Although information exists on the cost of workers' compensation low back pain (LBP), there is limited information on the duration of lost work time as well as the association between cost and duration. For this study, cost and duration of lost work time information were derived from a large workers' compensation company's database for 1992 LBP claims (n = 106,961). The distribution of cost was skewed, with an average cost of a claim being 20 times higher than its median. A disproportionately small percentage of the costliest LBP claims (10%) were responsible for a large percentage of the total cost (86%). The distribution of length of disability (LOD) was also skewed, with an average of 102 days and a median of zero. The average and median LOD for those claims with at least one day of compensable disability was 303 and 39 days, respectively. As a "rule of thumb," it was found that of those claimants who remain on disability at the end of n weeks, approximately 50% will be off disability at the end of 6.n weeks. Additionally, the 7% of the claims with an LOD greater than one year accounted for 75.1% of the cost and 84.2% of the total disability days. Disability days that were accrued after one year of disability accounted for 59.3% of the total number of disability days. This result suggests that other LOD estimation techniques, which may not account for disability days beyond one calendar year (e.g., the Bureau of Labor Statistics Annual Survey of Occupational Injuries and Illnesses), may result in a marked underestimation of LOD.

Previously published epidemiologic studies of low back pain (LBP) have reported that the prevalence of low back disability has increased dramatically. These studies based their findings on either the number of disability claims filed, the disability duration, or both. This information was from countries other than the United States or from the US Social Security Disability Insurance data, with findings reported only to the early 1980s. More recent studies of US workers' compensation LBP claims reported a decrease in the incidence rate from the late 1980s to the mid-1990s. No studies have been found that report on the trends of disability duration for workers' compensation LBP claims. This study examined recent trends in the length of disability (LOD) for LBP claims and associated costs, using a large sample of claims from the privately insured US workers' compensation market. LOD and cost information were derived for injuries from 1988, 1990, 1992, 1994, and 1996. For each year, the distributions of LOD and cost were skewed, with the small percentage of claims that lasted more than one year (4.6%-8.8%, depending on the year) accounting for a large percentage of the total disability days (77.6%-90.1%) and cost (64.9%-84.7%). From 1988 to 1996, the average LOD decreased 60.9%, from 156 days to 61 days. The probability of being on disability for a long period of time has decreased over the years. Over the study period, the average cost of a claim decreased 41.4%, while the median cost increased 19.7%. The most influential change in the LOD and cost distributions was a reduction in expensive claims with a long disability duration. The evolution of LOD and cost is also detailed for different disability durations for the study period.

There is little information on the length of disability (LOD) reported for work-related musculoskeletal disorders of the upper extremity (WMSDUE). For this study, LOD, cost, and the relationship between LOD and cost were derived from a large workers' compensation company's claims data for 1994 WMSDUE (n = 21,338). The average LOD was 87 days, with a median of zero days. For those claims with at least one day of compensable disability (25.2%), the average and median LOD were 294 and 99 days, respectively. The distribution of cost was skewed, with the average cost of a claim being 13 times higher than its median. Approximately 60% of the claims cost $1000 or less. Additionally, the 6.8% of the claims with an LOD greater than one year accounted for 59.9% of the cost and 75% of the total disability days. The majority of WMSDUE claimants did not lose sufficient time to qualify for indemnity. For those who did receive lost time wages, a disability duration of more than three months was typical.

Reducing prematurity, rate of HIV disease progression, and maternal viral load at or after delivery could help to reduce vertical transmission. Treatment of sexually transmitted infections at onset of prenatal care, about 20 weeks on average, was inadequate for prevention of transmission. Whether sustained clearance of lower genital tract infections result in reduced transmission remains to be determined.

Difficulties with ensuring the quality of the peer support in this study may be in part responsible for our failure to see more-definitive and -positive results. As the peer support specialist profession evolves, an understanding of its effective ingredients and mechanisms must be elucidated to allow for more-rigorous studies. (PsycINFO Database Record

Laparoscopy is more cost-effective and produces better patient outcomes than open colorectal surgery. Minimally invasive colorectal surgery is now the standard that should be offered to patients, providing value to both patient and provider.

No abstract

Workers' compensation claims associated with manual materials handling (MMH) represent the single largest source of claims and costs. Surprisingly, there have been few analyses of such losses associated with MMH. An examination of the nature of the injuries associated with MMH as well as the body parts most frequently affected can lead to a better understanding of the losses attributed to MMH to suggest further research efforts. A large sample of MMH claims was analysed and stratified with respect to body part affected and the nature of the injury. The outcome measures examined were frequency (number of claims) and severity (cost measures) of the claims. The analyses revealed that the lower back area and upper extremities were the body parts associated with approximately 70% of the claims. Strain was the nature of injury most frequently reported (51.3%). Lower back area strains were the most frequently reported nature of injury and body part combination. Additionally, an analysis of median claims costs revealed the occurrence of a small number of very expensive traumatic injuries.