A review of self-report instruments measuring health-related work productivity: a patient-reported outcomes perspective

Unveiling the Impact of Moderate and Severe Atopic Dermatitis: Insights on Burden, Clinical Characteristics, and Healthcare Resource Utilization in Adult Greek Patients from the APOLO Cross-Sectional Study

Background: Moderate to severe (M2S) atopic dermatitis (AD) is a chronic condition impacting individuals, society, and healthcare systems. Considering the changing M2S-AD treatment landscape, this study assesses the M2S-AD burden in patients reaching referral centers in Greece. Methods: This was a multicenter, cross-sectional study. Patients aged 12 years or older with clinically diagnosed M2S-AD were enrolled. Data collected included clinical practice assessments and the following validated patient-reported instruments: Dermatology Life Quality Index (DLQI); EuroQol-5 Dimensions-3 Level scale (EQ-5D-3L); Patient Oriented Eczema Measure (POEM); Peak Pruritus Numerical Rating Scale (PP-NRS); and Work Productivity and Activity Impairment: General Health (WPAI:GH). A pain frequency/intensity/cause questionnaire and a sleep disturbance scale were also used. Results: Outcomes of 184 adults (51.1% female) with M2S-AD based on the Eczema Area and Severity Index (EASI) are presented (n = 117 moderate; n = 67 severe). Among the patients, 14.8% were obese, 59.2% had allergic comorbidities, and 88.0% were receiving AD-specific therapy (systemic: 38.6%). The median age, disease duration, body surface area, and total EASI scores were 38.8 years, 11.8 years, 30.0%, and 16.9, respectively. The median DLQI score was 12.0, with 'symptoms/feelings' being the most affected domain. EQ-5D dimensions 'anxiety/depression' and 'pain/discomfort' were also affected (65.2% and 64.1% reporting problems, respectively). The median POEM score was 17.0. Pain, severe pruritus (PP-NRS ≥ 7), and sleep disturbance were reported by 80.4%, 62.0%, and 88.5%, respectively. The median WPAI:GH 'work productivity loss' and 'activity impairment' scores were 23.8% and 30.0%, respectively. Conclusions: Both moderate and severe AD patients reaching Greek specialized centers experience significant symptom burden and impairments in quality of life, sleep, work, and daily activities.

Polyethylene Glycol-Fusion Repair of Peripheral Nerve Injuries

Axons successfully repaired with polyethylene glycol (PEG) fusion tecnology restored axonal continuity thereby preventing their Wallerian degeneration and minimizing muscle atrophy. PEG fusion studies in animal models and preliminary clinical trials involving patients with digital nerve repair have shown promise for this therapeutic approach. PEG fusion is safe to perform, and given the enormous potential benefits, there is no reason not to explore its therapeutic potential.

Supervised Exercise Therapy Reduces Presenteeism to Greater Extent Than Unsupervised Self-Care in Workers with Musculoskeletal Pain: a Systematic Review and Meta-Analysis

PURPOSE

Presenteeism is defined as the loss of work productivity due to health issues in workers, which can be measured subjectively. This study aimed to compare the effectiveness of supervised exercise therapy and unsupervised self-care in reducing presenteeism in workers with musculoskeletal disorders.

METHODS

PubMed, Embase, and Cochrane Library were searched for various keywords from their inception to January 2023. Two examiners independently assessed the eligibility of studies: (1) studies involving workers suffering from musculoskeletal pain, (2) those involving supervised exercise therapy intervention with interactive communication, and (3) those in which the comparison group was subjected to interventions other than supervised exercise therapy, and (4) those including patient-reported outcome measures of presenteeism or work productivity or ability. Standardized mean differences (SMD) were calculated using a random effects model, with higher scores indicating reduced presenteeism in the intervention group compared with that in the comparison group. The GRADE assesses the overall certainty of the evidence.

RESULTS

Only the short-term effects of interventions on presenteeism could be obtained using four studies. The intervention group showed statistically significant short-term effects on presenteeism compared with the comparison group (p < 0.001; SMD, 0.52; 95% confidence interval, 0.27-0.77). The GRADE score was downgraded by two levels from high to low due to concerns for indirectness.

CONCLUSIONS

Although the certainty of the evidence was low, it was assumed that supervised exercise therapy was more effective than unsupervised self-care in reducing presenteeism in workers with musculoskeletal disorders.

Work productivity and activity impairment in patients with narcolepsy type 1

The aim of this study was to assess work productivity and activity impairments and to explore their association with excessive daytime sleepiness, body mass index (BMI), depression, and anxiety in patients with narcolepsy type 1. We carried out a cross-sectional study in which patients with narcolepsy type 1 and matched controls for sex, age, and education were assessed for occupational features, EDS (Epworth Sleepiness Scale), BMI, depression (Beck Depression Inventory), anxiety (State-Trait Anxiety Inventory), and Work Productivity and Activity Impairment (WPAI). Different statistical approaches were used to investigate differences between groups and correlations between WPAI scores and clinical features. The 127 patients with narcolepsy type 1 (mean age 38.2 ± 15.5, 91.3% taking drugs for narcolepsy) and 131 controls (mean age of 37.4 ± 14.3) included did not differ in terms of occupational features, except for hours worked/week (29.9 in patients vs. 34.9 in controls) and officially recognised disability (30.7% vs. 5.3%). Impairment in all WPAI scores was approximately three times greater in patients. Narcolepsy was associated with work time missed in 27.4% of patients, while 93.2% to 95.5% of them had some impairment while working or during daily activities (vs. 37.5-46.8% of controls). Correlations with WPAI scores were found for excessive daytime sleepiness only in patients, and for both depression and anxiety in patients and controls, with a stronger correlation for activity impairment in patients. These results suggest that, despite treatment, narcolepsy type 1 was associated with extensive impairment especially regarding job effectiveness and daily activities. Future studies should investigate risk factors and effects of interventions on these outcomes.

The effects of an 8-week selective corrective exercises program on the worker's productivity with the upper crossed syndrome - a randomized controlled trial

BACKGROUND

The purpose of this study was to investigate the effectiveness of a corrective exercise program on workers' productivity with Upper Crossed Syndrome (UCS).

METHODS

We used Randomized Controlled Trial (RCT) with parallel groups, double-blind, randomized. The participants were workers recruited at a company of Markazi Province that 23 persons in test group and 25 in control group participated. Before and after the intervention, work productivity and activity impairment was measured by the WPAI-GH questionnaire. In addition, angles of FH and RS were measured by Goniometer, and kyphosis angle was measured by a flexible ruler. The exercise program consisted of stretching, strengthening, and stabilization exercises, conducted three times a week for eight weeks. The primary outcome was work productivity and activity impairment, and the secondary outcomes were FH, RS, and KY. All primary and secondary outcomes were measured before the interventions, one week after intervention.

RESULTS

Results revealed significant differences for KY (MD = 3.84, 95% CI: 0.75,6.94, p = 0.017), RS (MD = -1.83, 95% CI: -2.88, -0.88, p = 0.001), and FH (MD = 3.01, 95% CI: 1.98,4.04, p = 0.001) before and after the intervention. In addition, within-group differences showed a significant difference in work time missed (MD = -2.60, CI: -4.84, -0.37, p = 0.003**), and overall work productivity loss (MD = -2.02, CI: -3.78, -0.26, p = 0.013**) in exercise group. However, there were no significant effects on impairment at work and activity.

CONCLUSIONS

Since significant differences were detected in a selective exercise program on productivity, a continuous exercise program for more than 8-week could be effective in managing productivity and increasing practical working hours.

Is erenumab an efficient alternative for the prevention of episodic and chronic migraine in Spain? Results of a cost-effectiveness analysis

BACKGROUND

The reimbursement of erenumab in Spain and other European countries is currently restricted because of the cost of this novel therapy to patients with migraine who have experienced previous failures to traditional preventive treatments. However, this reimbursement policy should be preferably based on cost-effectiveness studies, among other criteria. This study performed a cost-effectiveness analysis of erenumab versus topiramate for the prophylactic treatment of episodic migraine (EM) and versus placebo for chronic migraine (CM).

METHODS

A Markov model with a 10-year time horizon, from the perspective of the Spanish National Healthcare System, was constructed based on data from responder and non-responder patients. A responder was defined as having a minimum 50% reduction in the number of monthly migraine days (MMD). A hypothetical cohort of patients with EM with one or more prior preventive treatment failures and patients with CM with more than two treatment failures was considered. The effectiveness score was measured as an incremental cost per quality-adjusted life year (QALY) gained and cost per migraine day (MD) avoided. Data from clinical outcomes and patient characteristics were obtained from erenumab clinical trials (NCT02066415, STRIVE, ARISE, LIBERTY and HER-MES). Deterministic and probabilistic sensitivity analyses were performed to validate the robustness of the model.

RESULTS

After a 10-year follow-up, the estimated QALYs were 5.88 and 6.11 for patients with EM treated with topiramate and erenumab, respectively. Erenumab showed an incremental cost per patient of €4,420 vs topiramate. For CM patients, erenumab resulted in 0.756 QALYs gained vs placebo; and an incremental cost of €1,814. Patients treated with erenumab achieved reductions in MD for both EM and CM (172 and 568 MDs, respectively). The incremental cost per QALY gained with erenumab was below the Spanish threshold of €30,000/QALY for both health and societal perspectives (EM €19,122/QALY and CM €2,398/QALY).

CONCLUSIONS

Erenumab is cost-effective versus topiramate as a preventive treatment for EM and versus placebo for patients with CM from the perspective of the Spanish National Health System.

Improvement in work productivity among psoriatic arthritis patients treated with biologic or targeted synthetic drugs: a systematic literature review and meta-analysis

BACKGROUND

Capacity to work is impacted by psoriatic arthritis (PsA). Our objective was to describe the course of work productivity and leisure activity in patients with PsA treated with biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs (DMARDs).

METHODS

A systematic literature review identified all trials and observational studies published January 1, 2010-October 22, 2021, reporting work productivity using the Work Productivity and Activity Impairment Questionnaire (WPAI) in patients with PsA treated with b/tsDMARDs. Outcomes for WPAI domains (absenteeism, presenteeism, total work productivity, and activity impairment) were collected at baseline and time point closest to 24 weeks of treatment. A random effects meta-analysis of single means was conducted to calculate an overall absolute mean change from baseline for each WPAI domain.

RESULTS

Twelve studies (ten randomized controlled and two observational) assessing patients treated with adalimumab, bimekizumab, guselkumab, ixekizumab, risankizumab, secukinumab, or upadacitinib were analysed. Among 3741 employed patients, overall mean baseline scores were 11.4%, 38.7%, 42.7%, and 48.9% for absenteeism, presenteeism, total work productivity impairment, and activity impairment, respectively. Estimated absolute mean improvements (95% confidence interval) to week 24 were 2.4 percentage points (%p) (0.6, 4.1), 17.8%p (16.2,19.3), 17.6%p (15.9,19.4), and 19.3%p (17.6, 21.0) respectively, leading to a mean relative improvement of 41% for total work productivity. The change in work outcomes in the b/tsDMARDs appeared similar.

CONCLUSIONS

This systematic literature review and meta-analysis confirmed that patients with active PsA have a substantially reduced capacity to work and participate in leisure activities. Substantial improvements across various WPAI domains were noted after 24 weeks of b/tsDMARD treatment, especially in presenteeism, total work productivity, and activity impairment. These findings may be useful for reimbursement purposes and in the context of shared decision-making. This systematic literature review (SLR) of randomized clinical trials and observational studies of biologic (b) and targeted synthetic (ts) disease-modifying antirheumatic drugs b/tsDMARDs in patients with PsA found that at treatment introduction, patients presented with a 42.7% mean productivity loss per week as assessed by the Work Productivity and Activity Impairment (WPAI) Questionnaire. Through a meta-analysis comparing before/after values without adjustment for placebo response, we found that after 24 weeks of treatment with b/tsDMARDs, there was a mean absolute improvement of 17.6 percentage points and a mean relative improvement of 41% in total work productivity, with similar magnitudes of improvement in time spent at work and regular activities outside of work. These results provide clinical-, regulatory- and reimbursement decision-makers with data on the potential societal and socio-economic benefits of b/tsDMARDs in PsA.

Work productivity in patients with axial spondyloarthritis initiating biological or targeted synthetic disease-modifying antirheumatic drugs: a systematic literature review and meta-analysis

BACKGROUND

Axial spondyloarthritis (axSpA) can limit work participation. Our objective was to characterise productivity in patients with axSpA, including changes after 12-16 weeks of treatment with biological and targeted synthetic disease-modifying antirheumatic drugs (b/tsDMARDs).

METHODS

A systematic literature review identified studies published from 1 January 2010 to 21 October 2021 reporting work productivity using the Work Productivity and Activity Impairment (WPAI) questionnaire in patients with axSpA initiating b/tsDMARDs. Baseline and Week 12-16 overall work productivity, absenteeism, presenteeism and activity impairment scores were used in a random-effects meta-analysis to calculate absolute mean change from baseline for each WPAI-domain.

RESULTS

Eleven studies in patients with axSpA who received either placebo (n=727) or treatment with adalimumab, bimekizumab, etanercept, ixekizumab, secukinumab or tofacitinib (n=994) were included. In working patients initiating a b/tsDMARD, mean baseline overall work productivity impairment, absenteeism and presenteeism scores were 52.1% (N=7 studies), 11.0% and 48.8% (N=6 studies), respectively. At Week 12-16, the pooled mean change from baseline in overall work impairment for b/tsDMARDs or placebo was -21.6% and -12.3%. When results were extrapolated to 1 year, the potential annual reductions in cost of paid and unpaid productivity loss per patient ranged from €11 962.88 to €14 293.54.

CONCLUSIONS

Over 50% of employed patients with active axSpA experienced work impairment, primarily due to presenteeism. Overall work productivity improved at Weeks 12-16 to a greater extent for patients who received b/tsDMARDs than placebo. Work productivity loss was associated with a substantial cost burden, which was reduced with improvements in impairment.

An economic evaluation of pharmacopuncture versus usual care for chronic neck pain: a pragmatic randomized controlled trial

BACKGROUND

This study aimed to evaluate the cost utility of pharmacopuncture in comparison with usual care for patients with chronic neck pain.

METHODS

A 12-week, multicenter, pragmatic randomized controlled trial was conducted, and 101 patients suffering from chronic neck pain for more than six months were randomly placed into the pharmacopuncture and usual care groups to receive four weeks of treatment and 12 weeks of follow-up observations. The quality-adjusted life year (QALY) was calculated using EQ-5D and SF-6D. Concerning costs in 2019, a primary analysis was performed on societal perspective cost, and an additional analysis was performed on healthcare perspective cost.

RESULTS

Compared to usual care, pharmacopuncture was superior as it showed a slightly higher QALY and a lower incremental cost of $1,157 from a societal perspective. The probability that pharmacopuncture would be more cost-effective at a willingness-to-pay (WTP) of $26,374 was 100%. Pharmacopuncture was also superior from a healthcare perspective, with a lower incremental cost of $26. The probability that pharmacopuncture would be more cost-effective at a WTP of $26,374 was 83.7%.

CONCLUSIONS

Overall, pharmacopuncture for chronic neck pain was found to be more cost-effective compared to usual care, implying that clinicians and policy makers should consider new treatment options for neck pain.

TRIAL REGISTRATION

Number NCT04035018 (29/07/2019) Clinicaltrials.gov; Number KCT0004243 (26/08/2019) Clinical Research Information Service.

Impact of adalimumab in patients with active non-infectious intermediate, posterior, and panuveitis in real-life clinical practice: HOPE study

BACKGROUND/AIM

This study evaluated real-life adalimumab impact in patients with active non-infectious intermediate, posterior, or panuveitis (NIIPPU).

METHODS

Adults with active NIIPPU received adalimumab in this prospective, observational study (06/2017-04/2020). Patients were evaluated at baseline (V0) and four follow-up visits over 12 months (V1-V4).

PRIMARY ENDPOINT

proportion of patients achieving quiescence (anterior chamber (AC) cells grade and vitreous haze (VH) grade≤0.5+ in both eyes, no new active chorioretinal lesions) at any follow-up visit. Secondary endpoints: proportion of patients achieving quiescence at each visit; proportion of patients maintaining response; and proportion of patients with flares. Workability, visual function, healthcare resource utilisation, and safety were evaluated.

RESULTS

Full analysis set included 149 patients. Quiescence at any follow-up visit was achieved by 129/141 (91%) patients. Quiescence at individual visits was achieved by 99/145 (68%), 110/142 (77%), 102/131 (78%), and 99/128 (77%) patients at V1-V4, respectively. Number of patients in corticosteroid-free quiescence increased from 51/147 (35%; V1) to 67/128 (52%; V4; p<0.05). Proportion of patients with maintained response increased from 89/141 (63%; V2) to 92/121 (76%; V4; p<0.05) and proportion of patients with flare decreased from 25/145 (17%; V1) to 13/128 (10%; V4; p=0.092). Workability and visual function improved throughout the study. Proportion of patients with medical visits for uveitis decreased from 132/149 (89%; V0) to 27/127 (21%; V4). No new safety signals were observed.

CONCLUSION

These results demonstrated adalimumab effectiveness in improving quality of life while reducing economic burden of active NIIPPU.

A randomized trial comparing the 52-mg levonorgestrel system with combination oral contraceptives for treatment of heavy menstrual bleeding

BACKGROUND

The levonorgestrel intrauterine system and combined oral contraceptives are the 2 most commonly used nonsurgical treatments for heavy menstrual bleeding in the United States. However, there are limited data on their relative effectiveness and on their impact on bleeding-specific quality of life.

OBJECTIVE

This study aimed to compare the effectiveness of the 52-mg levonorgestrel intrauterine system with that of combined oral contraceptives for improving quality of life among individuals who self-report heavy menstrual bleeding. We hypothesized that the levonorgestrel intrauterine system would be more effective than combined oral contraceptives at 6 and 12 months after treatment.

STUDY DESIGN

We conducted a pragmatic randomized trial of individuals who self-reported heavy menstrual bleeding. Individuals were eligible if they did not have contraindications to either the levonorgestrel intrauterine system or combined oral contraceptives and were determined to have a nonstructural cause of heavy menstrual bleeding. Eligible and consenting participants were randomly assigned in a 1:1 ratio to receive a 52-mg levonorgestrel intrauterine system or a monophasic 30- or 35-μg ethinyl estradiol-containing combined oral contraceptive. The main outcome was mean change in bleeding-related quality of life, measured by the 20-question Menstrual Bleeding Questionnaire (score range, 0-75) at 6 and 12 months. Differences in group means and confidence intervals for the Menstrual Bleeding Questionnaire score were computed by multivariable linear mixed-effects regression; 24 participants per group were needed to detect a 10-point difference in change in mean Menstrual Bleeding Questionnaire score between individuals treated with the levonorgestrel intrauterine system and those treated with combined oral contraceptives at each follow-up time point.

RESULTS

A total of 62 individuals were randomly assigned to treatment (n=29 allocated to levonorgestrel intrauterine system and n=33 allocated to combined oral contraceptives) and included in the intention-to-treat analyses; 19 of 29 received the levonorgestrel intrauterine system and 31 of 33 received combined oral contraceptives. Eleven percent identified as Black or African American and 44% identified as Hispanic or Latina. Participant characteristics were similar among study groups. Bleeding-related quality of life increased in both study arms, as reflected by a significant decrease in Menstrual Bleeding Questionnaire scores beginning at 6-week follow-up. In the main intention-to-treat analyses (n=62), there were no differences in mean change in Menstrual Bleeding Questionnaire scores at 6 months (difference=-2.5; 95% confidence interval, -10.0 to +5.0) or 12 months (difference=-1.1; 95% confidence interval, -8.7 to +6.5). Findings were similar in the subsets of participants with any follow-up visits (n=52) and who completed all follow-up visits (n=42). In the per-protocol analyses (n=47), a significantly greater decrease in Menstrual Bleeding Questionnaire score was observed in the levonorgestrel intrauterine system arm at 6 months after treatment (difference=-7.0; 95% confidence interval, -13.8 to -0.2) but not at 12 months (difference=-4.8; 95% confidence interval, -11.8 to 2.3) compared with the combined oral contraceptive arm.

CONCLUSION

No differences in change of bleeding-related quality of life were observed between the levonorgestrel intrauterine system and combined oral contraceptives at 6 or 12 months. Patients should be counseled that the levonorgestrel intrauterine system and combined oral contraceptives are both effective options for improving bleeding-related quality of life.

Functional performance recovery after individualized nutrition therapy combined with a patient-tailored physical rehabilitation program versus standard physiotherapy in patients with long COVID: a pilot study

BACKGROUND

Long COVID is suggested to be present in 14 to 43% of COVID 19-survivors. Literature on this new condition states a need for a multidisciplinary approach including physical exercise and nutrition. The aim of the current pilot study is to investigate the feasibility of the proposed protocol to prepare for a randomized controlled study that addresses the effectiveness of a personalized multimodal treatment compared to standard physiotherapy.

METHODS

This is a protocol of the UNLOCK (Nutrition and LOComotoric rehabilitation in long COVID) study, a pragmatic, single center, randomized controlled pilot trial with two groups. Patients with persisting symptoms related to a SARS-CoV-2 infection will receive either standard physiotherapy or a personalized multimodal treatment for a period of 12 weeks, consisting of individualized physical exercise program combined with individualized nutritional therapy. They will be followed-up at 6, 12, and 18 weeks after randomization.

DISCUSSION

A multidisciplinary approach for dealing with long COVID is needed. Because of the lack of clear data and the fact that this is a very heterogenic group, we aim to prepare and optimize a randomized controlled study that addresses the effectiveness of a personalized multimodal treatment.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT05254301 (since February 24, 2022).

A Pilot Study for Effectiveness of Non-Pharmacological versus Pharmacological Treatment Strategies for Lumbar Disc Herniation: A Pragmatic Randomized Controlled Trial

Purpose

We aimed to compare the efficacy, safety, and cost-effectiveness of non-pharmacological- and pharmacological treatment strategies for Lumbar disc herniation (LDH) in pragmatic clinical settings.

Patients and Methods

This study was a pilot, two-armed, parallel pragmatic randomized controlled trial. Thirty patients aged 19-70 years with a numeric rating scale (NRS) score ≥5 for sciatica and confirmed LDH on magnetic resonance imaging (MRI) were included. Participants were assigned in a 1:1 ratio to non-pharmacological (non-Phm) or pharmacological (Phm) treatment group. They were treated for 8 weeks and a total follow-up period was 26 weeks after randomization. Non-Phm treatment included acupuncture, spinal manual therapy, etc., Phm included medication, injection, nerve block, etc., The primary outcome was a numeric rating scale (NRS) of radiating leg pain. NRS for low back pain, Oswestry disability index, visual analog scale, Fear-Avoidance Beliefs Questionnaire, patient global impression of change, Short Form-12 Health Survey, version 2, 5-level European Quality of Life-5 dimensions (EQ-5D) were also measured. Linear mixed model was used to evaluated the difference in change of outcomes from baseline between two groups. An economic evaluation was conducted using incremental cost-effectiveness ratios.

Results

There was no significant difference between the two groups in the intervention period, but non-Phm group showed significantly greater degree of improvement in follow-up of Week 14. Difference in the NRS for sciatica and ODI were 1.65 (95% CI 0.59 to 2.71, p=0.003) and 8.67 (95% CI 1.37 to 15.98, p=0.21), respectively in Week 14. The quality-adjusted life year (QALY) value calculated by EQ-5D and Short Form-6 Dimension were 0.006 (95% CI -0.012 to 0.024, p=0.472) and 0.015 (95% CI -0.008 to 0.038, p=0.195) higher in non-Phm group than in Phm group. The cost was lower in non-Phm group than in Phm group (Difference: -682, 95% CI -3349 to 1699, p=0.563).

Conclusion

We confirmed that the non-Phm treatment could be more cost-effective treatments than Phm treatments and feasibility of a large-scale of main study in future.

Comparison Between Burden of Care Partners of Individuals with Alzheimer's Disease Versus Individuals with Other Chronic Diseases

BACKGROUND

Caregiving in Alzheimer's disease (AD) is often provided by informal care partners, who spend more hours per week on average than care partners of individuals with conditions other than AD. However, the burden of care in partners of individuals with AD has not been systematically compared to that of other chronic diseases.

OBJECTIVE

The current study therefore aims to compare the care partner burden of AD to that of other chronic diseases through a systematic literature review.

METHODS

Data was collected from journal articles published in the last 10 years, using two unique search strings in PubMed and analysed using pre-defined patient-reported outcome measures (PROMs) including the EQ-5D-5L, GAD-7, GHQ-12, PHQ-9, WPAI and the ZBI. The data was grouped according to the included PROMs and the diseases studied. The number of participants in the studies reporting burden of caregiving in AD was adjusted to reflect the number of participants in studies reporting care partner burden in other chronic diseases.

RESULTS

All results in this study are reported as a mean value and standard deviation (SD). The ZBI measurement was the most frequently used PROM to collect care partner burden (15 studies) and showed a moderate burden (mean 36.80, SD 18.35) on care partners of individuals with AD, higher than most of the other included diseases except for those characterized by psychiatric symptoms (mean scores 55.92 and 59.11). Other PROMs such as PHQ-9 (six studies) and GHQ-12 (four studies) showed a greater burden on care partners of individuals with other chronic diseases such as heart failure, haematopoietic cell transplantations, cancer and depression compared to AD. Likewise, GAD-7 and EQ-5D-5L measurements showed a lesser burden on care partners of individuals with AD compared to care partners of individuals with anxiety, cancer, asthma and chronic obstructive pulmonary disease. The current study suggests that care partners of individuals with AD experience a moderate burden, but with some variations depending on the PROMs used.

CONCLUSION

The results of this study were mixed with some PROMs indicating a greater burden for care partners of individuals with AD versus other chronic diseases, and other PROMs showing a greater burden for care partners of individuals with other chronic diseases. Psychiatric disorders imposed a greater burden on care partners compared to AD, while somatic diseases in the musculoskeletal system resulted in a significantly smaller burden on care partners compared to AD.

Replicability of motor cortex-excitability modulation by intermittent theta burst stimulation

OBJECTIVE

Transcranial Magnetic Stimulation (TMS) allows for cortical-excitability (CE) assessment and its modulation has been associated with neuroplasticity-like phenomena, thought to be impaired in neuropsychiatric disorders. However, the stability of these measures has been challenged, defying their potential as biomarkers. This study aimed to test the temporal stability of cortical-excitability modulation and study the impact of individual and methodological factors in determining within- and between-subject variability.

METHODS

We recruited healthy-subjects to assess motor cortex (MC) excitability modulation, collecting motor evoked potentials (MEP) from both hemispheres, before and after left-sided intermittent theta burst stimulation (iTBS), to obtain a measure of MEPs change (delta-MEPs). To assess stability across-time, the protocol was repeated after 6 weeks. Socio-demographic and psychological variables were collected to test association with delta-MEPs.

RESULTS

We found modulatory effects on left MC and not on right hemisphere following iTBS of left MC. Left delta-MEP was stable across-time when performed immediately after iTBS (ICC = 0.69), only when obtained first in left hemisphere. We discovered similar results in a replication cohort testing only left MC (ICC = 0.68). No meaningful associations were found between demographic and psychological factors and delta-MEPs.

CONCLUSIONS

Delta-MEP is stable immediately after modulation and not impacted by different individual factors, including expectation about TMS-effect.

SIGNIFICANCE

Motor cortex excitability modulation immediately after iTBS should be further explored as a potential biomarker for neuropsychiatric diseases.

Caregiving-Related Work Productivity Loss Among Employed Family and Other Unpaid Caregivers of Older Adults

OBJECTIVES

Although nearly half of all family and unpaid caregivers to older adults work, little is known about short-term work impacts of caregiving using measures encompassing both missed work time and reduced productivity while physically at work. We quantify the prevalence, costs, and correlates of caregiving-related work productivity loss.

METHODS

We used the 2015 National Study of Caregiving and National Health and Aging Trends Study to estimate caregiving-related work absences (absenteeism) and reduced productivity while at work (presenteeism). We calculated costs of lost productivity using hours lost, compensation, and a wage multiplier, accounting for the additional cost of replacing employee time. We examined correlates of caregiving-related absenteeism and presenteeism separately, using multivariable logistic regression models, adjusting for caregiver sociodemographic characteristics, occupation and hours worked, role overload, older adult health, use of respite care, support groups, flexible workplace schedules, help from family or friends, and caregiver training.

RESULTS

Nearly 1 in 4 (23.3%) of the estimated 8.8 million employed family caregivers reported either absenteeism or presenteeism over a 1-month period owing to caregiving. Among those affected, caregiving reduced work productivity by one-third on average-or an estimated $5600 per employee when annualized across all employed caregivers-primarily because of reduced performance while present at work. Productivity loss was higher among caregivers of older adults with significant care needs and varied according to sociodemographic characteristics and caregiver supports.

CONCLUSIONS

Findings emphasize the potential economic value of targeted policy intervention to support working caregivers.

Development and validation of an electronic daily control score for asthma (e-DASTHMA): a real-world direct patient data study

BACKGROUND

Validated questionnaires are used to assess asthma control over the past 1-4 weeks from reporting. However, they do not adequately capture asthma control in patients with fluctuating symptoms. Using the Mobile Airways Sentinel Network for airway diseases (MASK-air) app, we developed and validated an electronic daily asthma control score (e-DASTHMA).

METHODS

We used MASK-air data (freely available to users in 27 countries) to develop and assess different daily control scores for asthma. Data-driven control scores were developed based on asthma symptoms reported by a visual analogue scale (VAS) and self-reported asthma medication use. We included the daily monitoring data from all MASK-air users aged 16-90 years (or older than 13 years to 90 years in countries with a lower age of digital consent) who had used the app in at least 3 different calendar months and had reported at least 1 day of asthma medication use. For each score, we assessed construct validity, test-retest reliability, responsiveness, and accuracy. We used VASs on dyspnoea and work disturbance, EQ-5D-VAS, Control of Allergic Rhinitis and Asthma Test (CARAT), CARAT asthma, and Work Productivity and Activity Impairment: Allergy Specific (WPAI:AS) questionnaires as comparators. We performed an internal validation using MASK-air data from Jan 1 to Oct 12, 2022, and an external validation using a cohort of patients with physician-diagnosed asthma (the INSPIRERS cohort) who had had their diagnosis and control (Global Initiative for Asthma [GINA] classification) of asthma ascertained by a physician.

FINDINGS

We studied 135 635 days of MASK-air data from 1662 users from May 21, 2015, to Dec 31, 2021. The scores were strongly correlated with VAS dyspnoea (Spearman correlation coefficient range 0·68-0·82) and moderately correlated with work comparators and quality-of-life-related comparators (for WPAI:AS work, we observed Spearman correlation coefficients of 0·59-0·68). They also displayed high test-retest reliability (intraclass correlation coefficients range 0·79-0·95) and moderate-to-high responsiveness (correlation coefficient range 0·69-0·79; effect size measures range 0·57-0·99 in the comparison with VAS dyspnoea). The best-performing score displayed a strong correlation with the effect of asthma on work and school activities in the INSPIRERS cohort (Spearman correlation coefficients 0·70; 95% CI 0·61-0·78) and good accuracy for the identification of patients with uncontrolled or partly controlled asthma according to GINA (area under the receiver operating curve 0·73; 95% CI 0·68-0·78).

INTERPRETATION

e-DASTHMA is a good tool for the daily assessment of asthma control. This tool can be used as an endpoint in clinical trials as well as in clinical practice to assess fluctuations in asthma control and guide treatment optimisation.

FUNDING

None.

Asbestos dust concentrations and health conditions of workers at asbestos-cement corrugated sheet production manufacturers in Vietnam: a nationwide assessment

This study examined contemporary concentrations of asbestos dust during production and the health conditions of workers at asbestos-cement corrugated sheet production manufacturers in Vietnam. A nationwide survey was conducted on 28 factories (with 206 air samples) and 2459 workers. Asbestos fiber dust and the health status of workers were assessed. Results showed that 108/206 (52.4%) samples had asbestos fiber dust. The average concentration of asbestos fibers was 0.19 ± 0.14 fibers/ml. The percentage of workers with thickened pleural lesions/pleural calcification nodules was low. More studies are needed to evaluate the effectiveness of biomarkers in preventing the onset of lung cancer and mesothelioma in workers.

Partially different? The importance of general equilibrium in health economic evaluations: An application to nocturia

Both the human capital approach and the friction cost approach are frequently used to quantify the productivity costs associated with illness, disability or death in health economic evaluations. In this paper we argue that these approaches have one major, but common shortcoming: they only capture partial equilibrium (PE) effects and therefore underestimate the true potential productivity costs associated with health conditions. They neglect the sizable, indirect, ripple effects in the economy captured by general equilibrium (GE) models. To demonstrate our point, we compare a traditional PE with a GE approach for the application to nocturia, a condition characterized by the need to frequently wake up at night to urinate. Nocturia is associated with substantial impairment of daytime functioning and work productivity. We employ large-scale United Kingdom (UK) employer-employee survey data to estimate the prevalence and productivity loss. These estimates are then used as shared inputs to drive both approaches. We find that the traditional PE approach underestimates the annual productivity cost of clinically relevant nocturia by around 16%. We propose a generalized GE/PE multiplier to approximate the GE effect for other health conditions. Our findings stress the importance of accounting for sizable GE effects when conducting health economic evaluations.

Reduced Immune Fitness and Job Performance: Absenteeism, Presenteeism, and Associated Costs for the Dutch Economy

Reduced immune fitness can have a significant negative impact on work performance. The aim of the current study was to evaluate the impact of reduced immune fitness on job performance and associated costs for the Dutch economy. Data from n = 425 Dutch working adults (18-65 years old) who completed an online survey were analyzed to evaluate the number of days of absenteeism (not going to work) and presenteeism (working while sick) due to reduced immune fitness, and the performance level on days worked with reduced immune fitness. Data from for the year 2019 were analyzed. Participants reported 2.9 absenteeism days and 19 presenteeism days, with an average performance reduction of 22.8% when working on days with reduced immune fitness. Significantly more days of absenteeism and presenteeism were reported by women, individuals with a poorer immune fitness, and those with underlying disease. Performance impairment on days worked while experiencing reduced immune fitness was significantly greater among individuals with a younger age at the junior career level, those with underlying disease, and among highly educated individuals. The associated costs of reduced immune fitness were estimated at €4.3 billion for absenteeism and €6.4 billion for presenteeism. Together, the costs of reduced immune fitness for the Dutch economy in 2019 were estimated at €10.7 billion. These findings demonstrate that reduced immune fitness has a significant negative impact on the Dutch economy.

Family Spillover Effects: Are Economic Evaluations Misrepresenting the Value of Healthcare Interventions to Society?

The societal impacts of health interventions are seldom incorporated into health economic evaluations, including the impact that illness can have on informal or unpaid caregivers and other family members (i.e., "family spillover effects"). Previous research has demonstrated that by excluding family spillover effects, the value of health interventions may be underestimated on average. In this commentary, we discuss how the inclusion of spillover effects influences how we value interventions and, given the extent to which caregiver/family effects are largely not captured or known, propose ways in which these data could be more systematically collected or estimated and used by researchers. These recommendations include prioritizing data collection alongside clinical trials and patient registries, engaging expert opinion panels, and developing mapping algorithms for estimating caregiver/family utility values from non-preference-based caregiver health-related quality-of-life measures and/or from patient preference-based measures.

Effectiveness of rib fixation compared to pain medication alone on pain control in patients with uncomplicated rib fractures: study protocol of a pragmatic multicenter randomized controlled trial-the PAROS study (Pain After Rib OSteosynthesis)

Background

Persistent pain and disability following rib fractures result in a large psycho-socio-economic impact for health-care system. Benefits of rib osteosynthesis are well documented in patients with flail chest that necessitates invasive ventilation. In patients with uncomplicated and simple rib fractures, indication for rib osteosynthesis is not clear. The aim of this trial is to compare pain at 2 months after rib osteosynthesis versus medical therapy.

Methods

This trial is a pragmatic multicenter, randomized, superiority, controlled, two-arm, not-blinded, trial that compares pain evolution between rib fixation and standard pain medication versus standard pain medication alone in patients with uncomplicated rib fractures. The study takes place in three hospitals of Thoracic Surgery of Western Switzerland. Primary outcome is pain measured by the brief pain inventory (BPI) questionnaire at 2 months post-surgery. The study includes follow-up assessments at 1, 2, 3, 6, and 12 months after discharge. To be able to detect at least 2 point-difference on the BPI between both groups (standard deviation 2) with 90% power and two-sided 5% type I error, 46 patients per group are required. Adjusting for 10% drop-outs leads to 51 patients per group.

Discussion

Uncomplicated rib fractures have a significant medico-economic impact. Surgical treatment with rib fixation could result in better clinical recovery of patients with uncomplicated rib fractures. These improved outcomes could include less acute and chronic pain, improved pulmonary function and quality of life, and shorter return to work. Finally, surgical treatment could then result in less financial costs.

Trial registration

ClinicalTrials.govNCT04745520. Registered on 8 February 2021.

Incorporating productivity loss in health economic evaluations: a review of guidelines and practices worldwide for research agenda in China

Introduction

Productivity loss may contribute to a large proportion of costs of health conditions in an economic evaluation from a societal perspective, but there is currently a lack of methodological consensus on how productivity loss should be measured and valued. Despite the research progress surrounding this issue in other countries, it has been rarely discussed in China.

Methods

We reviewed the official guidelines on economic evaluations in different countries and regions and screened the literature to summarise the extent to which productivity loss was incorporated in economic evaluations and the underlying methodological challenges.

Results

A total of 48 guidelines from 46 countries/regions were included. Although 32 (67%) guidelines recommend excluding productivity loss in the base case analysis, 23 (48%) guidelines recommend including productivity loss in the base case or additional analyses. Through a review of systematic reviews and the economic evaluation studies included in these reviews, we found that the average probability of incorporating productivity loss in an economic evaluation was 10.2%. Among the economic evaluations (n=478) that explicitly considered productivity loss, most (n=455) considered losses from paid work, while only a few studies (n=23) considered unpaid work losses. Recognising the existing methodological challenges and the specific context of China, we proposed a practical research agenda and a disease list for progress on this topic, including the development of the disease list comprehensively consisting of health conditions where the productivity loss should be incorporated into economic evaluations.

Conclusion

An increasing number of guidelines recommend the inclusion of productivity loss in the base case or additional analyses of economic evaluation. We optimistically expect that more Chinese researchers notice the importance of incorporating productivity loss in economic evaluations and anticipate guidelines that may be suitable for Chinese practitioners and decision-makers that facilitate the advancement of research on productivity loss measurement and valuation.

Development and Validation of Lost Days of Labor Productivity Scale to Evaluate the Business Cost of Intimate Partner Violence

Developing scientific evidence showing the impact of intimate partner violence (IPV) on companies' productivity is an effective way to involve them in IPV prevention. However, there are no suitable and brief self-report instruments available that measure this impact on labor settings. This study develops and assesses the measurement properties of lost days of labor productivity scale based on tardiness, absenteeism, and presenteeism which may be due to IPV. Fourteen items have been developed and tested for 2,017 employees in 306 companies in Ghana, Pakistan, and South Sudan. Descriptive statistics, confirmatory factor analysis, heterotrait-monotrait matrix, and reliability coefficients have been conducted to assess the reliability of the scores. Confirmatory factor analysis indicates a two-factor second-order solution, stable by sex and countries. All subscales demonstrate good reliability, construct and discriminant validity, showing that the scale is a valid and reliable self-report questionnaire, which may measure the impact of IPV on businesses.

Development and validation of combined symptom-medication scores for allergic rhinitis

BACKGROUND

Validated combined symptom-medication scores (CSMSs) are needed to investigate the effects of allergic rhinitis treatments. This study aimed to use real-life data from the MASK-air^® app to generate and validate hypothesis- and data-driven CSMSs.

METHODS

We used MASK-air^® data to assess the concurrent validity, test-retest reliability and responsiveness of one hypothesis-driven CSMS (modified CSMS: mCSMS), one mixed hypothesis- and data-driven score (mixed score), and several data-driven CSMSs. The latter were generated with MASK-air^® data following cluster analysis and regression models or factor analysis. These CSMSs were compared with scales measuring (i) the impact of rhinitis on work productivity (visual analogue scale [VAS] of work of MASK-air^® , and Work Productivity and Activity Impairment: Allergy Specific [WPAI-AS]), (ii) quality-of-life (EQ-5D VAS) and (iii) control of allergic diseases (Control of Allergic Rhinitis and Asthma Test [CARAT]).

RESULTS

We assessed 317,176 days of MASK-air^® use from 17,780 users aged 16-90 years, in 25 countries. The mCSMS and the factor analyses-based CSMSs displayed poorer validity and responsiveness compared to the remaining CSMSs. The latter displayed moderate-to-strong correlations with the tested comparators, high test-retest reliability and moderate-to-large responsiveness. Among data-driven CSMSs, a better performance was observed for cluster analyses-based CSMSs. High accuracy (capacity of discriminating different levels of rhinitis control) was observed for the latter (AUC-ROC = 0.904) and for the mixed CSMS (AUC-ROC = 0.820).

CONCLUSION

The mixed CSMS and the cluster-based CSMSs presented medium-high validity, reliability and accuracy, rendering them as candidates for primary endpoints in future rhinitis trials.

Fracture-related infection in long bone fractures: A comprehensive analysis of the economic impact and influence on quality of life

OBJECTIVES

Fracture-related infection (FRI) is a feared complication with substantial clinical and economic consequences. The main objective of this study was to compare direct and indirect healthcare costs related to long bone fractures in patients with and without FRI and to assess its impact on the patient's quality of life (QoL).

PATIENTS AND METHODS

Between January 2015 and March 2019, 175 patients with FRI were treated at the University Hospitals Leuven (Belgium). Using a matched-pair analysis, patients with an FRI were matched by age, sex, and fracture location (humeral, femoral, or tibial shaft) to a non-FRI cohort treated during the same time period. Clinical and process-related variables, direct hospital-related healthcare costs, and indirect costs due to absenteeism were compared between the two groups. Furthermore, the patient's QoL was evaluated using Patient-Reported Outcomes Measurement Information System (PROMIS) physical function and pain interference.

RESULTS

After matched-pair analysis, 15 patients in both the FRI and non-FRI group were included. FRI was associated with direct hospital-related costs being eight times that of non-FRI patients (€ 47,845 [€ 43,072-€ 82,548] vs. € 5,983 [€ 4,519-€ 8,428], p < 0.001). Furthermore, FRI was associated with prolonged absenteeism (340 [340-676] vs. 86 [65-216] days, p = 0.007) and a median indirect cost that was nearly four times that of patients without FRI (€ 77,909 vs. € 19,706). Lastly, FRI patients showed significantly poorer outcomes on both physical function (35.6 vs. 48.4, p < 0.001) and pain interference (60.4 vs. 46.3, p < 0.001) PROMIS scales.

CONCLUSION

Direct hospital-related healthcare costs of FRI are eight times that of non-FRI long bone fractures. Total healthcare costs are mainly driven by hospitalisation costs, wherein FRI is associated with prolonged length of stay. To the best of our knowledge, this study is the first to demonstrate that FRI is also associated with substantial absenteeism, which is almost four times higher compared to non-FRI patients. In addition to this economic impact, FRI significantly deteriorates QoL. Generalizing the outcome of this study should be done cautiously due to the small sample size of 15 patients in both the FRI and non-FRI group after matched-pair analysis.

Measurement Instruments of Productivity Loss of Paid and Unpaid Work: A Systematic Review and Assessment of Suitability for Health Economic Evaluations From a Societal Perspective

OBJECTIVES

This study aimed (1) to perform a systematic literature review of instruments for measuring productivity loss of paid and unpaid work and (2) to assess the suitability (in terms of identification, measurement, and valuation) of these instruments for use in health economic evaluations from a societal perspective.

METHODS

Articles published from 2018 were sourced from PubMed/Medline, PsycInfo, Embase, and Econlit. Using 2 separate search strategies, eligible economic evaluations and validation studies were selected and unique measurement instruments identified. A data-extraction form was developed by studying previous literature and consulting an international panel of experts in the field of productivity costs. This data-extraction form was applied to assess the suitability of instruments for use in economic evaluations.

RESULTS

A total of 5982 articles were retrieved from the databases, of which 99 economic evaluations and 9 validation studies were included in the review. A total of 42 unique measurement instruments were identified. Nine instruments provided quantified measures of absenteeism, presenteeism, and unpaid work. Five instruments supplied the necessary information to enable the use of at least 1 common valuation method. The Health and Labour Questionnaire-Short Form, Health and Labour Questionnaire, and Institute for Medical Technology Assessment Productivity Cost Questionnaire met both criteria. Nevertheless, the developers replaced the Health and Labour Questionnaire-Short Form and Health and Labour Questionnaire by the more recently developed Institute for Medical Technology Assessment Productivity Cost Questionnaire.

CONCLUSIONS

Although many instruments for measuring productivity loss were identified, most were not suitable for capturing productivity changes for economic evaluations from a societal perspective. Future research can benefit from this study by making an informed instrument choice for the measurement of productivity loss of paid and unpaid work.

Domain-Specific Active and Sedentary Behaviors in Relation to Workers' Presenteeism and Absenteeism

OBJECTIVES

To examine the associations between domain-specific sedentary and active behaviors and workers' presenteeism and absenteeism in a sample of company employees.

METHODS

This study recruited participants (n = 2466) from a nationwide online survey database (Japan, 2019). Participants completed a questionnaire that captured data on relative and absolute presenteeism and absenteeism and domain-specific physical activity and sedentary behaviors.

RESULTS

Daily minutes of work-related physical activity were negatively associated with relative absenteeism. Daily minutes of leisure-related physical activity were positively associated with absolute presenteeism (ie, better productivity). Daily minutes of total physical activity were negatively and positively associated with relative absenteeism and absolute presenteeism (ie, better productivity). There was also a positive association between car sitting time and absolute absenteeism.

CONCLUSIONS

A change in work culture and practices that support active behaviors at work and outside of work may improve employee's productivity indices.

Epidemiology, work and economic impact of migraine in a large hospital cohort: time to raise awareness and promote sustainability

BACKGROUND

Migraine is not routinely assessed at work, making impossible to realize its impact and the potential benefit of migraine-related health strategies. We aimed to assess epidemiology, work and economic impact of migraine in a workplace cohort of a tertiary hospital.

METHODS

Cross-sectional analysis of a cohort of employees working in a Spanish tertiary hospital. Through a web questionnaire, we screened participants for migraine, collecting demographic data, work characteristics, work impairment due to headache (WPAI), treatments and healthcare resource utilization. We calculated direct and indirect costs for the hospital.

RESULTS

Six hundred sixty-seven employees participated (8.8%). 71.2% (475/667) fulfilled criteria for migraine, being 76.8% (365/475) low-frequency episodic migraine (LFEM), 12.6% (60/475) high-frequency episodic migraine (HFEM) and 10.5% (50/475) chronic migraine (CM). Only 56.2% (267/475) were aware of suffering from migraine. Only 43.3% (26/60) of HFEM and 56.0% (28/50) of CM have been on preventive treatment in the last year. Migraine caused an overall economic loss for the hospital of 439,848.90 €/month, as a result of utilization of healthcare resources at the workplace (136,028.0 €/month) and indirect costs (absenteeism + presenteeism: 303,820.90 €/month). Specifically, only 110 participants (HFEM + CM) were responsible for half of indirect costs (165,017.2€/month).

CONCLUSIONS

Although healthcare professionals have greater knowledge on health issues, migraine is underdiagnosed and undertreated, leading to a significant economic loss for the hospital. These results urge companies to assess migraine and promote stronger and migraine-specific health strategies at the workplace as a way to improve their own economic sustainability and the burden of migraine in their workforce.

Supervisor ratings of productivity loss associated with presenteeism and sick leave due to musculoskeletal disorders and common mental disorders in Sweden

BACKGROUND

Health problems due to musculoskeletal disorders (MSD) and common mental disorders (CMD) result in costs due to lost productivity.

OBJECTIVE

This study aimed to increase knowledge of employers' productivity loss due to employees' presenteeism and sickness absence.

METHODS

A web questionnaire was sent to employers of workers who were sick-listed for more than 30 days due to MSD or CMD, response rate: 50%, n = 198. Presenteeism and the impact on productivity before and after sick leave, and the performance of work tasks by replacement workers during sick leave, were measured using supervisors' ratings.

RESULTS

The average loss of productivity per sick-leave case amounted to almost 10 weeks, 53%of productivity loss was attributable to presenteeism and 47%to lower productivity by replacement workers. Employees with a CMD diagnosis had significantly higher presenteeism-related productivity loss than those with MSD.

CONCLUSIONS

Employers experienced substantial productivity loss associated with employees' presenteeism and sick leave. Whether the supervisory rating of presenteeism is preferable to employee self-rating needs to be studied further. The long duration of presenteeism is counter-productive to resource-efficient organisations and indicates the need for improved supervisory skills to identify workers with poor health, both before and after sick leave.

Effects of an Internet-Based Cognitive Behavioral Therapy for Insomnia Program on Work Productivity: A Secondary Analysis

BACKGROUND

Cognitive-behavioral therapy for insomnia (CBT-I) may improve productivity along with insomnia symptoms, but the long-term duration of productivity gains is unknown.

PURPOSE

In this secondary analysis, effects of Internet-delivered CBT-I on work-related and daily activity productivity were examined through 1 year post-treatment.

METHODS

Adults with chronic insomnia (N = 303) were randomized to Internet-delivered CBT-I (Sleep Healthy Using the Internet [SHUTi]) or to patient education (PE). Participants reported interference with attendance (absenteeism) and productivity (presenteeism) at paid employment and in daily activities outside work on the Work Productivity Activity Impairment scale at baseline, 9 weeks later for postintervention assessment (post-assessment), and 6- and 12-month follow-ups.

RESULTS

Participants randomized to SHUTi were about 50% less likely than those in the PE condition to report any absenteeism (logistic regression odds ratio [OR] = 0.48 [95% confidence intervals {CI} = 0.24,0.96]), total impairment (OR = 0.52 [95% CI = 0.29,0.93]), or activity impairment (OR = 0.50 [95% CI = 0.30,0.85]) at post-assessment; however, differences were not detected at 6- or 12-month follow-ups. SHUTi participants also reported lower overall levels of presenteeism (constrained longitudinal data analysis MDiff = -6.84 [95% CI = -11.53, -2.15]), total impairment (MDiff = -7.62 [95% CI = -12.50, -2.73]), and activity impairment (MDiff = -7.47 [95% CI = -12.68, -2.26]) at post-assessment relative to PE participants. Differences were sustained at 6-month follow-up for presenteeism (MDiff = -5.02 [95% CI = -9.94, -0.10]) and total impairment (MDiff = -5.78 [95% CI = -10.91, -0.65]). No differences were detected by 12-month follow-up.

CONCLUSIONS

Findings suggest that Internet-based CBT-I may help accelerate improvement in work-related and daily activity impairment corroborating prior research, but did not find that CBT-I has persistent, long-term benefits in productivity relative to basic insomnia education.

TRIAL REGISTRATION

NCT00328250 "Effectiveness of Internet Cognitive Behavioral Therapy Intervention for Treating Insomnia" (https://clinicaltrials.gov/ct2/show/NCT00328250).

Golimumab improves work productivity in patients suffering from moderate to severe ulcerative colitis: results of a prospective study over 24 months

BACKGROUND

Ulcerative colitis (UC) is a chronic inflammatory bowel disease with recurrent episodes of debilitating symptoms negatively affecting work productivity and health-related quality of life (HRQoL). The use of biologics in UC treatment improves work and HRQoL but prospective long-term data concerning the treatment with TNFα inhibitor golimumab in UC patients are still rare. Therefore, our study aimed to evaluate the change in work productivity, capacity for daily activities and HRQoL in UC patients treated with golimumab in Germany.

METHODS

Using the Work Productivity and Activity Impairment questionnaire, the change in work productivity and in capacity for daily activities after 3 months and over the whole observational period of 24 months were assessed (both primary endpoints). Disease-specific and health-related quality of life (QoL) were analyzed with the Inflammatory Bowel Disease Questionnaire (IBDQ), the Short-Form 12 Health Survey Questionnaire (SF-12), and the Partial Mayo Score (secondary endpoints). Further, disease-related hospitalization rates were assessed.

RESULTS

This prospective non-interventional study included 286 patients. Thereof, 212 patients were employed at baseline (modified intention to treat analysis set employed at baseline, mITTe). 61.3% of the mITTe patients had moderate and 17.0% had severe UC. Three months after initiation of golimumab therapy, total work productivity impairment (TWPI) score and activity impairment score improved significantly from baseline with a mean change of - 17.3% (p < 0.0001) and - 14.4% (p < 0.0001), respectively. Results persisted over 24 months (mean change TWPI score: - 24.5%, mean change activity impairment score: - 30.0%). Disease- and health-related QoL also improved significantly under golimumab treatment as indicated by increased IBDQ [mean change: 28.0 (SD: ± 36.1, month 3), 42.1 (SD: ± 39.5, month 24)] and SF-12 scores [PCS-12: 45.9 (SD: ± 8.5), MCS-12: 4.9 (SD: ± 10.6, month 3), PCS-12: 5.9 (SD: ± 9.0), MCS-12: 6.4 (SD: ± 11.1, month 24)]. Disease-related hospitalization rate decreased from 16.0% (BL) to 4.3% at month 24 and the mean number of missed working days due to UC decreased from 8.2 (SD: 17.6, BL) to 0.7 (SD: 2.1) after golimumab induction.

CONCLUSIONS

Golimumab leads to notable long-term improvements in work productivity, daily activity, HRQoL, and disease-related hospitalization rates in patients with moderate to severe UC.

TRIAL REGISTRATION

PEI (Paul-Ehrlich-Institute, Langen, Germany) Registration Nr: NIS#255 ( https://www.pei.de/SharedDocs/awb/nis-0201-0300/0255.html ).

Patients With Uncomplicated Coronavirus Disease 2019 (COVID-19) Have Long-Term Persistent Symptoms and Functional Impairment Similar to Patients with Severe COVID-19: A Cautionary Tale During a Global Pandemic

To assess the prevalence of persistent functional impairment after coronavirus disease (COVID-19), we assessed 118 individuals 3-4 months after their initial COVID-19 diagnosis with a symptom survey, work productivity and activity index questionnaire, and 6-minute walk test. We found significant persistent symptoms and functional impairment, even in non-hospitalized patients with COVID-19.

Identifying Health Economic Considerations to Include in the Research Protocol of a Randomized Controlled Trial (the REDUCE-RISK Trial): Systematic Literature Review and Assessment

Background

The REDUCE-RISK trial was set up to compare the effectiveness of weekly subcutaneously administered methotrexate with daily oral azathioprine or 6-mercaptopurine in low-risk Crohn disease (CD) or subcutaneously administered adalimumab (ADA) in high-risk CD in a pediatric population (age 6-17 years).

Objective

The aim of this study is to perform a systematic review to provide input into the research protocol to gather the necessary information to improve the performance of an evidence-based economic evaluation when the trial is finished.

Methods

The Centre for Reviews and Dissemination (CRD) Health Technology Assessment (HTA) database, websites of HTA institutes, CRD’s National Health Service Economic Evaluation Database, MEDLINE (OVID), and Embase databases were consulted to retrieve (reviews of) relevant economic evaluations. Studies were eligible if they included a pediatric or adult population with inflammatory bowel diseases (CD and ulcerative colitis [UC]) treated with ADA (Humira). There were no restrictions on the comparator. Only economic evaluations expressing outcomes in life years gained or quality-adjusted life years gained were selected.

Results

A total of 12 primary studies were identified. None of these studies included a pediatric population because of a lack of supporting trials. The economic evaluations identified in our systematic review indicate that ADA is an appropriate intervention for inclusion in such a trial. From a health economic point of view, it is important to make an incremental analysis comparing such an intervention with standard care and not immediately versus another (expensive) biological treatment. Information on the impact of children’s school attendance and parents’ productivity is currently lacking in economic evaluations, and none of the underlying trials measured quality of life (QoL) using a generic utility instrument.

Conclusions

The review of the economic literature on ADA for the treatment of patients with CD supports the performance of a trial with biologicals in pediatric patients, including making a distinction according to disease severity. Conducting an economic literature review enabled us to decide which variables should be added to the research protocol from an economic point of view. Measurements for children’s and parents’ QoL (EuroQol 5-Dimension questionnaires), children’s school attendance, and parents’ productivity (WPAI-CD-CG questionnaire) were added to the research protocol. This will provide support for the calculation of the cost-effectiveness of the interventions evaluated in the REDUCE-RISK trial.

Trial Registration

ClinicalTrials.gov NCT02852694; https://clinicaltrials.gov/ct2/show/NCT02852694

Healthcare resource use and indirect costs associated with migraine in Italy: results from the My Migraine Voice survey

AIMS

To evaluate the healthcare resource use (HRU) and cost of lost productivity due to migraine among Italians with ≥4 monthly migraine days (MMDs), with a focus on those with ≥2 prior preventive treatment failures (TFs).

MATERIALS AND METHODS

Data from Italian participants from the My Migraine Voice survey were used to assess migraine-related HRU and migraine's impact on work productivity and daily activities using the Work Productivity and Activity Impairment questionnaire. The mean, annualized cost of lost productivity was estimated using the Human Capital Approach and extrapolated to employed Italian population with ≥4 MMDs to calculate the overall migraine-related indirect cost burden in Italy.

RESULTS

Data of 420 participants, enrolled between September 2017 and February 2018, were analyzed (mean age: 38.5 years, 81.2% women, 37.8% with ≥2 TF). During a 6-month period, 57.6% of participants visited general practitioners (mean visits: 4.5), 31.9% neurologists (mean visits: 2.6), and 26.4% headache specialists (mean visits: 2.8). Overall, 32.0% of participants had ≥1 emergency room visit (mean visits: 2.8) and 15.0% had ≥1 hospitalization (mean visits: 2.9) because of migraine in the past 12 months. Participants who were employed (N = 215) reported 15.5% absenteeism, 45.3% presenteeism, 53.8% overall work impairment, and 52.6% activity impairment. The mean annualized indirect cost was estimated to be €14,368. The annual indirect cost burden was estimated to be €7.6 billion for the employed Italian population with ≥4 MMDs. The impact of migraine was particularly high among the ≥2 TF subgroups on all parameters. The indirect cost was estimated to be €15,881 (€5,007 attributed to absenteeism).

CONCLUSION

Migraine-related HRU and indirect costs are high among individuals with ≥4 MMDs (particularly those with ≥2 TF). There is a need for more effective treatments and better management of migraines to reduce the functional and economic burden among this difficult-to-treat population.

How to Know if You're Really There: An Evaluation of Measures for Presenteeism in Nursing

OBJECTIVES

To report presenteeism prevalence across presenteeism measures from the work-stress and sickness domains. To evaluate the psychometric fit of those measures in a nursing population.

METHODS

Cross-sectional descriptive survey of 447 US RNs using five reliable and validated measures of presenteeism: Stanford Presenteeism Scale (SPS), Job-Stress-Related Presenteesim Scale (JSRPS), Healthcare Productivity Scale (HPS), Nurses Work Functioning Questionnaire (NWFQ), and Health and Work Questionnaire (HWQ). The survey was evaluated using descriptive, exploratory, and confirmatory factor analysis.

RESULTS

Mean rates among nurses (SPS = 19.50, JSRPS = 2.1, HPS = -15.1, NWFQ = 17.0, and HWQ = 6.7) were higher than previously published and spanned both job-stress and sickness domains of presenteeism. We identified different factor structures than previously published for three of the five instruments.

CONCLUSION

An inclusive conceptualization of presenteeism that includes work-stress and sickness domains is crucial to developing future measures and interventions for presenteeism.

Self-Report Measures of Presenteeism Are Not Strongly Correlated With Health Workers' Logged Activity

OBJECTIVE

Low productivity while at work (presenteeism) has been reported to produce significant cost excesses for organizations and economies. However, many of these reports have been based on estimates drawn from self-report instruments that are not supported by evidence showing their efficacy. Thus, the aim of this study was to assess associations between responses to leading self-report tests of presenteeism and self-recorded on-the-job productivity.

METHODS

Health care worker self-ratings of productivity were taken from a questionnaire that contained the key item from each presenteeism instrument. Productivity levels were drawn from employee reported daily work activity logs.

RESULTS

Test-based productivity estimates did not show strong associations with daily recordings of work activity.

CONCLUSIONS

Associations were too low to recommend any test as a proxy measure for reported productivity. It is suggested that objective measures of work output be explored.

Impact of nutrition interventions and dietary nutrient density on productivity in the workplace

The global spread of diet-related noncommunicable diseases represents a threat to public health and national economies alike. The elimination of poverty and the eradication of hunger, two key United Nations Sustainable Development Goals, cannot be accomplished without a well-nourished labor force. Easy access to low-cost diets that are energy dense but nutrient poor has resulted in hidden hunger, in which micronutrient deficiencies coexist with obesity or overweight. Workplace interventions in low- and middle-income countries have addressed nutrient adequacy and micronutrient deficiencies, often using fortified foods. Workplace interventions in high-income countries have largely focused on weight loss, smoking cessation, stress reduction, and physical activity. Even though improvement of productivity may have been the ultimate goal, relatively few interventions in high-income countries have explored the likely impact of improved dietary nutrient density on workplace performance. Given that optimal nutrition benefits both physical and mental health, interventions to improve diet quality ought to have a measurable impact on the productivity of the labor force. The present review examines the evidence linking workplace dietary interventions with workplace productivity measures.

Development and validation of a questionnaire assessing household work limitations (HOWL-Q) in women with rheumatoid arthritis

INTRODUCTION

Rheumatoid arthritis (RA) has female preponderance and interferes with the ability to perform job roles. Household work has 2 dimensions, paid and unpaid. There is not a validated instrument that assesses the impact of RA on limitations to perform household work. We report the development and validation of a questionnaire that assesses such limitations, the HOWL-Q.

METHODS

The study was performed in 3 steps. Step-1 consisted on HOWL-Q conceptual model construction (literature review and semi-structured interviews to 20 RA outpatients and 20 controls, household workers, who integrated sample (S)-1). Step-2 consisted of instructions selection (by 25 outpatients integrating S-2), items generation and reduction (theory and key informant suggestions, modified natural semantic network technique, and pilot testing in 200 household workers outpatients conforming S-3), items scoring, and questionnaire feasibility (in S-3). Step-3 consisted of construct (exploratory factor analysis) and criterion validity (Spearman correlations), and HOWL-Q reliability (McDonald's Omega and test-retest), in 230 household work outpatients integrating S-4.

RESULTS

Patients conforming the 4 samples were representative of typical RA outpatients. The initial conceptual model included 8 dimensions and 76 tasks/activities. The final version included 41 items distributed in 5 dimensions, was found feasible and resulted in 62.46% of the variance explained: McDonald's Omega = 0.959, intraclass-correlation-coefficient = 0.921 (95% CI = 0.851-0.957). Moderate-to-high correlations were found between the HOLW-Q, the HAQ, the Quick-DASH and the Lawton-Brody index. HOWL-Q score ranged from 0 to 10, with increasing scores translate into increase limitations.

CONCLUSION

The HOWL-Q showed adequate psychometric properties to evaluate household work limitations in women with RA.

Cultural Adaptation and Validation of the Korean Version of the iMTA Productivity Cost Questionnaire

This study develops the Korean version of the Institute for Medical Technology Assessment Productivity Cost Questionnaire (iPCQ) through translation/cultural adaptation and evaluation of psychometric properties. We included 110 outpatients visiting a gynecology clinic. We conducted the translation and cross-cultural adaptation of the iPCQ, including forward and back-translation, pilot test with cognitive debriefing, and finalization. We analyzed the feasibility (using average time of filling in the iPCQ and the proportion of missing values), test–retest reliability (using the intra-class correlation coefficient [ICC]), and validity (concurrent validity with the Work Productivity and Activity Impairment [WPAI] and construct validity with the 36-Item Short Form Survey [SF-36], using Spearman’s ρ). The Korean version of iPCQ showed appropriate feasibility (average filling in time was 5.0 min without missing values), and had excellent values in the domains of absenteeism, presenteeism, and unpaid work for test–retest reliability (ICC: 0.92–0.99). For concurrent validity, the Korean version of iPCQ showed moderate–high correlation for absenteeism and presenteeism with the WPAI. All domains of productivity losses measured by the Korean version of iPCQ showed negative correlation with the quality of life estimated by the SF-36. Through this study, we developed a Korean instrument that can measure and value health-related productivity losses including unpaid work as well as absenteeism and presenteeism.

Assessment of Work Productivity and Activity Impairment (WPAI) questionnaire for migraine with the help of a smartphone app

BACKGROUND

Migraine is a major cause of disability, which affects many areas of life, including productivity at work. Measuring absenteeism and presenteeism resulting from migraine with the use of appropriate tools is essential for better understanding the impact of this disease.

OBJECTIVE

The aim of the present study was to assess the work impact of migraine using the Brazilian Portuguese version of Work Productivity and Activity Impairment (WPAI) questionnaire.

METHODS

This survey was carried out with the aid of a smartphone app (Dr Cefaleia for Doctors) containing the questionnaires: ID-Migraine, Headache Impact Test (HIT-6), and WPAI. The data were collected during a headache awareness event. Correlations were assessed between migraine impact (HIT-6) with WPAI parameters: a) work time missed (absenteeism), b) impairment at work (presenteeism), c) overall work productivity loss (absenteeism+presenteeism), and d) activity impairment outside work.

RESULTS

Overall, 305 subjects with headache were interviewed and 167 were classified as having migraine. No significant differences in migraine impact according to sex (p=0.8) and modality of work were registered (p=0.8). Females had significantly higher absenteeism score (p<0.001), but presenteeism score was not significantly different between genders (p=0.3). WPAI absenteeism and presenteeism scores significantly correlated with migraine impact (HIT-6).

CONCLUSIONS

The results suggest WPAI Brazilian Portuguese version was efficient in assessing migraine related work impact. The use of an app with validated questionnaires facilitates the conduction of migraine impact research in different populations, allowing a better understanding of the burden of this disease.

Golimumab in real-world practice in patients with ulcerative colitis: Twelve-month results

BACKGROUND

The introduction of biologics has revolutionized the management of the chronic inflammatory bowel disease, ulcerative colitis (UC), with many patients experiencing significant improvements not only in their symptoms but in other outcomes relevant to individuals and society as a whole. In Germany, there are no prospective data > 3 mo that assess the work productivity, daily activities and quality of life (QoL) of patients with moderate-to-severe UC treated with golimumab.

AIM

To assess change in work productivity, capacity for daily activities and QoL in UC patients treated with golimumab in Germany.

METHODS

The validated Work Productivity Activity Impairment (WPAI) Questionnaire was used to analyze the change in work productivity, the capacity for daily activities after three months (primary endpoint) and disease specific and health related QoL (HRQoL) up to 1 year (secondary endpoints). The changes in work productivity and activity impairment were evaluated every three months until month twelve compared to baseline. Disease-specific and health-related QoL were assessed with the inflammatory bowel disease questionnaire and with the short-form 12 health survey questionnaire (SF-12).

RESULTS

This prospective non-interventional study included 287 patients. The analysis population was comprised of 282 patients who had completed at least two visits. At baseline, 61% of patients had moderate UC and 18% had severe UC. Furthermore, 75% of patients worked full-time or part-time at baseline. A total of 212 patients who were employed at the start of the study (employed population) were evaluated for the primary endpoint. Golimumab significantly reduced all WPAI sub-scores compared to baseline after three, six, nine and twelve months after the start of treatment (P < 0.0001). In addition, disease-specific QoL and HRQoL, as measured by the SF-12 questionnaire, improved significantly with golimumab at all evaluation times (P < 0.0001 in each case vs baseline).

CONCLUSION

Treatment of moderate-to-severe UC with golimumab leads to significant improvements in patient´s work productivity, daily activity and QoL over twelve months.

The socioeconomic burden of chronic lung disease in low-resource settings across the globe - an observational FRESH AIR study

Background

Low-resource settings are disproportionally burdened by chronic lung disease due to early childhood disadvantages and indoor/outdoor air pollution. However, data on the socioeconomic impact of respiratory diseases in these settings are largely lacking. Therefore, we aimed to estimate the chronic lung disease-related socioeconomic burden in diverse low-resource settings across the globe. To inform governmental and health policy, we focused on work productivity and activity impairment and its modifiable clinical and environmental risk factors.

Methods

We performed a cross-sectional, observational FRESH AIR study in Uganda, Vietnam, Kyrgyzstan, and Greece. We assessed the chronic lung disease-related socioeconomic burden using validated questionnaires among spirometry-diagnosed COPD and/or asthma patients (total N = 1040). Predictors for a higher burden were studied using multivariable linear regression models including demographics (e.g. age, gender), health parameters (breathlessness, comorbidities), and risk factors for chronic lung disease (smoking, solid fuel use). We applied identical models per country, which we subsequently meta-analyzed.

Results

Employed patients reported a median [IQR] overall work impairment due to chronic lung disease of 30% [1.8–51.7] and decreased productivity (presenteeism) of 20.0% [0.0–40.0]. Remarkably, work time missed (absenteeism) was 0.0% [0.0–16.7]. The total population reported 40.0% [20.0–60.0] impairment in daily activities. Breathlessness severity (MRC-scale) (B = 8.92, 95%CI = 7.47–10.36), smoking (B = 5.97, 95%CI = 1.73–10.22), and solid fuel use (B = 3.94, 95%CI = 0.56–7.31) were potentially modifiable risk factors for impairment.

Conclusions

In low-resource settings, chronic lung disease-related absenteeism is relatively low compared to the substantial presenteeism and activity impairment. Possibly, given the lack of social security systems, relatively few people take days off work at the expense of decreased productivity. Breathlessness (MRC-score), smoking, and solid fuel use are potentially modifiable predictors for higher impairment. Results warrant increased awareness, preventive actions and clinical management of lung diseases in low-resource settings from health policymakers and healthcare workers.

Who gains the most from improving working conditions? Health-related absenteeism and presenteeism due to stress at work

Work stress-related productivity losses represent a substantial economic burden. In this study, we estimate the effects of social and task-related stressors and resources at work on health-related productivity losses caused by absenteeism and presenteeism. We also explore the interaction effects between job stressors, job resources and personal resources and estimate the costs of work stress. Work stress is defined as exposure to an unfavorable combination of high job stressors and low job resources. The study is based on a repeated survey assessing work productivity and workplace characteristics among Swiss employees. We use a representative cross-sectional data set and a longitudinal data set and apply both OLS and fixed effects models. We find that an increase in task-related and social job stressors increases health-related productivity losses, whereas an increase in social job resources and personal resources (measured by occupational self-efficacy) reduces these losses. Moreover, we find that job stressors have a stronger effect on health-related productivity losses for employees lacking personal and job resources, and that employees with high levels of job stressors and low personal resources will profit the most from an increase in job resources. Productivity losses due to absenteeism and presenteeism attributable to work stress are estimated at 195 Swiss francs per person and month. Our study has implications for interventions aiming to reduce health absenteeism and presenteeism.

Perceived Workplace Health and Safety Climates: Associations With Worker Outcomes and Productivity

INTRODUCTION

This study investigates the associations between perceived workplace health and safety climates and a variety of worker and employer outcomes.

METHODS

Self-reported data were collected from an employee health assessment offered at 3 companies (n=959) in 2014. Independent variables included 2 climate variables: perceived safety climate and perceived health and well-being climate. Logistic regression models, performed in 2016-2017, explored the associations between the 2 climate variables and 3 sets of outcomes: worker outcomes, worker health behaviors, and employer outcomes.

RESULTS

Perceived workplace safety climate was positively associated with physical activity and optimal sleep. Stronger perceived workplace health and well-being and safety climates were related to less depression, higher job and life satisfaction, less back pain, and higher general health. Stronger perceived climates of workplace safety and health and well-being were associated with less productivity loss.

CONCLUSIONS

Conditions of work, such as perceived climate, are associated with improved worker behaviors (physical activity and sleep), worker outcomes (depression, job and life satisfaction, back pain, and general health), and employer (productivity) outcomes.

Do job stress, health, and presenteeism differ between Chinese healthcare workers in public and private hospitals: a cross sectional study

To determine if job stress, health, and presenteeism differ between healthcare workers at Chinese public and private hospitals. This cross-sectional study analyzed the records of 1080 healthcare workers in eastern, central, and western China for the period from January2015 through November2015. Data on challenge stress, hindrance stress, health, and presenteeism were collected. Using univariate and multivariate regression and SPSS, we investigated differences between Chinese public and private hospitals in China. Challenge stress, hindrance stress, and presenteeism, but not health status, significantly differed between healthcare workers at public and private hospitals in China. Challenge stress and hindrance stress were significantly higher in public hospitals, while presenteeism was significantly lower in private hospitals. The significant differences between public and private hospitals are attributable to differences in the business practices and management of public and private hospitals. To achieve successful long-term medical reform in China, the adverse effects of psychosocial factors should be considered in future research plans and policies. Chinese hospitals urgently require improvements in management and leadership. Reform efforts should encompass fields such as management science, psychology, and the behavioral sciences.

Validity and responsiveness of the Work Functioning Impairment Scale (WFun) in rheumatoid arthritis patients: A multicenter prospective study

Objective: Previous studies have not fully evaluated the measurement properties of the Work Functioning Impairment Scale (WFun) in clinical situations and there are no data from patients with rheumatoid arthritis (RA). This study aimed to investigate the convergent validity and responsiveness of the WFun in patients with RA.Methods: This substudy was a part of the multicenter, observational, prospective FIRST ACT-SC study. In total, 322 paid workers with RA received anti-rheumatic drugs at baseline. The WFun, Disease Activity Score based on 28 joints and erythrocyte sedimentation rate (DAS28-ESR), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), Work Productivity and Activity Impairment Questionnaire (WPAI), and Japanese Health Assessment Questionnaire Disability Index (HAQ-DI) were administrated at baseline and weeks 12, 24, and 52. Multilevel regression analyses were performed.Results: High average WFun scores were associated with higher score categories of the DAS28-ESR, CDAI, SDAI, WPAI and HAQ-DI. Average WFun change scores linearly decreased with decreases on each instruments.Conclusion: The findings indicate that the WFun has reasonable measurement properties: the scale demonstrated validity and responsiveness with RA patients. The WFun could be useful in assessing presenteeism in patients with RA.

Rationale, design, and baseline data for a multicenter randomized clinical trial comparing depression screening strategies after acute coronary syndrome: The comparison of depression identification after acute Coronary Syndromes-Quality of Life and Cost Outcomes (CODIACS-QOL) trial

BACKGROUND

Elevated depressive symptoms among survivors of acute coronary syndromes (ACS) confer recurrent cardiovascular events and mortality, worse quality of life, and higher healthcare costs. While multiple scientific groups advise routine depression screening for ACS survivors, no randomized trials exist to inform this screening recommendation. We aimed to assess the effect of screening for depression on change in quality of life over 18 months among ACS patients.

METHODS

The Comparison of Depression Identification after Acute Coronary Syndrome on Quality of Life and Cost Outcomes (CODIACS-QoL) trial is a pragmatic, 3-arm trial that randomized ACS patients to 1) systematic depression screening using the 8-item Patient Health Questionnaire (PHQ-8) and if positive screen (PHQ-8 ≥ 10), notification of primary care providers (PCPs) and invitation to participate in centralized, patient-preference, stepped depression care (Screen, Notify, and Treat, N = 499); 2) systematic depression screening and PCP notification only (Screen and Notify, N = 501); and 3) usual care (No Screen, N = 500). Adults hospitalized for ACS in the previous 2-12 months without prior history of depression were eligible for participation. Key outcomes will be quality-adjusted life years (primary), cost of health care utilization, and depression-free days across 18 months.

RESULTS

A total of 1500 patients were randomized in the CODIACS-QOL trial (28.3% women; 16.3% Hispanic; mean age 65.9 (11.5) years). Only 7% of ACS survivors had elevated depressive symptoms.

CONCLUSIONS

Using a novel randomization schema and pragmatic design principles, the CODIACS-QoL trial achieved its enrollment target. Eventual results of this trial will inform future depression screening recommendations in cardiac patients.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT01993017).

The Effect of Presenteeism on Productivity Loss in Nurses: The Mediation of Health and the Moderation of General Self-Efficacy

Background: Seventy-four percent of Chinese employees have experienced working with illness, but limited number of researchers have paid attention on this phenomenon. Most of the previous research on presenteeism has almost exclusively focused on North America and Europe and have gone to the financial emphasis. The current researches have two shortages, which are laying in the consensus on the definition and measurement of presenteeism, as well as the mechanism of presenteeism and its outcomes have set barriers for scholars to generate deeper understanding of the behavior. The aim of the present study was to explore the current situation of presenteeism among Chinese nurses and the mediating effect of health and the moderating effect of general self-efficacy between presenteeism and productivity loss. Methods: Data were collected from a sample of 340 female nurses from a 3A-graded general hospital in Henan Province, China by using the Sickness Presenteeism Questionnaire (SPQ), the Stanford Presenteeism Scale (SPS-6), the 12-item General Health Questionnaire (GHQ-12), and the General Self-Efficacy Scale (GSES). Results: The results indicated that the mean of SPQ was 3.2 ± 0.7 in this sample, and there were significant differences in age and marital status in SPQ scores. Presenteeism was significantly associated with health and productivity loss, and health was significantly associated with productivity loss, and general self-efficacy was negatively associated with productivity loss. A bootstrap test showed that health fully mediated the relationship between presenteeism and productivity loss in nurses. Hierarchical regression analysis confirmed the moderating role of general self-efficacy between presenteeism and productivity loss. Conclusions: Presenteeism can significantly predict productivity loss in nurses, and hospital management can improve the physical and mental health of nurses and enhance their self-efficacy level to reduce the negative impact of presenteeism on productivity loss.