The relationship of occupational injury and use of mental health care.

INTRODUCTION: Symptoms of depression and anxiety are a common consequence of occupational injury regardless of its cause and type. Nevertheless, mental health care is rarely covered by workers' compensation systems. The aim of this study was to assess the use of mental health care post-injury. METHODS: We used a subsample of patient-care workers from the Boston Hospital Workers Health Study (BHWHS). We matched one injured worker with three uninjured workers during the period of 2012-2014 based on age and job title (nurse or patient-care associate) and looked at their mental health care use pre- and post-injury using medical claims data from the employer sponsored health plan. We used logistic regression analysis to assess the likelihood of mental health care use three and six months post-injury controlling for any pre-injury visits. Analyses were repeated separately by job title. RESULTS: There were 556 injured workers between 2012 and 2014 that were matched with three uninjured workers at the time of injury (n = 1,649). Injured workers had a higher likelihood of seeking mental health care services than their uninjured counterparts during the six months after injury (OR = 1.646, 95% CI: 1.23-2.20), but not three months post-injury (OR = 0.825, 95% CI: 0.57-1.19). Patient-care associates had a higher likelihood to seek mental health care post-injury, than nurses (OR: 2.133 vs OR: 1.556) during the six months period. CONCLUSIONS: Injured workers have a higher likelihood to experience symptoms of depression and anxiety based on their use of mental health care post-injury and use is more predominant among patient-care associates; however, our sample has a small number of patient-care associates. Practical Applications: Treating depression and anxiety as part of the workers' compensation system has the potential of preventing further physical ailment and improving the return to work process regardless of nature of injury.

Development and Validation of Cervical Prediction Models for Patient-Reported Outcomes at 1 Year After Cervical Spine Surgery for Radiculopathy and Myelopathy.

STUDY DESIGN: Retrospective analysis of prospectively collected registry data. OBJECTIVE: To develop and validate prediction models for 12-month patient-reported outcomes of disability, pain, and myelopathy in patients undergoing elective cervical spine surgery. SUMMARY OF BACKGROUND DATA: Predictive models have the potential to be utilized preoperatively to set expectations, adjust modifiable characteristics, and provide a patient-centered model of care. METHODS: This study was conducted using data from the cervical module of the Quality Outcomes Database. The outcomes of interest were disability (Neck Disability Index:), pain (Numeric Rating Scale), and modified Japanese Orthopaedic Association score for myelopathy. Multivariable proportional odds ordinal regression models were developed for patients with cervical radiculopathy and myelopathy. Patient demographic, clinical, and surgical covariates as well as baseline patient-reported outcomes scores were included in all models. The models were internally validated using bootstrap resampling to estimate the likely performance on a new sample of patients. RESULTS: Four thousand nine hundred eighty-eight patients underwent surgery for radiculopathy and 2641 patients for myelopathy. The most important predictor of poor postoperative outcomes at 12-months was the baseline Neck Disability Index score for patients with radiculopathy and modified Japanese Orthopaedic Association score for patients with myelopathy. In addition, symptom duration, workers' compensation, age, employment, and ambulatory and smoking status had a statistically significant impact on all outcomes (P < 0.001). Clinical and surgical variables contributed very little to predictive models, with posterior approach being associated with higher odds of having worse 12-month outcome scores in both the radiculopathy and myelopathy cohorts (P < 0.001). The full models overall discriminative performance ranged from 0.654 to 0.725. CONCLUSIONS: These predictive models provide individualized risk-adjusted estimates of 12-month disability, pain, and myelopathy outcomes for patients undergoing spine surgery for degenerative cervical disease. Predictive models have the potential to be used as a shared decision-making tool for evidence-based preoperative counselling. LEVEL OF EVIDENCE: 2.

Economic Evaluation and Systematic Review of Publicly Available Workers' Compensation Practice Details and Mod Rate Calculators Applied to Upper Midwest Agriculture.

Background: Agricultural employment is one of the most dangerous occupations in the United States. Workers' compensation coverage requirements for agricultural work vary from state to state, and experience modifier rates (E-mods) affecting insurance premiums sometimes vary drastically across state lines and according to claim severities and farm sizes. We proposed to develop an interactive software application that would educate farmers on the impact of employee time loss on annual E-mod factor change specific to their geographic location and farm size.Methods: We conducted a comparative analysis of workers' compensation formulations, including E-mods among Upper Midwestern states. We performed sensitivity analysis of the formulas to claim amount and payroll to highlight differences related to claim severity and to farm size.Results: The state to state variation and remarkable complexity of these formulas was confirmed. E-Mod factors are shown to increase substantially across states with both claim size and payroll, though are found to be similar across Wisconsin and Minnesota which were examined in detail.Conclusions: The findings confirm that creating a nationally applicable interactive educational software tool for farmers and ranchers to view hypothetical rate changes by inputting on-farm injury scenarios represents a significant challenge and that educational outreach coupled with the use of commercial software, especially as less costly options become available, may serve the role of minimizing misunderstandings by current producers as may other informational sources.

History of Dose, Risk, and Compensation Assessments for US Veterans of the 1966 Plutonium Cleanup in Palomares, Spain.

In 1966, about 1,600 US military men-mostly Air Force-participated in a cleanup of plutonium dispersed from two nuclear bombs in Palomares, Spain. As a base for future analyses, we provide a history of the Palomares incident, including the dosimetry and risk analyses carried out to date and the compensation assessments made for veterans. By law, compensation for illnesses attributed to ionizing radiation is based on maximum estimated doses and standard risk coefficients, with considerable benefit of the doubt given to claimants when there is uncertainty. In the Palomares case, alpha activity in urine fell far faster than predicted by plutonium biokinetic excretion models used at the time. Most of the measurements were taken on-site but were disqualified on the grounds that they were "unreasonably high" and because there was a possibility of environmental contamination. Until the end of 2013, the Air Force used low dose estimates derived from environmental measurements carried out well after the cleanup. After these estimates were questioned by Congress, the Air Force adopted higher dose estimates based on plutonium concentration measurements in urine samples collected from 26 veterans after they left Palomares. The Air Force assumed that all other cleanup veterans received lower doses and therefore assigned to them maximum organ doses based on the individual among the 26 with the lowest urine measurements. These resulting maximum organ doses appear to be sufficient to justify compensation to all Palomares veterans with lung and bone cancer and early-onset liver cancer and leukemia but not other radiogenic cancers.

Burnout syndrome in Europe: towards a harmonized approach in occupational health practice and research.

Health practitioners and decision makers in the medical and insurance systems need knowledge on the work-relatedness of burnout. To gather the most reliable information regarding burnout diagnosis and recognition in Europe, we used an 8-item standard questionnaire sent by e-mail to occupational health specialists identified via the Network on the Coordination and Harmonization of European Occupational Cohorts (OMEGA-NET) within the European Cooperation in Science and Technology (COST) Action. Participation rate was 100%, and the questionnaire was completed for 37 countries. In 14 (38%) countries burnout syndrome can be acknowledged as an occupational disease. However, only one country included burnout on the list of occupational diseases. The results showed a high variability in burnout diagnosis, in assessment of its work-relatedness, and in conditions allowing compensation of patients. These results reflect a lack of graded evidence on burnout and its determinants. The ongoing research on burnout conducted in the frame of the OMEGA-NET COST Action should be helpful through facilitating standardization of both existing and new data on burnout, a priority outcome requiring harmonization.

The Uneven Foci of Work Disability Research Across Cause-based and Comprehensive Social Security Systems.

This scoping review identified what kinds of work disability policy issues are critiqued in articles published in countries with cause-based versus comprehensive welfare systems. Drawing on a review of work disability policy research, we identified 74 English-language, peer-reviewed articles that focused on program adequacy and design. Articles on cause-based systems dwelled on system fairness and policies of proof of entitlement, while those on comprehensive systems focused more on system design complexities relating to worker inclusion and scope of medical certificates. Overall, we observed a clear difference in the nature of problems examined in the different systems. Gaps in work disability policy literature are identified, and challenges for comparative policy research are discussed.

Comparative Analysis of Impairment Ratings From the 5th to 6th Editions of the AMA Guides.

OBJECTIVE: The association of American Medical Association's (AMA) Guides edition with impairment ratings is uncertain. METHODS: We used data from a consecutive sample of 249 injured workers referred for an independent evaluation 10 months before and after assessors switched from the 5th to the 6th edition of the AMA Guides. RESULTS: The median whole person impairment rating was 7.0% (interquartile range [IQR]: 4 to 14) for 131 claimants assessed with the 5th edition of the Guides, and 4.0% (IQR: 2 to 8) for 118 claimants assessed with the 6th edition (P-value for difference: 0.002). Multivariable analysis showed a 36.4% relative reduction (95% confidence interval [CI] 17.2% to 57.3%) in impairment rating with the 6th edition of the Guides versus the 5th edition. CONCLUSIONS: The 6th edition of the AMA Guides provides systematically lower impairment ratings for injured workers than the 5th edition.

Healthcare providers' experience with the management of mental health conditions in the context of Workers' Compensation.

BACKGROUND: Little is known about how healthcare providers (HCPs) in Canada manage mental health claims and the return to work (RTW) of injured workersOBJECTIVE:To examine HCPs' experience and challenges on the treatment of mental health conditions (MHCs) in the context of Workers' Compensation (WC) processes and their involvement in RTW. METHODS: Ninety-seven interviews with HCPs (general practitioners, n = 59; allied HCPs, n = 19; specialists, n = 19) were conducted in British Columbia, Manitoba, Ontario and Newfoundland. A thematic content analysis was used to analyze interviews. RESULTS: HCPs reported that while RTW is extolled at virtually all costs by WC boards, they did not always see it as beneficial. Most HCPs were convinced that successful recovery and RTW depend on being aware of how mental and physical health is intertwined and treating both issues. Organizational barriers within WC processes and adversarial relationships between injured workers (IWs) and WC boards made it difficult for HCPs to adequately treat patients and facilitate RTW. Dealing with IWs' MHCs and their emotional distress due to 'going through WC systems' was challenging. CONCLUSIONS: WC boards must identify how policies can be modified to mitigate compensation processes and RTW for WC claimants with MHC.

Insurance workers' and physiotherapists' perceptions of their roles in the management of workers with injuries in the Western Australian workers' compensation system.

BACKGROUND: Insurance workers and physiotherapists are important stakeholders in the rehabilitation of workers with an injury and subsequent musculoskeletal pain. Understanding perceptions of roles may facilitate communication between these stakeholders. OBJECTIVE: Increase knowledge around, (i) the self-perception of and (ii) the external perception of the insurance workers and physiotherapists roles in the management of a worker with an injury in an Australian workers' compensation environment. METHODS: A cross-sectional study assessed the perceptions of insurance workers and physiotherapists related to the roles of these two professions in managing a worker with an injury via questionnaire. Respondents were also asked about potential communication barriers. RESULTS: Insurance workers (n = 48) and physiotherapists (n = 80) reported contrasting role perceptions, with their perception of the other profession leaning towards negative attributes. There was greater alignment of their beliefs of roles in the 'ideal' situation. The perception of barriers to communication also differed between the two professions. Effective and efficient communication was identified as a central component of mismatched role perceptions between stakeholders, but recognised as a critical attribute of 'ideal' stakeholder roles. CONCLUSION: Insurance workers and physiotherapists self-perception of their roles differs from external perceptions. This information highlights the importance of a shared understanding of stakeholder roles in the management of a worker with an injury.

Financial Considerations for Health and Safety in the Australian Dairy Industry.

OBJECTIVE: This study aimed to quantify the burden of fatal and workers' compensation-related injuries on the dairy sector in Australia and to assess current financial inputs for work health and safety actions. METHODS: The first and second phases entailed a review of the financial costs associated with fatal (2001-2013) and workers' compensation cases (2008-2009 to 2012-2013). The third element was a case-study approach focusing on actual production and cost data from a small sample of dairy farms (n = 6) to ascertain an estimate for current financial inputs to work health and safety. RESULTS: The estimated financial impact was approximately AUD$12.4 million each year, comprising AUD$6.8 million for fatalities and AUD$5.6 million for compensable injuries. All sample businesses were investing in health and safety initiatives; however, this was modest and on average represented 0.4% of total expenditure (AUD$4,472) or

Accidentes de trabajo y enfermedades laborales en los sistemas de compensación laboral / Work accidents and occupational diseases in work compensation systems

Introducción: Las contingencias laborales constituyen un importante problema de salud pública en el mundo. Para reducir los daños, los países han introducido leyes y normas técnicas para la prevención de las mismas y reparación de las víctimas a través de seguros de compensación laboral y atención médica integral. Objetivo: Conocer el nivel de evidencia existente sobre los accidentes de trabajo y enfermedades profesionales compensados y las características de los trabajadores que los presentaron e industrias más afectadas. Métodos: Se realizó una revisión sistemática bajo la metodología "Prisma". La búsqueda bibliográfica se llevó a cabo en bases de datos y revistas científicas a través de palabras claves que fueron combinadas y restringidas a artículos publicados entre los años 2003 y 2013. Resultados: Se incluyeron 11 artículos de investigaciones que fueron realizadas en cuatro continentes: Europa, Asia, Oceanía y América. Los tipos de estudios fueron, principalmente, retrospectivos con fuentes secundarias. Las muestras variaron entre 307 hasta 1.320.792 registros en diferentes grupos poblacionales, que tuvieron una o múltiples reclamaciones de compensación por accidentes de trabajo y/o enfermedades laborales. El género masculino tuvo el porcentaje más alto de reclamaciones; las industrias más afectadas fueron la manufactura y la construcción; predominaron como primera causa los esguinces o torceduras, seguidos por los trastornos musculoesqueléticos. Conclusiones: Las investigaciones revisadas proporcionan informaciones para caracterizar las contingencias ocupacionales y orientar las estrategias de prevención en las industrias y en las poblaciones trabajadoras más afectadas. Sin embargo, tienen limitaciones para establecer la gravedad de las lesiones y los tipos de compensación otorgados.

Introduction: Occupational injuries constitute an important problem of public health in the world. In order to reduce damage, countries have introduced laws and technical standards for their prevention, and to provide the victims support by means of worker's compensation insurance and comprehensive health care. Objective: To know the existing evidence level of work accidents and compensated occupational diseases and the characteristics of workers who presented them, and the most affected branches of industries. Methods: A systematic review following the "Prisma" methodology was conducted. The bibliographic research was carried out in databases and scientific journals through keywords that were combined and restricted to articles published between 2003 and 2013. Results: Eleven articles about researches conducted in four continents (Europe, Asia, Oceania and America) were included. The studies were mainly retrospective with secondary sources, and the samples ranged from 307 to 1,320,792 records in different population groups, who had one or multiple claims of compensation for work-related accidents or illnesses. The male gender had the highest percentage of claims; the most affected industries were manufacture and construction; the first causes were sprains and strains followed by musculoskeletal disorders. Conclusions: The reviewed investigations provide information to characterize the occupational contingencies and to orient the strategies of prevention in the industries and in the most affected working population. However, there are limitations to establish the seriousness of the injuries and the types of compensation awarded.

Enhancing direct access and authority for work capacity certificates to physiotherapists.

The mantra 'work is good for health' is familiar to those assisting in the rehabilitation of injured workers and is well supported in the literature. Regulators, workers compensation insurers and health professional bodies have taken steps over the last few years to promote early and safe return to work after a workplace injury. Improving direct access to physiotherapy and extending the role of physiotherapists to authorise work capacity certificates for injured workers will potentially facilitate early intervention, reduce absence from work in a cost-effective system while maintaining patient satisfaction. Several challenges to advancing the role of physiotherapists exist but are not insurmountable.

The Clinical Practice Guideline on Carpal Tunnel Syndrome and Workers' Compensation.

The American Academy of Orthopedic Surgeons has released an updated Clinical Practice Guideline (CPG) on the evaluation and treatment of carpal tunnel syndrome (CTS). In 2007, the initial CPG on CTS evaluated diagnosis and in 2008 and 2011, the CPG on CTS assessed treatment. The most recent CPG assesses both diagnosis and treatment in a generally non-controversial way. We assess the potential impact of this CPG on the care of workers compensation patients.

[Analysis of problems connected with formation of new social security system for workers].

The authors analyzed problems of operating system of workers' social security, among them - insurance payments are provided on basis of experts'lists of productions, work types, occupations without consideration of real work conditions on specific workplaces, health state and performance of workers. Solutions of the problems are suggested.

Quality management and federal workers' compensation: the Veterans Health Administration workers' compensation program model.

OBJECTIVE: The federal workers' compensation program includes under a single employer five commonly encountered roles and responsibilities-injured patient, clinical provider, third-party administrator, adjudicator, and insurer. Data within the Veterans Health Administration (VHA) provide a unique opportunity to apply a simple model of health care quality improvement, exploring interactions between structures, processes, and outcomes. METHODS: A facility survey identified reporting structures, levels of education and training, policies and processes, tool availability and use, and perceptions of role adherence. Administrative data included process and outcome metrics, including short-term disability, long-term disability, and lost time cases. RESULTS: Improved collaboration between clinical and administrative staff within VHA and with the Department of Labor was associated with improved performance. CONCLUSIONS: Applying a clinical quality improvement model clarifies roles, expectations, and likely relationships for improved program management.