Wellbeing After Finalization of a Workers' Compensation Claim: A Systematic Scoping Review.

OBJECTIVE: A workers' compensation claim may have significant negative impacts on an injured worker's wellbeing. Wellbeing provides a good global measure of potential effects of a claim on an individual, and is important for contemporary economic modelling. The purpose of this study was to synthesize knowledge about the wellbeing of injured workers after the finalization of a workers' compensation claim and identify gaps in the current literature. METHODS: A systematic scoping review was conducted. RESULTS: 71 full-text articles were screened for inclusion, with 32 articles eligible for this review. None of the included articles evaluated overall wellbeing. Included articles did evaluate a variety of constructs inherent in wellbeing. Injured workers were generally disadvantaged in some manner following claim finalization. The literature recommends a focus on reducing negative impacts on injured workers after finalization of a compensation claim, with a need for regulatory bodies to review policy in this area. CONCLUSION: There appears to be potential for ongoing burden for individuals, employers, and society after finalization of a workers' compensation claim. A gap in knowledge exists regarding the specific evaluation of wellbeing of injured workers following finalization of a workers' compensation claim.

Emerging Issues from COVID-19 in the Australian Workplace.

This article addresses a range of workplace issues, with a focus on workers' compensation and return to work, and employment law and related medical issues after the outbreak and spread of COVID-19 in Australia since 2020. It will briefly address some changes to the insurance industry generally and then consider the sometimes complex issues arising from workers' compensation claims, which have changed behaviours in claims and injury management. It concludes the theme emerging from decided cases to date that employers, insurers, and rehabilitation providers must adopt a reasonable approach to the consultation and implementation of workplace changes affecting injured workers subject to return-to-work programs.

Workers' Compensation, Return to Work, Behavioural Health and COVID-19 in Australia.

The COVID-19 pandemic has highlighted a range of challenges for the participants in Australian workers' compensation schemes. Although there are some jurisdictional differences in legislation operating at sub-national levels, this article addresses some common themes that have emerged since the outbreak of the pandemic in Australia in early 2020. One of the major concerns which has emerged is the issue of proving the causal link between COVID-19 and work. In some jurisdictions, legislation has specifically addressed these causation concerns. While the number of workers' compensation claims overall is low, there are specific industries which have been heavily affected by the pandemic which may result in a spike in claims in areas such as aged care and the medical and allied professions. We speculate that a number of legal and practical concerns will emerge that may in time contribute to some new jurisprudence in the workers' compensation arena.

Victim/survivors of crime in the workplace: interactions between workplace injuries and criminal injuries compensation and financial assistance.

Bowie identified a typology of workplace violence which features four broad categories: namely, 'intrusive', 'consumer-related', 'relationship-related' and 'organisational' violence. Identifying the form of workplace violence provides an insight into the likelihood and nature of workplace violence and consequently informs the potential for legal proceedings against employers or others. This article explores the typology of workplace injuries as proposed by Bowie and considers the relationship between criminal injuries compensation and victim/survivors financial assistance schemes and workplace injuries. In considering this relationship, it also reflects on the gendered nature of some forms of workplace violence.

Linagliptin in patients with type 2 diabetes and cardiovascular and/or renal disease: results from a cardiovascular and renal outcomes trial.

Review of: Rosenstock J, Perkovic V, Johansen, OE, et al. Effect of linagliptin vs placebo on major cardiovascular events in adults with type 2 diabetes and high cardiovascular and renal risk: the CARMELINA randomized clinical trial. JAMA. 2019;321:69-79. McGuire DK, Alexander JH, Johansen OE, et al. Linagliptin effects on heart failure and related outcomes in individuals with type 2 diabetes mellitus at high cardiovascular and renal risk in CARMELINA. Circulation. 2019;139:351-361. These two papers describe the findings from the CARMELINA trial (Cardiovascular and Renal Microvascular Outcome Study with Linagliptin): the first paper reported results for the primary cardiovascular composite outcome (cardiovascular [CV] death, nonfatal myocardial infarction [MI], or nonfatal stroke; 3-point major adverse cardiovascular event [3P-MACE]) and the key secondary renal composite outcome (renal death, end-stage kidney disease, or sustained ≥40% decrease in eGFR from baseline); the second paper reported secondary analyses of heart failure (HF) and related outcomes. The CARMELINA trial was a randomized, placebo-controlled, multicenter non-inferiority trial of adults with type 2 diabetes mellitus (T2DM) and elevated CV and renal risk. After a median 2.2-year follow-up of 6979 participants, patients allocated to linagliptin demonstrated no increase in the risk of 3P-MACE versus placebo: hazard ratio (HR) 1.02 [95% confidence interval (CI) 0.89-1.17]; P < 0.001 for non-inferiority. There was also no increase in the risk of hospitalization for HF for linagliptin versus placebo (HR 0.90 [0.74-1.08]). There was no increased risk of progression to end-stage kidney disease or death due to kidney disease (HR 0.87 [0.69-1.10]). Additionally, progression of albuminuria occurred less frequently in patients who received linagliptin versus placebo (HR 0.86 [0.78-0.95]). Overall, no new safety findings were identified for linagliptin, and no increased risk of hypoglycemia was observed for linagliptin versus placebo. Together, these findings from the CARMELINA trial reaffirm treatment guidelines for choosing additional therapies for patients with T2DM at elevated CV and/or renal risk, and provide new information on the role of linagliptin in the management of T2DM.

The National Redress Scheme for Institutional Child Sexual Abuse - The Western Australian Response.

The Royal Commission into Institutional Responses to Child Sexual Abuse estimated 60,000 people were sexually abused as children in Australian Institutions during the period it examined and recommended the Australian Government establish a single National Redress Scheme. The National Redress for Institutional Child Sexual Abuse Act 2018(the NRS Act) commenced on 1 July 2018 enacting some, but not all, of the recommendations of the Royal Commission, including the implementation of the three elements of redress, the use of a matrix to determine monetary payments, and the provision of an internal review scheme. Redress under the NRS Act includes a "direct personal response by the institution", "counselling and psychological care" and "monetary payments". All States and Territories were required to respond to the NRS Act by referring relevant powers to the Commonwealth in order to facilitate the operation of the national scheme. In addition each jurisdiction enacted particular responses to the NRS having regard to the existing victims of crime legislation in each State or Territory. This article surveys the NRS Act and the approach adopted by Western Australia and the other sub-national jurisdictions in responding to the NRS Act.

Misconduct, Self-inflicted Injury, and Suicide in Workers Compensation: A Review of the Australian Legal Framework.

The no-fault principle is one of the pillars of workers' compensation schemes operating in the States, Territories and the Commonwealth in Australia. This article examines the strength of this principle having regard to provisions common to all jurisdictions which disentitle workers where there is evidence of serious and wilful misconduct or self-inflicted injury. It examines the legislative framework of these provisions in detail noting some differences in approach and effect. The article also traces the origins of these provisions and how they have been applied since enacted. We conclude that the no-fault principle remains robust and intact in Australian workers' compensation schemes.

Physical activity following acute concussion and persistent postconcussive symptoms in children and adolescents.

The management of concussion in pediatric patients has always been guided by treatment guidelines that have been drawn from consensus statements rather than clinical research projects. Grool and colleagues conducted a clinical research project on an early return to physical activity and its effect on post-concussion symptoms. The study enrolled 3063 pediatric patients, age 5.0 to 17.99 years of age who presented to one of nine Pediatric Emergency Research Centers in Canada. 2413 patients completed the primary outcome for exposure. A total of 1677 patients (69.5%) instituted some level of early physical activity, including light aerobic exercise (n = 795 or 32.9%), sport-specific exercise (n = 214 or 8.9%), non-contact drills (n = 143 or 5.9%), full-contact practice (n = 106 or 4.4%), or full competition (n = 419 or 17.4%), while 736 (30.5%) instituted no physical activity. Patients were evaluated by a web-based survey or a telephone-based survey at days 7 and 28 after their initial visit, and their symptoms were evaluated by using the Post Concussive Symptom Inventory (PCSI). Early return to physical activity was associated with a lower risk of Persistent Post-Concussive Syndrome (PPCS) than in patients reporting no physical activity at 28 days (24.6% vs. 43.5%, Absolute risk difference, (ARD), 18.9% (95% CI 14.7-23.0%). Among the sub-group of patients who were symptomatic at day 28 (n = 803), PPCS was more present in the patients that reported no physical activity, (n = 584: PPCS 52.9%), than those with light aerobic activity (n = 494 [46.4%; ARD, 6.5%; 95% CI 5.7-12.5%], moderate activity [n = 176 (38.6%; ARD, 14.3%; 95% CI 5.9%-22.2%], or full contact activity [n = 133 (36.1%; ARD, 16.8%; 95% CI 7.5%- 25.5%]. Therefore, in patients aged 5 to 18 years with acute concussion, a return to physical activity within 7 days of acute injury was associated with less symptoms at 28 days than in patients who had a period of prolonged rest rather than an early return to physical activity.

Practice pearl: liraglutide and cardiovascular and renal events in type 2 diabetes.

Review of: Marso S, Daniels G, Brown-Frandsen K, et al. Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 2016; 375: 311-322. Mann J, Orsted D, Brown-Frandsen K, et al. Liraglutide and Renal Outcomes in Type 2 Diabetes. N Engl J Med 2017; 377: 839-848. This comprehensive research project, LEADER, led to two reports, one focusing on the effect of liraglutide on cardiovascular events, and the second one reporting on the renal effects on the same study population. The study group included 9340 patients with type 2 diabetes. Patients were required to have type 2 diabetes and an age 50 with a previous cardiovascular problem or chronic heart failure, or an age of 60 with at least one cardiovascular risk factor. Patients were randomized to 1.8 mg (or the maximum tolerated dose) of liraglutide, or placebo. The median follow up was 3.8 years. The primary cardiovascular outcome, a combined endpoint of death from cardiovascular causes, nonfatal myocardial infarction, and nonfatal stroke, was seen in 13% (608 of 4668 patients) treated with liraglutide versus 14.9 % (694 of 4672 patients) in the placebo patients (HR 0.87; 95% confidence interval [CI] 0.78 to 0.97; P = 0.01 for superiority). Death from cardiovascular disease and death from any cause were also lower in the liraglutide group. The rates for nonfatal myocardial infarction, nonfatal stroke, and hospitalization for heart failure were not significantly reduced. In the renal report, the renal outcome was reduced in the liraglutide versus the placebo group (268 of 4668 versus 337 out of 4672 in the placebo group; HR 0.78; CI 0.67 to 0.92; p = 0.003). This improvement was mainly driven by a lower rate of the new onset of persistent macroalbuminuria in the liraglutide patients (161 vs 215 patients; HR 0.74; 95% CI, 0.60 to 0.91; p = 0.004), while the rates of other renal adverse events were similar in both groups. When taken together these two reports are the first data to show that the glucagon-like peptide 1 (GLP-1) analogue liraglutide can reduce cardiovascular events and halt progression to macroalbuminuria in patients with Type 2 diabetes.

Canagliflozin and cardiovascular and renal events in type 2 diabetes.

Review of: Neal B, Perkovic V, Mahaffey K, et al. Canagliflozin and cardiovascular and renal events in type 2 diabetes. N Engl J Med. 2017;377:644-657. The report combines the data from two trials, CANVAS and CANVAS-Renal, which were designed to evaluate the safety and effect of canagliflozin, an SGLT-2 inhibitor, on the appearance of cardiovascular and renal events in patients with type 2 diabetes. Enrollees were patients with type 2 diabetes of at least 30 years of age, with a glycated hemoglobin of > or equal to 7.0% and < or equal to 10.5%. Patients either had to have preexisting cardiovascular disease or to be at elevated risk for cardiovascular disease, and to have an estimated glomerular filtration rate (eGFR) of >30 ml/min. Patients were randomized to canagliflozin at doses of either 100 mg or 300 mg or matching placebo in CANVAS, and to canagliflozin 100 mg with a possible increase to 300 mg, or placebo, in CANVAS-Renal. Physicians were instructed to continue appropriate diabetic management and other therapies in accordance with the best practices in their community. There was a significant 14% reduction in the combined endpoint of cardiovascular events of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke in the canagliflozin treated patients. There was also a pattern of improvement in markers of renal disease, including the change in the level and nature of albuminuria, a 40% decrease in the glomerular filtration rate, the need for renal replacement therapy, or death from renal causes. This study expands the scope of SGLT-2 inhibitor therapy to prevent cardiovascular disease in diabetic patients beyond those with preexisting cardiovascular disease studied in the previous empagliflozin study, raising the question as to whether SGLT-2 inhibitor therapy should be considered appropriate for most, if not all, type 2 diabetes patients, not only to control hyperglycemia but also to reduce cardiovascular and renal events.

GBS-Based Deconvolution of the Surviving North American Collection of Cold-Hardy Kiwifruit (Actinidia spp.) Germplasm.

Plant germplasm collections can be invaluable resources to plant breeders, provided they are well-characterized. After 140 years of acquisition and curation efforts by a wide and largely non-coordinated array of private and institutional actors, the current US collection of cold-hardy kiwifruit (Actinidia spp.) is rife with misclassifications, misnomers, and mix-ups. To facilitate the systematic improvement and resource-efficient curation of these species of long-recognized horticultural potential, we used genotyping-by-sequencing (GBS) data to deconvolute this historic collection. Evaluation of a total of 138 accessions (103 A. arguta, 28 A. kolomikta, and 7 A. polygama) with an interspecific set of 1,040 high-quality SNPs resulted in clear resolution of the three species. Intraspecific analysis (2,964 SNPs) within A. arguta revealed a significant level of redundancy (41.7%; only 60 unique genotypes out of 103 analyzed) and a sub-population structure reflecting likely geographic provenance, phenotypic classes, and hybrid pedigree. For A. kolomikta (3,425 SNPs), the level of accession redundancy was even higher (53.6%; 13 unique genotypes out of 28 analyzed); but no sub-structure was detected. Numerous instances were discovered of distinct genotypes sharing a common name, different names assigned to the same genotype, mistaken species assignments, and incorrect gender records, all critical information for both breeders and curators. In terms of method, this study demonstrates the practical and cost-effective use of GBS data to characterize plant genetic resources, despite ploidy differences and the lack of reference genomes. With the recent prohibition on further imports of Actinidia plant material into the country and with the active eradication of historic vines looming, this analysis of the US cold-hardy kiwifruit germplasm collection provides a timely assessment of the genetic resource base of an emerging, high-value specialty crop.

Canagliflozin use in Type I diabetes mellitus.

Peters et al documented the appearance of diabetic ketoacidosis without significant elevation of serum glucose in patients treated with Canagliflozin. They solicited patient reports from their practice and from other colleagues' practices and identified nine patients, mainly with Type I Diabetes. Erondu et al evaluated the Canagliflozin development data base to describe the rate and appearance of ketoacidosis in the study patients. They found that in the research patients with Type 2 Diabetes, the rate of ketoacidosis in Canagliflozin patients was uncommon and similar to the reported rate in Type 2 patients not receiving Canagliflozin. Finally, Henry et al reported on a research program that added Canagliflozin onto insulin therapy in Type I patients, finding that there were only modest improvements in HgBA1 C levels and weight, while this therapy produced increased levels of ketosis and 6% rate of ketoacidosis in Canagliflozin patients. This information strongly suggests that Canagliflozin, and possibly the other SGLT-2 inhibitors, are not proper therapy for patients with Type I Diabetes.

Empagliflozin reduces cardiovascular events and mortality in type 2 diabetes.

Review of: Zinnam, B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. New England Journal of Medicine. 2015; 373: 2117-2128. Patients were required to have a history of established cardiovascular disease, along with Type 2 Diabetes but were either not on antidiabetic therapy for the preceding 12 weeks, with a glycated hemoglobin level between 7% and 9%, or were on stable antidiabetic therapy for the preceding 12 weeks, with a glycated hemoglobin between 7.0% and 10.0%. Patients were randomized in a 1:1:1 ratio to either empagliflozin 10 mg or 25 mg or matching placebo. Antidiabetic therapy was not to be changed for the first 12 weeks after randomization, with intensification of antidiabetic therapy allowed if the patient had a confirmed glucose of >240 mg/dl (>13.3 mmol/l). Physicians were encouraged to treat other cardiac risk factors like hyperlipidemia according to local guidelines. The primary outcome was a composite of death from cardiovascular causes, non-fatal myocardial infarction, or nonfatal stroke. Results showed a significant reduction in the rates of death from cardiovascular causes, overall mortality, and in hospital admissions for heart failure, while there was no reduction in the rates of non-fatal myocardial infarction or stroke.

Criminal injuries compensation: Protecting vulnerable applicants.

Each year large numbers of persons sustain injury as a consequence of criminal behaviour. All Australian jurisdictions provide State-funded compensation to those harmed in this way. In the case of vulnerable applicants, the Assessor must consider not simply the appropriate and fair amount of compensation, but also how a person will be affected by the payment of compensation. Often a vulnerable applicant will apply through a guardian or a public trustee, although many apply in person. This article examines the use of legislative provisions, rules, regulations and practices in the various Australian jurisdictions in relation to how vulnerable applicants may be protected and supported once an award of compensation is made in their favour. Most jurisdictions provide for a mechanism by which compensation may be held in trust where the Assessor considers that the applicant may be unable to manage his or her financial affairs in his or her best interests. This article explores what factors are taken into account by Assessors in the absence of and pursuant to legislative directions. It considers how the approach may vary across jurisdictions and creative approaches to financial protection of vulnerable applicants.

Practice pearl: the effect of canagliflozin on HbA1c and blood pressure in patients with type 2 diabetes mellitus.

Review of: Wilding JPH, Blonde L, Leiter LA, et al. Efficacy and safety of canagliflozin by baseline HbA1c and known duration of type 2 diabetes mellitus. J Diabetes Complications. 2015;29(3):438-444; and Weir MR, Januszewicz A, Gilbert RE, et al. Effect of canagliflozin on blood pressure and adverse events related to osmotic diuresis and reduced intravascular volume in patients with type 2 diabetes mellitus. J Clin Hypertension. 2014;16(12):875-882. Two authors did secondary analyses on the original research data for canagliflozin. Wilding et al. found that the degree of the lowering of the HbA1c in patients was greater in patients with a higher baseline HbA1c. Weir et al. found that the blood pressure lowering seen with canagliflozin was greater if the baseline blood pressures were higher. This shows that canagliflozin will have increased effects in more complicated patients.

Emerging data on the incidence of concussion in football practice at all levels of amateur play.

There has been increasing concern, particularly in the US, about potential long-term neurological deterioration syndromes seen in the US football players. Recurrent concussions are a potential area of concern. The authors of this paper have used data bases from three levels of amateur US football to identify the rate and risk of concussion injury in both football games and practice at the youth, high school, and college levels. This information is very important initial data around concussion rates at these levels.

Clinical use of dipeptidyl peptidase-4 and sodium-glucose cotransporter 2 inhibitors in combination therapy for type 2 diabetes mellitus.

OBJECTIVE: To review the efficacy, safety, and tolerability of combination treatment regimens including a dipeptidyl peptidase-4 (DPP-4) inhibitor and/or sodium-glucose cotransporter 2 (SGLT2) inhibitor for type 2 diabetes mellitus (T2DM). METHODS: Clinical trials of combination therapies including a DPP-4 and/or SGLT2 inhibitor were identified through a PubMed database search. To be included, studies had to have a primary end point of change from baseline to ≥24 weeks in glycated hemoglobin, include ≥1 other oral antidiabetic drug (OAD), and have randomized more than 200 patients. Results were limited to medications approved by the US Food and Drug Administration at the time of the search (March 2015). RESULTS: A total of 1534 articles for the DPP-4 inhibitor class and 434 articles for the SGLT2 inhibitor class were retrieved from PubMed. Of these, 33 articles from the DPP-4 inhibitor class and 24 articles from the SGLT2 inhibitor class were included for review. In each study, the addition of a DPP-4 or SGLT2 inhibitor as a second or third agent resulted in improved glycemic control versus comparator arms. Reductions in weight or lack of weight gain were consistently observed, as were low rates of hypoglycemic events, particularly when the combination regimen also included metformin. Overall, the pattern of adverse events observed in combination treatment groups was consistent with the known effects of the individual agents. CONCLUSION: Combination treatment with a DPP-4 and/or SGLT2 inhibitor is an efficacious option for patients with T2DM starting pharmacological therapy, or for patients who have received treatment but require additional glycemic control. Study findings indicate that the underlying mechanisms of action of DPP-4 inhibitors and SGLT2 inhibitors complement a variety of OADs.

The impact of weight loss on weight-related quality of life and health satisfaction: results from a trial comparing canagliflozin with sitagliptin in triple therapy among people with type 2 diabetes.

Type 2 diabetes mellitus (T2DM) is primarily a self-managed disease in which self-care behaviors play an important role in achieving optimal outcomes. Because self-care does not result in immediate tangible or noticeable benefits, adherence to such a regimen can be confusing, difficult, and frustrating. People are more likely to adhere to treatment regimens that offer benefits from the patient perspective, such as convenience, avoidance of hypoglycemic episodes, and weight loss, compared with regimens that do not. In this study, we explored the impact of the average weight loss amount demonstrated with canagliflozin treatment on improvement in 3 patient-relevant outcomes that have been linked to performance of healthy behaviors and better outcomes in T2DM: weight-related quality of life, as measured by the Impact of Weight on Quality of Life-Lite (IWQOL-Lite) questionnaire, and satisfaction with physical health and emotional health, as measured by the Current Health Satisfaction Questionnaire (CHES-Q), using data from a previously reported study. Weight loss of an amount demonstrated in clinical trials of canagliflozin was associated with improvements in weight-related quality of life and satisfaction with physical and emotional health, concepts shown to be important to the persistent and consistent performance of healthy behaviors.