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2.
Am J Public Health ; 110(12): 1811-1813, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33058706

RESUMO

Objectives. To examine public support for health insurance, income support, and unemployment policies during the initial phase of disease transmission and economic distress following the coronavirus disease 2019 (COVID-19) outbreak and to assess varying public support based on beliefs about the role of government.Methods. We fielded a nationally representative survey of US adults (n = 1468) from April 7, 2020, to April 13, 2020.Results. Of US adults, 77% supported paid sick leave, and a majority also supported universal health insurance, an increased minimum wage, and various unemployment support policies. Public support for an active government role in society to improve citizens' lives increased by 10 percentage points during this initial pandemic response relative to September 2019. Belief in a strong governmental role in society was associated with greater support for social safety-net policies.Conclusions. During the initial phase of the COVID-19 pandemic in early April 2020, most US adults favored a range of safety-net policies to ameliorate its negative health and economic consequences. For most safety-net policies, public support was highest among those favoring a stronger governmental role in society.


Assuntos
/epidemiologia , Assistência Pública/tendências , Política Pública/tendências , Humanos , Pandemias , Licença Médica/economia , Estados Unidos/epidemiologia
3.
Aliment Pharmacol Ther ; 52(4): 655-668, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32902894

RESUMO

BACKGROUND: There are limited data on population-wide assessment of cost in Crohn's disease (CD) and ulcerative colitis (UC). AIM: To estimate the societal cost of actively treated CD and UC in Sweden. METHODS: We identified 10 117 prevalent CD and 19 762 prevalent UC patients, aged ≥18 years on 1 January 2014 and 4028 adult incident CD cases and 8659 adult incident UC cases (2010-2013) from Swedish Patient Register. Each case was matched to five population comparators. Healthcare costs were calculated from medications, outpatient visits, hospitalisations and surgery. Cost of productivity losses was derived from disability pension and sick leave. RESULTS: The mean annual societal costs per working-age patient (18-64 years) with CD and UC were $22 813 (vs $7533 per comparator) and $14 136 (vs $7351 per comparator), respectively. In patients aged ≥65 years, the mean annual costs of CD and UC were $9726 and $8072 vs $3875 and $4016 per comparator, respectively. The majority of cost for both CD (56%) and UC (59%) patients originated from productivity losses. Higher societal cost of working-age CD patients as compared to UC patients was related to greater utilisation of anti-TNF (22.2% vs 7.4%) and increased annual disability pension (44 days vs 25 days). Among incident CD and UC patients, the mean total cost over the first year per patient was over three times higher than comparators. CONCLUSION: In Sweden, the societal cost of incident and prevalent CD and UC patients was consistently two to three times higher than the general population.


Assuntos
Colite Ulcerativa , Doença de Crohn , Custos de Cuidados de Saúde , Recursos em Saúde , Licença Médica , Absenteísmo , Adolescente , Adulto , Colite Ulcerativa/economia , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/terapia , Doença de Crohn/economia , Doença de Crohn/epidemiologia , Doença de Crohn/terapia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Prevalência , Licença Médica/economia , Licença Médica/estatística & dados numéricos , Suécia/epidemiologia , Fator de Necrose Tumoral alfa/uso terapêutico , Trabalho/economia , Trabalho/estatística & dados numéricos , Adulto Jovem
4.
PLoS One ; 15(8): e0236029, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760082

RESUMO

Health is a critical factor for the generation of value by workers. Companies bear substantial costs associated with absenteeism and presenteeism among their employees. This study investigates the impact of the environmental conditions in the workplace on the health and job satisfaction of employees, as core factors of productivity. We provide evidence based on a natural experiment, in which 70% of the workforce of a municipality in the Netherlands was relocated to a building with a design focused on sustainability and health and well-being. We construct a longitudinal dataset based on individual surveys of the entire municipality workforce and include measures before and after the move. The estimation results show a significant improvement in the perceived environmental conditions, as well as in the health and well-being of the relocated workers, measured by the drop in incidence of sick building syndrome symptoms. Results are heterogeneous based on age: older groups of employees enjoy larger health impacts. The relocation effects remain persistent in the medium term (two years after the moving date). Importantly, a mediation analysis suggests that the achieved improvements in health and well-being lead to significantly enhanced job satisfaction and a 2% reduction in the prevalence of sick leave.


Assuntos
Arquitetura de Instituições de Saúde , Satisfação no Emprego , Saúde do Trabalhador/economia , Síndrome do Edifício Doente/epidemiologia , Local de Trabalho , Absenteísmo , Adulto , Feminino , Nível de Saúde , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Presenteísmo/economia , Presenteísmo/estatística & dados numéricos , Síndrome do Edifício Doente/economia , Licença Médica/economia , Licença Médica/estatística & dados numéricos , Desenvolvimento Sustentável
5.
Artigo em Inglês | MEDLINE | ID: mdl-32698470

RESUMO

The cost-benefit and cost-effectiveness of a work-directed intervention implemented by the occupational health service (OHS) for employees with common mental disorders (CMD) or stress related problems at work were investigated. The economic evaluation was conducted in a two-armed clustered RCT. Employees received either a problem-solving based intervention (PSI; n = 41) or care as usual (CAU; n = 59). Both were work-directed interventions. Data regarding sickness absence and production loss at work was gathered during a one-year follow-up. Bootstrap techniques were used to conduct a Cost-Benefit Analysis (CBA) and a Cost-Effectiveness Analysis (CEA) from both an employer and societal perspective. Intervention costs were lower for PSI than CAU. Costs for long-term sickness absence were higher for CAU, whereas costs for short-term sickness absence and production loss at work were higher for PSI. Mainly due to these costs, PSI was not cost-effective from the employer's perspective. However, PSI was cost-beneficial from a societal perspective. CEA showed that a one-day reduction of long-term sickness absence costed on average €101 for PSI, a cost that primarily was borne by the employer. PSI reduced the socio-economic burden compared to CAU and could be recommended to policy makers. However, reduced long-term sickness absence, i.e., increased work attendance, was accompanied by employees perceiving higher levels of production loss at work and thus increased the cost for employers. This partly explains why an effective intervention was not cost-effective from the employer's perspective. Hence, additional adjustments and/or support at the workplace might be needed for reducing the loss of production at work.


Assuntos
Serviços de Saúde do Trabalhador/economia , Saúde do Trabalhador/estatística & dados numéricos , Estresse Ocupacional/prevenção & controle , Licença Médica/economia , Análise Custo-Benefício , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Transtornos Mentais/prevenção & controle , Transtornos Mentais/reabilitação , Serviços de Saúde do Trabalhador/métodos , Retorno ao Trabalho , Licença Médica/estatística & dados numéricos
6.
Glob Public Health ; 15(7): 925-934, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32396447

RESUMO

Well-designed paid sick leave is critical to ensure workers stay home when sick to prevent the spread of SARS-CoV-2 and other infectious pathogens, both when the economy is open and during an economic shutdown. To assess whether paid sick leave is available in countries around the world, we created and analysed a database of legislative guarantees of paid leave for personal illness in 193 UN member states. Original labour and social security legislation and global information on social security systems for each country were obtained and analysed by a multilingual research team using a common coding framework. While strong models exist across low- middle- and high-income countries, critical gaps that jeopardise health and economic security remain. 27% of countries do not guarantee paid sick leave from the first day of illness, essential to encouraging workers to stay home when they are sick and prevent spread. 58% of countries do not have explicit provisions to ensure self-employed and gig economy workers have access to paid sick leave benefits. Comprehensive paid sick leave policies that cover all workers are urgently needed if we are to reduce the spread of COVID-19, and be ready to respond to threats from new pathogens.


Assuntos
Infecções por Coronavirus/epidemiologia , Saúde Global , Pneumonia Viral/epidemiologia , Política Pública/legislação & jurisprudência , Licença Médica/economia , Licença Médica/legislação & jurisprudência , Adulto , Betacoronavirus , Infecções por Coronavirus/transmissão , Feminino , Humanos , Masculino , Pandemias , Pneumonia Viral/transmissão , Salários e Benefícios , Nações Unidas
7.
PLoS One ; 15(4): e0229530, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32251479

RESUMO

BACKGROUND: Peripheral nerve injury in the upper extremity is linked to high socioeconomic burden, yet cost-analyses are rare and from small cohorts. The objective of this study was to determine the costs and long-term socioeconomic effects of peripheral nerve injuries in the upper extremity in Germany. METHODS: We analyzed data of 250 patients with 268 work-related upper extremity nerve injuries from acute treatment to long-term follow-up on rehabilitation, sick-leave and disability-pension. RESULTS: Patients were on average 39.9±14.2 years old, male (85%) and mean inpatient treatment was 7±6 days. Location of nerve was 8% (N = 19) proximal to the wrist, 26% (N = 65) at the wrist and metacarpus, and 66% (N = 166) at phalangeal level. Acute in-patient treatment for (single) median nerve injury accounted for 66% with hospital reimbursement of 3.570€, ulnar nerve injury for 24% and 2.650€ and radial nerve injury for 10% and 3.166€, all including finger nerve injuries. The remaining were combined nerve injuries, with significantly higher costs, especially if combined with tendon 5.086€ or vascular injury 4.886€. Based on location, nerve injuries proximal to the wrist averaged 5.360±6.429€, at the wrist and metacarpus 3.534±2.710€ and at the phalangeal level 3.418±3.330€. 16% required rehabilitation with average costs of 5.842€ and stay of 41±21 days. Sick leave was between 11-1109 days with an average of 147 days with socioeconomic costs of 197€/day, equaling on average 17.640€. 30% received a mean yearly disability pension of 3.187€, that would account to 102.167€ per lifetime. CONCLUSION: This large German patient sample indicates that nerve injury has a major impact on function and employment, resulting in significant health care costs. Both proximal and distal nerve injuries led to long-term disability, subsequent sick-leave and in 30% to permanent disability pension. These data are determined to support future studies and health economical work on prevention, treatment and rehabilitation of these often small injuries with great consequences.


Assuntos
Traumatismos Ocupacionais/economia , Traumatismos dos Nervos Periféricos/economia , Fatores Socioeconômicos , Extremidade Superior/patologia , Adulto , Feminino , Alemanha/epidemiologia , Custos de Cuidados de Saúde , Hospitalização/economia , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos Ocupacionais/epidemiologia , Traumatismos Ocupacionais/fisiopatologia , Traumatismos dos Nervos Periféricos/epidemiologia , Traumatismos dos Nervos Periféricos/patologia , Traumatismos dos Nervos Periféricos/terapia , Licença Médica/economia
8.
Rev Bras Epidemiol ; 23: e200015, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32159626

RESUMO

OBJECTIVE: To study associated factors with loss productivity in people involved road traffic accidents (RTA). METHODS: The population based cohort study was conducted in Jequié, Brazil between 2013 to 2015. The instrument for interview was used in people involved in RTA and interview in four months. Individuals, occupational, health conditions, injury and support variables were used for bivariate and multivariate analysis. RESULTS: The cumulative incidence was loss productivity was 61.1% and density incidence of 7.45 cases/100 person-month. Multivariate analysis showed association for injury (IDR = 4.23; 95%CI = 2.90 - 6.17) and vehicle used with work instrument (IDR = 2.80; 95%CI = 1.62 - 4.85). CONCLUSION: Public policies are needed to ensure traffic safety in order to minimize the effects of RTA about productivity and to carry news studies to expand knowledge about loss productivity.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/estatística & dados numéricos , Efeitos Psicossociais da Doença , Eficiência , Licença Médica/estatística & dados numéricos , Ferimentos e Lesões/economia , Adulto , Brasil , Estudos de Coortes , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Licença Médica/economia , Índices de Gravidade do Trauma , Ferimentos e Lesões/etiologia
9.
Rev. esp. quimioter ; 33(1): 49-67, feb. 2020. graf
Artigo em Inglês | IBECS | ID: ibc-ET5-1152

RESUMO

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in the World, and one of the most important causes of mortality and morbidity. In adults 40 years and older, it affects more than 10% of the population and has enormous personal, family and social burden. Tobacco smoking is its main cause, but not the only one, and there is probably a genetic predisposition that increases the risk in some patients. The paradigm of this disease is changing in Spain, with an increase of women that has occurred in recent years. Many of the physio pathological mechanisms of this condition are well known, but the psychological alterations to which it leads, the impact of COPD on relatives and caregivers, the limitation of daily life observed in these patients, and the economic and societal burden that they represent for the health system, are not so well-known. A major problem is the high under-diagnosis, mainly due to difficulties for obtaining, in a systematic way, spirometries in hospitals and health-care centers. For this reason, the Fundación de Ciencias de la Salud and the Spanish National Network Center for Research in Respiratory Diseases (CIBERES) have brought together experts in COPD, patients and their organizations, clinical psychologists, experts in health economics, nurses and journalists to obtain their opinion about COPD in Spain. They also discussed the scientific bibliometrics on COPD that is being carried out from the CIBERES and speculated on the future of this condition. The format of the meeting consisted in the discussion of a series of questions that were addressed by different speakers and discussed until a consensus conclusion was reached


La enfermedad pulmonar obstructiva crónica (EPOC) es una de las enfermedades más prevalentes en el mundo y una de las causas más importantes de mortalidad y morbilidad. En los adultos de más de 40 años, afecta al menos al 10% de la población y tiene una enorme carga personal, familiar y social. El tabaquismo es su principal causa, pero no la única, y probablemente existe una predisposición genética que aumenta el riesgo en algunos pacientes. El paradigma de esta enfermedad está cambiando en España, con un aumento de la incidencia en mujeres que se ha producido en los últimos años. Muchos de los mecanismos fisiopatológicos de la EPOC son bien conocidos, pero no lo son tanto las alteraciones psicológicas a las que conduce, el impacto de la enfermedad en los familiares y cuidadores, la limitación de la vida cotidiana que se observa en estos pacientes y la carga económica y social que representan para el sistema sanitario. Un problema importante es el elevado infradiagnóstico, debido principalmente a las dificultades para obtener, de forma sistemática, espirometrías en los hospitales y centros de salud. Por este motivo, la Fundación de Ciencias de la Salud y el Centro de Investigación en Enfermedades Respiratorias (CIBERES) han reunido a expertos en EPOC, pacientes y sus organizaciones, psicólogos clínicos, expertos en economía de la salud, enfermeras y periodistas para obtener su opinión sobre la EPOC en España. También se ha hablado de la bibliometría científica sobre la EPOC que se está llevando a cabo desde el CIBERES y se ha especulado sobre el futuro de esta enfermedad. El formato de la reunión consistió en la discusión de una serie de cuestiones que fueron abordadas por diferentes ponentes y discutidas hasta llegar a una conclusión consensuada


Assuntos
Humanos , Masculino , Feminino , Doença Pulmonar Obstrutiva Crônica , Efeitos Psicossociais da Doença , Cuidados de Enfermagem , Cooperação do Paciente , Participação do Paciente , Prevalência , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Anos de Vida Ajustados por Qualidade de Vida , Fatores Sexuais , Licença Médica/economia , Fumar/efeitos adversos , Espirometria
10.
Rev Esp Quimioter ; 33(1): 49-67, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31933347

RESUMO

Chronic obstructive pulmonary disease (COPD) is one of the most prevalent diseases in the World, and one of the most important causes of mortality and morbidity. In adults 40 years and older, it affects more than 10% of the population and has enormous personal, family and social burden. Tobacco smoking is its main cause, but not the only one, and there is probably a genetic predisposition that increases the risk in some patients. The paradigm of this disease is changing in Spain, with an increase of women that has occurred in recent years. Many of the physio pathological mechanisms of this condition are well known, but the psychological alterations to which it leads, the impact of COPD on relatives and caregivers, the limitation of daily life observed in these patients, and the economic and societal burden that they represent for the health system, are not so well-known. A major problem is the high under-diagnosis, mainly due to difficulties for obtaining, in a systematic way, spirometries in hospitals and health-care centers. For this reason, the Fundación de Ciencias de la Salud and the Spanish National Network Center for Research in Respiratory Diseases (CIBERES) have brought together experts in COPD, patients and their organizations, clinical psychologists, experts in health economics, nurses and journalists to obtain their opinion about COPD in Spain. They also discussed the scientific bibliometrics on COPD that is being carried out from the CIBERES and speculated on the future of this condition. The format of the meeting consisted in the discussion of a series of questions that were addressed by different speakers and discussed until a consensus conclusion was reached.


Assuntos
Doença Pulmonar Obstrutiva Crônica , Ansiedade/etiologia , Bibliometria , Pesquisa Biomédica , Meios de Comunicação , Efeitos Psicossociais da Doença , Depressão/etiologia , Família , Feminino , Humanos , Masculino , Cuidados de Enfermagem , Cooperação do Paciente , Participação do Paciente , Prevalência , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/prevenção & controle , Pneumologia/educação , Anos de Vida Ajustados por Qualidade de Vida , Fatores Sexuais , Licença Médica/economia , Fumar/efeitos adversos , Fumar/epidemiologia , Abandono do Hábito de Fumar , Espanha/epidemiologia , Espirometria , Poluição por Fumaça de Tabaco/efeitos adversos
11.
Breast Cancer Res Treat ; 179(1): 207-215, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31555940

RESUMO

PURPOSE: Little is known about racial variations in the financial impact of cancer care. Using data from a national survey of racially diverse patients with metastatic breast cancer, we examined racial/ethnic patterns in employment and cost-management (i.e., financial coping) behaviors. METHODS: We conducted an online survey of patients with metastatic breast cancer. Participants reported on socio-demographic characteristics, employment, and financial coping behaviors. We employed adjusted modified Poisson regressions to evaluate racial/ethnic differences in changes in work for pay and financial coping. RESULTS: Our analysis included 1052 respondents from 41 states, including Non-Hispanic Blacks (NHB, 9%), Hispanics (7%), Asians/Pacific Islanders/Native Hawaiians (API/NH, 10%), American Indians/Alaskan Natives (AI/AN, 8%), and Non-Hispanic Whites (NHW, 66%). In adjusted analyses comparing NHWs with patients of color, patients of color were more likely to take unpaid leave (NHB Adjusted Risk Ratio [ARR] = 2.27; 95% CI 1.54, 3.34), take paid leave (Hispanic ARR = 2.27; 95% CI 1.54, 1.29), stop work (AI/AN ARR = 1.22; 95% CI 1.05, 1.41), and reduce work hours (AI/AN ARR = 1.33; 95% CI 1.14, 1.57). Patients of color were more likely than NHWs to stop treatment (NHB ARR = 1.22; 95% CI 1.08, 1.39), borrow money from friends/family (Hispanic ARR = 1.75; 95% CI 1.25, 2.44), skip other medical bills (API/NH ARR = 2.02; 95% CI 1.54, 2.63), and skip non-medical bills (AI/AN ARR = 1.67 95% CI 1.06, 2.63). Non-Hispanic Whites more commonly reported using savings or skipping a vacation to help manage costs. CONCLUSIONS: Racial/ethnic differences exist in employment changes and financial coping among metastatic breast cancer patients, with patients of color experiencing worse consequences. Equity must be a guiding principle in strategies addressing financial burden during cancer care.


Assuntos
Neoplasias da Mama/economia , Neoplasias da Mama/etnologia , Emprego/estatística & dados numéricos , Adulto , Neoplasias da Mama/epidemiologia , Emprego/economia , Feminino , Gastos em Saúde , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Licença Médica/economia , Licença Médica/estatística & dados numéricos , Estados Unidos/etnologia
12.
Rev. bras. epidemiol ; 23: e200015, 2020. tab
Artigo em Português | LILACS | ID: biblio-1092604

RESUMO

RESUMO: Objetivo: Estudar fatores associados à perda de produtividade em pessoas envolvidas em acidentes de trânsito (AT). Métodos: Realizou-se uma coorte prospectiva de base comunitária no município de Jequié, Bahia, Brasil, entre 2013 e 2015. Foi aplicado instrumento de coleta em forma de formulário em participantes que se envolviam em AT, seguido de entrevistas a cada quatro meses. Investigou-se, por meio da análise bivariada e multivariável, a associação entre perda de produtividade e variáveis sociodemográficas e ocupacionais, condições de saúde e gravidade das lesões. Resultados: Observaram-se incidência cumulativa de perda de produtividade de 61,1% e densidade de incidência geral de 7,45 casos/100 pessoas/mês. A análise multivariável demonstrou associação com perda de produtividade para quem utilizava o veículo como instrumento de trabalho (razão de densidade de incidência - RDI = 4,23; intervalo de confiança de 95% (IC95%) = 2,90 - 6,17) e aqueles que apresentaram lesão corporal (RDI = 2,80; IC95% = 1,62 - 4,85). Conclusão: São necessárias políticas públicas que assegurem a segurança no trânsito a fim de minimizar os efeitos dos AT sobre a produtividade, além da realização de novos estudos na área para ampliar o conhecimento sobre o tema.


ABSTRACT: Objective: To study associated factors with loss productivity in people involved road traffic accidents (RTA). Methods: The population based cohort study was conducted in Jequié, Brazil between 2013 to 2015. The instrument for interview was used in people involved in RTA and interview in four months. Individuals, occupational, health conditions, injury and support variables were used for bivariate and multivariate analysis. Results: The cumulative incidence was loss productivity was 61.1% and density incidence of 7.45 cases/100 person-month. Multivariate analysis showed association for injury (IDR = 4.23; 95%CI = 2.90 - 6.17) and vehicle used with work instrument (IDR = 2.80; 95%CI = 1.62 - 4.85). Conclusion: Public policies are needed to ensure traffic safety in order to minimize the effects of RTA about productivity and to carry news studies to expand knowledge about loss productivity.


Assuntos
Humanos , Masculino , Feminino , Adulto , Condução de Veículo/estatística & dados numéricos , Ferimentos e Lesões/economia , Acidentes de Trânsito/estatística & dados numéricos , Efeitos Psicossociais da Doença , Licença Médica/estatística & dados numéricos , Eficiência , Ferimentos e Lesões/etiologia , Brasil , Índices de Gravidade do Trauma , Incidência , Estudos Prospectivos , Fatores de Risco , Estudos de Coortes , Licença Médica/economia , Pessoa de Meia-Idade
13.
Eur J Sport Sci ; 20(2): 240-248, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31386823

RESUMO

Several unhealthy lifestyles are associated with increased sickness absence (SA). This study examined the associations of changes in diet and leisure-time physical activity (LTPA) with employer's direct cost of subsequent short-term (<10 working days) SA. The survey data from phases 1 (2000-2002) and 2 (2007) of the Helsinki Health Study (HHS), a longitudinal cohort study of initially 40-60-year-old employees of the City of Helsinki, Finland, were linked with SA register data. Final data consisted of 4157 employees. Dietary habits were inquired with a short food frequency questionnaire. Consumption of fruits (F) and vegetables (V) was used to indicate healthiness of diet. LTPA was measured with a series of questions on the intensity and the amount of LTPA. Data on short-term SA and salaries (2008-2012) were received from the employers' registers. A two-part model was used to analyse the associations. Those who improved their F&V consumption from non-daily to daily and persevered physically active got 620 € (95% CI -1194, -47) lower cost than those remaining non-daily F&V consumers and physically inactive. When examining LTPA only, those who persevered physically active or improved from moderately active to active got 19% less cost for the employer than those remaining inactive. Dietary changes were not independently associated with the cost. Improving employees' diet and LTPA may reduce employer's direct cost of SA. Although the associations of diet with SA cost were not statistically significant, improvements in diet may contribute to the beneficial associations of LTPA and employer's cost of SA.


Assuntos
Dieta , Exercício Físico , Atividades de Lazer , Licença Médica/economia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
14.
Respir Res ; 20(1): 215, 2019 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-31601216

RESUMO

BACKGROUND: Evidence on the economic impact of chronic obstructive pulmonary disease (COPD) for third-party payers and society based on large real world datasets are still scarce. Therefore, the aim of this study was to estimate the economic impact of COPD severity and its comorbidities, stratified by GOLD grade, on direct and indirect costs for an unselected population enrolled in the structured German Disease Management Program (DMP) for COPD. METHODS: All individuals enrolled in the DMP COPD were included in the analysis. Patients were only excluded if they were not insured or not enrolled in the DMP COPD the complete year before the last DMP documentation (at physician visit), had a missing forced expiratory volume in 1 s (FEV1) measurement or other missing values in covariates. The final dataset included 39,307 patients in GOLD grade 1 to 4. We used multiple generalized linear models to analyze the association of COPD severity with direct and indirect costs, while adjusting for sex, age, income, smoking status, body mass index, and comorbidities. RESULTS: More severe COPD was significantly associated with higher healthcare utilization, work absence, and premature retirement. Adjusted annual costs for GOLD grade 1 to 4 amounted to €3809 [€3691-€3935], €4284 [€4176-€4394], €5548 [€5328-€5774], and €8309 [€7583-9065] for direct costs, and €11,784 [€11,257-€12,318], €12,985 [€12,531-13,443], €15,805 [€15,034-€16,584], and €19,402 [€17,853-€21,017] for indirect costs. Comorbidities had significant additional effects on direct and indirect costs with factors ranging from 1.19 (arthritis) to 1.51 (myocardial infarction) in direct and from 1.16 (myocardial infarction) to 1.27 (cancer) in indirect costs. CONCLUSION: The findings indicate that more severe GOLD grades in an unselected COPD population enrolled in a structured DMP are associated with tremendous additional direct and indirect costs, with comorbidities significantly increase costs. In direct cost category hospitalization and in indirect cost category premature retirement were the main cost driver. From a societal perspective prevention and interventions focusing on disease control, and slowing down disease progression and strengthening the ability to work would be beneficial in order to realize cost savings in COPD.


Assuntos
Gerenciamento Clínico , Custos de Cuidados de Saúde/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/economia , Doença Pulmonar Obstrutiva Crônica/terapia , Fatores Etários , Idoso , Comorbidade , Progressão da Doença , Feminino , Volume Expiratório Forçado , Alemanha , Hospitalização/economia , Humanos , Renda , Masculino , Aceitação pelo Paciente de Cuidados de Saúde , Doença Pulmonar Obstrutiva Crônica/complicações , Aposentadoria/economia , Aposentadoria/estatística & dados numéricos , Fatores Sexuais , Licença Médica/economia , Licença Médica/estatística & dados numéricos , Fumar/efeitos adversos , Fumar/economia
15.
J Bone Joint Surg Am ; 101(15): 1366-1374, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31393427

RESUMO

BACKGROUND: Upper-limb injuries and musculoskeletal disorders represent a major economic burden for both patients and society, largely due to limitations in returning to work. We hypothesized that a positive patient-surgeon relationship may facilitate patients' recovery and lead to a faster return to work. METHODS: This longitudinal observational study comprised 219 patients, from 8 French hand trauma centers, who were 18 to 55 years of age and were on sick leave from work because of an injury or musculoskeletal disorder of the upper limb. In addition to instruments measuring patients' functional scores and quality of life, the quality of the patient-surgeon relationship was assessed at enrollment using a specific questionnaire (Q-PASREL [Quality of PAtient-Surgeon RELationship]). Six months after enrollment, the return-to-work status was assessed. Logistic and Cox regression models were developed to identify predictors of return to work (yes/no) and the time off from work in days. RESULTS: Overall, 74% of the patients who returned to work within 6 months after enrollment had a high or medium-high Q-PASREL score, whereas 64% of the patients who were still on sick leave had a low or medium-low Q-PASREL score. The odds of patients with a low or medium-low Q-PASREL score returning to work were, respectively, 95% and 71% lower than the odds of patients with a high score doing so, with a percent difference of 56% (95% confidence interval [CI] = 40% to 71%) for low versus high (odds ratio [OR] = 0.05 [95% CI = 0.02 to 0.13]) and 25% (95% CI = 6% to 44%) for medium-low versus high (OR = 0.29 [95% CI = 0.11 to 0.76]). All Q-PASREL items and scores were significantly associated with return to work. CONCLUSIONS: Patients with a lower Q-PASREL score and more severe disability were less likely to return to work within 6 months and had a longer time off from work. Efforts to improve the quality of patient-surgeon relationships may minimize the duration of sick leaves and accelerate patient recovery. LEVEL OF EVIDENCE: Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Traumatismos do Braço/cirurgia , Avaliação da Deficiência , Custos de Cuidados de Saúde , Retorno ao Trabalho/economia , Licença Médica/economia , Adolescente , Adulto , Fatores Etários , Traumatismos do Braço/diagnóstico , Traumatismos do Braço/reabilitação , Estudos de Coortes , Feminino , França , Humanos , Escala de Gravidade do Ferimento , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/reabilitação , Relações Médico-Paciente , Valor Preditivo dos Testes , Modelos de Riscos Proporcionais , Medição de Risco , Fatores Sexuais , Inquéritos e Questionários , Centros de Traumatologia , Adulto Jovem
16.
BMC Public Health ; 19(1): 609, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31109317

RESUMO

BACKGROUND: In multiple sclerosis (MS), half of affected people are unemployed within 10 years of diagnosis. The aim of this study was to assess the economic impact of MS in adult subjects with relapsing-remitting MS (RRMS) and primary progressive MS (PPMS). METHODS: A multicenter, non-interventional, cross-sectional study was conducted. The Expanded Disability Status Scale (EDSS) and the 23-item Multiple Sclerosis Work Difficulties Questionnaire (MSWDQ-23) were used to assess disability and work performance, respectively. Only indirect costs were considered using the human capital method, including work costs. Professional support costs and informal caregivers' costs were also estimated. RESULTS: A total of 199 subjects were studied (mean age: 43.9 ± 10.5 years, 60.8% female, 86.4% with RRMS). Median EDSS score was 2.0 (interquartile range: 1.0-3.5) and median MSWDQ-23 total score was 31.5 (15.2, 50.0). The number of employed subjects decreased after MS diagnosis from 70.6 to 47.2%, and the number of retired people increased (23.6%). Mean age of retirement was 43.6 ± 10.5 years. Ten percent of the population had sick leaves (absenteeism was seen in 90.9% of the student population and 30.9% of the employed population). Professional support in their daily life activities was needed in 28.1% of subjects. Costs for sick leave, work absenteeism, premature retirement and premature work disability/pensioner were €416.6 ± 2030.2, €763.4 ± 3161.8, €5810.1 ± 13,159.0 and €1816.8 ± 9630.7, respectively. Costs for professional support and informal caregiving activities were €1026.93 ± 4622.0 and €1328.72, respectively. CONCLUSIONS: MS is responsible for a substantial economic burden due to indirect and informal care costs, even in a population with low physical disability.


Assuntos
Efeitos Psicossociais da Doença , Pessoas com Deficiência/estatística & dados numéricos , Esclerose Múltipla/economia , Absenteísmo , Adulto , Estudos Transversais , Emprego/economia , Emprego/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pensões/estatística & dados numéricos , Aposentadoria/economia , Aposentadoria/estatística & dados numéricos , Licença Médica/economia , Licença Médica/estatística & dados numéricos , Espanha , Inquéritos e Questionários
17.
Muscle Nerve ; 60(2): 147-154, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31136007

RESUMO

INTRODUCTION: We previously reported our amyotrophic lateral sclerosis (ALS) video televisit experience. Here we report on video televisit versus in-clinic costs, adjusting for perceived medical usefulness (MU). METHODS: We take the patient-perspective and a focused institutional-perspective. Costs are adjusted for patient/caregiver and physician perceptions of visit MU. The base-case reflects our outpatient ALS practice. RESULTS: In the base-case, from the patient perspective, in-clinic visits cost $1,116 and video televisits cost $89 ($119 after MU-adjustment). From the institutional perspective, clinic visits cost $799, and video televisits cost $354 ($472 after MU-adjustment). Adjusted cost-savings per televisit are $997 (patient) and $327 (institution). Sensitivity analyses on 5 variables accounted for uncertainty in base-case assumptions. CONCLUSIONS: Video televisits provide marked adjusted cost-savings for patients and institutions. Adjusted costs are sensitive to perceived MU of video televisits. Future research should explore the ability of video televisits to reduce healthcare resource usage. Muscle Nerve 60: 147-154, 2019.


Assuntos
Esclerose Amiotrófica Lateral/economia , Telemedicina/economia , Comunicação por Videoconferência/economia , Assistência Ambulatorial , Esclerose Amiotrófica Lateral/terapia , Cuidadores , Redução de Custos , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Habitação/economia , Humanos , Licença Médica/economia , Viagem/economia
18.
BMC Gastroenterol ; 19(1): 69, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064345

RESUMO

BACKGROUND: Irritable bowel syndrome with predominant constipation (IBS-C) is a complex disorder with gastrointestinal and nervous system components. The study aim was to assess the economic burden of moderate to severe IBS-C in six European countries (France, Germany, Italy, Spain, Sweden and the UK). METHODS: An observational, one year retrospective-prospective (6 months each) study of patients diagnosed in the last five years with IBS-C (Rome III criteria) and moderate to severe disease at inclusion (IBS Symptom Severity Scale score ≥ 175). The primary objective was to assess the direct cost to European healthcare systems. RESULTS: Five hundred twenty-five patients were included, 60% (range: 43.1-78.8%) suffered from severe IBS-C. During follow-up 11.1-24.0% of patients had a hospitalisation/emergency room (ER) visit, median stay range: 1.5-12.0 days and 41.1-90.4% took prescription drugs for IBS-C. 21.4-50.8% of employed patients took sick leave (mean: 11.6-64.1 days). The mean annual direct cost to the healthcare systems was €937.1- €2108.0. The total direct cost (combined costs to healthcare systems and patient) for IBS-C was €1421.7-€2487.1. CONCLUSIONS: IBS-C is not a life-threatening condition; however, it has large impact on healthcare systems and society. Direct and indirect costs for moderate to severe IBS-C were high with the largest direct cost driver being hospitalisations/ER visits.


Assuntos
Constipação Intestinal/complicações , Constipação Intestinal/economia , Efeitos Psicossociais da Doença , Custos de Cuidados de Saúde , Síndrome do Intestino Irritável/complicações , Síndrome do Intestino Irritável/economia , Adulto , Idoso , Constipação Intestinal/diagnóstico , Custos de Medicamentos , Europa (Continente) , Utilização de Instalações e Serviços , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Síndrome do Intestino Irritável/diagnóstico , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico/economia , Visita a Consultório Médico/estatística & dados numéricos , Estudos Prospectivos , Estudos Retrospectivos , Índice de Gravidade de Doença , Licença Médica/economia
19.
Acta Derm Venereol ; 99(9): 762-768, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31073619

RESUMO

Given the introduction of new therapies targeting specific immune pathways for atopic dermatitis (AD), information on the economic burden of AD patients is needed. Direct costs (medication use and healthcare resource utilization) and costs of productivity loss were studied in 90 adult patients with AD indicated for systemic treatment. Costs were calculated for patients with controlled (Investigator Global Assessment (IGA) 0-2) and uncontrolled (IGA 3-5) disease at inclusion. Mean (95% confidence interval (95% CI)) total direct costs were €5,191 (€4,382-6,019) per patient per year (PPY), €4,401 (€3,695-5,215) for patients with controlled AD vs. €6,993 (€5,552-8,406), mean difference €2,593 (€820-4,282) (p=0.014) for patients with uncontrolled AD. Costs of productivity loss were €10,040 (€6,260-14,012) PPY for the total group, €6,886 (€4,188-10,129) PPY for patients with controlled AD vs. €13,702 (€6,124-22,996) for patients with uncontrolled AD, mean difference €6,816 (-€1,638-16,677; p=0.148). Total costs (direct costs+costs of productivity loss) were €15,231 (€11,487-19,455) PPY for the total group, €11,287 (€7,974-15,436) for patients with controlled AD vs. €20,695 (€14,068-34,564), mean difference €9,408 (-€119-19,964) (p=0.077) for patients with uncontrolled AD. Patients with AD using systemic immunosuppressive treatment incur considerable direct costs and costs of productivity loss.


Assuntos
Efeitos Psicossociais da Doença , Dermatite Atópica/tratamento farmacológico , Dermatite Atópica/economia , Fármacos Dermatológicos/administração & dosagem , Fármacos Dermatológicos/economia , Custos de Medicamentos , Imunossupressores/administração & dosagem , Imunossupressores/economia , Absenteísmo , Adulto , Fatores Etários , Dermatite Atópica/diagnóstico , Dermatite Atópica/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Presenteísmo/economia , Índice de Gravidade de Doença , Licença Médica/economia , Fatores de Tempo , Resultado do Tratamento , Desempenho Profissional/economia
20.
BMJ Open ; 9(4): e027832, 2019 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-30948617

RESUMO

OBJECTIVES: To quantify population-level health and economic consequences of sick leave among workers with influenza symptoms. INTERVENTIONS: Compared with current sick leave practice (baseline), we evaluated the health and cost consequences of: (1) increasing the proportion of workers on sick leave from 65% (baseline) to 80% or 90%; (2) shortening the maximum duration from symptom onset to sick leave from 4 days (baseline) to 2 days, 1.5 days, 1 day and 0.5 days; and (3) combinations of 1 and 2. METHODS: A dynamic compartmental influenza model was developed using Norwegian population data and survey data on employee sick leave practices. The sick leave interventions were simulated under 12 different seasonal epidemic and 36 different pandemic influenza scenarios. These scenarios varied in terms of transmissibility, the proportion of symptomatic cases and illness severity (risk of primary care consultations, hospitalisations and deaths). Using probabilistic sensitivity analyses, a net health benefit approach was adopted to assess the cost-effectiveness of the interventions from a societal perspective. RESULTS: Compared with current sick leave practice, sick leave interventions were cost-effective for 31 (65%) of the pandemic scenarios, and 11 (92%) of the seasonal scenarios. Economic benefits from sick leave interventions were greatest for scenarios with low transmissibility, high symptomatic proportions and high illness severity. Overall, the health and economic benefits were greatest for the intervention involving 90% of sick workers taking sick leave within one-half day of symptoms. Depending on the influenza scenario, this intervention resulted in a 44.4%-99.7% reduction in the attack rate. Interventions involving sick leave onset beginning 2 days or later, after the onset of symptoms, resulted in economic losses. CONCLUSIONS: Prompt sick leave onset and a high proportion of sick leave among workers with influenza symptoms may be cost-effective, particularly during influenza epidemics and pandemics with low transmissibility or high morbidity.


Assuntos
Influenza Humana/economia , Pandemias , Licença Médica/economia , Absenteísmo , Adulto , Análise Custo-Benefício , Feminino , Humanos , Influenza Humana/epidemiologia , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Saúde do Trabalhador/estatística & dados numéricos , Estações do Ano , Licença Médica/estatística & dados numéricos , Adulto Jovem
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