Cost and disability trends of work-related musculoskeletal disorders in Ohio.

BACKGROUND: With expected changes in age demographics many industry sectors may see their workforce significantly increase in age. The impact of claims and costs associated with musculoskeletal disorders in these industries may also change accordingly. AIMS: To determine the age-related trends in musculoskeletal disorders, including claims and costs, in different industrial sectors in the state of Ohio, USA. METHODS: Worker's compensation claims for musculoskeletal disorders in the state of Ohio between 1999 and 2004 were analysed in respect of age, industry sector, body region, and impact on cost and medical care (percentage of claims associated with surgery and number of procedures costing in excess of US$600). RESULTS: More than 570000 claims were analysed. Patterns of cost and disability among the majority of body regions demonstrated an increasing trend until 55 years of age, decreasing in older age groups. However, many industries demonstrated a continued increasing trend in costs with age. Shoulder and lumbar spine disorders showed unique industry-specific trends for older age groups as compared to the bell-shaped relationships for other body regions. CONCLUSIONS: Ageing appeared to have a role in the frequency and costs of musculoskeletal disorder claims in this study. However, industry-specific trends in the data suggest that job-specific risk factors may also play a role. The impact of age alone on the cost of musculoskeletal disorders cannot be determined because age is confounded by numerous lifestyle and work-related factors not identifiable in this study.

Can a transitional work grant program in a workers' compensation system reduce cost and facilitate return to work?

Although previous research has shown returning the injured worker to work as soon as possible is important to the long-term prospects of the worker remaining in the work force, there is limited economic support for implementing such programs. Thus, the purpose of this case control study was to determine the cost savings of the implementation of a Transitional Work Grant (TWG) program, which consisted of several components including job analyses, education, communication and transitional work (TW). Companies that enrolled in the TWG program were matched to nonparticipating companies (NTW) based on employer size, type of industry, number of overall claims, and number of claims with > 7 days lost time (LT claims) submitted the year prior to enrollment. The study analyzed economic data: number of claims, number of LT claims, indemnity costs, medical costs, and days lost (days away from the workplace). An additional outcome was the ratio of LT claims (> 7 days lost work) to medical only (MO) claims (LT/MO ratio). Overall, participation in the TWG program was associated with decreased indemnity cost and decreased LT/MO ratio. However, effectiveness of the program varied by employer size and industry. In terms of the state of Ohio, these costs translate into substantial savings: more than $2.3 million per year. Although the cost savings and reduction in lost time claims is encouraging, the true benefit of TW has yet to be completely quantified. Future work must account for other potential co-factors and programs that could also contribute to the savings as well as document further the indirect benefits associated with a TWG program, such as improved employee morale and increased productivity and product quality that could be four times greater than the direct savings. In summary, programs such as this one adopted by several companies in Ohio can reduce the cost burden of injuries.

Invasive pneumococcal disease in Oxford, 1985-2001: a retrospective case series.

AIMS: To describe a series of children with invasive pneumococcal disease (IPD). METHODS: A review of patient records for children aged 0-18 years admitted to the John Radcliffe Hospital with IPD from 1985 to 2001. Social deprivation was measured by the Jarman index. The proportion of children with congenital abnormalities was compared with national data. RESULTS: We identified 140 children with IPD; complete data were available for 136 children. The median age at diagnosis was 1.5 years. The social deprivation score of households of children with IPD was higher than that of the average Oxfordshire household (-2.5 v -7.3, p < 0.001). Forty four per cent of cases had at least one preceding health problem. The children with preceding health problems were significantly older than those with no preceding problems (median age 2.67 years, interquartile range 1.21 to 6.20 versus 1.11 years, interquartile range 0.51 to 2.21; p < 0.001). There was an increased risk of IPD for children with central nervous system malformations (OR = 99, 95% CI 31 to 236), congenital heart disease (OR = 62, 95% CI 24 to 131), and chromosomal abnormalities (OR = 32, 95% CI 6.6 to 96). CONCLUSIONS: There is an increased risk of IPD associated with increased social deprivation; and also with central nervous system malformations, congenital heart disease, and chromosomal abnormalities.

Pseudoneglect: a review and meta-analysis of performance factors in line bisection tasks.

An exhaustive qualitative (vote-counting) review is conducted of the literature concerning visual and non-visual line bisection in neurologically normal subject populations. Although most of these studies report a leftward bisection error (i.e., pseudoneglect), considerable between-study variability and inconsistency characterize this literature. A meta-analysis of this same literature is performed in which the total quantitative data set, comprising 73 studies (or sub-studies) and 2191 subjects, is analyzed with respect to 26 performance factors. The meta-analytic results indicate a significant leftward bisection error in neurologically normal subjects, with an overall effect size of between -0.37 and -0.44 (depending on integration method), which is significantly modulated to varying degrees by a number of additional task or subject variables. For example, visual bisection tasks, midsagittal-pointing tasks and tactile bisection tasks all lead to leftward errors, while kinesthetic tasks result in rightward errors. Tachistoscopic forced-choice testing methods reveal much greater estimates of bisection error (effect size = -1.32) than do manual method-of-adjustment procedures (effect size= -0.40). Subject age significantly modulates line bisection performance such that older subjects err significantly rightward compared to younger subjects, and to veridical line midpoint. Male subjects make slightly larger leftward errors than do female subjects. Handedness has a small effect on bisection errors, with dextrals erring slightly further to the left than sinistral subjects. The hand used to perform manual bisection tasks modulated performance, where use of the left hand lead to greater leftward errors than those obtained using the right hand. One of the most significant factors modulating bisection error is the direction in which subjects initiate motor scanning (with either eye or hand), where a left-to-right scan pattern leads to large leftward errors while a right-to-left scan pattern leads to rightward errors.

Visuospatial attention in line bisection: stimulus modulation of pseudoneglect.

Neglect and pseudoneglect are asymmetries of spatial attention which are often assumed to possess a fundamental theoretical and neurological relationship to each other, although this assumption has never been directly tested and there is as yet no unifying quantitative theory. A total of 217 subjects participated in five experiments demonstrating that both the magnitude and direction of bisection errors in normal subjects (pseudoneglect) are modulated by stimulus factors that similarly influence the magnitude and direction of neglect. Stimulus positional uncertainty did not abolish pseudoneglect, indicating that bisection judgements are made within an object-centered frame of reference. Backward masking line stimuli had no influence on the magnitude of pseudoneglect, signifying that pseudoneglect is not a byproduct of covert directional scanning of the line stimulus in iconic or short-term visual memory. Finally, bisection errors are influenced by the direction of contrast gradients imposed on line stimuli, such that perceived line midpoint is drawn toward the lower-contrast line end. The magnitude and direction of pseudoneglect are modulated by stimulus factors that also influence the magnitude and direction of neglect. Both phenomena are succinctly described as biases in attention (i.e., neglect is a right-bias, whereas pseudoneglect is a left-bias). The two phenomena are modulated by stimulus factors as follows. Line length: there is an increased bias with increasing line length for both phenomena, and a cross-over to an reversed bias for short lines. Azimuthal line position: an increasing bias accompanies increasing leftward placement for both phenomena. Line aspect ratio: there is a decreasing bias with increasing line height for both phenomena. Line elevation: there is a decreasing bias with increasing elevation for neglect, and an increasing bias with increasing elevation for pseudoneglect. The only case in which a factor's influence on the two phenomena is discrepant is for elevation, and this difference is explicable. Taken together these congruencies strongly support the notion that neglect and pseudoneglect are phenomena that are twin manifestations of parameter changes in a unitary set of underlying hemispheric attentional asymmetries.

Appendectomy and tonsillectomy in patients with inflammatory bowel disease.

Recent reports of reduced appendectomy rates in patients with ulcerative colitis have not distinguished between primary appendectomy (surgery for appendicitis) and incidental appendectomy (removal of the appendix for other reasons). In the present case control study, we examined the frequency of primary appendectomy in subjects with ulcerative colitis (n = 197) and Crohn's disease (n = 117) compared to a control group of dermatology outpatients (n = 243). A reduced rate of primary appendectomy was found in the ulcerative colitis group (adjusted odds ratio 0.20, 95% confidence intervals 0.070-0.53, p < 0.0005) but not in the Crohn's disease patients (adjusted odds ratio 0.93, 95% confidence intervals 0.39-2.18, p = NS). These data suggest that appendicitis occurs less commonly than would be expected in individuals who develop ulcerative colitis. Environmental or immunoregulatory factors may be responsible. Tonsillectomy rates were also examined in each study group, but no overall differences were found between patients with inflammatory bowel disease and controls.

The effectiveness of vision screening by school nurses in secondary school.

Vision screening of 13 and 15 year old children by school nurses in Oxfordshire has declined in recent years due to the pressure of other commitments. A study was carried out to evaluate the likely consequences of failing to provide vision screening for secondary schoolchildren, in order to make a decision about the future of the service. Parents were also asked to complete a questionnaire about their children's past eye histories. Eight schools that had had no vision screening for at least three years participated in the study. Overall, 3.8% of children between 13 and 15 years old had a visual acuity of worse than 6/12 in one or both eyes, that is they failed vision screening; there was no evidence that this percentage increased significantly across this age range. Less than 1% of children were prescribed and wore spectacles as a consequence of failing vision screening and no new cases of eye pathology were detected. Questionnaire responses suggested that about 50% of children who did not wear spectacles had had an eye examination in the previous two years. The results indicate that vision screening is not the best way to meet the eye/vision needs of secondary schoolchildren. Strategies for targeting the school nursing resource more appropriately are being considered.

Emergency resuscitation in children. The role of intraosseous infusion.

Intraosseous infusion is a temporary procedure for use in pediatric emergencies when intravenous access is difficult. Multiple drugs and fluids can be safely administered through the intraosseous route. Dosage and rate of infusion are essentially the same as with intravenous infusion.

How to assess the risk of HIV exposure.

The physician must screen patients for risk of exposure to the human immunodeficiency virus (HIV). This requires direct and specific questioning about blood product exposure, sexual practices and use of intravenous drugs. If risk factors are uncovered, patients must then be counseled on how to minimize their risk. The screening process is potentially uncomfortable for both the physician and the patient. However, intensive educational efforts, including behavioral changes, are necessary to reduce the number of HIV-infected individuals.

Psychotic-like reaction to procaine penicillin G.

A patient developed a psychotic-like reaction immediately after receiving an intramuscular injection of procaine penicillin G. The patient complained of a metallic taste, dizziness, ringing of the ears, and the fear of imminent death. No cardiovascular or pulmonary disturbances were noted. The reaction and all symptoms resolved within 15 minutes, and the patient has reported no further episodes. The case and a review of the literature are presented.

Interatrial conduction (activation) times.

Left atrial electrograms were recorded simultaneously from sites located in the coronary sinus, right pulmonary artery and esophagus in order to determine and correlate the interatrial conduction times obtained from these locations. Ten patients with normal-sized atria and 16 patients with isolated left atrial enlargement were studied. A high correlation existed between the P wave duration and the interatrial conduction times obtained from the coronary sinus and pulmonary artery; good correlations were also found for the interatrial conduction times recorded from the pulmonary artery and esophagus correlated well with those recorded from the distal coronary sinus (the generally accepted standard for the indirect interatrial conduction time measurements). In addition to providing information on the mechanism of atrial arrhythmias, the electrograms obtained from the various indirect left atrial recording sites provide satisfactory quantification of interatrial conduction.

Electrophysiologic studies of perphenazine and protriptyline in a patient with psychotropic drug-induced ventricular fibrillation.

A 51 year old woman sustained ventricular fibrillation while receiving perphenazine and protriptyline. After successful resuscitation and clinical stabilization, cardiac electrophysiologic studies were performed before and after the administration of each of these medications. Perphenazine widened the ventricular echo zone and facilitated induction of short salvoes of ventricular tachycardia (repetitive ventricular response). Protriptyline also widened the ventricular echo zone and allowed easy induction of long runs of ventricular tachycardia. Both psychotropic agents increased the incidence of ventricular dysrhythmias in this patient. The electrophysiologic study is a useful technique in determining the interaction between psychotropic drugs and life-threatening arrhythmias; it may provide a means of identifying the patients with cardiac disease in whom administration of these agents may be fatal.

Mitochondrial enzyme pathways and their possible role during curing.

The velocity of oxidation of exogenous ferrocytochrome c by nitrite under anaerobic conditions in the presence of skeletal muscle mitochondria is dependent upon pH over at least the range 5.6-6.7, increasing markedly as the pH is lowered. A product of the reaction is the complex formed between nitric oxide and ferricytochrome c. At levels up to 20 mM, nitrite inhibits aerobic cytochrome oxidase action; at higher concentrations, however, a partial resuscitation of the oxidation of ferrocytochrome c occurs, the enhancement of reaction velocity being considerably greater at pH 6.0 than at 6.5. Mitochondrial respiration is also inhibited by nitrite but no similar resurgence was, however, observed and thus the oxidation of ferrocytochrome c by high levels of nitrite is considered to be a direct non-enzymic action. Under anaerobic conditions, the rate of increase of the velocity constant of the oxidation of ferrocytochrome c with nitrite concentration in the presence of muscle mitochondria similarly decreased with rise of pH over the same range. The permeability of the muscle mitochondrion to nitrire has been demonstrated by swelling studies and by the rapid conversion of endogenous ferrocytochrome a3 into its nitrosyl-derivative. Over longer periods of anaerobic incubations of mitochondria with nitrite, oxidation of endogenous cytochromes occurs with the formation of nitrosylferricytochrome c. Above a nitrite concentration of 0.3 mM, the mitochondrial enzyme system probably involved is increasingly inhibited but by a concentration of 30 mM a direct non-enzymic oxidation has intervened. Commercial vacuum packed bacons were examined by electron microscopy. Mitochondria were clearly recognisable although they contained fewer cristae than those observed in fresh meat.