Arthritis, occupational class, and the aging US workforce

Pediatric Esophageal Foreign Bodies: The Role of Socioeconomic Status in Ingestion Patterns

OBJECTIVE

Pediatric esophageal foreign bodies (EFBs) are common and can result in serious complications. Little is known about the influence of socioeconomic status (SES) on EFB ingestion in children. The goal was to study SES as a risk factor for dangerous foreign body ingestion and in-hospital complications in children.

METHODS

This was a retrospective cohort study of children presenting to a tertiary care pediatric hospital with an esophageal foreign body from 2010 to 2021. SES was assessed for each patient by linking their postal code to the Ontario Marginalization Index to determine a quintile score across four dimensions of deprivation: residential instability, material deprivation, dependency, and ethnic concentration. Dangerous EFBs were defined as magnets, batteries, sharp objects, or bones. In-hospital complications included: intensive care unit admission, prolonged length of stay, and postoperative sequelae.

RESULTS

A total of 680 patients were included. Dangerous EFB ingestion was higher for children with increased residential instability (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.2-3.6) and increased material deprivation (OR, 2.2; CI, 1.9-2.8), which was similarly true for odds of complications. Odds of dangerous EFB ingestion were higher in older children (OR, 1.1; CI, 1.0-1.1) and odds of complications were higher in children with comorbidities (OR, 1.1; CI, 1.0-1.3).

CONCLUSION

Higher levels of housing instability and material deprivation are associated with dangerous EFB ingestion and complications related to EFB ingestion. These findings emphasize the role that SES plays on child health outcomes and the need for initiatives to mitigate these disparities.

LEVEL OF EVIDENCE

3 Laryngoscope, 134:2945-2953, 2024.

Assessing the Role of Infant and Toddler MenACWY Immunisation in the UK: Does the Adolescent MenACWY Programme Provide Sufficient Protection?

A combined Haemophilus influenzae type b (Hib)/meningococcal serogroup C (MenC) vaccine will soon be unavailable in the UK immunisation schedule due to discontinuation by the manufacturer. An interim statement by the Joint Committee on Vaccination and Immunisation (JCVI) advises stopping MenC immunisation at 12 months of age when this occurs. We undertook an analysis of the public health impact of various potential meningococcal vaccination strategies in the UK in the absence of the Hib/MenC vaccine. A static population-cohort model was developed evaluating the burden of IMD (using 2005-2015 epidemiological data) and related health outcomes (e.g., cases, cases with long-term sequelae, deaths), which allows for the comparison of any two meningococcal immunisation strategies. We compared potential strategies that included different combinations of infant and/or toddler MenACWY immunisations with the anticipated future situation in which a 12-month MenC vaccine is not used, but the MenACWY vaccine is routinely given in adolescents. The most effective strategy is combining MenACWY immunisation at 2, 4, and 12 months of age with the incumbent adolescent MenACWY immunisation programme, resulting in the prevention of an additional 269 IMD cases and 13 fatalities over the modelling period; of these cases, 87 would be associated with long-term sequelae. Among the different vaccination strategies, it was observed that those with multiple doses and earlier doses provided the greatest protection. Our study provides evidence suggesting that the removal of the MenC toddler immunisation from the UK schedule would potentially increase the risk of unnecessary IMD cases and have a detrimental public health impact if not replaced by an alternate infant and/or toddler programme. This analysis supports that infant and toddler MenACWY immunisation can provide maximal protection while complementing both infant/toddler MenB and adolescent MenACWY immunisation programmes in the UK.

WOMAC score and arthritis diagnosis predict decreased agricultural productivity

Background

Arthritis and joint pain are highly prevalent in agricultural (ag) workers. Many ag operations are sustained by a small number of workers, and the disability of even one worker thus contributes to economic hardship. This study investigated associations between joint health in Montana ag workers and economic well-being and work capacity.

Methods

This observational mixed-methods study utilized quantitative survey data and qualitative focus group data. 299 ranchers and farmers in 9 Montana counties completed either an online or paper survey that included participant demographics, joint symptoms, history of arthritis and arthritis type, financial status, work capacity, and the need to rely on others to complete one’s work. The Western Ontario and McMaster Universities arthritis index (WOMAC) survey was completed by those with hip or knee pain. Data were entered into REDCap v8.9.2 for analysis with SAS 9.4, using logistic and linear regression models to detect associations between covariables and to calculate odds ratios and confidence intervals. Focus groups were held with ranchers in two Montana counties, discussing similar topics, and the themes expressed were identified.

Results

87.6% of survey respondents reported joint pain, 47.8% a diagnosis of arthritis, and 22.4% osteoarthritis (OA). A 10-point increase in WOMAC was significantly associated with lower work capacity (OR 2.00; 95% CI [1.58, 2.55], p < 0.01), worse financial condition (OR 1.23; 95% CI [1.01,1.48], p = 0.04), and increased reliance on others (OR 1.82; 95% CI [1.32, 2.55], p < 0.01). An arthritis diagnosis was associated with worsening work capacity (OR 4.66; 95% CI [2.71, 8.01], p < 0.01) and increased odds of relying on others (OR 3.23; 95% CI [1.56, 6.66], p < 0.01). A diagnosis of OA was significantly associated with decreased work capacity (OR 3.47; 95% CI [1.97, 6.11], p < 0.01). Unadjusted for age and BMI, we found a significant association between years spent working in agriculture and joint health, which became non-significant after adjusting for age and BMI. Focus group themes included decreased productivity with increased joint symptoms and a tendency for ranchers to avoid interaction with the health care system.

Conclusion

Poor joint health is associated with economic risk on Montana ranches and farms.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-021-04041-x.

[Ongoing employment and chronic conditions among community-dwelling elderly people: evidence from Rede Fibra in Belo Horizonte]

This cross-sectional study was based on a probabilistic sample of 597 community-dwelling elderly people living in Belo Horizonte. Theaim was to assess which chronic conditions are independently associated with ongoing employment among elderly people. It was conducted to assess the isolated effect of each one. The multivariate analysis was based on Poisson regression models with robust variance, adjusted by sex, age, schooling, retirement and chronic conditions. Arthritis (or rheumatism) was the only chronic condition with independent and statistic significant association with ongoing employment, even after adjustment for other chronic conditions: older people with medical diagnosis of arthritis have lower odds of being in the labor market (Fully adjusted Prevalence ratio [PR] = 0.54; CI 95%: 0.35-0.85). Moreover, our results showed that gender modifies this association, with a lower propensity among females (PR=0.45; CI 95%: 0.25-0.84). Our results highlight the importance of health promotion among workers, mostly arthritis prevention and management among women.

America's Declining Well-Being, Health, and Life Expectancy: Not Just a White Problem

Although recent declines in life expectancy among non-Hispanic Whites, coined "deaths of despair," grabbed the headlines of most major media outlets, this is neither a recent problem nor is it confined to Whites. The decline in America's health has been described in the public health literature for decades and has long been hypothesized to be attributable to an array of worsening psychosocial problems that are not specific to Whites. To test some of the dominant hypotheses, we show how various measures of despair have been increasing in the United States since 1980 and how these trends relate to changes in health and longevity. We show that mortality increases among Whites caused by the opioid epidemic come on the heels of the crack and HIV syndemic among Blacks. Both occurred on top of already higher mortality rates among all Americans relative to people in other nations, and both occurred among declines in measures of well-being. We believe that the attention given to Whites is distracting researchers and policymakers from much more serious, longer-term structural problems that affect all Americans.

Fatores associados à ótima capacidade para o trabalho em servidores idosos de uma universidade no Sul do Brasil

Resumo Objetivo: investigar a associação entre o índice de capacidade para o trabalho e os fatores sociodemográficos, ocupacionais, estilo de vida e saúde em idosos. Métodos: estudo transversal, com amostra de servidores idosos de uma instituição de ensino superior. Foram coletadas informações sociodemográficas e dados referentes a comportamento social, saúde, e trabalho. Utilizou-se análise uni e multivariada pelo Modelo de Regressão Logística para determinar os fatores associados à ótima capacidade para o trabalho. Resultados: na amostra prevaleceram os homens (57,8%), entre 60 e 64 anos (75,6%), com ensino superior (57,8%). A maioria declarou ser sedentária (89,1%) e com exigência mental de trabalho (62,8%). Mais da metade da amostra era de idosos em sobrepeso (53%), que relataram quedas (21,3%) e uso regular de múltiplos medicamentos (25,6%). As variáveis associadas à menor chance de ótima capacidade para o trabalho foram sexo feminino (OR=0,39; IC95%=0,18-0,83); cor não branca (OR=0,37; IC95%=0,16-0,84); exigência física para o trabalho (OR=0,40; IC95%=0,17-0,97); hospitalização (OR=0,14; IC95%=0,03-0,57); dificuldades no sono (OR=0,12; IC95%=0,04-0,43); autopercepção de saúde ruim (OR=0,22; IC95%=0,09-0,54); queixas de sintomas osteomusculares nos últimos 7 dias (OR=0,29, IC95%=0,10-0,87); e sintomas que comprometem o trabalho (OR=0,25; IC95%=0,08-0,82). Conclusão: fatores sociodemográficos, ocupacionais e condição de saúde comprometeram a ótima capacidade para o trabalho em idosos.

Prevalence and occupational impact of arthritis in Saskatchewan farmers

Agricultural workers have physically demanding occupations. In this study of Saskatchewan farmers, the authors examined (1) self-reported prevalence of physician-diagnosed rheumatoid arthritis and osteoarthritis; and (2) the impact of these chronic arthridities on engagement in physical tasks related to farming. This study was conducted through a cross-sectional analysis of baseline data from the Saskatchewan Farm Injury Cohort Study in which 2,473 adult residents upon 1,216 farms participated. Collected survey data included demographic and health information; regional musculoskeletal symptoms for each participant assessed via the Standard Nordic Questionnaire; and engagement in various specific physical tasks or activities associated with mixed farming practices. Of the 2,473 respondents, 13% reported chronic arthritic diagnoses (10% osteoarthritis, 4% rheumatoid arthritis, with 1% from each category overlapping with both forms of arthritis). Participants reporting arthritis were more likely to also report disabling musculoskeletal symptoms involving their shoulders, elbows, hands, lower back, hips, knees, and ankles. Farmers with arthritis reported less participation in all physical farming activities studied, including various machinery operations, herd maintenance and veterinary activities, overhead work, shoveling/pitchfork work, and lifting/carrying. When adjusted for age, gender, and comorbidities, operation of combines and shoveling/pitchfork work continued to be significantly less engaged in by farmers with arthritis. The overall prevalence of arthritis was consistent with general population prevalence, although the category of rheumatoid arthritis was overrepresented. Farmers with arthritis were significantly less likely to participate in combine operation and shoveling/pitchfork chores compared with their counterparts without arthritis.

Racial Disparities in the Prevalence of Arthritis among Native Hawaiians and Pacific Islanders, Whites, and Asians

The health disparities of Native Hawaiians and Pacific Islanders (NHPI) are well established for diabetes and cardiovascular disease, but less is known about disparities in arthritis. This study examined possible disparities in the prevalence of arthritis by age, sex, and severity comparing NHPI, Whites, and Asians. The study population included adult Hawai'i participants in the 2013 Behavioral Risk Factor Surveillance Survey. NHPI males had a significantly higher prevalence of arthritis, which peaked twenty years earlier, than White and Asian males (P<.001). The prevalence of arthritis peaked at 65-79 years in males and females in all racial groups, except in NHPI males where it peaked at 45-54 years. The mean ages (years) for males with arthritis were 46.2 for NHPI, 59.1 for Whites, and 60.5 for Asians; the respective ages for females were 54.2, 60.5, and 58.8. NHPI males body mass index averaged 2.4 kg/m(2) greater than White males (P<.001), and obese NHPI males had twice the age-adjusted odds of arthritis than obese White males. Although NHPI females had a greater body mass index than White females (P=.05), the prevalence of arthritis was only slightly and not significantly higher. NHPI males and females reported high pain scores more frequently than Whites did, but the differences did not reach statistical significance. Diabetes was a comorbidity more than twice as often in NHPI and Asians of both sexes than among Whites. This study demonstrated racial disparities in the prevalence of arthritis among NHPI, Whites, and Asians.

Vaccinating Italian infants with a new multicomponent vaccine (Bexsero®) against meningococcal B disease: A cost-effectiveness analysis

The European Medicines Agency has approved a multicomponent serogroup B meningococcal vaccine (Bexsero®) for use in individuals of 2 months of age and older. A cost-effectiveness analysis (CEA) from the societal and Italian National Health Service perspectives was performed in order to evaluate the impact of vaccinating Italian infants less than 1 y of age with Bexsero®, as opposed to non-vaccination. The analysis was carried out by means of Excel Version 2011 and the TreeAge Pro® software Version 2012. Two basal scenarios that differed in terms of disease incidence (official and estimated data to correct for underreporting) were considered. In the basal scenarios, we considered a primary vaccination cycle with 4 doses (at 2, 4, 6 and 12 months of age) and 1 booster dose at the age of 11 y, the societal perspective and no cost for death. Sensitivity analyses were carried out in which crucial variables were changed over probable ranges. In Italy, on the basis of official data on disease incidence, vaccination with Bexsero® could prevent 82.97 cases and 5.61 deaths in each birth cohort, while these figures proved to be three times higher on considering the estimated incidence. The results of the CEA showed that the Incremental Cost Effectiveness Ratio (ICER) per QALY was €109,762 in the basal scenario if official data on disease incidence are considered and €26,599 if estimated data are considered. The tornado diagram indicated that the most influential factor on ICER was the incidence of disease. The probability of sequelae, the cost of the vaccine and vaccine effectiveness also had an impact. Our results suggest that vaccinating infants in Italy with Bexsero® has the ability to significantly reduce meningococcal disease and, if the probable underestimation of disease incidence is considered, routine vaccination is advisable.

Midlife Occupational Physical Activity and Risk of Disability Later in Life: National Health and Aging Trends Study

OBJECTIVES

To determine whether midlife occupational physical activity (PA) is associated with disability in older adults and to test disease as a mediating variable.

DESIGN

Cross-sectional study.

SETTING

National Health and Aging Trends Study.

PARTICIPANTS

Individuals aged 65 and older (N = 7,307).

MEASUREMENTS

Participants were classified as to occupational PA levels by linking information from the Occupational Information Network database using standard occupation codes. Disability outcomes and covariates were obtained through in-person interviews. Logistic regression models were used to examine the association between occupational PA and disability. Structural equation modeling (SEM) was fitted to examine the mediating effect of disease.

RESULTS

Occupations with high physically demands were associated with greater decline in functional capacity later in life. Individuals with occupations with high and very high PA were less likely to be able to perform activities of daily living than those with occupations with low PA. SEM showed that occupational PA has a very strong direct effect on disability (P < .001) and has an indirect effect on disability through disease (P = .003). The population attributable fraction for high occupational PA was 11%.

CONCLUSION

Higher midlife occupational PA levels were significantly associated with poorer ability to perform activities of daily living in older age. Performing the optimal level of occupational PA may be instrumental in reducing disability later in life.

Occupational physical activity assessment for chronic disease prevention and management: A review of methods for both occupational health practitioners and researchers

Occupational physical activity (OPA) is an occupational exposure that impacts worker health. OPA is amenable to measurement and modification through the hierarchy of controls. Occupational exposure scientists have roles in addressing inadequate physical activity, as well as excessive or harmful physical activity. Occupational health researchers can contribute to the development of novel OPA exposure assessment techniques and to epidemiologic studies examining the health impacts of physical activity at work. Occupational health practitioners stand to benefit from understanding the strengths and limitations of physical activity measurement approaches, such as accelerometers in smartphones, which are already ubiquitous in many workplaces and in some worksite health programs. This comprehensive review of the literature provides an overview of physical activity monitoring for occupational exposure scientists. This article summarizes data on the public health implications of physical activity at work, highlighting complex relationships with common chronic diseases. This article includes descriptions of several techniques that have been used to measure physical activity at work and elsewhere, focusing in detail on pedometers, accelerometers, and Global Positioning System technology. Additional subjective and objective measurement strategies are described as well.

Musculoskeletal safety for older adults in the workplace: review of current best practice evidence

Age-associated physical musculoskeletal alterations increase elder adults' (age 55 and older) risk for injury. Research has demonstrated that on-the-job injuries result in increased absenteeism, and fatalities are more common for the elder adult population. Older adults aged above 65 years comprise the fastest-growing segment of the U.S. population, growing from 40.2 million in 2010 to 88.5 million projected by 2050; this population shift will generate challenges for occupational health nurses providing care for older workers. A paucity of evidence-based "best practices" exists in which occupational health nurses can assess the physical status of older workers, evaluate their risk for age-related musculoskeletal injuries, and educate these workers on injury prevention. This article provides a critical synthesis of research on age-related physical and cognitive changes and their impact on safety, providing "best practice" evidence for occupational health nurses to examine and apply.

Aspectos sociodemográficos e de saúde associados ao trabalho remunerado em adultos (50-69 anos) na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil

Foram examinados os fatores associados ao trabalho remunerado em uma amostra probabilística de 3.320 indivíduos (50-69 anos de idade), residentes na Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil. A prevalência do trabalho remunerado foi de 62,8% entre homens e 35,8% entre mulheres. Em ambos os gêneros, o trabalho remunerado apresentou associação positiva com o nível de escolaridade e negativa com a autoavaliação da saúde. A propensão de ter trabalho remunerado foi maior entre mulheres sem cônjuge e aquelas que conheciam alguém que havia sido discriminado no ambiente de trabalho. Entre os homens, a prevalência do trabalho remunerado caiu de 67,2%, entre aqueles com ≥ 8 anos de escolaridade e que avaliaram melhor a sua saúde, para 37,8% entre aqueles com escolaridade mais baixa e que avaliaram a sua saúde como ruim (RP = 0,56; IC95%: 0,37-0,87). Entre as mulheres, a prevalência correspondente caiu de 42,1% para 3,6% (RP = 0,09; IC95%: 0,03-0,26). A propensão de ter trabalho remunerado entre mulheres com baixa escolaridade e pior avaliação da saúde foi dez vezes menor do que entre seus equivalentes homens.

Health and economic outcomes of introducing the new MenB vaccine (Bexsero) into the Italian routine infant immunisation programme

Introduction

In January 2013 a novel type of multicomponent protein-based vaccine against group B meningococcal disease was licensed by the European Medicines Agency. With the widespread use of the meningococcal serogroup C conjugate vaccines, serogroup B remains now the major cause of bacterial meningitis and septicaemia in young children in Europe. The aim of this study is to investigate the health and the economic outcomes of MenB vaccine introduction into the Italian routine mass vaccination programme.

Methods

The present work is structured in two main parts. Firstly, we assess the epidemiological burden of group B meningococcal disease using official hospitalisation and notification data from two of the most populated Italian regions (Lombardia and Piemonte) during a 6-year study period (2007-2012). Secondly, we evaluate the cost-effectiveness of the immunisation programme in Italy from the public health payer perspective under base case parameters assumptions and performing a comprehensive sensitivity analysis to assess the robustness and the uncertainty of our model results.

Results

MenB serotype is responsible for 59% of the 341 cases of Invasive Meningococcal Disease in Lombardia and Piemonte. Incidence rate for MenB infection is estimated to be 0.21/100,000/y resulting at the highest level in children ≤4 years of age. Although the new MenB vaccine can potentially prevent about one third of the disease cases in the Italian population, model results show this strategy is unlikely to be cost-effective (ICER value over €350,000/QALY) with a vaccine that prevents disease only. These results are robust under most of the sensitivity scenarios except when allowing for lower discount rates.

Discussion

The introduction of the novel vaccine into the routine immunisation schedule needs to be carefully evaluated. The new MenB vaccine has the potential to reduce the disease burden at the population level. However, from the Italian Health Service perspective, the immunisation programme is unlikely to be cost-effective at the current incidence levels and vaccine price.

Workplace-based health and wellness programs: the intersection of aging, work, and health

Workplace-based health and wellness programs (HWPs) may be an obvious yet under-utilized strategy for promoting positive health-related behaviors among older workers and for increasing their ability to continue to work. Given the unprecedented number of older adults who extend their labor force attachment beyond traditional retirement ages, a new vision of older adults' economic security and overall quality-of-life should take into account the intersections of aging, work, and health. The purpose of this article is to: (a) discuss the workplace as an increasingly important setting that can expand the reach and effectiveness of health promotion efforts; (b) examine current knowledge of barriers and facilitators that can affect older workers' participation in workplace-based HWPs; and (c) suggest new incentive structures that may increase older workers' engagement in these programs. We develop a rationale for our proposition that sustained participation in HWPs may improve the health status of older workers and reduce health care costs. It is our conclusion that there is significant potential for workplace-based HWPs to support older adults who want to or need to work.

Health-related quality-of-life of coal-based sponge iron plant workers in Barjora, India: a cross-sectional study

OBJECTIVES

During the last decade, coal-based sponge iron plants, a highly polluted industry, have grown rapidly in Barjora, India. Understanding their workers' perception of health is essential in people-centered healthcare. The aim of the study was to assess their health-related quality-of-life (HRQoL), and to determine factors that independently predict their HRQoL.

DESIGN

Cross-sectional study.

SETTING

Coal-based sponge iron plants in Barjora, India.

PARTICIPANTS

258 coal-based sponge iron plant workers.

PRIMARY OUTCOME MEASURE

HRQoL was measured using the EuroQol-5D-5L.

RESULTS

The response rate was 100%. Participants with problems in mobility, self-care, usual activities, pain/discomfort and anxiety/depression were 23.3%, 5.1%, 10.9%, 39.5% and 45.5%, respectively. 36.8% of participants reported health state 11111 (no problem in any EQ-5D dimension). The mean visual analogue scale (EQ-VAS) was 69.8 (18.5 SD). The odds of mobility problems decreased with age (OR 0.95, 95% CI 0.91 to 0.99, p=0.016), were lower in participants with presence/history of any respiratory disease (0.27, 0.13 to 0.55, p<0.001), scheduled caste/scheduled tribe/other backward class workers (0.44, 0.22 to 0.89, p=0.021), manual workers (0.40, 0.16 to 0.99, p=0.047) and non-smokers (2.63, 1.27 to 5.46, p=0.009). The odds of pain/discomfort and anxiety/depression were lower in participants with any respiratory disease (0.44, 0.24 to 0.79, p=0.006; and 0.52, 0.29 to 0.92, p=0.026, respectively). The EQ-VAS was worse in manual participants (coefficient -6.91, 95% CI -12.40 to -1.41, p=0.014), with any respiratory disease (-8.13, -13.12 to -3.13, p=0.002), alcohol drinkers (-4.81, -9.47 to -0.15, p=0.043), literates (7.70, 0.97 to 14.43, p=0.025) and Hindus (13.41, 2.62 to 24.20, p=0.015).

CONCLUSIONS

Many coal-based sponge iron plant workers in Barjora have problems in their HRQoL, and the predictors of different aspects of HRQoL were identified. The study findings could be taken into consideration in future interventional studies aimed at improving the HRQoL of these workers.

The economic burden of disease by industry: Differences in quality-adjusted life years and associated costs

BACKGROUND

This study compares differences in quality-adjusted life expectancy across the eight original National Occupational Research Agenda (NORA) industry sectors.

METHODS

Data from the 1997 to 2012 National Health Interview Survey (NHIS) were used to estimate quality-adjusted life years (QALYs) for all workers and by NORA sector. Differences in QALYs were calculated and translated into economic values using estimates of the societal willingness-to-pay per QALY.

RESULTS

Mean QALYs across workers was 29.17 years. Among NORA sectors, wholesale, and retail trade workers had the highest average QALYs remaining (35.88), while mining workers had the lowest QALYs (31.4). The economic value of this difference ranges from $604,843 to $1,155,287 per worker depending on the societal willingness-to-pay per QALY.

CONCLUSION

The value of life lost within some industries is very high relative to others. Additional investments in occupational safety, benefits, and health promotion initiatives may reduce these losses, but experimental research is needed to assess the effectiveness of such programs.

Is midlife occupational physical activity related to disability in old age? The SNAC-Kungsholmen study

Objectives

Leisure-time physical activity (PA) has been established to be related to more years lived without disability. However, less is known about the relationship between occupational PA and disability in old age. The aim of the study was 1) to investigate whether midlife occupational PA is related to late-life disability, and 2) to test the hypothesis that the association differs according to the occupational categories of blue and white collar work.

Methods

The study population was derived from the Swedish National Study on Aging and Care, and consisted of a random sample of 1804 subjects aged 72 and above. The association of occupational PA during the longest held occupation with disability in old age was determined using logistic regression.

Results

There was no significant relationship between occupational PA and disability in personal or instrumental activities of daily living (ADL) after controlling for demographic and health-related factors. However, in stratified analyses moderate levels of occupational PA was associated with a lower odds ratio of dependency in personal ADL amongst white collar workers, compared to low level of occupational PA (OR = 0.34 95% C1 0.12–0.98).

Conclusions

Moderate levels of midlife occupational PA were associated with a decreased risk of personal ADL disability in old age among white collar workers, but not among blue collar workers. Our results highlight the importance of encouraging white collar workers to engage in physical activity during or outside work hours.

Chronic back problems and labor force participation in a national population survey: impact of comorbid arthritis

Background

Back problems and arthritis are common chronic conditions, while having back problems is a frequent reason for lost work time. The objective of this study was to investigate employment status amongst individuals who report having both back problems and arthritis, compared to having either condition alone.

Methods

We analyzed data from the 2007/2008 Canadian Community Health Survey (ages 25–64, n = 79,719). Respondents who reported neither having worked in the past 12 months nor the past week were coded as not currently employed. Those reported being permanently unable to work were considered to be out of the labor force. Log-Poisson regressions, adjusting for socio-demographic and lifestyle factors, were used to estimate risks for being not currently employed or being out of the labor force for 5 mutually exclusive groups of chronic conditions: arthritis and back problems, back problems, arthritis, any other chronic conditions, and no chronic conditions.

Results

12.7% of respondents reported being not currently employed and 2.9% being out of the labor force. 5.8% of respondents reported both arthritis and back problems, while 16.1% reported back problems and 7.3% arthritis. The back problems and arthritis group had the highest risk of not being currently employed. The risk was higher for men (PR = 1.90; 95% CI = 1.58, 2.29) than for women (PR = 1.31; 95% CI = 1.18, 1.46). Risks of being permanently unable to work were also the greatest for those with comorbid back problems and arthritis.

Conclusions

There is a need for a reappraisal of back problems as a cause of work disability to account for the possibility of co-occurring arthritis.

Relationship between markers of type II collagen metabolism and tibiofemoral joint space width changes after ACL injury and reconstruction

BACKGROUND

Those who suffer anterior cruciate ligament (ACL) disruptions are at increased risk of experiencing posttraumatic osteoarthritis (OA); however, by the time they become symptomatic, irreversible damage has likely occurred. Little is known regarding the physiological changes in articular cartilage that occur after an ACL injury and the onset of OA.

PURPOSE

To assess whether patient, functional, and clinical outcomes and type II collagen metabolism are associated with abnormal tibiofemoral joint space width (JSW) 4 years after injury and reconstruction.

STUDY DESIGN

Cohort study; Level of evidence, 2.

METHODS

A total of 35 ACL-injured patients who underwent ACL reconstruction were enrolled soon after injury, as were 32 matched controls. At baseline and 1- and 4-year follow-ups, patient-oriented subjective and objective outcomes and markers of type II collagen metabolism (considered as the ratio of cleavage to synthesis of type II collagen) were evaluated, as were radiographic measurements of JSW changes about the medial and lateral compartments of the knee. ACL-injured patients were divided into normal and abnormal JSW groups.

RESULTS

Both ACL-injured groups (normal and abnormal JSW) had an increased ratio of collagen type I and II cleavage product (uC1,2C) to serum procollagen II C-propeptide (sCPII) compared with controls at 1- and 4-year follow-ups. Patients in the ACL group with an abnormal JSW difference had significantly increased cleavage-to-synthesis ratios of type II collagen (assessed as C-terminal cross-linked telopeptide of type II collagen [uCTX-II]/sCPII ratio) compared with controls at 4-year follow-up. ACL-injured patients with an abnormal JSW difference had significantly increased pain and decreased quality of life (Knee Injury and Osteoarthritis Outcome Score [KOOS]) scores than did ACL-injured patients with a normal JSW difference.

CONCLUSION

ACL-injured patients with an abnormal tibiofemoral JSW had diminished quality of life, increased pain, and increased type II collagen uCTX-II/sCPII ratios compared with healthy controls. These changes occurred over an interval shortly after injury in patients who were fully functional and who had normal clinical examination findings, no pivoting/giving-way episodes, and no decrease in activity level.

Social determinants and osteoarthritis outcomes

Osteoarthritis (OA) is one of the most frequently occurring musculoskeletal diseases, posing a significant public health problem due to its impact on pain and disability. Traditional risk factors fail to account for all of the risk observed for OA outcomes. In recent years, our view of disease causation has broadened to include health risks that are created by an individual's socioeconomic circumstances. Early research into social determinants has focused on social position and explored factors related to the individual such as education, income and occupation. Results from these investigations suggest that low education attainment and nonprofessional occupation are associated with poorer arthritis outcomes. More recently, research has expanded to examine how one's neighborhood socioeconomic environment may be relevant to OA outcomes. This narrative review proposes a framework to help guide our understanding of how social context may interact with pathophysiological processes and individual-level variables to influence health outcomes in those living with OA.

Attractiveness of employment sectors for physical therapists in Ontario, Canada (1999-2007): implication for the long term care sector

Background

Recruiting and retaining health professions remains a high priority for health system planners. Different employment sectors may vary in their appeal to providers. We used the concepts of inflow and stickiness to assess the relative attractiveness of sectors for physical therapists (PTs) in Ontario, Canada. Inflow was defined as the percentage of PTs working in a sector who were not there the previous year. Stickiness was defined as the transition probability that a physical therapist will remain in a given employment sector year-to-year.

Methods

A longitudinal dataset of registered PTs in Ontario (1999-2007) was created, and primary employment sector was categorized as ‘hospital’, ‘community’, ‘long term care’ (LTC) or ‘other.’ Inflow and stickiness values were then calculated for each sector, and trends were analyzed.

Results

There were 5003 PTs in 1999, which grew to 6064 by 2007, representing a 21.2% absolute growth. Inflow grew across all sectors, but the LTC sector had the highest inflow of 32.0%. PTs practicing in hospitals had the highest stickiness, with 87.4% of those who worked in this sector remaining year-to-year. The community and other employment sectors had stickiness values of 78.2% and 86.8% respectively, while the LTC sector had the lowest stickiness of 73.4%.

Conclusion

Among all employment sectors, LTC had highest inflow but lowest stickiness. Given expected increases in demand for services, understanding provider transitional probabilities and employment preferences may provide a useful policy and planning tool in developing a sustainable health human resource base across all employment sectors.