Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 11 de 11
Filtrar
1.
Mult Scler Relat Disord ; 54: 103131, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34274739

RESUMEN

BACKGROUND: Studies have documented reduced work capacity and work productivity loss in multiple sclerosis (MS). Little is known about the longitudinal trajectories of work productivity in MS. OBJECTIVES: To examine trajectories of work productivity in people living with multiple sclerosis (PwMS) and the factors associated with the trajectories. METHODS: Study participants were employed participants of the Australian MS Longitudinal Study (AMSLS) followed from 2015 to 2019 with at least two repeated measures (n=2121). We used group-based trajectory modelling to identify unique work productivity trajectories in PwMS. RESULTS: We identified three distinct trajectories of work productivity: 'moderately reduced' (17.0% of participants) with a mean work productivity level of 47.6% in 2015 (slope -0.97% per year (p= 0.22)), 'mildly reduced' (46.7%) with a mean work productivity of 86.3% in 2015 (slope 0.70% per year (p=0.12)), and 'full' (36.3%) with a mean work productivity of 99.7% in 2015 (slope 0.29% per year (p= 0.30)). Higher education level, higher disability, and higher MS symptom severity are associated with increased probability of being in a worse work productivity trajectory. CONCLUSION: We identified three distinct work productivity trajectories in PwMS which were stable over time and differentiated by their baseline level of work productivity.


Asunto(s)
Esclerosis Múltiple , Absentismo , Australia/epidemiología , Eficiencia , Humanos , Estudios Longitudinales , Esclerosis Múltiple/epidemiología
2.
Mult Scler ; 27(13): 2093-2102, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33591218

RESUMEN

BACKGROUND: While employment rates have increased in people with multiple sclerosis (PwMS), little is known about the longitudinal trends of work productivity. OBJECTIVE: To describe the longitudinal patterns of work productivity and examine the factors associated with annual change of work productivity of PwMS. METHODS: Study participants were employed participants of the Australian MS Longitudinal Study (AMSLS) followed from 2015 to 2019 with at least two repeated measures (n = 2121). We used linear mixed models to examine if the within-individual variations in MS symptoms are associated with changes in work productivity. RESULTS: The mean annual change in work productivity between 2015 and 2019 was -0.23% (SD = 18.68%). Not the actual severity of symptoms but rather the changes in severity of symptoms that are associated with change in work productivity in the same year. In a multivariable model, every unit increase in mean annual change in 'pain and sensory symptoms', 'feelings of anxiety and depression', and 'fatigue and cognitive symptoms' were independently associated with 2.43%, 1.55% and 1.01% annual reductions in work productivity, respectively. CONCLUSION: Individual changes in work productivity are largely driven by the changes in symptom severity rather than the absolute severity. Stabilising/improving MS symptoms might improve work productivity.

3.
Mult Scler ; 27(8): 1250-1261, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-32880529

RESUMEN

BACKGROUND: No studies have assessed changes in employment survival in multiple sclerosis (MS) populations over recent decades, including the introduction of disease-modifying therapies (DMTs). OBJECTIVES: To evaluate factors associated with leaving employment due to MS; to assess whether the risk of leaving employment has changed over recent decades in Australia, stratified by MS phenotype. METHODS: We included 1240 participants who were working before MS diagnosis. Information on employment status, reasons for leaving employment and year of leaving were collected. Data were analysed using competing risk survival analysis. RESULTS: Males, progressive MS, lower education level and older age at diagnosis were associated with a higher sub-distribution hazard of leaving employment. Compared to the period before 2010, the sub-distribution hazard during 2010-2016 for relapsing-remitting multiple sclerosis (RRMS) was reduced by 43% (sub-distribution hazard ratio (sHR) 0.67, 95% confidence interval (CI): 0.50 to 0.90), while no significant reduction was seen for primary-progressive multiple sclerosis (PPMS) (sHR 1.25, 95% CI: 0.72 to 2.16) or secondary-progressive multiple sclerosis (SPMS) (sHR 1.37, 95% CI: 0.84 to 2.25). CONCLUSION: Males, people with progressive MS and those of lower education level were at higher risk of leaving employment. The differential changed risk of leaving employment between people with different MS phenotype after 2010 coincides with the increased usage of high-efficacy DMTs for RRMS.


Asunto(s)
Esclerosis Múltiple Crónica Progresiva , Esclerosis Múltiple Recurrente-Remitente , Esclerosis Múltiple , Anciano , Empleo , Humanos , Masculino , Factores de Riesgo , Análisis de Supervivencia
4.
Mult Scler ; 26(12): 1550-1559, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33063620

RESUMEN

BACKGROUND: More work is needed to understand the burden of comorbidities in people with multiple sclerosis (MS). OBJECTIVE: To assess prevalence of 30 comorbidities and impacts of comorbidities on employment outcomes in a working-aged MS cohort. METHODS: Participants were from the Australian MS Longitudinal Study (n = 929). Information on specific comorbidity was obtained (whether or not each was present, doctor-diagnosed, limited their activities and being treated). RESULTS: Comorbidities most frequently reported to limit activities were osteoarthritis (51%), migraines (40%), anxiety (33%), depression (29%) and allergies (18%). Mean MS-related work productivity loss in past 4 weeks was 1.3 days for those without comorbidities and 2.5 days for those with any comorbidity. The annual population costs of work productivity loss were highest for people with depression, allergies, anxiety, migraines and osteoarthritis. Higher number of comorbidities was associated with more work productivity loss and a higher likelihood of not working. These associations were substantially reduced after adjustment for MS symptom severity. CONCLUSIONS: Comorbidities substantially impact employment outcomes and these effects were mainly mediated through MS symptom severity. This suggests that optimal and simultaneous management of comorbidities may be a viable strategy to reduce MS symptom severity, which in turn could improve employment outcomes.


Asunto(s)
Esclerosis Múltiple , Anciano , Australia/epidemiología , Comorbilidad , Empleo , Humanos , Estudios Longitudinales , Esclerosis Múltiple/epidemiología
5.
BMC Health Serv Res ; 20(1): 192, 2020 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-32164709

RESUMEN

BACKGROUND: In the Netherlands, health care is regulated by the Health and Youth Care Inspectorate. Forty-six indicators are used to prioritize supervision of psychiatric hospitals. The objective of this study is to define a smaller set of weighted indicators which reflects a consensus among inspectors about which aspects are most important for risk assessment. METHODS: The set of 46 indicators, complemented with missing information, was reduced to six indicators by means of interviews, group discussions and ranking among the inspectors. These indicators were used as attributes in a discrete choice experiment (DCE) to define their weights. RESULTS: Twenty-six inspectors defined the top four indicators suitable for the risk assessment of psychiatric hospitals. These are: the policy on prevention of compulsory treatment; the policy on dysfunctional professionals; the quality of internal research after a serious incident; and the implementation of multidisciplinary guidelines on suicidal behaviour. These indicators share the same importance with regard to risk assessment. The screening of somatic symptoms and the policy on integrated care are important indicators too, but less relevant. CONCLUSION: Through a DCE, we reduced the amount of information for risk assessment of psychiatric hospitals to six weighted indicators. Inspectors can use these indicators to prioritize their inspections.


Asunto(s)
Hospitales Psiquiátricos/normas , Indicadores de Calidad de la Atención de Salud , Consenso , Humanos , Países Bajos
6.
Mult Scler ; 25(7): 994-1004, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-29911469

RESUMEN

BACKGROUND: Little is known about the work productivity loss in multiple sclerosis (MS). OBJECTIVES: To quantify the MS-related work productivity loss and to compare factors associated with labour force participation and work productivity loss. METHODS: Participants were from the Australian MS Longitudinal Study. MS-related work productivity loss included absenteeism (time missed from work) and presenteeism (reduced productivity while working). Data were analysed using log-binomial and Cragg hurdle regression. RESULTS: Among 740 MS employees, 56% experienced any work productivity loss due to MS in the past 4 weeks. The mean total work productivity loss was 2.5 days (14.2% lost productive time), absenteeism 0.6 days (3.4%) and presenteeism 1.9 days (10.8%)), leading to AU$6767 (US$4985, EURO€4578) loss per person annually. Multivariable analyses showed that work productivity was determined most strongly by symptoms, particularly 'fatigue and cognitive symptoms' and 'pain and sensory symptoms', while older age, and lower education level were also predictive of not being in the labour force. CONCLUSION: MS-related presenteeism was three times higher than absenteeism, highlighting the importance of presenteeism being included in employment outcomes. The dominance of symptom severity as predictors of both work participation and productivity loss emphasises the need for improved management of symptoms.


Asunto(s)
Absentismo , Eficiencia , Empleo/estadística & datos numéricos , Esclerosis Múltiple/epidemiología , Presentismo/estadística & datos numéricos , Adulto , Australia/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/fisiopatología , Índice de Severidad de la Enfermedad
7.
Mult Scler ; 23(10): 1415-1423, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27885063

RESUMEN

BACKGROUND AND OBJECTIVES: Previous studies have documented far lower employment participation rates for people with multiple sclerosis (PwMS) compared to the general population. In a large national sample of PwMS, we examined employment status, longitudinal changes in employment and the provision of modifications to work role/environment from 2010 to 2013. METHODS: Employment data were collected through the Australian MS Longitudinal Study from 2010 to 2013, with 1260 people responding to all four surveys. Employment rates were compared with the Australian general population. The survey included questions on the provision of modifications to employees' work role and work environment. RESULTS: Employment (full- and part-time) increased from 48.8% in 2010 to 57.8% in 2013, mainly due to increases in male full-time employment. The employment gap between PwMS and the general population fell from 14.3% in 2010 to 3.5% in 2013. Male employment rates, however, remain significantly lower than the general population. The majority of PwMS who required adjustments to either their work role or environment received them. CONCLUSION: The gap in employment between PwMS and the general population has substantially reduced from 2010 to 2013, with organisations responding positively to requests for work role/environment adjustments.


Asunto(s)
Empleo/estadística & datos numéricos , Esclerosis Múltiple , Adulto , Anciano , Australia , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios
9.
J Am Geriatr Soc ; 53(4): 660-5, 2005 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-15817014

RESUMEN

OBJECTIVES: To investigate the effect of chronic diseases and disease combinations on 1-year mortality in nursing home residents. DESIGN: Retrospective cohort study using electronically submitted Minimum Data Set (MDS) information and Missouri death certificate data. SETTING: Five hundred twenty-two nursing homes in Missouri. PARTICIPANTS: Forty-three thousand five hundred ten nursing home residents with a full MDS assessment in 1999. MEASUREMENTS: Information about chronic diseases, age, sex, and performance in activities of daily living (ADLs) available from the first full MDS 2.0 assessment in 1999; death within 1 year after the first full MDS-assessment in 1999. RESULTS: After adjustment for age and sex, eight variables were predictive for 1-year mortality: seven chronic diseases (dementia, cancer, heart failure, renal failure, emphysema/chronic obstructive pulmonary disease, diabetes mellitus, and anemia) and an interaction variable containing age and cancer. Adding terms for disease combinations (e.g., diabetes mellitus and heart failure) did not enhance survival prediction. When there was also adjustment for ADL performance as measured using the MDS-ADL Short Form, dementia and anemia were not included, because they had no prognostic value above that of the other variables. CONCLUSION: Several chronic diseases were associated with 1-year mortality in the institutionalized elderly after adjustment for ADL performance, age, and sex. Evidence of a synergistic effect of disease combinations on mortality is lacking.


Asunto(s)
Enfermedad Crónica/mortalidad , Comorbilidad , Hogares para Ancianos/estadística & datos numéricos , Mortalidad , Casas de Salud/estadística & datos numéricos , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Enfermedad Crónica/epidemiología , Femenino , Humanos , Modelos Logísticos , Masculino , Missouri/epidemiología , Análisis Multivariante , Estudios Retrospectivos
11.
Radiology ; 223(2): 517-24, 2002 May.
Artículo en Inglés | MEDLINE | ID: mdl-11997562

RESUMEN

PURPOSE: To evaluate whether mangafodipir trisodium (Mn-DPDP)-enhanced magnetic resonance (MR) imaging surpasses dual-phase spiral computed tomography (CT) in differentiating focal liver lesions. MATERIALS AND METHODS: One hundred forty-five patients who had or were suspected of having focal liver lesions were included in a multicenter study and underwent dual-phase spiral CT and enhanced MR imaging. Image interpretations performed by independent experienced radiologists were compared with the final diagnosis that was based on all available clinical information (including histopathologic findings in 77 patients) and that was determined with consensus. Differences in classifications by using either enhanced MR imaging or dual-phase spiral CT were analyzed with the McNemar test, and receiver operating characteristic (ROC) curves were used to compare the diagnostic performance of enhanced MR imaging and dual-phase spiral CT. RESULTS: Lesion classification was correct in 108 (74%) patients with enhanced MR imaging and in 83 (57%) with dual-phase spiral CT (P =.001). Lesions were correctly classified as either malignant or benign in 123 (85%) patients with enhanced MR imaging and in 98 (68%) with dual-phase spiral CT (P =.001). Classification of lesions as either hepatocellular or nonhepatocellular was correct in 130 (90%) patients with enhanced MR imaging and in 93 (64%) with dual-phase spiral CT (P =.001). These differences remained when analyses were restricted to histopathologically confirmed diagnoses. Comparison of the ROC curves illustrated that enhanced MR imaging performance surpassed that of dual-phase spiral CT. CONCLUSION: Mn-DPDP-enhanced MR imaging is superior to dual-phase spiral CT in classification of focal liver lesions.


Asunto(s)
Ácido Edético/análogos & derivados , Hepatopatías/diagnóstico , Imagen por Resonancia Magnética , Fosfato de Piridoxal/análogos & derivados , Tomografía Computarizada por Rayos X , Adulto , Anciano , Distribución de Chi-Cuadrado , Medios de Contraste , Diagnóstico Diferencial , Femenino , Humanos , Aumento de la Imagen/métodos , Hepatopatías/patología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , Sensibilidad y Especificidad
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...