay of the infant. Excessive prepregnancy BMI and excessive GWG independently predicted maternal hypertension. A high prepregnancy BMI increased the risk of the infant being born prematurely, having a longer hospital stay, and having an excessive birth weight. Excessive GWG predicted a longer infant hospital stay and excessive birth weight. A low pregnancy BMI and a lower than recommended GWG were also associated with poor outcomes: prematurity, low birth weight, and an increased risk of the infant admitted to ICU. These findings support the importance of preconception care that promotes achievement of a healthy weight to enhance optimal reproductive outcomes.

Impact of Increasing Coverage for Select Smoking Cessation Therapies With no Out-of-Pocket Cost Among the Medicaid Population in Alabama, Georgia, and Maine.

Prevalence of smoking is particularly high among individuals with low socioeconomic status and who may be receiving Medicaid benefits. This study evaluates the public health and economic impact of providing coverage for nicotine replacement therapy with no out-of-pocket cost to the adult Medicaid population in Alabama, Georgia, and Maine, in 2012. We estimated the increase in the number of quitters and the savings in Medicaid medical expenditures associated with expanding Medicaid coverage of nicotine replacement therapy to the entire adult Medicaid population in the 3 states. With an expansion of Medicaid coverage of nicotine replacement therapy from only pregnant women to all adult Medicaid enrollees, the state of Alabama might expect 1873 to 2810 additional quitters ($526,203 and $789,305 in savings of annual Medicaid expenditures from both federal and state funds), Georgia 2911 to 4367 additional quits ($1,455,606 and $2,183,409 savings), and Maine 1511 to 2267 additional quits in ($431,709 and $647,564 savings). The expansion of coverage for smoking cessation therapy with no out-of-pocket cost could reduce Medicaid expenditures in all 3 states.

Obese Mothers have Lower Odds of Experiencing Pro-breastfeeding Hospital Practices than Mothers of Normal Weight: CDC Pregnancy Risk Assessment Monitoring System (PRAMS), 2004-2008.

OBJECTIVES: This study examines the extent to which a mother's pre-pregnancy body mass index (BMI) category is associated with her exposure to pro-breastfeeding hospital practices. METHODS: Data from the 2004-2008 CDC PRAMS were analyzed for three states (Illinois, Maine, and Vermont) that had administered an optional survey question about hospital pro-breastfeeding practices. RESULTS: Of 19,145 mothers surveyed, 19 % were obese (pre-pregnancy BMI ≥ 30). Obese mothers had lower odds than mothers of normal weight of initiating breastfeeding [70 vs. 79 % (unweighted), p < 0.0001]. Compared with women of normal weight, obese mothers had lower odds of being exposed to pro-breastfeeding hospital practices during the birth hospitalization. Specifically, obese mothers had higher odds of using a pacifier in the hospital [odds ratio (OR) 1.31, 95 % confidence interval (CI) (1.17-1.48), p < 0.0001] and lower odds of: a staff member providing them with information about breastfeeding [OR 0.71, 95 % CI (0.57-0.89), p = 0.002], a staff member helping them breastfeed [OR 0.69, 95 % CI (0.61-0.78), p < 0.0001], breastfeeding in the first hour after delivery [OR 0.55, 95 % CI (0.49-0.62), p < 0.0001], being given a telephone number for breastfeeding help [OR 0.65, 95 % CI (0.57-0.74), p < 0.0001], rooming in [OR 0.84, 95 % CI (0.73-0.97), p = 0.02], and being instructed to breastfeed on demand [OR 0.66, 95 % CI (0.58-0.75), p < 0.0001]. Adjusting for multiple covariates, all associations except rooming in remained significant. CONCLUSIONS: Obesity stigma may be a determinant of breastfeeding outcomes for obese mothers. Breastfeeding support should be improved for this at-risk population.

11-year trends in pregnancy-related health indicators in Maine, 2000-2010.

The objective of this study is to understand health and demographic trends among mothers and infants in Maine relative to the goals of Healthy People 2020. Pregnancy risk assessment monitoring system (PRAMS) data from Maine for 2000-2010 were used to determine yearly values of pregnancy-related variables. Means (for continuous variables) and percentages (for categorical variables) were calculated using the survey procedures in SAS. Linear trend analysis was applied with study year as the independent variable. The slope and significance of the trend were then calculated. Over the study period, new mothers in Maine became better educated but the fraction of households with incomes <$20,000/year remained stagnant. Maternal prepregnancy BMI increased. Average pregnancy weight gain decreased but the number of women whose pregnancy weight gain was within the recommended range was unchanged. The rates of smoking and alcohol consumption (before and during pregnancy) increased. The Caesarean section rate rose and the fraction of infants born premature (<37 wks gestation) or underweight (<2500 gms) remained unchanged. The fraction of infants who were breast-fed increased. These results suggest that, despite some positive trends, Maine faces significant challenges in meeting Healthy People 2020 goals.

Factors affecting costs in Medicaid populations with behavioral health disorders.

BACKGROUND: Persons with behavioral disorders incur higher healthcare costs. Although they utilize behavioral health (BH) services others do not, they also have higher utilization of medical services OBJECTIVES: : To determine the degree to which higher costs for persons with BH disorders are attributable to utilization of BH services, multiple chronic medical conditions (CMCs) or other issues specific to populations with BH disorders. RESEARCH DESIGN: Data base consisted of claims for 63,141 Medicaid beneficiaries, 49% of whom had one of 5 categories of BH disorder. Generalized linear models were used to identify relative impact of demographics, BH status, multiple CMCs and primary care access on total, behavioral, nonbehavioral, and medical/surgical costs. RESULTS: Number of CMCs was associated with significant increases in all cost categories, including behavioral costs. Presence of any BH disorder significantly influenced these same costs, including those not associated with BH care. Effect size in each cost category varied by BH group. CONCLUSIONS: BH status has a large impact on all healthcare costs, including costs of medical and other non-BH services. The number of CMCs affects BH costs independent of BH disorder. Results suggest that costs might be reduced through better integration of behavioral and medical health services.

An ergonomic assessment of the long handle blueberry harvesting rake.

BACKGROUND: Previous work shows the superiority of the long-handled blueberry harvesting rake (LHR) for worker preference and productivity compared to the short-handle rake (SHR). METHODS: Post-shift interviews on occurrence, location, and severity of pain, and video-based observation of body postures enabled ergonomic assessment of Maine workers harvesting blueberries. Workers randomly crossed between LHR and SHR on consecutive work days. Wilcoxon tests compared proportions of specific body postures between LHR and SHR. RESULTS: Subjects used SHR for shorter work periods than LHR. Thirty workers provided interviews for both one LHR and one SHR shift. Assessment of these matched pairs suggested a trend toward less frequent overall pain (P = 0.07) and back pain (P = 0.11) with the LHR versus the SHR. Video tape analysis included 17 sets of observations (8 SHR and 9 LHR) on 12 individuals. Posture assessment showed more severe forward bend and squatting with the SHR and more moderate/neutral postures with the LHR. CONCLUSION: Harvesting with the traditional SHR is likely to be associated with increased frequency of pain in general, and mid-low back pain in particular, when compared to the newer LHR. This may well relate to the work postures associated with each rake. Periodicals, Inc.

It's all in the lens: differences in views on obesity prevention between advocates and policy makers.

BACKGROUND: Intervention strategies to reduce obesity include policy and environmental changes that are designed to provide opportunities, support, and cues to help people develop healthier behaviors. Policy changes at the state level are one way to influence access, social norms, and opportunities for better nutrition and increased physical activity among the population. METHODS: Ten states were selected for a broad variance in obesity rates and number of enacted obesity prevention policies during the years of 2006-2009. Within the selected states, a purely qualitative study of attitudes of childhood obesity policy using semistructured telephone interviews was conducted. Interviews were conducted with state policy makers who serve on public health committees. A set of six states that had more than eight childhood obesity policies enacted were selected for subsequent qualitative interviews with a convenience sample of well-established advocates. RESULTS: Policy makers in states where there was more childhood obesity policy action believed in the evidence behind obesity policy proposals. Policy makers also varied in the perception of obesity as a constituent priority. The major differences between advocates and policy makers included a disconnect in information dissemination, opposition, and effectiveness of these policies. CONCLUSIONS: The findings from this study show differences in perceptions among policy makers in states with a greater number of obesity prevention bills enacted. There are differences among policy makers and advocates regarding the role and effectiveness of state policy on obesity prevention. This presents an opportunity for researchers and practitioners to improve communication and translation of evidence to policy makers, particularly in states with low legislation.

Impact of a work-focused intervention on the productivity and symptoms of employees with depression.

OBJECTIVE: To test a new program's effectiveness in reducing depression's work burden. METHODS: A brief telephonic program to improve work functioning was tested in an early-stage randomized controlled trial involving 79 Maine State Government employees who were screened in for depression and at-work limitations (treatment group = 59; usual care group = 27). Group differences in baseline to follow-up change scores on the Work Limitations Questionnaire (WLQ), WLQ Absence Module, and Patient Health Questionnaire (PHQ)-9 depression severity scale were tested with analysis of covariance. RESULTS: Although there were no baseline group differences (P ≥ 0.05), by follow-up, the treatment group had significantly better scores on every outcome and differences in the longitudinal changes were all statistically significant (P = 0.0.27 to 0.0001). CONCLUSIONS: The new program was superior to usual care. The estimated productivity cost savings is $6041.70 per participant annually.

A half-century of burn epidemiology and burn care in a rural state.

The aim of this study is to quantify the changes in incidence, severity, and mortality in burn injuries in the state of Maine over the past 50 years from both prevention and treatment perspectives. The authors analyzed the data from multiple sources, including the U.S. Census, death certificates, hospital discharge abstracts, and institutional burn registries in Maine and Boston. The average annual number of burn-related deaths decreased from 53 in 1960-1964 to 14 in 2004-2008. The Maine age-adjusted rate of burn deaths was 8.6% above the national rate in 1960 and 1.4% below it in 2006. The annual number of burn patients admitted to Maine hospitals declined by 65% from 1978 to 2009. Since 1999, 12% of hospitalized patients in Maine were treated in an American Burn Association-certified burn center in Boston. Mortality for Maine burn patients, including those treated at Boston hospitals, is directly related to age and burn severity and similar to stratified mortality in the National Burn Repository. Incidence, severity, and mortality of burn injuries in Maine have decreased dramatically over the past 5 decades. Prevention programs, legislation, and a regionalized system of burn care have all likely contributed to bringing Maine's morbidity and mortality rate below the national average.

Association between prior authorization for medications and health service use by Medicaid patients with bipolar disorder.

OBJECTIVE: This study examined the association between a Medicaid prior-authorization policy for second-generation antipsychotic and anticonvulsant agents and medication discontinuation and health service use by patients with bipolar disorder. METHODS: A pre-post design with a historical comparison group was used to analyze Maine Medicaid and Medicare claims data. A total of 946 newly treated patients were identified during the eight-month policy (July 2003-February 2004), and a comparison group of 1,014 was identified from the prepolicy period (July 2002-February 2003). Patients were stratified by number of visits to community mental health centers (CMHCs) before medication initiation (proxy for illness severity): CMHC attenders, at least two visits; nonattenders, fewer than two. Changes in rates of medication discontinuation and outpatient, emergency room, and hospital visits were estimated. RESULTS: Compared with nonattenders, at baseline CMHC attenders had substantially higher rates of comorbid mental disorders and use of medications and health services. The policy was associated with increased medication discontinuation among attenders and nonattenders, reductions in mental health visits after discontinuation among attenders (-.64 per patient per month; p<.05), and increases in emergency room visits after discontinuation among nonattenders (.16 per patient per month; p<.05). During the eight-month policy period, the policy had no detectable impact on hospitalization risk. CONCLUSIONS: The prior-authorization policy was associated with increased medication discontinuation and subsequent changes in health service use. Although small, these unintended effects raise concerns about quality of care for a group of vulnerable patients. Long-term consequences of prior-authorization policies on patient outcomes warrant further investigation.

Testing the sensitivity, specificity and feasibility of four falls risk assessment tools in a clinical setting.

AIM: This paper reports on a study undertaken to test the sensitivity, specificity and feasibility of four fall risk assessment tools. BACKGROUND: Falls risk assessment tools have been developed based on literature and findings from empirical studies, but the instruments often lack further testing in the clinical setting. METHOD: Four falls risk assessment tools were tested simultaneously in this study. The data was collected in May-June 2006. All assessment tools were completed on a total of 1546 patients. Descriptive statistics were used for data analysis. RESULTS: The use of the instruments was moderately consistent among registered nurses, but the education provided did not entirely eliminate problems with accuracy. The sensitivity of the instruments was 57.1-100% and specificity was 24.9-69.3%. CONCLUSION: The sensitivity and specificity of the instruments are important factors to consider when choosing an instrument. However, the strategies to educate staff and to intervene appropriately are equally important for an organization undertaking a proactive stance in mitigating the risk of falls. IMPLICATIONS FOR NURSING MANAGEMENT: It is important for managers to test instruments in their own organizations and specific populations. It is also critical to carefully assess that the chosen instrument is easy and accurate in use.

The impact of socioeconomic factors on asthma hospitalization rates by rural classification.

Asthma hospitalization rates have increased in the past decade. Research has shown that there are multiple correlates for this increase but that driving causal factors may differ for asthma hospitalization rates in rural and non-rural settings. Here we examine the socioeconomic correlates to asthma hospitalization rates in Maine for both rural and non-rural populations to examine the similarity and differences in causal factors. Findings indicate a clear SES gradient relative to asthma hospitalization rates; as population measured SES decreased, asthma hospitalization rates increased. The associated causal factors were found to differ in rural and non-rural areas. In non-rural areas, the presence of insurance was associated with increases in the asthma hospitalization rates while in rural areas, income, occupation and the percentage of non-English language speaking persons were associated with lower asthma hospitalization rates. Public policy should focus on targeted prevention strategies at the community level, especially in rural areas where cultural competency and socioeconomic factors are increasingly important.