This randomized controlled trial was designed to evaluate the 2-year costs and effects of a proactive, public health nursing case management approach compared with a self-directed approach for 129 single parents (98% were mothers) on social assistance in a Canadian setting. A total of 43% of these parents had a major depressive disorder and 38% had two or three other health conditions at baseline.
Study participants were recruited over a 12 month period and randomized into two groups: one receiving proactive public health nursing and one which did not.
At 2 years, 69 single parents with 123 children receiving proactive public health nursing (compared with 60 parents with 91 children who did not receive public health nursing services) showed a slightly greater reduction in dysthymia and slightly higher social adjustment. There was no difference between the public health and control groups in total per parent annual cost of health and support services. However, costs were averted due to a 12% difference in non-use of social assistance in the previous 12 months for parents in the public health nursing group. This translates into an annual cost saving of 240,000 dollars (Canadian) of costs averted within 1 year for every 100 parents.
In the context of a system of national health and social insurance, this study supports the fact that it is no more costly to proactively service this population of parents on social assistance.
The aim of the present study was to evaluate the long-term outcome of a behavioural medicine rehabilitation programme and the outcome of its two main components, compared to a 'treatment-as-usual' control group. The study employed a 4 x 5 repeated-measures design with four groups and five assessment periods during a 3-year follow-up. The group studied consisted of blue-collar and service/care workers on sick leave, identified in a nationwide health insurance scheme in Sweden. After inclusion, the subjects were randomised to one of the four conditions: behaviour-oriented physiotherapy (PT), cognitive behavioural therapy (CBT), behavioural medicine rehabilitation consisting of PT+CBT (BM) and a 'treatment-as-usual' control group (CG). Outcome variables were sick leave, early retirement and health-related quality of life. A cost-effectiveness analysis, comparing the programmes, was made. The results showed, consistently, the full-time behavioural medicine programme being superior to the three other conditions. The strongest effect was found on females. Regarding sick leave, the mean difference in the per-protocol analysis between the BM programme and the control group was 201 days, thus reducing sick leave by about two-thirds of a working year. Rehabilitating women has a substantial impact on costs for production losses, whereas rehabilitating men seem to be effortless with no significant effect on either health or costs. In conclusion, a full-time behavioural medicine programme is a cost-effective method for improving health and increasing return to work in women working in blue-collar or service/care occupations and suffering from back/neck pain.
There is a scarcity of prospective long-term studies on work disability caused by depression. We investigated predictors for disability pension among psychiatric patients with MDD.
The Vantaa Depression Study followed up prospectively 269 psychiatric in- and out-patients with DSM-IV MDD for 5 years with a life chart, including 230 (91.3%) patients belonging to labour force. Information on disability pensions was obtained from interviews, patient records and registers.
Within 5 years, 20% of the patients belonging to labour force at baseline were granted a disability pension. In multivariate analyses, the significant baseline predictors for granted disability pension were age =50 years (HR = 3.91, P
The aim of the study was to evaluate the outcome 6 years after completing a multiprofessional 8-week rehabilitation programme regarding the following objectives: (1) return to work, (2) level of activity and (3) pain intensity. Of 149 patients attending a rehabilitation programme, 122 were followed up after 6 years, through a structured telephone interview, and their present work situation, level of activity, sleeping habits, their estimated pain intensity and consumption of analgesics were recorded. The questions presented were the same as they had answered before entering the programme. The return-to-work rate was compared to 79 patients in a control group. At the 6-year follow-up, compared to before entering the programme, 52% had returned to work (P
Mental disorders are a key cause of sickness absence (SA) and challenge prolonging working careers. Thus, evidence on the development of SA trends is needed. In this study, educational differences in long SAs due to mental disorders were examined in two age groups among employees of the City of Helsinki from 2004 to 2013.
All permanently and temporarily employed staff aged 18-34 and 35-49 were included in the analyses (n=~27800 per year). SA spells of =14 days due to mental disorders were examined annually. Education was classified to higher and lower levels. Joinpoint regression was used to identify major turning points in SA trends.
Joinpoint regression models showed that lower educated groups had more long SAs spells due to mental disorders than those groups with higher education. SA trends decreased during the study period in all studied age and educational groups. Lower educated age groups had similar SA trends. Younger employees with higher education had the fewest SAs.
A clear educational gradient was found in long SAs due to mental disorders during the study period. SA trends decreased from 2004 to 2013.
BACKGROUND AND PURPOSE: Neck/shoulder and low back pain are common in the Western world and can cause great personal and economic consequences, but so far there are few long term follow-up studies of the consequences of back pain, especially studies that separate the location of back pain. More knowledge is needed about different patterns of risk factors and prognoses for neck/shoulder and low back pain, respectively, and they should not be treated as similar conditions. The aim of the present study was to investigate possible long-term differences in neck/shoulder and low back symptoms, experienced over a 12-year period, with regard to work status, present health, discomfort and influence on daily activities. METHOD: A retrospective cohort study of individuals sicklisted with neck/shoulder or low back diagnoses 12 years ago was undertaken. Included were all 213 people who, in 1985, lived in the municipality of Linköping, Sweden, were aged 25-34 years and who had taken at least one new period of sickleave lasting > 28 days with a neck/shoulder or low back diagnosis. In 1996, a questionnaire was mailed to the 204 people who were still resident in Sweden (response rate 73%). RESULTS: Those initially absent with neck/shoulder diagnoses rated their present state of discomfort as worse than those sicklisted with low back diagnoses. Only 4% of the neck/shoulder group reported no present discomfort compared with 25% of the low back group. Notably, both groups reported the same duration of low back discomfort during the last year, which may indicate a higher risk for symptoms in more than one location for subjects with neck/shoulder problems. CONCLUSIONS: Individuals with sickness absence of more than 28 days with neck/shoulder or low back diagnoses appear to be at high risk of developing long-standing symptoms significantly more so for those initially having neck/shoulder diagnoses.
In a long-term series analysis the study had the aim of detecting how the used socioeconomic variables were related to the caries status development in the year group leaving the organised dental care. The study included caries epidemiological records of individuals at the Public Dental Service of Göteborg, leaving the organised dental care during 1986-2000. The City of Göteborg was divided into four districts. One incidence and one prevalence caries index was used, each presented in two subgroups: individuals with no caries record and patients with 20% of the highest index values. The socio-economical variable was individuals 18-64 years of age, seeking employment, as a percentage of the corresponding group of all inhabitants. The registered values were divided into three time sections of five years each. In the first, the socio-economic value curves were almost horizontal, in the second they showed a considerable increasing and in the third a declining tendency. The result curves for the caries-free patient groups and for patients with 20% of the highest caries index values compared to the three socioeconomical time sector results, showed an almost horizontal level concerning the incidence index values, and for the prevalence index values an inclined curve structure to the incidence curves. The result curves for the incidence index with respect to the caries-free patient group showed an almost horizontal structure, while the prevalence curves inclined towards the incidence curves during the study period. The linear structure of these curves deviated considerably from the result curves for the socio-economic time series. No correlation existed between the socio-economic data and the studied caries index values. The need for determining the time length concerning caries index observations was discussed. It must be of special interest to maintain the dental health of the studied patient group and the individuals' relation to regular dental care, when as adults they meet the dental care economy.
Microsurgical discectomies are an established procedure in spinal surgery. This operating technique was first used in the Department of Neurosurgery in Iceland in 1981 and has become standard operative treatment for herniated lumbar discs. There is a great variability in outcome reports regarding recurrence rate and re-operation rate. Few articles are based on follow-up of more than 10 years. This article presents the results of a 20 years follow-up study.
A retrospective study of all patients undergoing microsurgical discectomy for herniated lumbar disc, from June 1, 1981 to December 31, 1984. Outcome, based on recurrence rate, return to work and patient satisfaction was determined by a self-evaluation questionnaire, phone interviews and patient medical records.
Of the 170 patients, 134 (78.8%) were included in the study (M:F, 58:42%). Preoperative symptoms: back pain with sciatica 108 (80.6%), sciatica 20 (14.9%), back pain 2 (1.5%). Mean follow-up time was 20.7 years (19.5-22.8). Recurrence rate was 12.7%. 19 patients (14.2%) underwent a subsequent lumbar operation at a different level or side. A majority of patients 108 (80.6%) returned to previous level of work, 26 (19.4%) lost some or all working capabilities. Patient satisfaction was high, 91.1% reporting excellent (68.7%) or good (22.4%) results. 5.2% of patients rated the outcome fair and 3.7% poor. Women reported worse outcome than men, excellent M:F 74.7:60.7%, and poor 7.1:1.3%. There was no significant difference in patient satisfaction in patients undergoing additional operations or those with recurrence of the herniated disc.
Outcome was very good with 92.0% return to work and 91.1% patient satisfaction. The recurrence rate was 12.7% with a substantial number of cases occurring 10-20 years after operation. To conclude, microsurgical discectomies maintain a high success rate in the long-term.