ORCID Profile
0000-0003-2617-9339
Current Organisation
Monash University
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In Research Link Australia (RLA), "Research Topics" refer to ANZSRC FOR and SEO codes. These topics are either sourced from ANZSRC FOR and SEO codes listed in researchers' related grants or generated by a large language model (LLM) based on their publications.
Public Health and Health Services | Epidemiology | Environmental and Occupational Health and Safety | Public Administration | Social policy | Applied Sociology, Program Evaluation and Social Impact Assessment | Public participation and community engagement | Social Program Evaluation | Public Policy | Social Policy | Policy and Administration | Sociology | Public Health and Health Services not elsewhere classified | Health Information Systems (incl. Surveillance) | Occupational and workplace health and safety | Policy and administration
Social Structure and Health | Health Policy Evaluation | Occupational Health | Evaluation of Health Outcomes | Disability and Functional Capacity | Health Status (e.g. Indicators of Well-Being) |
Publisher: Wiley
Date: 19-10-2021
Abstract: The Disability Support Pension (DSP) provides financial support to more than 750,000 Australians with permanent physical, intellectual or psychiatric impairments that prevent them from engaging in employment. We sought to characterise the information, compliance and psychological costs of applying for the DSP. A cohort of 518 DSP applicants and recipients completed a questionnaire capturing medical, disability, benefit and demographic data. The questionnaire also included an Administrative Burden (AB) scale that was co‐developed with disability advocates and people with lived experience of DSP processes. Most respondents reported high or very high scores on three sub‐scales assessing information, compliance and psychological costs. In logistic regression models, DSP applicants reported greater costs than DSP recipients across all three scales. People with poorer health‐related quality of life, younger age and less education reported higher costs, consistent with the observation of an inequitable distribution of administrative burden in AB theory. All three scales had acceptable reliability. Study findings suggest that DSP applicants find the application process challenging and stressful. These effects are more pronounced in people who have applied for the DSP than those currently receiving the DSP, and in those with lower human capital.
Publisher: Elsevier BV
Date: 06-2002
DOI: 10.1016/S0003-4975(01)03375-6
Abstract: Currently, cognitive decline after coronary surgery is said to be significant if the in idual's postoperative test score is at least 1 standard deviation (SD) worse than their preoperative score. This "1-SD" technique fails to account for factors that may confound interpretation of serially acquired cognitive test scores, including regression to the mean, measurement error caused by poor test-retest reliability, and practice effects. We review the many alternative and potentially superior statistical techniques that have been described in the neuropsychologic and psychiatric literature for differentiating "true" changes in cognitive test score from changes caused by these factors.
Publisher: Informa UK Limited
Date: 03-06-2018
Publisher: BMJ
Date: 12-05-2015
Publisher: BMJ
Date: 12-2003
Abstract: Psychometric issues associated with computerised neuropsychological assessment in sports concussion are put forward. Issues critical to ensuring test reliability and sensitivity are discussed, with particular reference to how inappropriate test design can affect clinical decision making.
Publisher: Cold Spring Harbor Laboratory
Date: 11-12-2020
DOI: 10.1101/2020.12.08.20246181
Abstract: To identify geographic hotspots and coldspots of work disability burden and associated sociodemographic factors in Australia. Using Australian workers’ compensation and census data, we calculated weeks of compensated time off work per 1,000 labour force at Statistical Area Level 4, an indicator of work disability burden. Records included all claims with at least one day of compensated time off work lodged between 2010 and 2015. Work disability burden was z-transformed by state and mapped across Australia. Statistical Areas ≥ 1.5 standard deviations from the state/territory mean were considered hotspots and coldspots. We tested several sociodemographic factors as predictors of work disability burden. Work disability burden hotspots were concentrated in lower socioeconomic suburbs and exurbs of state capitals, plus several regional areas. Coldspots were primarily in wealthy central urban and suburban areas. Factors associated with greater work disability burden include socioeconomic disadvantage, rurality, lower labour force participation, higher unemployment, and more people with core activity limitations, aged 65+ years, and aged 65+ but fewer foreign-born. Work disability burden is unequally distributed across Australia and strongly influenced by sociodemographic factors. The findings can guide more efficient allocation of resources for primary and secondary work disability prevention and rehabilitation.
Publisher: Springer Science and Business Media LLC
Date: 05-08-2022
DOI: 10.1186/S12889-022-13884-5
Abstract: Road traffic injuries (RTIs), primarily musculoskeletal in nature, are the leading cause of unintentional injury worldwide, incurring significant in idual and societal burden. Investigation of a large representative cohort is needed to validate early identifiable predictors of long-term work incapacity post-RTI. Therefore, up until two years post-RTI we aimed to: evaluate absolute occurrence of return-to-work (RTW) and occurrence by injury compensation claimant status evaluate early factors (e.g., biopsychosocial and injury-related) that influence RTW longitudinally and identify factors potentially modifiable with intervention (e.g., psychological distress and pain). Prospective cohort study of 2019 adult participants, recruited within 28 days of a non-catastrophic RTI, predominantly of mild-to-moderate severity, in New South Wales, Australia. Biopsychosocial, injury, and compensation data were collected via telephone interview within one-month of injury (baseline). Work status was self-reported at baseline, 6-, 12-, and 24-months. Analyses were restricted to participants who reported paid work pre-injury ( N = 1533). Type-3 global p -values were used to evaluate explanatory factors for returning to ‘any’ or ‘full duties’ paid work across factor subcategories. Modified Poisson regression modelling was used to evaluate factors associated with RTW with adjustment for potential covariates. Only ~ 30% of people with RTI returned to full work duties within one-month post-injury, but the majority (76.7%) resumed full duties by 6-months. A significant portion of participants were working with modified duties (~ 10%) or not working at all (~ 10%) at 6-, 12-, and 24-months. Female sex, low education, low income, physically demanding occupations, pre-injury comorbidities, and high injury severity were negatively associated with RTW. Claiming injury compensation in the fault-based scheme operating at the time, and early identified post-injury pain and psychological distress, were key factors negatively associated with RTW up until two years post-injury. Long-term work incapacity was observed in 20% of people following RTI. Our findings have implications that suggest review of the design of injury compensation schemes and processes, early identification of those at risk of delayed RTW using validated pain and psychological health assessment tools, and improved interventions to address risks, may facilitate sustainable RTW. This study was registered prospectively with the Australian New Zealand Clinical Trials Registry (ACTRN12613000889752).
Publisher: Elsevier BV
Date: 09-2023
Publisher: Cold Spring Harbor Laboratory
Date: 19-11-2019
DOI: 10.1101/19012286
Abstract: To determine whether step-downs, which cut the rate of compensation paid to injured workers after they have been on benefits for several months, are effective as a return to work incentive. We aggregated administrative claims data from seven Australian workers’ compensation systems to calculate weekly scheme exit rates, a proxy for return to work. Jurisdictions were further sub ided into four injury subgroups: fractures, musculoskeletal, mental health, and other trauma. The effect of step-downs on scheme exit was tested using a regression discontinuity design. Results were pooled into meta-analyses to calculate combined effects and the proportion of variance attributable to heterogeneity. The combined effect of step-downs was a 0.86 percentage point (95% CI -1.45 to -0.27) reduction in the exit rate, with significant heterogeneity between jurisdictions ( I 2 = 68%, p = .003). Neither timing nor magnitude of step-downs was a significant moderator of effects. Within injury subgroups, only fractures had a significant combined effect (-0.84, 95% CI -1.61 to -0.07). Sensitivity analysis indicated potential effects within mental health and musculoskeletal conditions as well. The results suggest some workers’ compensation recipients anticipate step-downs and exit the system early to avoid the reduction in income. However, the effects were small and suggest step-downs have marginal practical significance. We conclude that step-downs are generally ineffective as a return to work policy initiative. 1. A number of workers’ compensation systems around the world reduce payments to injured workers after they have been in the system for several months. In Australia, where each state, territory, and Commonwealth system employs step-downs, the stated policy objective is to increase the rate of return to work through financial incentives. However, there is little empirical evidence to either support or reject this claim. 2. The rate at which claimants exited workers’ compensation systems increased ahead of step-downs taking effect, suggesting an anticipatory effect. However, the effect was relatively small, changing the exit rate by less than a percentage point overall, with substantial heterogeneity between systems. 3. While statistically significant, the findings suggest that step-downs provide workers’ compensation claimants little incentive to return to work. Policymakers may need to reconsider step-downs as a component of scheme design, or justify them according to their original purpose, which was to save costs.
Publisher: Springer Science and Business Media LLC
Date: 19-05-2015
Publisher: Oxford University Press (OUP)
Date: 08-08-2006
Publisher: Wiley
Date: 2006
DOI: 10.1002/HUP.799
Abstract: It has been proposed that objective cognitive testing provides additional information to that collected via adverse event (AE) recordings. However, in clinical trials of compounds with potentially negative effects on cognition, the results of cognitive testing may overlap with AE recordings. To examine cognitive function in subjects who do and do not report sedation-related AEs in a Phase I clinical trial. Five computerized cognitive tasks were administered to 28 healthy male volunteers enrolled in a simulated Phase I study using midazolam to induce sedation-related AEs and cognitive dysfunction. For each subject, the magnitude of cognitive change between pre-dose and 1 hr post-dose assessments was calculated. Group and in idual level cognitive outcome was compared between subjects who did and did not report sedation-related AEs following administration of 1.75 and 5.25 mg midazolam. At both doses of midazolam, cognitive dysfunction was observed in both subject groups (i.e., those who did and did not report AEs). Analysis of in idual outcomes identified consistent cognitive dysfunction among subjects who reported sedation-related AEs. Further, in the 5.25 mg condition a subset of in iduals (66.7%) who did not report sedation-related AEs nevertheless displayed substantial cognitive dysfunction. Following administration of oral midazolam, there is a dissociation between sedation-related AE recordings and performance on computerized cognitive tests of motor function, attention, strategy use and problem solving, learning and delayed recall. Inclusion of computerized cognitive tests in early phase trials may allow identification of subtle cognitive change, beyond that which is possible by self-report and clinical observation.
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.INJURY.2013.03.006
Abstract: The rate and extent of recovery after severe traumatic brain injury (TBI) is heterogeneous making prediction of likely healthcare service utilisation (HSU) difficult. Patterns of HSU derived from nomothetic s les do not represent the erse range of outcomes possible within this patient group. Group-based trajectory model is a semi-parametric statistical technique that seeks to identify clusters of in iduals whose outcome (however measured) follows a similar pattern of change over time. To identify and characterise patterns of HSU in the 5-year period following severe TBI. Detailed healthcare treatment payments data in 316 adults with severe TBI (Glasgow Coma Scale score 3-8) from the transport accident compensation system in the state of Victoria, Australia was accessed for this analysis. A semi-parametric group-based trajectory analytical technique for longitudinal data was applied to monthly observation counts of HSU data to identify distinct clusters of participants' trajectories. Comparison between trajectory groups on demographic, injury, disability and compensation relevant outcomes was undertaken. Four distinct patterns (trajectories) of HSU were identified in the s le. The first trajectory group comprised 27% of participants and displayed a rapid decrease in HSU in the first year post-injury. The second group comprised 24% of participants and showed a sharp peak in HSU during the first 12 months post-injury followed by a decline over time. The third group comprised 32% of participants and showed a slight peak in HSU in the first few months post-injury and then a slow decline over time. The fourth group comprised 17% of participants and displayed a steady rise in HSU up to 30 months post-injury, followed by a gradual decline to a level consistent with that received in the first months post-injury. Significant differences were observed between groups on factors such as age, injury severity, and use of disability services. There is substantial variation in patterns of HSU following severe TBI. Idiographic analysis can provide rich information for describing and understanding the resources required to help people with TBI.
Publisher: Springer Science and Business Media LLC
Date: 08-03-2022
DOI: 10.1186/S12889-022-12850-5
Abstract: The negative health consequences of truck driving are well documented. However, despite the distinct occupational challenges between long- and short-haul driving, limited research has been conducted on how the health profile of these drivers differ. The aims of this study were to characterise the physical and mental health of Australian truck drivers overall, and to identify any differences in factors influencing the health profile of long-haul compared to short-haul drivers. In this cross-sectional study, 1390 Australian truck drivers completed an online survey between August 2019 and May 2020. Questions included validated measures of psychological distress, general health, work ability and health-related quality-of-life. Participants driving 500 km or more per day were categorised as long-haul and those driving less than 500 km as short-haul. The majority of survey respondents were classified as either overweight (25.2%) or obese (54.3%). Three in ten reported three or more chronic health conditions (29.5%) and poor general health (29.9%). The most commonly diagnosed conditions were back problems (34.5%), high blood pressure (25.8%) and mental health problems (19.4%). Chronic pain was reported by 44% of drivers. Half of drivers reported low levels of psychological distress (50.0%), whereas 13.3 and 36.7% experienced severe or moderate level of psychological distress respectively. There were a small number of differences between the health of long- and short-haul drivers. A higher proportion of short-haul drivers reported severe psychological distress compared to long-haul drivers (15.2% vs 10.4%, χ 2 = 8.8, 0.012). Long-haul drivers were more likely to be obese (63.0% vs 50.9%, χ2 = 19.8, 0.001) and report pain lasting over a year (40.0% vs 31.5%, χ 2 = 12.3, 0.006). Having more than one diagnosed chronic condition was associated with poor mental and physical health outcomes in both long- and short-haul drivers. Australian truck drivers report a high prevalence of multiple physical and mental health problems. Strategies focused on improving diet, exercise and preventing chronic conditions and psychological distress, that can also be implemented within the unique occupational environment of trucking are needed to help improve driver health. Further research is needed to explore risk and protective factors that specifically affect health in both short-haul and long-haul drivers.
Publisher: Springer Science and Business Media LLC
Date: 15-04-2015
Publisher: Elsevier BV
Date: 04-2013
DOI: 10.1016/J.AAP.2013.01.007
Abstract: Injured people who are involved in compensation processes have less recovery and less well-being compared to those not involved in claims settlement procedures. This study investigated whether claim factors, such as no-fault versus common law claims, the number of independent medical assessments, and legal disputes, predict health care utilization after transport accidents. The s le consisted of 68,911 claimants who lodged a compensation claim at the Transport Accident Commission (TAC) in Victoria, Australia, between 2000 and 2005. The main outcome measure was health care utilization, which was defined as the number of visits to health care providers (e.g. general practitioners, physiotherapists, psychologists) during the 5 year period post-accident. After correction for gender, age, role in accident, injury type, and severity of injury, it was found that independent medical assessments were associated with greater health care utilization (β=.36, p<.001). Involvement in common law claims and legal disputes were both significantly related to health care utilization (respectively β=.05, p<.001 and β=-.02, p<.001), however, the standardized betas were negligible, therefore the effect is not clinically relevant. A model including claim factors predicted the number of health care visits significantly better (ΔR(2)=.08, p<.001) than a model including only gender, age, role in accident, injury type, and severity of injury. The positive association between the number of independent medical assessments and health care utilization after transport accidents may imply that numerous medical assessments have a negative effect on claimants' health. However, further research is needed to determine a causal relationship.
Publisher: Springer Science and Business Media LLC
Date: 11-04-2017
Publisher: Cold Spring Harbor Laboratory
Date: 24-07-2020
DOI: 10.1101/2020.07.23.20160416
Abstract: Time off work after workplace injury varies by compensation system. While often attributed to features of the compensation system, unaccounted regional factors may drive much of the effect. In this study, we compare disability durations by state and territory of residence within a single national workers’ compensation system. Large differences would indicate that factors other than compensation system settings are responsible for system effects observed in previous studies. We applied crude and adjusted Cox proportional hazards models to compare disability durations by state and territory of residence. Confounders included factors known to influence disability duration. Durations were left-censored at two weeks and right-censored at 104 weeks. We analysed N = 38,686 claims. In both crude and adjusted models, three of the seven states and territories significantly differed from the reference group, New South Wales. However, two of the three were different between crude and adjusted models. Regional effects were relatively small compared to other factors including insurer type, age, and type of injury. Regional factors influence disability duration, which persist with adjustment for demographic, work, insurer type, and injury confounders. However, the effects are inconsistently significant and fairly small, especially when compared to the effect of confounders and system effects found in previous studies. Regional factors likely only account for a small share of the difference in disability duration between compensation systems.
Publisher: Informa UK Limited
Date: 10-2006
DOI: 10.1080/13803390500205718
Abstract: There are many situations in which cognitive tests need to be administered on more than two occasions and at very brief test-retest intervals to detect change in group performance. However, previous literature has not specifically addressed these important issues. The main aim of the current study was to examine these two factors by using a computerized cognitive battery designed specifically for the repeated assessment of cognition (i.e., CogState) in healthy young adult in iduals. A further aim of the study was to examine how many times the battery needed to be completed before performance, as measured by the battery, stabilized. Forty-five adults (age range: 18-40 years) completed the battery four times at 10-minute test-retest intervals, and a fifth time at an interval of one week. The results illustrated that when brief test-retest intervals were used (i.e., 10 minutes), performance stabilized after the second assessment, as significant practice effects were generally observed between the first and the second assessments. Practice effects were also observed on some of the tasks at a one-week test-retest interval. Due to these findings, 55 adults (age range: 18-40 years) completed the battery twice at 10-minute test-retest intervals (i.e., to eliminate the initial practice effect), and a third time at an interval of one month. No practice effects were observed. The implications of the results are discussed in terms of methods that can be adopted in order to minimize practice effects when this particular cognitive battery is used.
Publisher: Springer Science and Business Media LLC
Date: 04-01-2022
DOI: 10.1007/S10926-021-10014-7
Abstract: Purpose To identify whether there were differences in work disability duration between injured workers employed by small, medium, large, and self-insured firms and whether these differences varied between workers' compensation jurisdictions in Canada and Australia. Methods Workers' compensation data were used to identify comparable lost-time, work-related injury and musculoskeletal disorder claims in five Canadian and five Australian jurisdictions between 2011 and 2015. Work disability duration was measured using cumulative disability days paid up to one-year post-injury. Jurisdiction-specific quantile regression models were used to estimate differences in cumulative disability days paid to claims from small (< 20 full-time equivalents (FTEs)) medium (20-199 FTEs), large (200 + FTEs) and self-insured firms at the 25th, 50th, and 70th percentiles in the disability distribution, adjusting for confounders. Results Compared to large firms, workers in small firms generally had longer work disability duration at each percentile, particularly in Saskatchewan and Alberta (Canada), Victoria and Australian Capital Territory (Australia), where an additional 31.1, 18.4, 58.5 and 37.0 days were paid at the 75th percentiles, respectively. The disability duration of workers from self-insured firms was longer than large firms in all Canadian jurisdictions but was shorter or no different in Australian jurisdictions. Smaller differences were observed between claims from large and medium-sized firms. Conclusions Workers in small firms had longer work disability duration than those in large firms in all but one of the study jurisdictions. Claims management processes need to be sensitive to the challenges that small firms face in accommodating and returning injured workers back to work.
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.INJURY.2011.03.011
Abstract: Transport injuries are a substantial cause of disability and death internationally. There is little published information regarding patterns of healthcare utilisation following transport injury. To investigate patterns of in-hospital and post-discharge healthcare use following transport injury. Analysis of all accepted adult claims from the database of the transport accident compensation regulator in Victoria, Australia between 1995 and 2008. The analyses focused on injuries resulting in hospitalisation. Indicators of in-hospital and post-discharge healthcare utilisation (e.g. number of services per practitioner group) within the first 12-months were summarised. More than a third (33.6%, n = 68,639) of all accepted compensable transport injuries resulted in admission to an acute care facility within 28 days of injury. In this group, the compensation authority paid for a total of 4.5 million healthcare services in the 12 months post-discharge (median of 19 services per claim). Services provided by medical practitioners were accessed by nearly all claimants (95.7%) at a median of 11 (5-26) per claimant. Less than half of claimants (46.7%) accessed paramedical or allied health services but the median number of services accessed was higher at 29 (9-82) per claimant. Transport-related injury cases require a substantial interaction with multiple components of the healthcare system in the year following hospital discharge. Compensation system data may provide a detailed understanding of healthcare utilisation, a key element of injury burden.
Publisher: BMJ
Date: 10-2001
Abstract: Professional and amateur participants in many sports are at risk of brain injury caused by impact with other players or objects. In many cases, mild cognitive deficits may persist after the common neurological signs of brain injury have passed. In recent years, the athlete's cognitive status after concussion has been measured with conventional "paper and pencil" neuropsychological tests. However, such tests are not ideal for sporting settings, as they are designed for the detection of gross cognitive impairments at a single assessment, not for the identification of mild cognitive deficits on repeated assessment. A number of computerised cognitive assessment tests and test batteries have been developed over the past two decades. These batteries offer major scientific and practical advantages over conventional neuropsychological tests which make them ideal for the assessment of cognitive function in sportspeople. This review first describes the problems associated with cognitive assessment of people with sports related cognitive deficits, and then critically examines the utility of conventional neuropsychological and computerised cognitive tests in sporting settings.
Publisher: Springer Science and Business Media LLC
Date: 25-02-2014
Publisher: BMJ
Date: 02-12-2019
DOI: 10.1136/OEMED-2019-106063
Abstract: To determine the impact of legislative changes to the New South Wales (NSW) workers’ compensation scheme on injured workers access to benefits, insurer claim processing and work disability duration. Population-based interrupted time series study of workers’ compensation claims made in NSW 2 years before and after legislative amendment in June 2012. Outcomes included incidence of accepted claims per 100 000 workers, the median and 75th percentile insurer decision time in days, and the median and 75th percentile of work disability duration in weeks. Effects were assessed relative to a comparator of seven other Australian workers’ compensation jurisdictions. n=1 069 231 accepted workers’ compensation claims were analysed. Claiming in NSW fell 15.3% following legislative reform, equivalent to 46.6 fewer claims per 100 000 covered workers per month. This effect was greater in time loss claims (17.3%) than medical-only claims (10.3%). Across models, there were consistent trend increases in insurer decision time. Median work disability duration increased following the legislative reform. The observed reduction in access to benefits was consistent with the policy objective of improving the financial sustainability of the compensation scheme. However, this was accompanied by changes in other markers of performance that were unintended, and are suggestive of adverse health consequences of the reform. This study demonstrates the need for care in reform of workers’ compensation scheme policy.
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.AAP.2012.11.010
Abstract: Studies addressing work disability after road traffic injury are generally aimed at seriously injured hospital patients, and less is known about the disability burden associated with injuries not requiring hospitalisation. The aim of this study was to describe the distribution and determinants of work disability outcomes for patients with musculoskeletal and orthopaedic traffic injuries, including those not sufficiently severe to require hospitalisation. Persons injured in road traffic accidents in 2005-2007 claiming compensation via the Transport Accident Commission (Victoria, Australia) were included if they had compensated time off work, and their most serious injury was musculoskeletal or orthopaedic (n=5970). Work disability outcomes were determined from income compensation payments over 17 months following the accident. Logistic regression models were used relating demographic and injury characteristics to work disability. Of the injuries, 59% required hospitalisation 15% required hospitalisation of >1 week. Long-term work disability was common with 32% of injuries resulting in work disability ≥6 months after the accident. The duration of work disability increased markedly with length of hospital stay. Those with no hospital stay accounted for 27% of all work disability days those with ≤7 days in hospital (including no hospital stay) accounted for 71%. Female sex, age ≥35 years and early opioid prescriptions were also risk factors for work disability ≥6 months after the accident. The majority of work disability days were among patients with one week or less in hospital. Because (short) hospitalisation was relatively common after traffic accidents, the relative work disability burden of non-hospitalised injury is not as great as in a mixed injury aetiology population.
Publisher: MIT Press
Date: 04-2002
DOI: 10.1162/089892902317361994
Abstract: Older people with declining cognitive function typically display deficits in declarative memory processes, often most evident on tests of associative learning (AL). The hippoc al formation (HF) is thought to be critically involved in the encoding and retrieval of such associations, consistent with neuroimaging findings that the HF is damaged in early stages of neurodegenerative disease and in older people with AL impairments. In the clinic, older people with cognitive decline commonly report difficulties associating names with faces. However, we have observed that such people are particularly impaired on tests requiring the association of novel stimuli. In Experiment 1, a series of AL tasks were administered to older people with cognitive decline to determine whether they were impaired at simply making associations, or at making associations between novel stimuli. In Experiment 2, we measured HF function in these subjects by administering an AL task designed to differentiate between HF-damaged and HF-intact in iduals. Our experimental protocols were guided by a computational model of HF function in AL described by Gluck and Myers (1997). Older people with cognitive decline displayed impaired performance on tasks designed to be highly dependent upon intact HF function, including a task in which novel patterns and spatial locations were to be associated. These results suggest that the AL impairments observed in older people with cognitive decline may be due to HF dysfunction.
Publisher: Springer Science and Business Media LLC
Date: 23-02-2018
DOI: 10.1007/S10926-018-9765-Y
Abstract: Purpose To determine whether healthcare use and return-to-work (RTW) outcomes differ with GPs' injured-worker caseload. Methods Retrospective analyses of the Compensation Research Database, which captures approximately 85% of all injured worker claims in Victoria, Australia was conducted. Four injured-worker caseload groups were examined that represented the 25th, 50th, 75th, and 100th percentiles of claimants seen per GP over the 8-year study period (2003-2010): (i) 1-13 claimants (ii) 14-26 claimants (iii) 27-48 claimants and (iv) 49+ claimants (total claims, n = 124,342 total GPs, n = 9748).The characteristics of claimants in each caseload group, as well as the influence of caseload on three outcomes relevant to RTW (weekly compensation paid, work incapacity days, medical-and-like costs), were examined. Results Distinct profiles for high versus low caseload groups emerged. High caseload GPs treated significantly more men in blue collar occupations and issued significantly more 'alternate duties' certificates. Conversely, low caseload GPs treated significantly more women in white collar occupations, predominantly for mental health injuries, and issued significantly more 'unfit-for-work' certificates. Few significant differences were found between the two intermediate GP caseload groups. High caseload was associated with significantly greater medical-and-like costs, however, no caseload group differences were detected for weekly compensation paid or duration of time-off-work. Conclusions Training GPs who have a low injured-worker caseload in workers' compensation processes, utilising high caseload GPs in initiatives involving peer-to-peer support, or system changes where employers are encouraged to provide preventive or rehabilitative support in the workplace may improve RTW outcomes for injured workers.
Publisher: Elsevier BV
Date: 09-2009
Publisher: Cambridge University Press (CUP)
Date: 25-02-2003
DOI: 10.1017/S1355617703930074
Abstract: Performance on many cognitive and neuropsychological tests may be improved by prior exposure to testing stimuli and procedures. These beneficial practice effects can have a significant impact on test performance when conventional neuropsychological tests are administered at test–retest intervals of weeks, months or years. Many recent investigations have sought to determine changes in cognitive function over periods of minutes or hours (e.g., before and after anesthesia) using computerized tests. However, the effects of practice at such brief test–retest intervals has not been reported. The current study sought to determine the magnitude of practice effects in a group of 113 in iduals assessed with an automated cognitive test battery on 4 occasions in 1 day. Practice effects were evident both between and within assessments, and also within in idual tests. However, these effects occurred mostly between the 1st and 2nd administration of the test battery, with smaller, nonsignificant improvements observed between the 2nd, 3rd, and 4th administrations. On the basis of these results, methodological and statistical strategies that may aid in the differentiation of practice effects from drug-induced cognitive changes are proposed. ( JINS , 2003, 9 , 419–428.)
Publisher: BMJ
Date: 10-2004
Publisher: Wiley
Date: 23-07-2016
DOI: 10.1111/COGS.12399
Abstract: Context is an important construct in many domains of cognition, including learning, memory, and emotion. We used dynamical systems methods to demonstrate the episodic nature of experience by showing a natural separation between the scales over which within-context and between-context relationships operate. To do this, we represented an in idual's emails extending over about 5 years in a high-dimensional semantic space and computed the dimensionalities of the subspaces occupied by these emails. Personal discourse has a two-scaled geometry with smaller within-context dimensionalities than between-context dimensionalities. Prior studies have shown that reading experience (Doxas, Dennis, & Oliver, 2010) and visual experience (Sreekumar, Dennis, Doxas, Zhuang, & Belkin, 2014) have a similar two-scaled structure. Furthermore, the recurrence plot of the emails revealed that experience is predictable and hierarchical, supporting the constructs of some influential theories of memory. The results demonstrate that experience is not scale-free and provide an important target for accounts of how experience shapes cognition.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2017
Publisher: SAGE Publications
Date: 02-2002
DOI: 10.1046/J.1440-1614.2002.00972.X
Abstract: Objective: Over the past two decades, a number of systems have been developed for the classification of cognitive and behavioural abnormalities in older people, in order that in iduals at high risk of developing neurodegenerative disease, particularly Alzheimer's disease, may be identified well before the disease manifests clinically. This article critically examines the inclusion and exclusion criteria of a number of such classification systems, to determine the effect that variations in criterion may have on clinical, behavioural and neuroimaging outcomes reported from older people with mild cognitive impairment. Method: Qualitative review of the literature describing systems of classifying mild cognitive impairment, and outcomes from clinical, behavioural, neuroimaging and genetic studies of older people with mild cognitive impairment. Results: The exclusion and inclusion criteria for these classification systems vary markedly, as do the design of studies upon which the validity of these systems has been assessed. Minor changes to in idual exclusion/inclusion criterion may result in substantial changes to estimates of the prevalence and clinical outcome of mild cognitive impairment, while inadequate experimental design may act to confound the interpretation of results. Conclusions: As a result of these factors, accurate and consistent estimates of the outcome of mild cognitive impairments in otherwise healthy older people are yet to be obtained. On the basis of this analysis of the literature, optimal criteria via which accurate classifications of mild cognitive impairment can be made in future are proposed.
Publisher: Elsevier BV
Date: 07-2019
DOI: 10.1016/J.INJURY.2019.05.032
Abstract: Road traffic crash (RTC) burden is typically reported using hospitalisations or fatalities, yet alternative measures such as work absence provide further insight into RTC impacts. This study aimed to quantify work absence due to compensable RTCs in Victoria, and to determine the characteristics associated with prolonged work absence. In Victoria, Australia, two systems provide income support whilst unable to work, among other benefits, to those injured during RTCs either at work (workers' compensation: WC) or elsewhere (RTC compensation). Administrative data of accepted claims between July 1 2003 and June 30, 2013 were included from working age people (15-65 years) if at least one day of income support was paid. Total time (in weeks) on income support, and hence absent from work, was calculated for each person and for each predictor (age group, sex, compensation system, length of hospital stay, injury type and road user type). Cox regression was used to determine the likelihood of prolonged work absence by predictor, presented as hazard ratios (HR) with 95% confidence intervals. For 36,640 injured people, 1,121,863 weeks were compensated (median 10 weeks). Median work absence was shortest among those involved in a train/tram crash (2.9 weeks, HR:0.57[0.51-0.64]) and those with contusions/abrasions (3.7 weeks, HR:0.66[0.64,0.69]). Median work absence was longest among those with spinal cord injury (115.9 weeks, HR:1.56[1.26,1.92]) or severe acquired brain injury (129.6 weeks, HR:1.60[1.44,1.77]). Work absence likelihood increased with length of hospital stay. Median work absence was similar between compensation systems (WC: 10.1 weeks, RTC: 10.0 weeks) yet likelihood of greater work absence was higher in the RTC compensation system (HR:1.12[1.08,1.17]). Work absence is both a measureable and important metric for assessing the impact of RTC injury in those working at the time of injury. Work absence was at least ten weeks for more than half of all injured persons, reinforcing need for road safety, injury prevention, and return to work services. Furthermore, this study identified those most at risk of prolonged work absence, providing the opportunity to target specific in iduals to develop strategies to reduce work absence, such as occupation-specific rehabilitation or graduated return to work.
Publisher: Springer Science and Business Media LLC
Date: 19-06-2020
Publisher: Public Library of Science (PLoS)
Date: 07-04-2022
DOI: 10.1371/JOURNAL.PONE.0266650
Abstract: To determine health impacts during, and following, an extended community lockdown and COVID-19 outbreak in the Australian state of Victoria, compared with the rest of Australia. A national cohort of 898 working-age Australians enrolled in a longitudinal cohort study, completing surveys before, during, and after a 112-day community lockdown in Victoria (8 July– 27 October 2020). Outcomes included psychological distress, mental and physical health, work, social interactions and finances. Regression models examined health changes during and following lockdown. The Victorian lockdown led to increased psychological distress. Health impacts coincided with greater social isolation and work loss. Following the extended lockdown, mental health, work and social interactions recovered to an extent whereby no significant long-lasting effects were identified in Victoria compared to the rest of Australia. The Victorian community lockdown had adverse health consequences, which reversed upon release from lockdown. Governments should weigh all potential health impacts of lockdown. Services and programs to reduce the negative impacts of lockdown may include increases in mental health care, encouraging safe social interactions and supports to maintain employment relationships.
Publisher: Elsevier BV
Date: 07-2007
DOI: 10.1016/J.CCT.2006.10.010
Abstract: Inclusion of cognitive assessment in Phase I trials of novel pharmaceutical agents may help identify subtle yet meaningful CNS effects early in clinical development, and lead to a greater understanding of the pharmacokinetic harmacodynamic relationship prior to entering pivotal late-phase trials. To examine issues surrounding the inclusion of a computerised cognitive test battery in Phase I clinical trials. A 12-minute battery of five computerized cognitive tasks was administered to 28 healthy males in a double-blind, single ascending dose study using three doses of midazolam (0.6 mg, 1.75 mg and 5.25 mg) with placebo insertion. Subjects were enrolled and assessed at two Phase I units. Statistical analyses sought to determine the sensitivity of the test battery to sedation-related cognitive dysfunction, any between-site differences in outcome, and also the effects of repeated test administration (i.e., practice or learning effects). There were no significant differences in data collected between sites. All standard safety measurements were completed. No substantial technical issues were noted. No learning effects were observed on four of the five cognitive tasks. ANOVA comparing baseline to post-baseline results revealed significant cognitive deterioration on all five cognitive tasks 1 h following administration of 5.25 mg midazolam. The magnitude of these changes were very large according to conventional statistical criteria. Smaller but significant changes were observed on a subset of memory and learning tasks at 1 h post-dosing in 1.75 mg condition, and at 2 h post-dosing in the 5.25 mg condition. The cognitive test battery was well tolerated by subjects and research unit staff. The tests demonstrated minimal learning effects, were unaffected by language and cultural differences between sites, and were sensitive to the sedative effects of midazolam. Inclusion of this cognitive test battery in future studies may allow identification of cognitive impairment or enhancement early in the clinical development cycle.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-03-2020
DOI: 10.1097/JOM.0000000000001850
Abstract: To examine associations between injury-related work disability duration and urban-rural place of residence and whether associations differed across the disability distribution and by industry sector. Workers’ compensation claims from six Canadian provinces were extracted between 2011 and 2015. Multivariable quantile regression models tested the associations between urban-rural place of residence and disability days paid between the 50th and 95th percentiles of the distribution. Compared to workers residing in metropolitan areas, those in all other areas experienced more disability days paid. Urban-rural differences increased toward the upper end of disability distribution and were largest in the construction, and transportation and warehousing sectors. Tailored interventions for workers in rural areas, particularly those in sectors associated with mobile work environments, may be warranted to reduce inequities in injury-related work disability duration by place of residence.
Publisher: Springer Science and Business Media LLC
Date: 07-03-2017
DOI: 10.1007/S10926-017-9697-Y
Abstract: Purpose Work absence can result in substantial losses to the economy and workers. As a result, identifying modifiable factors associated with return-to-work (RTW) following an injury or illness is the focus of many empirical investigations. Self-efficacy, the belief about one's ability to undertake behaviours to achieve desired goals, has been identified as an important factor in RTW for injured workers. This paper systematically reviewed the literature on the association between self-efficacy and RTW outcomes for workers with an upper-body musculoskeletal injury or psychological injury. Methods A systematic search was conducted across five databases using two main search concepts- 'self-efficacy' and 'RTW'. After removing duplicates, our search strategy identified 836 studies, which were screened for relevance using titles and abstracts. Results A two stage screening process reduced the study pool to six studies using psychological injury cohorts and three using upper-body musculoskeletal (UB-MSK) cohorts. Eight cohorts from seven prospective cohort studies and one s le from a randomised control trial (RCT) were subjected to a risk of bias assessment. Higher levels of self-efficacy appeared to have a consistent and positive association with RTW across return-to-work status and work absence outcomes, injury type and follow-up periods. Effect ratios ranged from 1.00 to 5.26 indicating a potentially large impact of self-efficacy on RTW outcomes. The relationship between self-efficacy and RTW strengthened as the domain of self-efficacy became more specific to RTW and job behaviours. Studies assessing workers with psychological injuries were of a lower quality compared to those assessing workers with UB-MSK injuries. Conclusions Higher self-efficacy had consistent positive associations with RTW outcomes. Further empirical research should identify the determinants of self-efficacy, and explore the processes by which higher self-efficacy improves RTW outcomes.
Publisher: Cold Spring Harbor Laboratory
Date: 16-01-2020
DOI: 10.1101/2020.01.13.20017343
Abstract: Low back pain (LBP) is a leading cause of work disability. While absent from work, workers with LBP may receive income support from a system such as workers’ compensation or social security. Current evidence suggests that income support systems can influence recovery from LBP, but provides little insight as to why and how these effects occur. This study examines how and in what contexts income support systems impact the healthcare quality for people with work disability and LBP and their functional capacity. We performed a realist review, a type of literature review that seeks to explain how social interventions and phenomena in certain contexts generate outcomes, rather than simply whether they do. Five initial theories about the relationship between income support systems and outcomes were developed, tested, and refined by acquiring and synthesising academic literature from purposive and iterative electronic database searching. This process was supplemented with grey literature searches for policy documents and legislative summaries, and semi-structured interviews with experts in income support, healthcare and LBP. Income support systems influence healthcare quality through funding restrictions, healthcare provider administrative burden, and allowing employers to select providers. They also influence worker functional capacity through the level of participation and financial incentives for employers, measures to prove the validity of the worker’s LBP, and certain administrative procedures. These mechanisms are often exclusively context-dependent, and generate differing and unintended outcomes depending on features of the healthcare and income support system, as well as other contextual factors such as socioeconomic status and labour force composition. Income support systems impact the healthcare quality and functional capacity of people with work disability and LBP through context-dependent financial control, regulatory and administrative mechanisms. Research and policy design should consider how income support systems may indirectly influence workers with LBP via the workplace.
Publisher: Springer Science and Business Media LLC
Date: 17-02-2015
Publisher: Elsevier BV
Date: 10-2019
DOI: 10.1016/J.HEALTHPOL.2019.06.010
Abstract: Delays in workers' compensation claim processing (CP) times have been associated with reduced recovery and delayed return-to-work. This study aimed to (1) determine the injury, worker, and workplace factors associated with CP delays and (2) investigate whether CP delays are associated with longer disability duration after adjusting for these factors. Retrospective cohort analysis of Australian workers' compensation claims was conducted from 1st July 2009 to 30th June 2016 for objective (1) and to 30th June 2014 for objective (2). CP times were derived by calculating differences in days between: injury and lodgement dates (lodgement) lodgement and decision dates (decision) and injury and decision dates (total). All CP times were shorter for younger workers and those with fractures or traumatic injury, and longer for those with neurological or mental health conditions, and other diseases. Claims from self-insured employers had shorter decision times. With increasing lodgement, decision and total time there was significantly higher hazard of longer disability duration. Findings suggest the need for more efficient claims management to ensure fewer barriers to claim lodgement or approval. This in turn should reduce disability duration and ensure improved return-to-work outcomes.
Publisher: Cold Spring Harbor Laboratory
Date: 14-01-2023
DOI: 10.1101/2023.01.13.23284453
Abstract: In 2015, South Australia replaced its workers’ compensation system with the aim of improving return to work rates. We tested whether time off work among injured workers changed under the new system, as well as indicators of potential mechanisms. We conducted a controlled interrupted time series using workers’ compensation claims data. The primary outcome was mean weeks of compensated disability duration. Secondary outcomes tested explanatory mechanisms: 1) claim volumes to determine whether the new system changed the makeup of claimants, and 2) mean employer report and insurer decision times to evaluate whether there had been changes in claim processing. Outcomes were aggregated into monthly units. South Australia was compared to six other Australian workers’ compensation systems. To test for moderation by condition type, disease claims were compared to injury claims and mental health claims to physical health claims. Disability duration and insurer decision time steadily declined before the RTW Act came into effect, but flatlined afterwards. Claim volumes did not change significantly. Employer report time initially increased but gradually decreased until it was lower than the counterfactual. There were non-significant increases in disability durations among injury claims compared to disease claims, and mental health claims compared to physical claims. The increase in disability duration after the RTW Act took effect may be attributable to the disruption of implementing a new compensation system or the elimination of provisional liability entitlements that incentivised early decision making and provided early intervention. Workers’ compensation systems are a major determinant of injured worker recovery. However, the specific mechanisms of how the compensation system influences outcomes are often opaque, which impedes the design of effective systems. This interrupted time series study evaluates the effect of a new workers’ compensation system in South Australia, which was designed specifically to improve return to work rates. Time off work increased relative to the counterfactual, which paralleled trends in the time for insurers to decide on liability. The findings highlight the importance of understanding how compensation systems influence injured workers outcomes and considering the entire claims process when designing new systems.
Publisher: BMJ
Date: 12-08-2014
DOI: 10.1136/INJURYPREV-2014-041336
Abstract: Traumatic injury is a leading contributor to the overall global burden of disease. However, there is a worldwide shortage of population data to inform understanding of non-fatal injury burden. An improved understanding of the pattern of recovery following trauma is needed to better estimate the burden of injury, guide provision of rehabilitation services and care to injured people, and inform guidelines for the monitoring and evaluation of disability outcomes. To provide a comprehensive overview of patient outcomes and experiences in the first 5 years after serious injury. This is a population-based, nested prospective cohort study using quantitative data methods, supplemented by a qualitative study of a seriously injured participant s le. All 2547 paediatric and adult major trauma patients captured by the Victorian State Trauma Registry with a date of injury from 1 July 2011 to 30 June 2012 who survived to hospital discharge and did not opt-off from the registry. To analyse the quantitative data and identify factors that predict poor or good outcome, whether there is change over time, differences in rates of recovery and change between key participant subgroups, multilevel mixed effects regression models will be fitted. To analyse the qualitative data, thematic analysis will be used to identify important themes and the relationships between themes. The results of this project have the potential to inform clinical decisions and public health policy, which can reduce the burden of non-fatal injury and improve the lives of people living with the consequences of severe injury.
Publisher: BMJ
Date: 02-2003
DOI: 10.1136/BJSM.37.1.2
Publisher: Springer Science and Business Media LLC
Date: 29-10-2018
DOI: 10.1007/S10926-018-9816-4
Abstract: Purpose This study sought to describe Australian systems of income support for people with work disability. Specific aims were to summarise and compare the features of the income support systems, including the rehabilitation and employment services funded or provided by those systems, and factors affecting transition between systems. Further objectives were to estimate the prevalence of work disability in Australia and the national expenditure on work disability income support. Methods A mixed methods project involving collation and analysis of existing publicly available documentation and data, and interviews with 25 experts across ten major systems of income support. The prevalence of work disability and expenditure in each system, and in total, was estimated using publicly accessible data sources. System features and service models were synthesised from data sources, tabulated and compared qualitatively. Results In Australia during the 2015/2016 financial year an estimated 786,000 people with work disability received income support from a Commonwealth, state, territory or private source. An additional 6.5 million people accessed employer provided leave entitlements for short periods of work incapacity. A total of $37.2 billion Australian dollars was spent on income support for these people during the year. This support was provided through a complex array of government authorities, private sector insurers and employers. Service models vary substantially between systems, with case management the only service provided across all systems. Healthcare and return to work services were provided in some systems, although models differed markedly between systems. Income support ranged from 19 to 100% of earnings for a person earning the average weekly Australian wage pre-disability. There is a paucity of information relating to movement between systems of support, however it is likely that many thousands of people with long periods of work disability transition between systems annually. Conclusions This study demonstrates the substantial financial and human impact of work disability on Australian society. Findings indicate multiple opportunities for reducing the burden of work disability, including aligning case management and healthcare service models, and engaging employers in prevention and rehabilitation. The findings suggest a need for greater interrogation and evaluation of Australian work disability support systems.
Publisher: Informa UK Limited
Date: 27-06-2012
DOI: 10.3109/02699052.2012.698790
Abstract: To describe the type, intensity and direct cost of healthcare and disability services used following transport-related traumatic brain injury (TBI). Using the transport accident compensation regulator database, claims records were examined of 423 cases of adult (18-65 years of age) transport-related TBI occurring between 1 January 1995 and 31 December 2004. Claimants were stratified by TBI severity using the Glasgow Coma Scale (GCS) score. Service utilization and costs were examined by TBI severity in the 5-year period post-injury. Claimants accessed a total of 409,740 services. Claimants with severe TBI accessed more medical (median 333 per claimant) and paramedical services (median 436 per claimant) than claimants with mild and moderate TBI. Almost 60% of claimants with severe TBI accessed attendant care services compared to 39% and 45% of claimants with moderate and mild TBI, respectively. Average total costs of services were highest among claimants with severe TBI (AUD $324,515 per claimant). Healthcare service utilization and the economic burden of TBI are substantial. Injury compensation data provides a unique opportunity to explore patterns of healthcare usage post-injury, which is important for the planning and management of resources.
Publisher: Informa UK Limited
Date: 2015
Publisher: Springer Science and Business Media LLC
Date: 04-08-2021
DOI: 10.1186/S13012-021-01146-8
Abstract: The Clinical Guideline for the Diagnosis and Management of Work-related Mental Health Conditions in General Practice (the Guideline) was published in 2019. The objective of this trial is to implement the Guideline in general practice. Implementing work-related Mental health conditions in general PRacticE is a hybrid III, parallel cluster randomised controlled trial undertaken in Australia. Its primary aim is to assess the effectiveness of a complex intervention on the implementation of the Guideline in general practice. Secondary aims are to assess patient health and work outcomes, to evaluate the cost-effectiveness of the trial, and to develop a plan for sustainability. A total of 86 GP clusters will be randomly allocated either to the intervention arm, where they will receive a complex intervention comprising academic detailing, enrolment in a community of practice and resources, or to the control arm, where they will not receive the intervention. GP guideline concordance will be assessed at baseline and 9 months using virtual simulated patient scenarios. Patients who meet the eligibility criteria ( years, employed, and receiving care from a participating GP for a suspected or confirmed work-related mental health condition) will be invited to complete surveys about their health and work participation and provide access to their health service use data. Data on health service use and work participation compensation claim data will be combined with measures of guideline concordance and patient outcomes to inform an economic evaluation. A realist evaluation will be conducted to inform the development of a plan for sustainability. We anticipate that GPs who receive the intervention will have higher guideline concordance than GPs in the control group. We also anticipate that higher concordance will translate to better health and return-to-work outcomes for patients, as well as cost-savings to society. The trial builds on a body of work defining the role of GPs in compensable injury, exploring their concerns, and developing evidence-based guidelines to address them. Implementation of these guidelines has the potential to deliver improvements in GP care, patient health, and return-to-work outcomes. ACTRN12620001163998 , November 2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2012
Publisher: BMJ
Date: 06-2006
Publisher: SAGE Publications
Date: 2023
DOI: 10.1177/20552076231176695
Abstract: Workers’ compensation schemes provide funding for wage replacement and healthcare for injured and ill workers. In Australia, workers’ compensation schemes operate independently in different jurisdictions, making comparisons of health service use challenging. We sought to develop and deploy a new database of health service and income support data, harmonising data from multiple Australian workers’ compensation jurisdictions. We worked with workers’ compensation authorities from six Australian jurisdictions to combine claims, healthcare, medicines and wage replacement data for a s le of compensated workers with claims for musculoskeletal conditions. We designed a structured relational database and developed a bespoke health services coding scheme to harmonise data across jurisdictions. The Multi-Jurisdiction Workers’ Compensation Database contains four data sets: claims, services, medicines and wage replacement. The claims data set contains 158,946 claims for low back pain (49.6%), limb fracture (23.8%) and non-specific limb conditions (26.7%). The services data set contains a total of 4.2 million cleaned and harmonised services including doctors (29.9%), physical therapists (56.3%), psychological therapists (2.8%), diagnostic procedures (5.5%) and examinations and assessments (5.6%). The medicines data set contains 524,380 medicine dispenses, with 208,504 (39.8%) dispenses for opioid analgesics. The development of this database presents potential opportunities to gain a greater understanding of health service use in the Australian workers’ compensation sector, to measure the impact of policy change on health services and to provide a method for further data harmonisation. Future efforts could seek to conduct linkage with other data sources.
Publisher: BMJ
Date: 21-07-2014
Publisher: Springer Science and Business Media LLC
Date: 10-11-2022
DOI: 10.1007/S10926-022-10081-4
Abstract: Background The transport and logistics industry contributes to a significant proportion of the Australian economy. However, few studies have explored the economic and clinical burden attributed to poor truck driver health. We therefore estimated the work-related mortality burden among truck drivers over a 10-year period. Methods Dynamic life table modelling was used to simulate the follow-up of the Australian male working-age population (aged 15–65 years) over a 10-year period of follow-up (2021–2030). The model estimated the number of deaths occurring among the Australian working population, as well as deaths occurring for male truck drivers. Data from the Driving Health study and other published sources were used to inform work-related mortality and associated productivity loss, hospitalisations and medication costs, patient utilities and the value of statistical life year (VoSLY). All outcomes were discounted by 5% per annum. Results Over 10 years, poor truck driver health was associated with a loss of 21,173 years of life lived (discounted), or 18,294 QALYs (discounted). Healthcare costs amounted to AU$485 million (discounted) over this period. From a broader, societal perspective, a total cost of AU$2.6 billion (discounted) in lost productivity and AU$4.7 billion in lost years of life was estimated over a 10-year period. Scenario analyses supported the robustness of our findings. Conclusions The health and economic consequences of poor driver health are significant, and highlight the need for interventions to reduce the burden of work-related injury or disease for truck drivers and other transport workers.
Publisher: BMJ
Date: 27-03-2020
DOI: 10.1136/OEMED-2019-106325
Abstract: To determine whether step-downs, which cut the rate of compensation paid to injured workers after they have been on benefits for several months, are effective as a return to work incentive. We aggregated administrative claims data from seven Australian workers’ compensation systems to calculate weekly scheme exit rates, a proxy for return to work. Jurisdictions were further sub ided into four injury subgroups: fractures, musculoskeletal, mental health and other trauma. The effect of step-downs on scheme exit was tested using a regression discontinuity design. Results were pooled into meta-analyses to calculate combined effects and the proportion of variance attributable to heterogeneity. The combined effect of step-downs was a 0.86 percentage point (95% CI −1.45 to −0.27) reduction in the exit rate, with significant heterogeneity between jurisdictions ( I 2 =68%, p=0.003). Neither timing nor magnitude of step-downs was a significant moderator of effects. Within injury subgroups, only fractures had a significant combined effect (−0.84, 95% CI −1.61 to −0.07). Sensitivity analysis indicated potential effects within mental health and musculoskeletal conditions as well. The results suggest some workers’ compensation recipients anticipate step-downs and exit the system early to avoid the reduction in income. However, the effects were small and suggest step-downs have marginal practical significance. We conclude that step-downs are generally ineffective as a return to work policy initiative. Postprint link: ontent/10.1101/19012286
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.INJURY.2017.09.019
Abstract: Workers in first responder (FR) occupations are at heightened risk for workplace injury given their exposure to physical sychological hazards. This study sought to (1) characterise the occupational risk of injury (2) determine factors associated with injury and (3) characterise the burden of injury-related disability in police, ambulance officers, fire/emergency workers, compared with other occupations. A retrospective cohort of 2,439,624 claims occurring between July 2003 and June 2012 was extracted from the Australian National Dataset for Compensation-Based Statistics. Cases aged 16-75 years working 1-100 pre-injury hours per week were included. Regression models estimated risk of making a workers' compensation (WC) claim by age, gender, occupation and injury type. Injury burden was calculated using count and time loss, and statistically compared between groups. The risk of making a WC claim among FR occupations was more than 3 times higher than other occupations. Risk of claiming was highest among female FRs and those aged 35-44 years. Ambulance officers had the greatest risk of upper-body MSK injuries and fire and emergency workers the greatest risk of lower-body MSK injuries. The risk of mental health conditions was elevated for all FR occupations but highest among police officers. The total burden of injury (expressed as working weeks lost per 1000 workers) differed significantly between groups and was highest amongst police. First responders record significantly higher rates of occupational injury claims than other occupations. Using a national population based dataset, this study demonstrates that not only are first responders exposed to significantly higher rates of occupational injury than all other occupations combined, but they experience differential injury patterns depending on their occupation. This suggests that among FR occupations injury prevention efforts should reflect these differences and be targeted to occupation-specific patterns of injury.
Publisher: Oxford University Press (OUP)
Date: 09-2014
DOI: 10.1111/PME.12421
Abstract: The objective of this study is to identify the prevalence of opioid prescription use in an Australian workers' compensation population and assess predictors of long-term use. Retrospective administrative data analysis. WorkSafe Victoria (Australia) workers' compensation. Workers with a workers' compensation claim were included if the injury/illness started in 2008 or 2009 (N = 54,931). Claim payments records dating up to 2 years postinjury were analyzed to determine receipt of prescription opioids. Long-term use was defined as use of any opioid beyond 1 year postinjury. Within the follow-up period, 8,933 (16.3%) workers claimed prescription opioids: 10.0% claimed opioids in the first year only, and 6.3% claimed opioids beyond the first year. The most commonly received opioids were codeine (10.4%), oxycodone (7.5%), and tramadol (5.0%). Dextropropoxyphene, which is considered unsafe in many countries because of potentially fatal side effects, was used by 1.9% of injured workers. Progression to long-term use of opioids was common (N = 3,446 39%): age (35-64 years the association with age followed an inverse U-shaped curve), women, laborers, lower socioeconomic status, greater work disability, and greater hospital expense were associated with opioid use beyond the first year postinjury. Prescription opioid use for workplace injury in Australia is common but not as common as reports from U.S. workers' compensation schemes. The type of opioid and number of repeat prescriptions are factors that should be carefully considered by practitioners prescribing opioids to injured workers: progression to long-term use is common and not fully explained by injury severity.
Publisher: Springer Science and Business Media LLC
Date: 12-03-2022
DOI: 10.1186/S12889-022-12897-4
Abstract: Engagement in work is an important determinant of health. In response to the COVID-19 pandemic, public health measures imposed to reduce viral transmission resulted in large-scale loss of work during the early stages of the pandemic, contributing to declined mental and physical health. As the pandemic unfolded, the Australian economy began to recover and some people could return to work, whilst localised lockdowns resulted in further loss of work for others. The long-term health effects of work loss remain unexplored within the COVID-19 pandemic context, in addition to whether any health effects are persistent upon returning to work. A prospective longitudinal cohort study of 2603 participants across Australia monitored changes in health and work between March and December 2020, with participants completing surveys at baseline and 1, 3 and 6 months later. Outcomes described psychological distress, and mental and physical health. Linear mixed regression models examined associations between changes in health and experiences of work loss, and return to work, over time. Losing work during the early stages of the pandemic was associated with long-term poorer mental health, which began to recover over time as some returned to work. Physical health deteriorated over time, greater for people not working at baseline. Being out of work was associated with poorer mental health, but better physical health. These effects were larger for people that had recently lost work than for people with sustained work loss, and retaining employment played a protective role. Generally, returning to work resulted in poorer physical health and improvements in mental health, although this depended on the broader context of changes in work. Work cessation during the pandemic led to poor health outcomes and had long-lasting effects. Returning to work benefits mental health but may reduce physical activity in the short-term. We encourage the provision of accessible mental health supports and services immediately following loss of work, and for people with prolonged forms of work loss. Australian New Zealand Clinical Trials Registry: ACTRN12620000857909 .
Publisher: Springer Science and Business Media LLC
Date: 19-03-2021
DOI: 10.1186/S12913-021-06255-0
Abstract: Healthcare is funded and delivered separately from income support programs such as unemployment and disability benefits. Greater understanding of the health service use (HSU) of benefit recipients would support more effective design and delivery of health and income support programs. This study aimed to characterise the HSU of disability and unemployment benefit recipients relative to people earning wages, while controlling for personal, household and health-related factors associated with HSU in benefit recipients. A cross-sectional national survey of 9110 working age Australian adults in three groups: (1) 566 receiving the disability support pension (DSP) (2) 410 receiving unemployment benefits and (3) 8134 earning wages. Outcomes included prevalence and frequency of health professional consultations, hospital attendance and admission in the past 12 months, as well as medication and supplement use in the past 2 weeks. Analyses compared DSP and unemployment benefit recipients to wage earners using prevalence ratios and incident rate ratios, adjusted for predisposing, enabling and need factors that may affect HSU. In adjusted regression models, both DSP and unemployment benefit recipients were significantly more likely than wage earners to have consulted psychologists and social workers. DSP recipients also reported a significantly higher prevalence of consultations with General Practitioners (GPs), specialist physicians and podiatrists.. Both groups reported significantly more frequent consultations with GPs and DSP recipients with specialists. No differences were observed between groups for hospital attendance or admission, or supplement use in fully adjusted models, though the DSP group reported more prevalent medication use than wage earners. Inclusion of confounders including self-assessed health, disability severity, health insurance status, and financial resources attenuated the relationship between benefit receipt and HSU, however significant associations were still observed. People receiving unemployment and disability insurance benefits use significantly more health services than wage earners. A range of personal and clinical characteristics explained much, but not all, of the association between greater HSU and benefit receipt. Greater coordination between health and income support systems may improve health, reduce HSU and improve work ability in unemployed and working age people.
Publisher: Cold Spring Harbor Laboratory
Date: 27-02-2020
DOI: 10.1101/2020.02.24.20027540
Abstract: To describe incidence, duration, and patterns of working time loss claims in compensated Australian workers with low back pain (LBP), and compare this with other musculoskeletal conditions. The National Dataset for Compensation-based Statistics (NDS) was used for this study. Any accepted workers’ compensation time loss claims for LBP, limb fracture or limb soft tissue disease occurring between July 2010 and June 2015 were included. Demographic information, occupation, and total cumulative time loss data were extracted. Counts, rates per 10,000 covered workers, the relative risk and median duration of time loss were calculated. Multivariate Cox and quantile regression models were used to determine factors affecting time loss duration and patterns. There were 56,102 LBP claims, 42,957 limb fracture claims, and 18,249 limb soft tissue disease claims. The relative risk of a claim for LBP was significantly greater than limb fractures after adjustment for all covariates (RR 1.30, 95%CI 1.29 – 1.32, p 0.001). LBP claims had longer median time loss (9.39 weeks) than limb fracture claims (9.21 weeks). Quantile regression demonstrated that LBP claims were more likely than limb fracture claims to resolve within seven weeks, and to persist for periods beyond seven weeks. There were differential patterns of time loss in LBP claims and limb fracture claims. The interaction between conditions, and policies and practices may contribute to these patterns. The findings should reiterate to workers’ compensation stakeholders the importance of returning a worker to work as soon as practicable, to avoid future delays or challenges. LBP is a prevalent musculoskeletal symptom the leading contributor to the burden of disability for people of working age. Musculoskeletal conditions like LBP comprise the largest proportion of compensated conditions in Australia. The incidence of claims for work-related LBP is higher than other work-related musculoskeletal conditions. Median time loss associated with a claim for LBP is similar to time loss for a claim for a limb fracture but less than for limb soft tissue disease claims. The likelihood of time loss duration is greater for workers with claims LBP than claims for limb fracture in the short term (seven weeks), but lower than limb fracture claims after this time. Workers’ compensation stakeholders including clinicians, insurers, and workers’ compensation authorities should carefully consider the importance of returning a worker to work as soon as practicable to avoid future challenges, particularly for a condition as burdensome as LBP.
Publisher: Springer Science and Business Media LLC
Date: 28-04-2021
DOI: 10.1007/S10926-021-09981-8
Abstract: Objectives To determine in Australian workers with an accepted workers' compensation claim for low back pain (LBP) (1) the prevalence of diagnostic imaging of the spine and factors associated with its use, and (2) the association between spinal diagnostic imaging events and wage replacement duration. Methods Workers with accepted workers' compensation claims for LBP longer than 2 weeks were grouped by whether workers' compensation funded no, single, or multiple diagnostic spinal imaging in the 2 years since reported LBP onset. Ordinal logistic regression was used to define the demographic, occupational and social factors associated with each group. Time-to-event analysis was used to determine the association between spinal imaging and wage replacement duration. Results In the s le of 30,530 workers, 9267 (30.4%) received single spinal imaging and 6202 (20.3%) received multiple spinal imaging. Male workers and workers from the state of Victoria had significantly higher odds of multiple imaging. Socioeconomically advantaged workers and workers from remote Australia had significantly lower odds of multiple imaging. Magnetic Resonance Imaging was the most common imaging modality. Workers with single spinal imaging (median duration 17.0 weeks HR 2.0, 95% CI 1.9, 2.1) and multiple spinal imaging (median duration 49.0 weeks HR 4.0, 95% CI 3.9, 4.1) had significantly longer wage replacement duration than those with no imaging (median duration 6.1 weeks). Conclusions Over half of Australian workers with an accepted workers' compensation claim for LBP longer than 2 weeks received diagnostic spinal imaging. Receipt of diagnostic imaging, particularly multiple imaging, was associated with longer wage replacement duration.
Publisher: Springer Science and Business Media LLC
Date: 02-2003
Publisher: Wiley
Date: 2003
DOI: 10.1002/HUP.532
Abstract: Kava is an extract from the Piper methysticum Forst. f. plant that has social and spiritual importance in Pacific islands societies. Herbal remedies that contain kava are used for the psychiatric treatment of anxiety and insomnia. Laboratory studies have found only subtle, if any, changes on cognitive or motor functions from the acute effects of consuming small clinical doses of kava products. Intoxication from recreational doses of kava has not been studied. The performance of in iduals intoxicated from drinking kava (n=11) was compared with a control group (n=17) using saccade and cognitive tests. On average, intoxicated in iduals had consumed 205 g of kava powder each (approximately 150 times clinical doses) in a group session that went for 14.4 h and ended 8 h prior to testing. Intoxicated kava drinkers showed ataxia, tremors, sedation, blepharospasm and elevated liver enzymes (GGT and ALP), together with saccadic dysmetria, saccadic slowing and reduced accuracy performing a visual search task that only became evident as the task complexity increased. Kava intoxication is characterized by specific abnormalities of movement coordination and visual attention but normal performance of complex cognitive functions. Saccade abnormalities suggest disruption of cerebellar and GABAergic functions.
Publisher: American Chemical Society (ACS)
Date: 28-04-2016
Abstract: Vacancy engineering is a crucial approach to manipulate physical properties of semiconductors. Here, we demonstrate that planar vacancies are formed in Sn1-xBixTe nanoribbons by using Bi dopants via a facile chemical vapor deposition. Through combination of sub-angstrom-resolution imaging and density functional theory calculations, these planar vacancies are found to be associated with Bi segregations, which significantly lower their formation energies. The planar vacancies exhibit polymorphic structures with local variations in the lattice relaxation level, determined by their proximity to the nanoribbon surface. Such polymorphic planar vacancies, in conjunction with Bi dopants, trigger distinct localized electronic states, offering platforms for device applications of ternary chalcogenide materials.
Publisher: BMJ
Date: 06-07-2006
Publisher: Informa UK Limited
Date: 31-12-2014
DOI: 10.1080/21622965.2014.939271
Abstract: There are significant merits to a comprehensive cognitive assessment, but they are also time-consuming, costly, and susceptible to practice effects and may not detect change in the context of medical interventions or minor brain disruptions. Brief computer-based assessments focused on "fluid" cognitive domains (e.g., information-processing skills), which are vulnerable to disruption as a result of a brain injury, may provide an alternative assessment option. This study sought to: (a) examine the utility of a well-established, adult-based computerized tool, CogSport for Kids (CogState), for evaluating information-processing skills in children and adolescents and (b) to report normative data for healthy children and adolescents. The study was a cross-sectional, community-based observational study of typically developing children aged 9 to 17 years old (N = 832). Participants completed the CogSport for Kids test battery, which includes six brief computerized tasks that assess cognitive functions including processing speed, attention, and working memory. Results showed an improvement with age for response speed and accuracy. The greatest change occurred between 9 and 12 years with performance stabilizing at 15 years. This brief screening tool is appropriate for clinical and research use in children aged 9 years and older and may be used to track cognitive development from childhood into adulthood and to identify children who deviate from normal expectations.
Publisher: Springer Science and Business Media LLC
Date: 09-12-2019
DOI: 10.1007/S10926-019-09867-W
Abstract: Purpose To characterise associations between fault attribution and work participation and capacity after road traffic injury. Methods People aged 15-65 years, working pre-injury, without serious brain injury, who survived to 12 months after road traffic injury were included from two Victorian trauma registries (n = 2942). Fault profiles from linked compensation claims were defined as no other at fault, another at fault, denied another at fault, claimed another at fault, and unknown. Claimant reports in the denied and claimed another at fault groups contradicted police reports. Patients reported work capacity (Glasgow outcome scale-extended) and return to work (RTW) at 6, 12 and 24 months post-injury (early and sustained RTW, delayed RTW (≥ 12 months), failed RTW attempts, no RTW attempts). Analyses adjusted for demographic, clinical and injury covariates. Results The risk of not returning to work was higher if another was at fault [adjusted relative risk ratio (aRRR) = 1.67, 95% confidence interval (CI) 1.29, 2.17] or was claimed to be at fault (aRRR = 1.58, 95% CI 1.04, 2.41), and lower for those who denied that another was at fault (aRRR = 0.51, 95% CI 0.29, 0.91), compared to cases with no other at fault. Similarly, people had higher odds of work capacity limitations if another was at fault (12m: AOR = 1.49, 95% CI 1.24, 1.80 24m: 1.63, 95% CI 1.35, 1.97) or was claimed to be at fault (12m: AOR = 1.54, 95% CI 1.16, 2.05 24m: AOR = 1.80, 95% CI 1.34, 2.41), and lower odds if they denied another was at fault (6m: AOR = 0.67, 95% CI 0.48, 0.95), compared to cases with no other at fault. Conclusion Targeted interventions are needed to support work participation in people at risk of poor RTW post-injury. While interventions targeting fault and justice-related attributions are currently lacking, these may be beneficial for people who believe that another caused their injury.
Publisher: Cold Spring Harbor Laboratory
Date: 05-05-2021
DOI: 10.1101/2021.05.02.21256492
Abstract: To determine the long-term effects of work loss on health during the COVID-19 pandemic, and whether any effects are persistent upon returning to work. A prospective longitudinal cohort study of 2603 participants across Australia monitored changes in health and work during between March and December 2020, with participants completing surveys at baseline and 1, 3 and 6 months later. Outcomes described psychological distress, and mental and physical health. Linear mixed regression models examined associations between changes in health and experiences of work loss, and return to work, over time. Losing work during the early stages of the pandemic was associated with long-term poorer mental health, which began to recover over time as some returned to work. Physical health deteriorated over time, greater for people not working at baseline. Being out of work was associated with poorer mental health, but better physical health. These effects were larger for people that had recently lost work than for people with sustained work loss, and retaining employment played a protective role. Generally, returning to work resulted in poorer physical health and improvements in mental health, although this depended on the broader context of changes in work. Work cessation during the pandemic led to poor health outcomes and had long-lasting effects. Returning to work benefits mental health but may reduce physical activity in the short-term. We encourage the provision of accessible mental health supports and services immediately following loss of work, and for people with prolonged forms of work loss.
Publisher: Springer Science and Business Media LLC
Date: 06-04-2016
Publisher: Elsevier BV
Date: 2009
DOI: 10.1016/J.SLEEP.2007.11.023
Abstract: Sleep and vigilance disorders are among the most commonly reported symptoms following a concussion. The aim of the study was thus to investigate the effects of sport-related concussions on subjective and objective sleep quality. Ten concussed athletes and 11 non-concussed athletes were included. Concussed athletes had a history of 4.6+/-2.1 concussions with at least one concussion during the last year. They were recorded for two consecutive nights in the laboratory and during a 10-min period of wakefulness. They completed questionnaires related to sleep quality and symptoms as well as neuropsychological tests and the CogSport computer battery. Concussed athletes reported more symptoms and worse sleep quality than control athletes, but no between-group differences were found on polysomnographic variables or on REM and NREM sleep quantitative EEG variables. However, concussed athletes showed significantly more delta activity and less alpha activity during wakefulness than did control athletes. In spite of the subjective complaints in sleep quality of concussed athletes, no change was observed in objective sleep characteristics. However, concussions were associated with an increase in delta and a reduction in alpha power in the waking EEG. Sport-related concussions are thus associated with wakefulness problems rather than sleep disturbances.
Publisher: Springer Science and Business Media LLC
Date: 06-12-2011
DOI: 10.1007/S10926-011-9344-Y
Abstract: After work-related injury or disease, multiple spells of work absences and unsuccessful return to work (RTW) are common. The purpose of this study was to identify predictors of sustained RTW and work disability recurrences. Australian WorkSafe Victoria claims containing income compensation payments starting between January 1st, 2001 and December 31st, 2004 (n = 59,526) were analysed over a 2-year observation window. Time until first RTW and final RTW, and 'recurrences' (cessations of payments of >7 days), were derived from claims payments data. Regression models were used relating demographic, occupational, workplace and injury characteristics to RTW outcomes. Although 94% of claimants had at least one RTW, only 79% achieved sustained RTW during follow-up. Median time until first RTW was 50 days median time until final RTW was 91 days. Independent predictors of delayed final RTW were older age, afflictions involving the neck or multiple locations, and working in manufacturing. Of those who returned to work, 37% had at least one recurrence: risk factors were ages 35-55, female sex, working as a labourer, working in manufacturing, traumatic joint/ligament or muscle/tendon injury and musculoskeletal and connective tissue diseases, and afflictions involving the neck or multiple locations. Work disability recurrences are common and have considerable impact on sustained RTW outcomes. A policy focus on education about secondary prevention may help improve long-term RTW outcomes, particularly for persons with musculoskeletal disorders and those working in manufacturing.
Publisher: Wiley
Date: 08-2003
DOI: 10.1046/J.1444-0903.2003.00405.X
Abstract: Heavy kava use in Aboriginal communities has been linked to various health effects, including anecdotes of sudden cardiac deaths. To examine associations between kava use and potential health effects. A cross-sectional study was carried out within a kava-using east Arnhem Land Aboriginal community in tropical northern Australia. One-hundred-and-one adults who were current, recent or non-users of kava were enrolled in March 2000. Main outcome measures were physical, anthropometric, biochemical, haematological, immunological and neurocognitive assessments. Kava users more frequently showed a characteristic dermopathy (P<0.001). They had increased levels of gamma-glutamyl transferase and alkaline phosphatase (P<0.001). Lymphocyte counts were significantly lower in kava users (P<0.001). Fibrinogen, plasminogen activator inhibitor-1 and neurocognitive tests were not different between kava use categories. IgE and IgG antibodies were elevated across the whole group, as were C-reactive protein and homocysteine. Kava use was associated with dermopathy, liver function abnormalities and decreased lymphocytes. If kava continues to be used by Aboriginal populations, monitoring should focus on the health consequences of these findings, including a possible increase in serious infections. The interaction between kava, alcohol and other substances requires further study. Although markers of cardiovascular risk are increased across the population, these were not higher in kava users, and this increase may be linked to the large infectious pathogen burden reflective of the socioeconomic disadvantage seen in many remote Aboriginal communities.
Publisher: Springer Science and Business Media LLC
Date: 20-11-2021
DOI: 10.1007/S10926-021-10013-8
Abstract: To compare the frequency of General Practitioner (GP) services and the time between first and last GP services (service duration) provided to workers with low back pain (LBP) between four Australian workers' compensation jurisdictions. Retrospective cohort study using service level data collated from the Australian states of Western Australia, South Australia, Victoria and Queensland. Negative binomial regression was used to compare GP service volume between jurisdictions in workers with accepted LBP compensation claims. Quantile regression was used to compare GP service duration. Models were adjusted for sociodemographic factors and occupation. Analyses were repeated in four cohorts with progressively more restrictive cohort definitions to account for the influence of jurisdictional policy variation in employer excess, service delivery and maximum time-loss benefit duration. The study s le included 47,185 time-loss claims accepted between July 2010 and June 2015, that were linked with 452,391 GP services. Workers with LBP in Queensland recorded significantly fewer GP services funded and recorded significantly shorter average service duration than in other states. This pattern of jurisdictional variation was evident in all four cohorts, but was attenuated when cohorts excluded short- and long duration claims. In the final, most restricted cohort statistically significant adjusted incidence rate ratios of 1.47-1.60 were observed in Victoria, South Australia and Western Australia, while these states recorded additional service duration of 4.3-20.7 weeks at the median. There is significant variation in provision of GP services to injured workers with LBP between four Australian workers' compensation jurisdictions. Administrative requirements for time-based provision of work capacity certificates by medical practitioners may be contributing to service variation.
Publisher: Springer Science and Business Media LLC
Date: 22-06-2011
Publisher: Springer Science and Business Media LLC
Date: 21-02-2017
Publisher: BMJ
Date: 09-2016
Publisher: BMJ
Date: 10-2015
DOI: 10.1136/BJSPORTS-2015-094663
Abstract: Recovery from concussion sustained in childhood and adolescence is poorly understood. We explored patterns of recovery for neurocognition and postconcussive symptoms following concussion in children and adolescents. Using a prospective, longitudinal design, we collected baseline data on 728 children and adolescents aged 10-17 years. 10 participants sustained a concussive injury (n=10) in the 12 months following baseline testing and they were reviewed at day 5, 10 and 30 postconcussion. Assessments included the CogSport for Kids computerised test battery to evaluate neurocognitive function and self-report, and parent measures of postconcussive symptoms. At day 30, parents also completed measures rating their child's quality of life and executive functions. Children and adolescents displayed a gradual reduction in postconcussive symptoms over the 30 days following injury. At day 5, 87% of participants were reporting physical and cognitive symptoms, with a generalised reduction in all symptoms by day 10 (40% of participants). On the computerised measure, reaction time was slower after concussion, but returned to baseline levels by day 30. At day 30, 10% of participants demonstrated ongoing postconcussive symptoms. Number of previous concussions was related to speed of symptom resolution. At 5 days postconcussion, the majority of children and adolescents experienced debilitating postconcussive symptoms. However, by 30 days postinjury, 90% demonstrated recovery to normal for both neurocognition and postconcussive symptoms.
Publisher: Cold Spring Harbor Laboratory
Date: 05-05-2020
DOI: 10.1101/2020.04.30.20041210
Abstract: The Disability Support Pension (DSP) is the major Australian government financial benefit program for people of working age with medical conditions and disabilities that restrict work capacity. Between 2012 and 2018 a series of policy reforms sought to restrict the growth in DSP payments and encourage more people with some work capacity to seek employment. We characterise changes in three markers of access to disability financial support over the reform period (1) DSP recipient rates (2) DSP grant (approval) rates and (3) the rate of unemployment benefit receipt in people with impaired work capacity. Results demonstrate a significant reduction in DSP receipt and grant rates, and significant increase in the rate of unemployment benefit receipt in working-age Australians with work disabling medical conditions and disability. These changes were not distributed uniformly. People whose primary medical condition was a musculoskeletal or circulatory system disorder demonstrated greater declines in DSP receipt and grant rates, while there was a more rapid increase in unemployment benefit receipt among people with primary mental health conditions. Some trend changes occur in periods during which new disability assessment and pension eligibility policies were introduced, though our ability to attribute changes to specific policy changes is limited. This study was supported by an Australian Research Council Future Fellowship awarded to the first author (FT190100218). De-identified, aggregate data for the study was provided by the Australian Government Department of Human Services and Department of Social Services.
Publisher: Elsevier BV
Date: 03-2019
Publisher: Springer Science and Business Media LLC
Date: 23-05-2014
Publisher: Springer Science and Business Media LLC
Date: 20-02-2016
Publisher: Springer Science and Business Media LLC
Date: 03-2019
DOI: 10.1007/S10926-018-9764-Z
Abstract: Purpose Many industrialised nations have systems of injury compensation and rehabilitation that are designed to support injury recovery and return to work. Despite their intention, there is now substantial evidence that injured people, employers and healthcare providers can experience those systems as difficult to navigate, and that this can affect injury recovery. This study sought to characterise the relationships and interactions occurring between actors in three Australian injury compensation systems, to identify the range of factors that impact on injury recovery, and the interactions and inter-relationships between these factors. Methods This study uses data collected directly from injured workers and their family members via qualitative interviews, analysed for major themes and interactions between themes, and then mapped to a system level model. Results Multiple factors across multiple system levels were reported by participants as influencing injury recovery. Factors at the level of the injured person's immediate environment, the organisations and personnel involved in rehabilitation and compensation processes were more commonly cited than governmental or societal factors as influencing physical function, psychological function and work participation. Conclusions The study demonstrates that injury recovery is a complex process influenced by the decisions and actions of organisations and in iduals operating across multiple levels of the compensation system. Changes occurring 'upstream', for instance at the level of governmental or organisational policy, can impact injury recovery through both direct and diffuse pathways.
Publisher: Springer Science and Business Media LLC
Date: 17-06-2011
Publisher: Elsevier BV
Date: 10-2018
DOI: 10.1016/J.INJURY.2018.08.008
Abstract: Persistent pain and mental health conditions often co-occur after injury, cause enormous disability, reduce social and economic participation, and increase long-term healthcare costs. This study aimed to characterise the incidence, profile and healthcare cost implications for people who have a treated mental health condition, persistent pain, or both conditions, after compensable transport injury. The study comprised a population cohort of people who sustained a transport injury (n = 74,217) between 2008 to 2013 and had an accepted claim in the no-fault transport compensation system in Victoria, Australia. Data included demographic and injury characteristics, and payments for treatment and income replacement from the Compensation Research Database. Treated conditions were identified from 3 to 24-months postinjury using payment-based criteria developed with clinical and compensation system experts. Criteria included medications for pain, anxiety, depression or psychosis, and services from physiotherapists, psychologists, psychiatrists, and pain specialists. The data were analysed with Cox Proportional Hazards regression to examine rates of treated conditions, and general linear regression to estimate 24 month healthcare costs. Overall, the incidence of treated mental health conditions (n = 2459, 3.3%) and persistent pain (n = 4708, 6.3%) was low, but rates were higher in those who were female, middle aged (35-64 years), living in metropolitan areas or neighbourhoods with high socioeconomic disadvantage, and for people who had a more severe injury. Healthcare costs totalled more than $A707 M, and people with one or both conditions (7.7%) had healthcare costs up to 7-fold higher (adjusting for demographic and injury characteristics) in the first 24 months postinjury than those with neither condition. The incidence of treated mental health and persistent pain conditions was low, but the total healthcare costs for people with treated conditions were markedly higher than for people without either treated condition. While linkage with other public records of treatment was not possible, the true incidence of treated conditions is likely to be even higher than that found in this study. The present findings can be used to prioritise the implementation of timely access to treatment to prevent or attenuate the severity of pain and mental health conditions after transport injury.
Publisher: Wiley
Date: 18-10-2004
DOI: 10.1002/CNCR.20601
Publisher: Springer Science and Business Media LLC
Date: 14-06-2014
DOI: 10.1007/S10926-013-9455-8
Abstract: To examine if the factors associated with days of absence following a work-related injury are similar for mental health versus musculoskeletal (MSK) conditions. A secondary analysis of wage replacement workers' compensation claims in the state of Victoria, Australia. We examined the relationship between in idual, injury, occupational and workplace variables with days of wage replacement over the 2-year period following first day of absence from work separately for mental health claims and MSK claims using negative binomial regression models. Mental health conditions were associated with a greater number of days of absence over the 2 years following first incapacity compared to MSK conditions. Differences were observed in employment, injury and industry variables on absence from work for mental claims compared to MSK claims. Working in the agriculture, forestry, fishing and mining industries and employment with a small organisation were more strongly associated with the number of days of wage-replacement among MSK compared to mental health claims, and working in the public administration and safety, or education and training industries or being employed in a position with high time pressure were associated with greater days of wage-replacement among mental health compared to MSK claims. Predictors of days away from work in the 2 years following an injury differ for mental health versus MSK claims. Given the increasing number of mental health claims in Australia more research is required to understand differences in return-to-work for this group of claimants compared to those with physical injuries.
Publisher: Public Library of Science (PLoS)
Date: 05-07-2017
Publisher: Springer Science and Business Media LLC
Date: 04-02-2019
DOI: 10.1007/S10926-018-09824-Z
Abstract: Purpose This study investigated the association between return to work self-efficacy (RTW-SE) and sustained return to work (RTW) at two different time points, over a 12-month period. The primary objective of the study was to examine if the relationship between RTW-SE and a sustained RTW changed over the RTW timeline. Methods This study used survey responses from a longitudinal cohort of n = 410 workers' compensation claimants with either an upper-body musculoskeletal injury or a psychological injury. A path analysis tested the associations between RTW-SE and a sustained RTW at two time-points. A Wald χ
Publisher: S. Karger AG
Date: 2004
DOI: 10.1159/000080229
Abstract: i Objective: /i Screening of normal older persons for progressive memory decline is a worthwhile strategy in the pursuit of the earliest possible stages of pre-clinical Alzheimer’s disease (AD) or mild cognitive impairment (MCI). Reliable tests are needed to both detect MCI and measure the natural history of decline over months rather than years. We aimed to detect memory decline over 1 year in a group of older in iduals with well-characterised amnestic MCI. i Methods: /i The continuous learning task (CLT) from the CogState test battery was administered 8 times in 12 months to 15 in iduals with MCI and 35 controls matched for age, education, IQ and gender. All subjects were recruited from an ongoing aging study. The rate of change in CLT performance over the year was compared between groups and also compared to that detected with a word list learning task and a computerised paired associate learning task. i Results: /i At baseline, memory performance in the amnestic MCI group was significantly worse than controls on all memory tests. However, at 12 months the magnitude of the difference between the groups had increased significantly on the CLT due to decline in memory accuracy in the MCI group. No decline over 12 months was detectable on the routine memory tests. i Conclusions: /i Subtle memory decline is detectable in amnestic MCI using reliable and sensitive tests of memory. Such measures may assist in the early identification of AD and also in trials of putative disease-modifying therapies to be conducted over as little as 12 months.
Publisher: Cold Spring Harbor Laboratory
Date: 31-03-2021
DOI: 10.1101/2021.03.28.21254520
Abstract: To determine the nature and prevalence of workers’ concerns regarding workplaces reopening during the pandemic. To identify characteristics of workers and industries where particular concerns are more common. Prospective cohort study of 1063 employed Australian adults, enrolled at the start of the pandemic. Data on attitudes to workplaces reopening were collected 1 July – 30 September 2020. The frequency of concerns describes infection risk and changes to work and impact on home life. Regression models examined associations between demographic and industry factors with reopening concerns. More than four in five (82.4%) of workers reported concerns about workplace infection risk. Just over half (53.4%) reported concerns about impacts to work and home life. Concerns were more prevalent for workers reporting psychological distress, financial stress, and among those exclusively working from home. Concerns regarding infection risk were common for workers in health care (IRR=1.16, 95% CI=[1.01, 1.33]), retail (IRR=1.31, 95% CI=[1.06, 1.61]), and accommodation/food service industries (IRR=1.25, 95% CI=[1.01, 1.55]). Concerns regarding changes to work and home life were more common for female workers (IRR=1.24, 95% CI=[1.07, 1.43]), and partners/spouses with dependent children (IRR=1.44, 95% CI=[1.16, 1.79]). Concerns of COVID-19 infection in the workplace are common. Many workers are also concerned about changes to their work and home life. The prevalence of concerns is related to the nature of work and responsibilities at home. Actions that reduce risk of workplace transmission, coupled with effective communication of infection controls, may alleviate worker concerns whilst recognising workers’ family and social circumstances.
Publisher: Public Library of Science (PLoS)
Date: 11-07-2023
DOI: 10.1371/JOURNAL.PONE.0283752
Abstract: Preterm birth, which accounts for 33.1% of neonatal death globally, is the main cause of under-five mortality. A growing number of studies indicate that occupational risk factors during pregnancy are linked to an increased likelihood of poor pregnancy outcomes. The effect of physical occupational risks on preterm birth has received very little attention, and previous reviews have produced inconclusive results. This systematic review aims to update the evidence on the relationship between maternal physical occupational risks and preterm birth. We will search electronic databases including Ovid Medline, Embase, Emcare, CINAHL, Scopus, and Web of science to find peer-reviewed studies examining the relationship between six common maternal physical occupational risks (heavy lifting, prolonged standing, heavy physical exertion, long working hours, shift work, and whole-body vibrations) and preterm birth. Articles published in English after 1 January 2000 will be included without geographic restrictions. Two reviewers will screen titles and abstracts independently, and then select full-text articles that meet inclusion criteria. Methodological quality of the included studies will be evaluated using the Joanna Briggs Institute (JBI) critical appraisal method. The quality of evidence across each exposure and the outcome of interest will be examined by using the GRADE (Grade of Recommendations, Assessment, Development, Evaluation) method. Accordingly, a high level of evidence will lead to “strong recommendations”. A moderate level of evidence will lead to “practice considerations”. For all evidence levels below moderate, the message will be “not enough evidence from the scientific literature to guide policymakers, clinicians, and patients. If data permits, a meta-analysis will be conducted using Stata Software. In case where meta-analysis is not possible, we will perform a formal narrative synthesis. Evidence suggests that preterm birth is linked to a number of maternal occupational risk factors. This systematic review will update, compile, and critically review the evidence on the effect of maternal physical occupational risk on preterm birth. This systematic review will provide guidance to support decision-makers including maternal and child health services, other health care providers, and government policy agencies. PROSPERO registration number: CRD42022357045 .
Publisher: Springer Science and Business Media LLC
Date: 15-08-2015
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 19-07-2022
DOI: 10.1097/JOM.0000000000002643
Abstract: The aims of the study are to determine the continuity of care (CoC) provided by primary care physicians among workers with low back pain, to identify factors associated with CoC, and to investigate whether CoC is associated with working time loss. Continuity of care was measured with the usual provider continuity metric. Ordinal logistic regression models examined factors associated with CoC. Quantile regression models examined the association between working time loss and CoC. Complete CoC was observed in 33.8% of workers, high CoC among 37.7%, moderate CoC in 22.1%, and low CoC in 6.4%. In workers with more than 2-months time loss, those with complete CoC had less time off work. Higher CoC with a primary care physician is associated with less working time loss and this relationship is strongest in the subacute phase of low back pain.
Publisher: BMJ
Date: 15-12-2018
DOI: 10.1136/INJURYPREV-2018-043019
Abstract: RTC burden is commonly measured using fatality or hospitalisation statistics. However, non-fatal and less severe injuries contribute substantial economic and human costs, including work absence. In Victoria, Australia, two major compensation systems provide income support to employed people injured in RTCs workers’ compensation (if RTC occurred during work) and an RTC-specific compensation system. This study aimed to describe the number and rate of episodes of work absence due to compensable RTC and determine factors associated with work-related RTC resulting in work absence. Administrative data for working-age people (15–65 years) with accepted compensation claims between 1 July 2003 and 30 June 2013 were extracted from Victoria’s Compensation Research Database and analysed. Injured people receiving at least one day of income support were retained. Rate calculations used Victoria’s labour force as the denominator and negative binomial regression determined any time-based trend changes. Multivariable logistic regression was used to determine odds of the RTC being work-related. There were 40 677 claims made by workers with an RTC injury that consequently missed work, averaging 4068 claims per year at a rate of 12.9 per 100 000 working population. Work-related cases contributed 17.4% (N=7061). Males, older adults and RTCs involving heavy vehicles, buses, trains and trams had higher odds of a work-related RTC resulting in work absence. More severe injuries tended not to be work-related. Work absence due to RTC injury constitutes a substantial burden, and this measure could provide a valuable addition to conventional RTC statistics.
Publisher: Medical Journals Sweden AB
Date: 05-07-2022
DOI: 10.2340/JRM.V54.30
Abstract: Objective: A prospective cohort study to investigate how injury and early post-injury psychosocial factors influence health outcomes 12 months after road traffic injury.Methods: Residents of New South Wales, Australia, with road traffic injury in the period 2013–16 were recruited. Explanatory factors were evaluated for outcomes over 12 months using 12-Item Short Form Survey (SF-12) Physical and Mental Component Scores (PCS and MCS). Path models and mediation analysis were used to examine the effect of injury severity and explanatory factors.Results: SF-12 PCS and MCS outcomes were poorer among participants with baseline psychological distress, for all injury severities (β coefficients –3.3 to –9.3, p 0.0001). Baseline pain and psychological distress, and baseline PCS and MCS were each involved in indirect effects of injury severity on 12-month PCS and MCS. Injury severity, baseline PCS and MCS, and baseline psychological distress were also associated with the likelihood of a compulsory third-party insurance claim, and claiming was negatively associated with 12-month PCS and MCS outcomes (beta coefficients –0.22 and –0.14, respectively, for both, p 0.01).Conclusion: Baseline factors, including pain, psychological distress and lodging a compulsory third-party insurance claim, negatively impact long-term physical and mental health status following road traffic injury, emphasizing the importance of early screening and intervention.Trial registration: Australia New Zealand Clinical trial registry identification number: AC- TRN12613000889752. LAY ABSTRACTRoad traffic injury (RTI) can lead to adverse long-term physical and mental health outcomes. This study followed participants with RTI for 12 months to assess the effects of acute post-injury psychological distress and physical and mental health outcomes. For physical health outcomes, greater severity of injury leads directly to a more restricted physical state pain and psychological distress soon after injury also contribute to negative physical outcomes for participants experiencing more severe injuries. For mental health outcomes, injury severity has no direct effect on worsening mental state mental state and psychological distress soon after injury leads to worsening outcomes for participants experiencing more severe injury. In iduals with higher psychological distress or pain were more likely to lodge a motor vehicle insurance claim. These people had subsequently poorer 12-month physical and mental health outcomes. It is essential to understand how early screening and interventions for psychological distress and pain can affect recovery.
Publisher: Wiley
Date: 15-03-2021
DOI: 10.1002/HPJA.472
Publisher: Springer Science and Business Media LLC
Date: 04-02-2019
DOI: 10.1007/S10926-019-09828-3
Abstract: Purpose General Practitioners (GPs) play an important role in personal injury compensation systems yet system processes have been perceived as burdensome. Objectives were to (1) determine attitudes of Australian GPs on health benefits of return to work (RTW) after injury/illness and (2) identify associations between GP characteristics and agreement with issues surrounding treating compensable patients. Methods Cross-sectional postal survey of 423 Australian GPs to determine agreement with issues associated with compensable patients (including patient advocacy, conflicting opinions between GPs and compensation systems, fitness-for-work certification, and refusal to treat). Results The vast majority of GPs agreed there was a health benefit to early RTW. GPs with 16-20 years' experience had significantly higher odds of agreeing that the certificate of work capacity is the primary method of communication between RTW stakeholders (OR 2.36 [1.13-4.92]) than those with greater experience. 49% of GPs agreed they should be able to refuse to treat compensable patients. Female GPs had significantly lower odds (OR 0.60 [0.40-0.90]) of agreeing with right to refuse than male GPs, as did those from remote or regional practices (OR 0.43 [0.20-0.94] OR 0.60 [0.39-0.92]) than GPs from urban practices. Conclusions Reducing administrative barriers identified by Australian GPs and improving communication with compensation systems will likely have a positive impact on their refusal to treat compensable patients.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2019
Publisher: Springer Science and Business Media LLC
Date: 03-03-2021
Publisher: Springer Science and Business Media LLC
Date: 23-10-2019
DOI: 10.1007/S10926-019-09862-1
Abstract: Purpose To determine the prevalence and predictors of psychological distress among injured and ill workers and their mental health service use. Methods Cross-sectional national survey of adults with work-related musculoskeletal or mental health conditions, accepted workers' compensation claims and at least 1 day off work. Psychological distress was measured using the Kessler-6 scale. Mental health service use was measured using self-report. Results A total of 3755 workers were included in the study (Musculoskeletal disorder = 3160 Mental health condition = 595). Of these, 1034 (27.5%) and 525 (14.0%) recorded moderate and severe psychological distress, respectively. Multivariate ordinal logistic regression revealed that being off work, poor general health, low work ability, financial stress, stressful interactions with healthcare providers and having diagnosed mental health conditions had the strongest associations with presence of psychological distress. Of the subgroup with musculoskeletal disorders and psychological distress (N = 1197), 325 (27.2%) reported accessing mental health services in the past four weeks. Severe psychological distress, being off work, worse general health and requiring support during claim were most strongly associated with greater odds of service use. Conclusions The prevalence of psychological distress among workers' compensation claimants is high. Most workers with musculoskeletal disorders and psychological distress do not access mental health services. Screening, early intervention and referral programs may reduce the prevalence and impact of psychological distress.
Publisher: Springer Science and Business Media LLC
Date: 03-06-2020
Publisher: Cold Spring Harbor Laboratory
Date: 09-12-2022
DOI: 10.1101/2022.12.08.22283265
Abstract: Pandemic public health measures have affected mental health for many people, resulting in varied approaches to mental health self-care. During 27 April – 26 July 2020, we surveyed a cohort of 1646 Australians, who were in paid employment prior to the pandemic, on changes in work, health, and managing their mental health concerns. Lifestyle changes were most the most frequently reported action to manage mental health concerns (78%), and were more common for women (OR=2.33, 95%CI=[1.82, 3.03]), and people experiencing recent work loss (OR=1.54, 95%CI=[1.04, 2.28]). Mental health self-care was more common for people experiencing psychological distress, or with pre-exisiting mental health conditions. Talking to friends about mental health, exercise and dietary changes, were more common for women and younger adults. Findings highlight potential benefits of reducing barriers to formal mental health services and supports during crises, particularly for people who less commonly seek help, and those experiencing psychological distress.
Publisher: Springer Science and Business Media LLC
Date: 18-04-2013
DOI: 10.1007/S10926-013-9435-Z
Abstract: Occupational injury and work-related disability is a significant public health problem. For published research to provide a collective knowledge base for return to work (RTW) policy and practice, features of the compensation system relevant to the research must be described clearly. The level of the reporting on compensation system features is yet to be established. The aim of the present study was to synthesize the evidence for the reporting on compensation systems in prognostic studies of RTW following work-related injuries. A systematic review of the literature was conducted. Ovid Medline and EMBASE were searched for studies published 1996-2011. Included studies were prognostic studies of RTW or work disability following work-related acute traumatic injuries. The initial search yielded 952 articles 37 articles fulfilled the inclusion criteria. The majority of studies were based on clinical practice eight studies were based on administrative data. Only two studies reported seven or more compensation features and two studies reported four to six. The majority of studies (19/37) did not report on any aspect of the compensation system that study participants were interacting with. The most common information reported was the extent of coverage at the population level (7/37) and the availability of wage replacement entitlements (7/37). The name of the compensation system was provided in 5 studies. Overall reporting on compensation systems in prognostic studies of RTW needs to be improved if research evidence is to inform policy and practice. Compensation system features that could be reported are provided.
Publisher: Springer Science and Business Media LLC
Date: 29-03-2023
DOI: 10.1007/S10926-023-10098-3
Abstract: Low back pain (LBP) is a leading cause of disability globally and interferes with work performance and quality of life. For work-related LBP, Australian workers can receive workers’ compensation and access funded healthcare to promote recovery, including mental health services, as there are strong links between chronic LBP and mental health. The objective of this study was to determine the prevalence of funded mental health services for workers with compensated LBP. Claims and services data from four Australian workers’ compensation jurisdictions were analysed. Prevalence of accessing at least one mental health service was reported as a percentage of all claims overall and by duration of time loss, age group, sex, financial year of claim lodgement, jurisdiction, socioeconomic status and remoteness. Odds of accessing at least one service was determined using logistic regression. Almost 10% of LBP claims accessed at least one mental health service (9.7%) with prevalence increasing with time loss. Prevalence was highest in Victoria however a higher percentage of workers with LBP accessed mental health services earlier in Queensland. Odds of accessing services was highest with longest time loss duration, among females and in Queensland. Lower odds were observed in regional areas and among those aged over 56 years. Findings suggest opportunities for workers’ compensation regulators and insurers to provide greater access to appropriate mental health services alongside physical treatment as standard practice, such as those in more remote locations or earlier in a claim, to improve recovery outcomes for workers with LBP.
Publisher: Springer Science and Business Media LLC
Date: 06-06-2023
DOI: 10.1186/S12889-023-15877-4
Abstract: Truck driving is one of the most common male occupations worldwide. Drivers endure long working hours, isolation, separation from family, compromised sleep, and face rigid regulatory requirements. Studies have documented the work factors contributing to poor health outcomes, however these have not been explored in the Australian context. The aim of this grounded theory study was to explore the impact of work and coping factors on mental health of Australian truck drivers from their perspective. Recruitment used a purposive snowball s ling, through social media c aigns and direct email invites. Interview data were collected via phone/teleconference, audio recorded and typed verbatim. Inductive coding and thematic analysis were completed with triangulation of themes. Seventeen interviews were completed (94% male). Six themes arose, two supporting (Connections Coping methods), and four disrupting mental health (Compromised supports Unrealistic demands Financial pressures Lack of respect). Drivers had concerns regarding the many things beyond their control and the interactions of themes impacting their health even further. This study explored the impact of work and coping factors affecting truck driver mental health in Australia. Themes described the importance of connections and coping methods drivers had to support their health. Many factors that compromised their health were often outside their control. These results highlight the need for a multi-faceted collaboration between stakeholders the driver, employing companies, policy makers/regulators and the public to address the negative impact of truck driving on mental health.
Publisher: Springer Science and Business Media LLC
Date: 07-08-2012
DOI: 10.1007/S10926-012-9382-0
Abstract: The study aim was to quantify physiotherapy service distribution among compensated workers with musculoskeletal disorders, and identify risk factors for under- and overuse. Andersen and Newman's model of service use determinants was adapted for a compensated population, to provide a conceptual basis for the analyses. WorkSafe Victoria (Australia) workers' compensation claims were analysed retrospectively. Workers with musculoskeletal disorders resulting in at least 10 days off work were included if their claim commenced between 1-1-2001 and 1-1-2005 (n = 36,995). Physiotherapy use over 4 years of follow-up was determined from service payment data. Regression models were used relating in idual level predictors, regional physiotherapist supply and the role of in idual physiotherapists to service use. Physiotherapy was used by 26,026 (70 %) workers. Young age, male gender, working as a labourer, disorders of the joints, and not being hospitalised were associated with non-use. Use above the 90th percentile (>125 sessions over 4 years) was considered 'high use': high users accounted for 41 % of all use. Age 50-60, female gender, working as tradespersons, and substantial hospital costs were associated with high use. For workers living in the most disadvantaged areas, use was positively associated with supply. Negative binomial modelling of the role of physiotherapists indicated that service providers were associated with the number of sessions used. Physiotherapy services were not underused, but a small group of patients had very high use. Recommendations to limit overuse should be aimed at physiotherapists, and these could include effective monitoring of adherence to proposed treatment plans.
Publisher: Springer Science and Business Media LLC
Date: 20-03-2014
DOI: 10.1007/S10926-014-9506-9
Abstract: Mental health conditions (MHC) are an increasing reason for claiming injury compensation in Australia however little is known about how these claims are managed by different gatekeepers to injury entitlements. This study, drawing on the views of four stakeholders-general practitioners (GPs), injured persons, employers and compensation agents, aims to describe current management of MHC claims and to identify the current barriers to return to work (RTW) for injured persons with a MHC claim and/or mental illness. Ninety-three in-depth interviews were undertaken with GPs, compensation agents, employers and injured persons. Data were collected in Melbourne, Australia. Thematic techniques were used to analyse data. MHC claims were complex to manage because of initial assessment and diagnostic difficulties related to the invisibility of the injury, conflicting medical opinions and the stigma associated with making a MHC claim. Mental illness also developed as a secondary issue in the recovery process. These factors made MHC difficult to manage and impeded timely RTW. It is necessary to undertake further research (e.g. guideline development) to improve current practice in order to enable those with MHC claims to make a timely RTW. Further education and training interventions (e.g. on diagnosis and management of MHC) are also needed to enable GPs, employers and compensation agents to better assess and manage MHC claims.
Publisher: Springer Science and Business Media LLC
Date: 15-05-2011
DOI: 10.1007/S00420-011-0644-5
Abstract: To describe and demonstrate issues with return to work (RTW) outcome metrics in common use among clinical researchers and injury compensation organisations. We also aim to describe a framework on which to capture relevant RTW information including current employment status and data on participation and maintenance. Structured telephone interviews discussing participant health and vocational status were conducted following compensable transport-related injury. Participants who were working at the time of injury and took time off work because of their injuries (N = 414) were asked questions relating to their work participation and maintenance, including length of continuous employment, hours worked and duties performed before and after injury. A series of RTW metrics was developed and applied to survey data. Rates of RTW according to each metric were calculated. Eighty-four per cent of participants had achieved some employment since their injury, and 74% were working at the time of the survey. In contrast, only 58% of participants were working the same hours as prior to their injury and had been doing so for at least 3 months. These data show that different impressions of rehabilitative success can be obtained depending on the criterion used to define RTW suggesting that reliance on a single RTW index (e.g. 'are you currently working?') will not represent important characteristics of employment. A multi-layered approach to measuring RTW that includes data on reasons for not working, length of continuous employment, hours and duties performed after injury provides greater insight into the vocational status of injured in iduals compared to single metrics or outcomes that fail to capture key detail on motives and participation. This information can assist clinicians to more accurately monitor the progress of rehabilitation following injury and compensation schemes to more effectively monitor their performance.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 29-06-2020
DOI: 10.1097/J.PAIN.0000000000001978
Abstract: Low back pain (LBP) is a leading cause of work disability. While absent from work, workers with LBP may receive income support from a system such as workers' compensation or social security. This study examines how and in what contexts income support systems impact the healthcare quality for people with work disability and LBP and their functional capacity. We performed a realist review. Five initial theories about the relationship between income support systems and outcomes were developed, tested, and refined by acquiring and synthesising academic literature from purposive and iterative electronic database searching. This process was supplemented with gray literature searches for policy documents and semistructured interviews with experts in income support, health care, and LBP. Income support systems influence healthcare quality through funding restrictions, healthcare provider administrative burden, and allowing employers to select providers. They also influence worker functional capacity through the level of participation and financial incentives for employers, measures to prove the validity of the worker's LBP, and certain administrative procedures. These mechanisms are often exclusively context-dependent, and generate differing and unintended outcomes depending on features of the healthcare and income support system, as well as other contextual factors such as socioeconomic status and labour force composition. Research and policy design should consider how income support systems may indirectly influence workers with LBP through the workplace.
Publisher: Elsevier BV
Date: 03-2006
DOI: 10.1016/J.BANDC.2005.10.004
Abstract: Mild memory impairment was detected in 28% of a s le of healthy community-dwelling older adults using the delayed recall trial of a word list learning task. Statistical analysis revealed that in iduals with memory impairment also demonstrated relative deficits on other measures of memory, and tests of executive function, processing speed and global cognition, as measured by the CERAD and CogState batteries and CANTAB paired associate learning task. These relative deficits cannot be explained by age-related changes, education, intelligence, mood, health-related factors, or the in iduals' ApoEepsilon4 status. Memory-impaired in iduals (n = 30) did not recognize the extent of their memory and cognitive difficulties beyond the general complaints expressed by normal elderly (n = 77) within the study and their apparent difficulties did not appear to impact on their participation in life activities. These findings suggest it is unlikely that the memory and cognitive difficulties demonstrated by in iduals with mild memory impairment reflect normal aging. Rather it is possible that such impairment may signal early neurodegenerative processes worthy of further investigation.
Publisher: Cold Spring Harbor Laboratory
Date: 21-01-2022
DOI: 10.1101/2022.01.20.22269619
Abstract: Work disability occurs when an injury, illness or other health condition limits the ability of a worker to participate in paid employment. Several lines of evidence suggest that people with work disability are also at increased risk of suicide and intentional self-harm, however the evidence on this relationship has not previously been the subject of systematic review. This systematic scoping review aims to assess and summarise the research literature regarding the relationship between work disability and subsequent suicide or intentional self-harm. Peer-reviewed quantitative and qualitative studies published in English from 1st January 2000 were included if they reported suicide or self-harm outcomes in people aged 15 years or older with work disability. Narrative synthesis summarised findings according to the system of work disability income support. Literature search yielded 859 records of which 47 eligible studies were included, including nine set in workers’ compensation, 20 in sickness absence, 13 in disability pension systems, and five from mixed cohorts. Of 44 quantitative studies, 41 reported a positive relationship between work disability and suicidal behaviour. The relationship is observed consistently across nations, work disability income support systems and in people with a range of health conditions. Several factors elevate risk of suicidal behaviour, including presence of mental health conditions and longer work disability duration. There were few quality studies in some nations and no suicide prevention interventions. The risk of suicide and intentional self-harm is elevated in people experiencing work disability. While further observational research is required to fill evidence gaps, this review suggests the need for governments, employers and those involved in the delivery of care and support to people with work disability to focus on identification and monitoring of those at greatest risk of suicidal behaviour, as well as suicide prevention.
Publisher: Informa UK Limited
Date: 22-01-2008
DOI: 10.1080/13803390701377829
Abstract: Cognitive and memory complaints were assessed in 100 healthy older adults on two occasions over 2.5 years as part of a 6-year study assessing cognition, mood, and general health factors. Diminished memory for names and actions and lapses in concentration were common complaints, regardless of the in iduals' actual cognitive status. No change in cognitive complaints occurred over time, even for in iduals whose memory had declined over 6 years. Cognitive complaints correlated with anxiety, depression, and general mental health but not with objectively measured memory or cognition, education or age. Complaints did not differ with gender, apolipoprotein E epsilon4 genotype, cardiovascular risk factors, or intake of sedating medications. Thus, cognitive complaints could not differentiate memory-declining older adults from cognitively normal older adults and were more closely associated with mood and general mental health than actual cognitive status, age, or potential risk factors for Alzheimer's disease. Thus, the evaluation of cognitive complaints must be broad and must consider the correspondence of complaints not only to relevant measurable cognitive abilities but also to the affect of the in idual.
Publisher: Springer Science and Business Media LLC
Date: 08-09-2021
DOI: 10.1007/S10926-021-10001-Y
Abstract: Purposes Timely delivery of treatment and rehabilitation is generally acknowledged to support injury recovery. This study aimed to describe the timing of health service use by injured truck drivers with work-related injury and to explore the association between demographic and injury factors and the duration of health service use. Methods Retrospective cohort study of injured truck drivers with accepted workers’ compensation claims in the state of Victoria, Australia. Descriptive analyses examined the percentage of injured truck drivers using health services by service type. Logistic regression model examined predictors of any service use versus no service use, and predictors of extended service use (≥ 52 weeks) versus short-term use. Results The timing of health service use by injured truck drivers with accepted workers’ compensation claims varies substantially by service type. General practitioner, specialist physician, and physical therapy service use peaks within the 14 weeks after compensation claim lodgement, whilst the majority of mental health services were accessed in the persistent phase beyond 14 weeks after claim lodgement. Older age, being employed by small companies, and claiming compensation for mental health conditions were associated with greater duration of health service use. Conclusions Injured truck drivers access a wide range of health services during the recovery and return to work process. Delivery of mental health services is delayed, including for those making mental health compensation claims. Health service planning should take into account worker and employer characteristics in addition to injury type.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2019
Publisher: Wiley
Date: 02-2005
DOI: 10.1111/J.1478-3231.2005.01012.X
Abstract: Cognitive dysfunction has been observed in a range of liver diseases including chronic hepatitis C virus, alcoholic liver disease, primary biliary cirrhosis and Wilson's disease. Such dysfunction may range from mild cognitive changes to overt hepatic encephalopathy, and represents a significant complication of liver disease that may negatively impact the patient's quality of life, and normal activities of daily living (e.g., driving). This article reviews the published evidence relating to cognitive dysfunction in liver disease. Issues of definition, diagnosis, epidemiology, aetiology, treatment and outcome are discussed. Particular attention is devoted to identifying the mild cognitive changes that occur in liver diseases of different aetiology.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-06-2001
Abstract: Criteria for mild cognitive impairment require objective evidence of a memory deficit but do not require objective evidence of memory decline. Application of these criteria may therefore result in the misclassification of older patients with memory decline as normal because their neuropsychological test performance at a single point in time may be within normal limits. This study aimed to identify and characterize older people with memory decline. Word list delayed recall (WLDR) test performance was assessed on five occasions during a 2-year period in a cohort of healthy older in iduals. Older people with declining (n = 35) and nondeclining (n = 66) WLDR scores were identified. Both subgroups were then compared on apoE genotype, Clinical Dementia Rating, and neuropsychological test performance at the fifth assessment. Thirty-four percent of the group with declining memory recorded a Clinical Dementia Rating of 0.5, compared with 5% of the nondeclining memory group. No between-group differences were observed in cognitive domains other than memory, self-reported cognitive failures, or the proportion of each group carrying the apoE epsilon 4 allele. A large proportion of healthy older in iduals show memory decline, which may represent the early stages of a potentially more severe cognitive impairment. Further investigation is necessary to determine the relationship between apoE genotype, self-reported cognitive impairment, and memory decline in older people.
Publisher: MDPI AG
Date: 07-10-2020
Abstract: Identifying who might develop disabling pain or poor mental health after injury is a high priority so that healthcare providers can provide targeted preventive interventions. This retrospective cohort study aimed to identify predictors of disabling pain or probable mental health conditions at 12 months post-injury. Participants were recruited 12-months after admission to a major trauma service for a compensable transport or workplace injury (n = 157). Injury, compensation claim, health services and medication information were obtained from the Victorian Orthopaedic Trauma Outcome Registry, Victorian State Trauma Registry and Compensation Research Database. Participants completed questionnaires about pain, and mental health (anxiety, depression, posttraumatic stress disorder) at 12 months post-injury. One third had disabling pain, one third had at least one probable mental health condition and more than one in five had both disabling pain and a mental health condition at 12 months post-injury. Multivariable logistic regression found mental health treatment 3–6 months post-injury, persistent work disability and opioid use at 6–12 months predicted disabling pain at 12 months post-injury. The presence of opioid use at 3–6 months, work disability and psychotropic medications at 6–12 months predicted a mental health condition at 12 months post-injury. These factors could be used to identify at risk of developing disabling pain who could benefit from timely interventions to better manage both pain and mental health post-injury. Implications for healthcare and compensation system are discussed.
Publisher: BMJ
Date: 06-2006
Publisher: Wiley
Date: 14-01-2015
DOI: 10.1002/AJIM.22414
Abstract: To describe the frequency and distribution of workplace injury claims by gender, and quantify the extent to which observed gender differences in injury claim rates are attributable to differential exposure to work-related factors. WorkSafe Victoria (Australia) workers' compensation data (254,704 claims with affliction onset 2004-2011) were analysed. Claim rates were calculated by combining compensation data with state-wide employment data. Mental disorder claim rates were 1.9 times higher among women physical injury claim rates were 1.4 times higher among men. Adjusting for occupational group reversed the gender difference in musculoskeletal and tendon injury claim rates, i.e., these were more common in women than men after adjusting for occupational exposure. Men had higher rates of physical injury claims than women, but this was mostly attributable to occupational factors. Women had higher rates of mental disorder claims than men this was not fully explained by industry or occupation.
Publisher: Informa UK Limited
Date: 24-02-2018
DOI: 10.1080/09638288.2017.1283450
Abstract: It is well acknowledged that involvement in injury compensation processes can have a substantial impact on the recovery of the injured person. However, little attention has been given to the social or family consequences of compensable injury. The aims of this study were to better understand both the impact of compensable injury on the family and the role that families play after an injury, throughout the compensation process, and during return to work. Eighteen injured persons and nine family members recruited through three compensation authorities in Victoria (Australia) were interviewed. A thematic analysis was used to identify the role that family played after injury and how family members were affected during the recovery and compensation process. The results highlight the important role family members play following a compensable injury, in addition to factors that impact family members' daily living, health, and well-being. The study suggests that compensation processes can have an impact on family members, despite compensation systems not formally acknowledging the family in policy or procedure. Compensation authorities should formally consider the role of family in recovery from injury, not only as one means of addressing the overall burden of injury but as a conduit for improving health and function among injured people. Implications for Rehabilitation Family members play an important role after compensable injury that includes providing administrative, instrumental, and emotional support. The recovery and injury compensation process can also have a major impact on family members, particularly in the case of prolonged and complex injuries and illnesses Compensation authorities should formally consider the role of family in the recovery from injury, not only as one means of addressing the overall burden of injury but, as a conduit for improving health and function among injured people.
Publisher: BMJ
Date: 13-06-2023
Abstract: In 2015, South Australia replaced its workers’ compensation system with the aim of improving return to work rates. We examined whether this was achieved by focusing on the duration of time off work, as well as claim processing times and claim volumes to understand how this may have been achieved. The primary outcome was mean weeks of compensated disability duration. Secondary outcomes tested alternative mechanisms of a change in disability duration: (1) mean employer report and insurer decision times to evaluate whether there had been changes in claim processing and (2) claim volumes to determine whether the new system altered the cohort under investigation. Outcomes were aggregated into monthly units and analysed with an interrupted time series design. Three condition subgroups—injury, disease and mental health—were compared in separate analyses. While disability duration steadily declined before the RTW Act came into effect, afterwards it flatlined. A similar effect was observed in insurer decision time. Claim volumes gradually increased. Employer report time gradually decreased. Condition subgroups mostly followed a similar pattern to overall claims, though the increase in insurer decision time appears largely driven by changes in injury claims. The increase in disability duration after the RTW Act took effect may be attributable to an increase in insurer decision time, which itself could be due to the disruption of overhauling a compensation system or the elimination of provisional liability entitlements that incentivised early decision making and provided early intervention.
Publisher: BMJ
Date: 02-2006
Publisher: Wiley
Date: 14-11-2020
DOI: 10.1002/AJIM.23072
Abstract: To identify patterns of health service use (HSU) in truck drivers with work-related injury or illness and to identify demographic and work-related factors associated with patterns of care. All accepted workers' compensation claims from truck drivers lodged between 2004 and 2013 in Victoria were included. Episodes of HSU were categorised according to practitioner type. Latent class analysis was used to identify the distinct profiles of users with different patterns of HSU. Multinomial logistic regression was used to examine the associations between latent class and predictors. Four profiles of HSU were identified: (a) Low Service Users (55% of the s le) were more likely to be younger, have an injury that did not result in time off work and have conditions other than a musculoskeletal injury (b) High Service Users (10%) tended to be those aged between 45 and 64 years, living in major cities with musculoskeletal conditions that resulted in time off work (c) Physical Therapy Users (25%) were more likely to be aged between 45 and 64 years, live in major cities and have nontraumatic injuries that resulted in time off work and (d) GP/Mental Health Users (10%) were more likely to be over 24 years of age, from the lowest socioeconomic band, be employed by smaller organizations and be claiming benefits for a mental health condition. This study identified distinct categories of HSU among truck drivers following work-related injury. The results can be used to prioritize occupational health and safety promotion to maintain a healthy truck driver work force.
Publisher: Springer Science and Business Media LLC
Date: 20-07-2016
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2020
DOI: 10.1097/JOM.0000000000001770
Abstract: To determine personal, injury, and scheme factors are associated with experiencing stressful healthcare provider (HCP) interactions, and to determine impact of stressful HCP interactions on return to work (RTW). Using the 2018 National RTW Survey of 4574 injured workers that submitted a workers’ compensation claim, multivariable logistic regression determined factors associated with stressful HCP interactions (recorded as “a bit stressful” to “extremely stressful”) and RTW (self-reported yes/no at interview). Workers claiming for mental illness, who found healthcare difficult to access, who consulted with multiple HCPs, and who experienced psychological or financial stress, were significantly more likely to experience stressful HCP interactions. Stressful HCP interactions were associated with lower odds of RTW. Findings provide impetus to investigate why HCP interactions are stressful to enable efforts to reduce stress, possibly improving RTW outcomes.
Publisher: Oxford University Press (OUP)
Date: 03-2009
Abstract: This study examined the validity of the four standard psychological paradigms that have been operationally defined within the CogState brief computerized cognitive assessment battery. Construct validity was determined in a large group of healthy adults. CogState measures of processing speed, attention, working memory, and learning showed strong correlations with conventional neuropsychological measures of these same constructs (r's = .49 to .83). Criterion validity was determined by examining patterns of performance on the CogState tasks in groups of in iduals with mild head injury, schizophrenia, and AIDS dementia complex. Each of these groups was impaired on the CogState performance measures (Cohen's d's = -.60 to -1.80) and the magnitude and nature of this impairment was qualitatively and quantitatively similar in each group. Taken together, the results suggest that the cognitive paradigms operationally defined in the CogState brief battery have acceptable construct and criterion validity in a neuropsychological context.
Publisher: BMJ
Date: 21-05-2004
Abstract: Neuropsychological (NP) testing is now often used to help to determine if the cognitive function of a concussed athlete has declined. The NP test score after concussion is compared with the baseline test score. Many clinicians simply subtract one from the other and make a clinical decision about the significance or otherwise of the resulting “difference score”. Such techniques are inadequate, as they fail to account for the many factors that may confound interpretation of serially acquired cognitive test scores. This is a review of a number of alternative approaches used in other areas of medicine for differentiating “true” changes from changes caused by these confounding factors. A case ex le is used to illustrate the effect that the statistical approach may have on clinical decision making.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2019
Publisher: BMJ
Date: 2016
Publisher: Springer Science and Business Media LLC
Date: 09-10-2014
Publisher: Elsevier BV
Date: 03-2021
Publisher: Informa UK Limited
Date: 10-02-2020
Publisher: Elsevier BV
Date: 05-2014
DOI: 10.1016/J.SOCSCIMED.2014.02.046
Abstract: This study examined external factors affecting policy and program decision-making in a specific public health policy context: injury prevention and rehabilitation compensation in the Australian state of Victoria. The aim was twofold: identify external factors that affect policy and program decision-making in this specific context use this evidence to inform targeting of interventions aimed at increasing research use in this context. Qualitative interviews were undertaken from June 2011 to January 2012 with 33 employees from two state government agencies. Key factors identified were stakeholder feedback and action, government and ministerial input, legal feedback and action, injured persons and the media. The identified external factors were able to significantly influence policy and program decision-making processes: acting as both barriers and facilitators, depending on the particular issue at hand. The factors with the most influence were the Minister and government, lawyers, and agency stakeholders, particularly health providers, trade unions and employer groups. This research revealed that interventions aimed at increasing use of research in this context must target and harness the influence of these groups. This research provides critical insights for researchers seeking to design interventions to increase use of research in policy environments and influence decision-making in Victorian injury prevention and rehabilitation compensation.
Publisher: Elsevier BV
Date: 09-2012
Publisher: Bristol University Press
Date: 05-2016
DOI: 10.1332/174426415X14292714863810
Abstract: This study explores the views and experiences of knowledge translation of 14 Australian public health academics. Capacity to engage in knowledge translation is influenced by factors within the academic context and the interaction of the academic and policy environments. Early and mid-career researchers reported a different set of experiences and pressures to senior researchers. Barriers to knowledge translation reported are largely consistent with prior research. However, this study also emphasised the importance of academic professional identity in research-policy translation. Strategies to enhance research uptake should both address structural barriers and seek to encourage a culture of engagement with public policy.
Publisher: Elsevier BV
Date: 05-2000
DOI: 10.1016/S0149-7634(00)00012-9
Abstract: Subjects in the preclinical stages of Alzheimer's disease (AD) typically record neuropsychological performance between that of healthy older in iduals and demented patients. More specifically, deficits on measures of verbal episodic memory are commonly reported in these patients, while other cognitive functions (e.g. language, praxis and executive function) seem to be spared. A similar neuropsychological profile is observed in elderly subjects with mild cognitive impairment (MCI), a disorder that is attracting increasing research interest. Evidence from lesion and functional imaging studies, as well as volumetric imaging in probable AD and MCI patients, suggests that the cognitive deficits observed in these disorders may be related to medial temporal lobe dysfunction. An issue currently under investigation is whether MCI represents the preclinical stages of AD or a distinct and static cognitive aetiology. In an attempt to address this issue, present investigations are adopting a convergent approach to the detection of preclinical AD, where multiple risk factors are considered when making a diagnosis.
Publisher: Elsevier BV
Date: 06-2022
Publisher: Springer Science and Business Media LLC
Date: 09-04-2019
Publisher: Informa UK Limited
Date: 24-09-2007
DOI: 10.1080/13825580600954256
Abstract: Decline in memory function was detected in 30% of healthy community-dwelling elderly over 6 years using a task assessing delayed word list recall. In iduals with memory decline over time also demonstrated relative deficits on additional tasks of memory and learning, a task of working memory and executive function, and on a verbal (category) fluency task at their most recent assessment. These relative deficits in the performance of in iduals with memory decline cannot be explained by age-related changes, education, intelligence, mood, health-related factors, or the in iduals' APOE epsilon 4 status. Decline in memory performance did not result in greater complaints of cognitive difficulties when compared with normal elderly, nor did it limit overall participation in life activities. Although the significance of memory decline in the current study was not determined quantitatively, memory decline is consistent with the early deterioration characteristic of mild cognitive impairment and preclinical Alzheimer's disease and confirms the need to monitor in iduals with objective memory decline, even when these in iduals fall within normal limits for a given neuropsychological task.
Publisher: BMJ
Date: 11-2007
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2003
DOI: 10.1097/00042752-200301000-00006
Abstract: To determine the repeatability of a computerized cognitive test designed to monitor recovery from concussion and assist team physicians make return to play decisions (CogSport). To determine the correlation between CogSport and two conventional neuropsychological tests. Prospective, serial investigation of cognitive function. Professional and semi-professional Australian Football clubs and a university affiliated research institute in Melbourne, Australia. Three-hundred healthy young adults, including 240 elite athletes. Intra-class correlation (ICC) coefficients for CogSport performance measures administered serially. ICC between CogSport performance measures and conventional neuropsychological tests. Normative data for CogSport performance measures. Measures of psychomotor function, decision making, working memory and learning were highly reliable. Some measures also displayed high correlations with conventional neuropsychological tests of information processing and attention. Preliminary normative data is described. CogSport is a highly reliable cognitive function test when administered to healthy young adults and elite athletes. CogSport measures similar cognitive functions as conventional tests used commonly in concussion research.
Publisher: Springer Science and Business Media LLC
Date: 29-05-2014
DOI: 10.1007/S10926-014-9521-X
Abstract: Healthcare providers (HCPs) are influential in the injured worker's recovery process and fulfil many roles in the delivery of health services. Interactions between HCPs and insurers can also affect injured workers' engagement in rehabilitation and subsequently their recovery and return to work. Consideration of the injured workers' perceptions and experiences as consumers of medical and compensation services can provide vital information about the quality, efficacy and impact of such systems. The aim of this systematic review was to identify and synthesize published qualitative research that focused on the interactions between injured workers, HCPs and insurers in workers' compensation systems in order to identify processes or interactions which impact injured worker recovery. A search of six electronic databases for literature published between 1985 and 2012 revealed 1,006 articles. Screening for relevance identified 27 studies which were assessed for quality against set criteria. A final 13 articles of medium and high quality were retained for data extraction. Findings were synthesized using a meta-ethnographic approach. Injured workers reported that HCPs could play both healing and harming roles in their recovery. Supportive patient-centred interaction with HCPs is important for injured workers. Difficult interactions between HCPs and insurers were highlighted in themes of adversarial relations and organisational pressures. Insurer and compensation system processes exerted an influence on the therapeutic relationship. Recommendations to improve relationships included streamlining administrative demands and increasing education and communication between the parties. Injured workers with long term complex injuries experience difficulties with healthcare in the workers' compensation context. Changes in insurer administrative demands and compensation processes could increase HCP participation and job satisfaction. This in turn may improve injured worker recovery. Further research into experiences of distinct healthcare professions with workers' compensation systems is warranted.
Publisher: Cold Spring Harbor Laboratory
Date: 12-05-2020
DOI: 10.1101/2020.05.06.20093773
Abstract: This study estimated the extent of psychological distress among people losing work during the coronavirus disease of 2019 (COVID-19) pandemic in Australia, and examined associations between distress, nature of work loss and degree of social interaction. Data were from a baseline online survey of an inception cohort recruited in the weeks following the introduction of physical distancing and movement restrictions to contain the spread of COVID-19 in Australia. These restrictions resulted in widespread unemployment and working hour reduction. Psychological distress was measured using the Kessler-6 scale. Data on nature of work loss, social interactions, demographic, job and occupational characteristics were also collected. Regression modelling was conducted to determine the relationship between work loss, social interactions and psychological distress, accounting for confounders. Among the 551 study participants 31% reported severe psychological distress, 35% in those with job loss and 28% in those still employed but working less. Those who had significantly greater odds of high psychological distress were younger, female, had lost their job and had lower social interactions. The relationship between job loss and distress became non-significant when financial stress, and occupation were included in the regression model, but the protective effect of higher social interactions remained significant. There was a high prevalence of psychological distress in people losing work during the coronavirus pandemic. Age, gender, job loss and social interactions were strongly associated with distress. Interventions that promote social interaction may help to reduce distress during among people losing work during the COVID-19 pandemic.
Publisher: Wiley
Date: 03-2005
DOI: 10.1111/J.1365-2869.2004.00438.X
Abstract: Cognitive performance is impaired by fatigue arising from sustained wakefulness and alcohol. Three recent papers directly compared the effects of increasing fatigue and blood alcohol concentration (%BAC) to provide a framework for understanding fatigue-related cognitive impairment. While the expression of fatigue-related cognitive impairments in terms of %BAC equivalents is sound, the methodology in each study was flawed in that the statistics used to compare the effects of %BAC and fatigue on cognition did not account for variation between or within each condition. The point estimates of the difference between a baseline and any level of fatigue or %BAC provided no indication of the size of difference that could reasonably be expected by chance. Importantly, all studies showed that variation increased as cognitive performance declined because of both increasing fatigue and %BAC. The current study compared the effect of increasing levels of %BAC and fatigue on the simple reaction task from the CogState test battery on 40 healthy adults using statistical methods that account for intra-in idual and within-group variability in performance. After 24 h of sustained wakefulness and with 0.08%BAC, in iduals showed maximal cognitive impairment however, the magnitude of impairment found for fatigue was equivalent only to that observed for 0.05%BAC. Re-analysis of the data using percentage change scores indicated that the magnitude of fatigue-related cognitive impairment was much greater than that detected for 0.08%BAC. This suggests that previous studies that have not accounted for variability in the performance data have overestimated the effect of fatigue on cognitive performance.
Publisher: Cambridge University Press (CUP)
Date: 23-02-2021
DOI: 10.1017/S0047279420000732
Abstract: The Disability Support Pension (DSP) is the major Australian government financial benefit program for people of working age with medical conditions and disabilities that restrict work capacity. Between 2012 and 2018 a series of policy reforms sought to restrict the growth in DSP payments and encourage more people with some work capacity to seek employment. We characterise changes in three markers of access to disability financial support over the reform period (1) DSP recipient rates (2) DSP grant (approval) rates and (3) the rate of unemployment benefit receipt in people with impaired work capacity. Results demonstrate a significant reduction in DSP receipt and grant rates, and significant increase in the rate of unemployment benefit receipt in working-age Australians with work disabling medical conditions and disability. These changes were not distributed uniformly. People whose primary medical condition was a musculoskeletal or circulatory system disorder demonstrated greater declines in DSP receipt and grant rates, while there was a more rapid increase in unemployment benefit receipt among people with primary mental health conditions. Some trend changes occur in periods during which new disability assessment and pension eligibility policies were introduced, though our ability to attribute changes to specific policy changes is limited.
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.INJURY.2015.09.011
Abstract: The aims of this study were to describe predictors of sustained return to work (RTW) among a cohort of workers with compensated work-related mental health conditions (MHCs) and to examine predictors of subsequent absences due to the same condition. This study was a retrospective analysis of compensation claims data in Victoria, Australia. We selected workers with an accepted wage replacement claim due to a work-related MHC from 1 January 2002 to 31 December 2009, with two years of follow-up data. We identified 8358 workers meeting our inclusion criteria. The median age of workers was 44 years (Interquartile range (IQR): 36-51) and 56% were female. In a multivariable Cox regression analysis, older age, being from a small organisation, working in some specific industry segments, consulting a psychiatrist or psychologist, using medications, and having a previous claim were all associated with a delayed RTW. Workers experiencing work pressure, assault/workplace violence or other mental stress factors, working in the public administration and safety industry and having a medical incapacity certification between 3-4 days and 5-7 days had a higher rate of multiple RTW attempts. This study identified a number of risk factors associated with a delayed RTW and multiple attempts at RTW. Predictors may help identify high-risk groups and facilitate the RTW process of workers with MHCs.
Publisher: Cold Spring Harbor Laboratory
Date: 02-07-2021
DOI: 10.1101/2021.06.28.21259672
Abstract: To determine health impacts during, and following, an extended community lockdown and COVID-19 outbreak in the Australian state of Victoria, compared with the rest of Australia. A national cohort of 898 working-age Australians enrolled in a longitudinal cohort study, completing surveys before, during, and after a 112-day community lockdown in Victoria (8 July – 27 October 2020). Outcomes included psychological distress, mental and physical health, work, social interactions and finances. Regression models examined health changes during and following lockdown. The Victorian lockdown led to increased psychological distress. Health impacts coincided with greater social isolation and work loss. Following the extended lockdown, mental health, work and social interactions recovered to an extent whereby no significant long-lasting effects were identified in Victoria compared to the rest of Australia. The Victorian community lockdown had adverse health consequences, which reversed upon release from lockdown. Governments should weigh all potential health impacts of lockdown. Services and programs to reduce the negative impacts of lockdown may include increases in mental health care, encouraging safe social interactions and supports to maintain employment relationships.
Publisher: Research Square Platform LLC
Date: 28-09-2020
DOI: 10.21203/RS.3.RS-74164/V1
Abstract: Background: Healthcare is funded and delivered separately from social care programs such as unemployment and disability insurance. Greater understanding of the health service use (HSU) of social assistance benefit recipients would support more effective design and delivery of health and social care. This study aimed to characterise the HSU of disability and unemployment benefit recipients relative to people earning wages, and to identify personal, household and health-related factors associated with HSU in disability benefit recipients. Methods: A cross-sectional national survey of 9,520 working age Australian adults in three groups: (1) 638 receiving the disability support pension (DSP) (2) 442 receiving unemployment benefits and (3) 8440 earning wages. Outcomes included count and frequency of health professional consultations, hospital attendance and admission in the past 12 months, as well as medication and supplement use in the past 2 weeks. Analyses compared DSP and unemployment benefit recipients to wage earners using age and sex adjusted risk ratios and incident rate ratios. Negative binomial regression models were constructed to examine factors associated with hospitalisation and general practitioner services in DSP recipients. Results: DSP recipients were significantly more likely than wage earners to have consulted 15 of 22 types of health professionals, had 2.5 times greater risk and 3.8 times higher rate of hospital admission, and 3.4 times greater risk of prescription medication use. Unemployment benefit recipients were significantly more likely than wage earners to have consulted 5 of 22 types of health professionals, had 1.5 times greater risk of hospital admission and 1.2 times greater risk of prescription medication use. Younger age, hypertension, more co-morbid conditions and poorer self-assessed health were associated with higher rate of hospital admission among DSP recipients. Conclusions: People receiving unemployment and disability insurance benefits use significantly more health services than wage earners. A range of personal and clinical characteristics are associated with greater HSU among disability benefit recipients. Greater coordination between health and social care systems may improve health, reduce HSU and improve work ability in unemployed and working age people.
Publisher: Informa UK Limited
Date: 09-2002
DOI: 10.1076/JCEN.24.6.720.8397
Abstract: Results from recent investigations of behavioral and genetic outcomes in older people with mild cognitive impairment (MCI) have been inconsistent. These conflicting results may be attributed to between-study differences in the diagnostic systems employed, as well as the use of unreliable neuropsychological measures. We investigated behavioral and genetic outcomes in older people classified as having MCI according to novel criterion that required evidence of cognitive impairment on three consecutive neurological/neuropsychological assessments. One hundred and seventy four healthy older people were evaluated semi-annually for 12 months. Of these, 23 subjects were rated as having MCI on three consecutive assessments and were compared to 23 matched control subjects. Subjects rated as impaired on one or two of the three semi-annual assessments were also identified. MCI and matched control groups were compared on a range of behavioral measures. The prevalence of the Apolipoprotein E4 (ApoE4) allele was determined in all groups, and estimates of anxiety and depressive symptomatology were obtained. Subjective cognitive complaints were also assessed. Many subjects were classified as impaired on one or two assessments, however relatively few (n = 23) recorded consistent cognitive deficits. The most severe impairment observed in MCI subjects was on a test of pattern-location associative learning, however MCI subjects did not have insight into this impairment. The prevalence of the ApoE4 allele was not different between matched control and MCI groups. These results indicate that in iduals with MCI can be differentiated from healthy older people and older people with transient cognitive impairments, but that such differentiation requires serial assessment of cognitive function.
Publisher: Elsevier BV
Date: 02-2019
Publisher: BMJ
Date: 10-2001
Abstract: "Paper and pencil" neuropsychological tests play an important role in the management of sports related concussions. They provide objective information on the athlete's cognitive function and thus facilitate decisions on safe return to sport. It has been proposed that computerised cognitive tests have many advantages over such conventional tests, but their role in this domain is yet to be established. To measure cognitive impairment after concussion in a case series of concussed Australian Rules footballers, using both computerised and paper and pencil neuropsychological tests. To investigate the role of computerised cognitive tests in the assessment and follow up of sports related concussions. Baseline measures on the Digit Symbol Substitution Test (DSST), Trail Making Test-Part B (TMT), and a simple reaction time (SRT) test from a computerised cognitive test battery (CogState) were obtained in 240 players. Tests were repeated in players who had sustained a concussive injury. A group of non-injured players were used as matched controls. Six concussions were observed over a period of nine weeks. At the follow up, DSST and TMT scores did not significantly differ from baseline scores in both control and concussed groups. However, analysis of the SRT data showed an increase in response variability and latency after concussion in the injured athletes. This was in contrast with a decrease in response variability and no change in latency on follow up of the control players (p<0.02). Increased variability in response time may be an important cognitive deficit after concussion. This has implications for consistency of an athlete's performance after injury, as well as for tests used in clinical assessment and follow up of head injuries.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 05-2019
Publisher: Springer Science and Business Media LLC
Date: 19-06-2018
Publisher: Springer Science and Business Media LLC
Date: 28-02-2019
DOI: 10.1007/S10926-019-09834-5
Abstract: Purpose The employer/worker relationship can be an important catalyst for-or obstacle to-successful return to work (RTW). An understanding of factors associated with an injured worker's relationship with their employer, and employer involvement in RTW planning, is warranted. Methods Analysis of n = 8808 cross-sectional survey responses from injured workers in nine Australian workers' compensation (WC) jurisdictions. Workers completed a telephone survey between 6 and 24 months post-WC claim acceptance. Factors associated with the worker's perception of employer support were examined using ordinal regression. Factors associated with employer provision of RTW plans were examined using logistic regression. Results Factors associated with employer support included being aged over 50 years, not having a mental health condition, better self-rated health and less time between injury and claim. Factors associated with having a RTW plan included being female, not having a mental health condition and working for a self-insurer. Factors associated with having a written RTW plan included being female and being under 50 years. There was wide variation in the provision of RTW plans between WC jurisdictions. Conclusions There are strong associations between worker, claim and injury-related factors and the injured worker's experience of employer support. Identification of workers at risk of receiving inadequate support during the RTW process may enable interventions to improve support and RTW outcomes.
Publisher: Public Library of Science (PLoS)
Date: 07-12-2022
DOI: 10.1371/JOURNAL.PGPH.0000922
Abstract: Work disability occurs when an injury or illness limits the ability of a worker to participate in employment. While evidence suggests that people with work disability are at increased risk of suicide and intentional self-harm, this relationship has not been the subject of systematic review. This scoping review aims to assess and summarise the research literature regarding the relationship between work disability and subsequent suicide or intentional self-harm. Review protocol was published on the Open Science Foundation and is reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Peer-reviewed studies published in English from 1st January 2000 were included if they reported suicide or self-harm outcomes in people aged 15 years or older with work disability. Studies were identified via systematic search of Medline, Scopus and Pubmed databases, via recommendation from topic experts, and citation searching of included articles. A narrative synthesis was undertaken. Literature search yielded 859 records of which 47 eligible studies were included, nine set in workers’ compensation, 20 in sickness absence, 13 in disability pension systems, and five from mixed cohorts. Of 44 quantitative studies, 41 reported a positive relationship between work disability and suicidal behaviour. The relationship is observed consistently across nations, work disability income support systems and health conditions. Several factors elevate risk of suicidal behaviour, including presence of mental health conditions and longer work disability duration. There were few studies in some nations and no suicide prevention interventions. The risk of suicide and self-harm is elevated in people experiencing work disability. Further observational research is required to fill evidence gaps. This review suggests the need for governments, employers and those involved in the care of people with work disability to focus on identification and monitoring of those at greatest risk of suicidal behaviour, and suicide prevention.
Publisher: Medical Journals Sweden AB
Date: 2012
Abstract: Given the burden associated with vehicle-related trauma, there is interest in time and cost effective methods of providing information to assist recovery. This systematic review aims to address the question: "Do targeted early information interventions improve outcomes following vehicle--related injuries for persons of working age?" Ovid Medline, EMBASE, PsychINFO and Cochrane databases were searched for studies published between 1990-April 2011. Included studies were randomized or pseudo--randomized controlled trials of information interventions delivered to working age persons following vehicle-related injuries. Two reviewers independently selected and appraised the studies. Sixteen publications (13 primary studies) met the inclusion criteria and were assessed for bias. Hetero-geneity in terms of the information interventions and measured outcomes was encountered. In 4 of the included studies, the intervention was positively associated with at least one outcome reported. Methodological issues limited the conclusions that could be drawn. Following vehicle-related trauma, people often experience difficulties in ongoing functioning. The current evidence neither supports nor fails to support the effectiveness of information interventions in promoting injury recovery. There is a need for larger more methodologically and conceptually rigorous randomized controlled trials that better consider the type and timing of the intervention.
Publisher: Springer Science and Business Media LLC
Date: 29-07-2016
Publisher: Springer Science and Business Media LLC
Date: 16-05-2014
DOI: 10.1007/S10926-014-9513-X
Abstract: Work-related injury is a major public health problem and a worker's recovery can be shaped by their interactions with employers, healthcare providers and the workers' compensation system. Most research on the effects of compensation has concentrated on examining outcomes rather than considering the compensation process itself. There has been little attention paid to the interactions between stakeholders and only recently has the client's view been considered as worthy of investigation. This systematic review aimed to identify and synthesize findings from peer reviewed qualitative studies that investigated injured workers interactions with insurers in workers' compensation systems. A search of six electronic library databases revealed 1,006 articles. After screening for relevance, 18 articles were read in full and a search of those bibliographies revealed a further nine relevant articles. Quality assessment of the 27 studies resulted in a final 13 articles of medium and high quality being retained for data extraction. Included studies focused mainly on experiences of injured workers, many of whom had long term claims. Findings were synthesized using a meta-ethnographic approach. Six themes were identified which characterised the interactions between insurers and injured workers. The majority of interactions were negative and resulted in considerable psychosocial consequences for injured workers. Positive interactions were less frequently reported and included respectful, understanding and supportive communication and efficient service from insurers. Findings from this synthesis support the growing consensus that involvement in compensation systems contributes to poorer outcomes for claimants. Interactions between insurers and injured workers were interwoven in cyclical and pathogenic relationships, which influence the development of secondary injury in the form of psychosocial consequences instead of fostering recovery of injured workers. This review suggests that further research is required to investigate positive interactions and identify mechanisms to better support and prevent secondary psychosocial harm to injured workers.
Publisher: BMJ
Date: 08-2003
Publisher: Hart Publishing
Date: 2020
Publisher: Wiley
Date: 28-05-2023
DOI: 10.1002/AJIM.23489
Abstract: Research has shown how regionally varying labor market conditions are associated with differences in work disability duration. However, the majority of these studies have not used multilevel models to appropriately account for the hierarchical clustering of in iduals nested within contextual units (e.g., regions). Studies that have used multilevel models have focused on privately insured workers or on disability not specifically caused by work‐related injury or illness. Using claims data from five Canadian provincial workers' compensation systems, linear random‐intercept models were used to estimate how much variance in temporary work disability duration ('work disability duration' for brevity) for work‐related injuries and musculoskeletal disorders was due to differences between economic regions, what economic region‐level labor market characteristics were associated with work disability duration, and what characteristics best explained economic region differences in work disability duration. Economic region characteristics, such as the unemployment rate and proportion of goods‐producing employment, were independently associated with in idual‐level work disability duration. However, economic region variation only accounted for 1.5%–2% of total variation in work disability duration. The majority (71%) of economic region‐level variation was explained by the provincial jurisdiction where the worker lived and was injured. Regional variation tended to be greater for female workers than males. The findings suggest that while regional labor market conditions matter for work disability duration, system‐level differences in workers' compensation and health care are more important factors influencing work disability duration. Furthermore, while this study includes both temporary and permanent disability claims, the work disability duration measure only captures temporary disability.
Publisher: Psychology Press
Date: 13-05-2013
Publisher: Cambridge University Press (CUP)
Date: 10-2002
DOI: 10.1017/S0033291702006128
Abstract: Background. It has been argued recently that the attentional dysfunction in schizophrenia occurs as a result of an inability to inhibit automatic attentional shifts to compelling external stimuli. However, this hypothesis is based on performance on paradigms that require overt or covert shifts of spatial attention. Method. We investigated responses to foveally presented stimuli in patients with schizophrenia and healthy controls as they performed unidimensional and bidimensional versions of the flanker task. In both tasks, centrally presented target stimuli were flanked by peripheral stimuli that were either congruent or incongruent with the behavioural goal of the subject. In the bidimensional task, the flanking stimuli could be congruent and incongruent on multiple stimulus characteristics. Results. On the unidimensional flanker task, the behavioural goal modulated the responses of the schizophrenia group such that response times (RTs) to target stimuli that were flanked by congruent stimuli were faster than RTs to target stimuli flanked by incongruent stimuli. However, on the bidimensional flanker task, the responses of schizophrenia patients were no longer constrained by the behavioural goal and RTs to both congruent and incongruent stimuli were equivalent. Conclusions. It appears that the attentional dysfunction in schizophrenia may reflect difficulty in resolving multiple and simultaneous response conflicts. These findings suggest a possible role for the anterior cingulate cortex in the attentional impairments associated with schizophrenia.
Publisher: Informa UK Limited
Date: 06-2005
Abstract: There is limited understanding of the problems associated with repeated neuropsychological assessment in children, including the statistics used to guide decisions about cognitive change. This study investigated the utility of a computerized assessment battery that was specifically designed for the repeated assessment of cognitive function in children. Eighty-seven participants aged 8 to 12 years completed the battery four times within a 2-hour testing session. The results support the application of this assessment battery for measuring cognitive change in children. A novel method for calculating measurement error is employed, and its use in the detection of cognitive change in in idual children is discussed. An estimate of the measurement error within each of the tests is provided, and recommendations are made regarding the application of this assessment battery for measuring cognitive change in children.
Publisher: Wiley
Date: 11-05-2021
DOI: 10.1002/AJIM.23253
Abstract: To identify geographic hotspots and coldspots of work disability burden and their associated sociodemographic factors in Australia. Using Australian workers' compensation and census data, we calculated weeks of compensated time off work per 1000 labor force, an indicator of work disability burden, at Statistical Area Level 4, the smallest level of labor force data produced by the Australian Bureau of Statistics. Records included all claims with at least 1 day of compensated time off work lodged between 2010 and 2015. Work disability burden was z ‐transformed by state and territory and mapped across Australia. Statistical Areas that were more than 1 standard deviation from the state or territory mean were considered hotspots and coldspots. We tested several sociodemographic factors as predictors of work disability burden. Work disability burden hotspots were concentrated in lower socioeconomic suburbs and exurbs of state capitals, in addition to several regional areas. Coldspots were primarily in wealthy central urban and suburban areas. Factors associated with greater work disability burden include higher area socioeconomic disadvantage, rurality, lower labor force participation, higher unemployment, higher proportion of work in production industries and in blue‐collar occupations, and higher numbers of those with core activity limitations, those aged 65+ years, and foreign‐born residents. Work disability burden is unequally distributed across Australia and strongly influenced by sociodemographic and occupational factors. The findings can guide more efficient allocation of resources for work disability prevention and rehabilitation.
Publisher: Springer Science and Business Media LLC
Date: 06-2022
DOI: 10.1007/S10926-022-10050-X
Abstract: The systems that societies construct to support work disability prevention can have powerful effects on both the experiences of people with work disability as well as their health and employment outcomes. Comparative studies between jurisdictions provide an opportunity to gain insights into these system level impacts, by comparing system features, processes and experiences and by determining if jurisdictional variation affects outcomes. In turn, this can prompt policy and practice reform. Reflecting the ersity of work disability systems globally, there is growing interest in cross-jurisdiction comparative research in the field. This special series presents seven articles addressing important methodological and conceptual aspects of comparative research in work disability prevention, and presents practical ex les of how jurisdictions vary and the impact this can have on workers.
Publisher: Bristol University Press
Date: 11-2015
DOI: 10.1332/174426414X14170304008766
Abstract: Organisational factors can affect the success of interventions aimed at increasing research use. Research is needed to identify organisational factors affecting research use in specific public health policy contexts. Qualitative interviews with decision makers from a specific public health context identified a range of organisational factors that affected policy and programme decision making. Interestingly, factors affecting decision making generally were comparable to factors that affect research use specifically, highlighting the complexity of policy and programme decision making. Results revealed a window of opportunity to frame increased research use as part of broader organisational change aimed at improving policy and programme development and outcome measurement.
Publisher: Springer Science and Business Media LLC
Date: 15-06-2021
Publisher: BMJ
Date: 08-2005
Publisher: AMPCo
Date: 10-2013
DOI: 10.5694/MJA13.10508
Abstract: To examine patterns of the sickness certification of workers compensation claimants by general practitioners in Victoria, Australia, by nature of injury or illness. Retrospective analysis of Victorian workers compensation data for all injured and ill workers with an accepted workers compensation claim between 2003 and 2010. Type (unfit for work, alternative duties, or fit for work) and duration of initial medical certificates relating to workers compensation claims that were issued by GPs, in six categories of injury and illness. Of 124,424 initial medical certificates issued by GPs, 74.1% recommended that workers were unfit for work and 22.8% recommended alternative duties. Unfit-for-work certificates were issued to 94.1% of workers with mental health conditions, 81.3% of those with fractures, 79.1% of those with other traumatic injuries, 77.6% of those with back pain and strains, 68.0% of those with musculoskeletal conditions and 53.0% of those with other diseases. Alternative-duties certificates were significantly longer in duration than unfit-for-work certificates in all injury and illness categories (P < 0.001) but certificates for workers with musculoskeletal injuries and diseases, back pain and strains and other traumatic injuries were of lesser duration than those for workers with fractures, mental health conditions and other diseases. The high proportion of medical certificates recommending complete absence from work presents major challenges in terms of return to work, labour force productivity, the viability of the compensation system, and long-term social and economic development. There is substantial variation in the type and duration of medical certificates issued by GPs. People with mental health conditions are unlikely to receive a certificate recommending alternative duties. Further research is required to understand GP certification behaviour.
Publisher: BMJ
Date: 2013
Publisher: Springer Science and Business Media LLC
Date: 03-01-2021
DOI: 10.1007/S10926-020-09947-2
Abstract: Purpose Time off work after workplace injury varies by compensation system. While often attributed to features of the compensation system, unaccounted regional factors may drive much of the effect. In this study, we compare disability durations by state and territory of residence within a single national workers' compensation system. Large differences would indicate that factors other than compensation system settings are responsible for system effects observed in previous studies. Methods We applied crude and adjusted Cox proportional hazards models to compare disability durations by state and territory of residence. Confounders included factors known to influence disability duration. Durations were left-censored at two weeks and right-censored at 104 weeks. Results We analysed N = 31,641 claims. In both crude and adjusted models, three of the seven states and territories significantly differed from the reference group, New South Wales. However, two of the three were different between crude and adjusted models. Regional effects were relatively small compared to other factors including insurer type, age, and type of injury. Conclusions Regional factors influence disability duration, which persist with adjustment for demographic, work, insurer type, and injury confounders. However, the effects are inconsistently significant and fairly small, especially when compared to the effect of confounders and system effects found in previous studies. Regional factors likely only account for a small share of the difference in disability duration between compensation systems.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-11-2022
DOI: 10.1097/J.PAIN.0000000000002539
Abstract: This study aimed to identify patterns of opioid dispensing in Australian workers with low back pain (LBP) and determine the association of dispensing patterns with wage replacement duration. Australian workers' compensation claimants with LBP and at least 1 day of wage replacement were included. We used group-based trajectory modelling to identify opioid dispensing patterns over a two-and-a-half-year period from reported LBP onset and quantile regression to compare wage replacement duration between each dispensing pattern group. Opioids were dispensed to one-third of workers with LBP (N = 3205, 33.3%) at least once during their claim. Three dispensing patterns were identified. Most had a short-term low-volume opioid dispensing pattern (N = 2166, 67.6%), whereas 798 (24.9%) had a long-term moderate-volume pattern and 241 (7.5%) had a long-term high-volume pattern. Workers with dispensed opioids had significantly longer wage replacement duration than those without dispensed opioids (median [weeks]: 63.6 vs 7.1, respectively). In addition, moderate-volume and high-volume long-term dispensing groups had significantly longer wage replacement duration compared with the short-term dispensing group (median [weeks]: 126.9, 126.0, and 30.7, respectively). Without controlling for pain severity, these results offer limited evidence that opioids lead to longer wage replacement duration. Further research controlling for pain severity, psychosocial factors, and recovery expectations is required to confirm whether the relationship between opioid dispensing pattern and wage replacement duration is causal in nature.
Publisher: Medical Journals Sweden AB
Date: 2013
Abstract: To establish trends in whiplash-related health service use and cost in Victoria, Australia. Administrative data analysis. Whiplash patients claiming Transport Accident Commission (TAC) compensation for accidents dating between 1 January 2000 and 31 December 2009 (n = 51,263). Injury-related health service use during one year following the accident was determined from claim payment records. The incidence of whiplash claims in Victoria was calculated, as were inflation-adjusted health care costs. In 2000-2009, the incidence of compensable whiplash decreased from 1.56 to 1.14 per 1,000 person-years. Physiotherapy, pharmaceuticals, general practitioner, chiropractic, radiology and osteopathy sessions were the most commonly claimed services. General practitioner, allied health and radiology services decreased, but analgesic use increased. Per person-years in the population, whiplash-related medical expenses were 71% greater for women than men. Overall, population burden decreased by 38% the decline was most pronounced in persons aged 18-24 (54% decrease) and least pronounced in those aged ≥ 55 (23% decrease). The population-based health service cost of whiplash decreased between 2000 and 2009. The overall reduction was related to a decrease in incidence and a reduction in service use per whiplash claim.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2016
Publisher: American Psychological Association (APA)
Date: 2000
Publisher: Elsevier BV
Date: 03-2003
Publisher: Swansea University
Date: 12-05-2021
Abstract: BackgroundIn 2012, the Australian state of New South Wales passed legislation that reformed its workers’ compensation system. Section 39 introduced a five-year limit on income replacement, with the first affected group having their benefits cease in December 2017. There is limited evidence on how this will affect their healthcare service use and where they will go for financial support. MethodsMultiple data sources will be linked: administrate workers’ compensation claims data from the State Insurance Regulatory Authority (SIRA), universal health insurance data from the Medical Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS), state hospital and emergency department data, and social welfare data from the Department of Social Services’ Data Over Multiple In idual Occurrences (DOMINO). An estimated 4,125 injured workers had their benefits cease due to Section 39. These will form the exposure group who will be compared to 1) a similar group of workers’ compensation claimants who have had at least two years of compensated time off work but whose benefits did not cease due to Section 39 and 2) a community comparison group drawn from state hospital and emergency department records. An accredited third party will link the data, which will be accessible only via secure virtual machine. Initial analyses will compare the prevalence and incidence of service use across groups in both the year before and year after benefit cessation the community control will be assigned the median benefit cessation date in lieu of an actual date. To estimate the impact of benefit cessation due to Section 39, we will conduct time series analysis of the prevalence and incidence of service use. DiscussionThis study will provide much-needed evidence on the consequences of long-term benefit cessation, particularly on subsequent healthcare and welfare service use.
Publisher: Cold Spring Harbor Laboratory
Date: 09-09-2020
DOI: 10.1101/2020.09.06.20189514
Abstract: To determine if losing work during the COVID-19 pandemic is associated with mental and physical health. To determine if social interactions and financial resources moderate the relationship between work loss and health. Baseline data from a prospective longitudinal cohort study. Australia, 27 th March to 12 th June 2020. Australians aged 18+ years, employed in a paid job prior to the COVID-19 pandemic who responded to an online or telephone survey. Kessler-6 score 18 indicating high psychological distress. Short Form 12 (SF-12) mental health or physical health component score = 45 indicating poor mental or physical health. 2,603 respondents including groups who had lost their job (N = 541), were not working but remained employed (N = 613), were working less (N = 789) and whose work was unaffected (N = 789). Three groups experiencing work loss had greater odds of high psychological distress (AOR = 2.22–3.66), poor mental (AOR = 1.78–2.27) and physical health (AOR = 2.10–2.12) than the unaffected work group. Poor mental health was more common than poor physical health. The odds of high psychological distress (AOR = 5.43–8.36), poor mental (AOR = 1.92–4.53) and physical health (AOR = 1.93–3.90) were increased in those reporting fewer social interactions or less financial resources. Losing work during the COVID-19 pandemic is associated with mental and physical health problems, and this relationship is moderated by social interactions and financial resources. Responses that increase financial security and enhance social connections may partially alleviate the health impacts of work loss. Australian New Zealand Clinical Trials Registry: ACTRN12620000857909.
Publisher: Springer Science and Business Media LLC
Date: 10-07-2019
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 28-12-2004
Publisher: Springer Science and Business Media LLC
Date: 27-02-2020
Publisher: CSIRO Publishing
Date: 2020
DOI: 10.1071/AH18017
Abstract: Objective Health and social care workers have a significantly higher rate of work-related injury and illness than workers in other industries. The objective of this study was to examine the rate and distribution of work-related injury and illness in the Victorian health and social care sector by demographic, occupation and injury characteristics. Methods A retrospective cohort analysis was conducted of population-level workers’ compensation claim records, including 43910 claims from the Victorian health and social care over a 10-year period from 2006 to 2015. Negative binomial regression was used to compare claim rates between occupation categories. Results The 55–64 year age group had the highest injury rate compared with the 15–24 year age group (rate ratio 2.26 95% confidence interval 1.91–2.68). Ambulance officers had the highest overall injury claim rates and had a fluctuating trend of musculoskeletal, psychological and neurological injury claims during the study period. Social workers had the second highest rate of psychological injury and up to threefold the risk of psychological injury compared with nurse professionals. Conclusions Although the greatest volume of claims was observed in nurses, ambulance officers and paramedics were at higher risk for injury, followed by social workers. The differential patterns of injury and illness among occupation groups suggests a need for primary and secondary prevention responses tailored by occupation. What is known about the topic? The health and social care industry is a large and erse industry. Health and social care workers encounter unique occupational health risks, with exposure varying by occupation. What does this paper add? This study provides evidence of a high rate of work-related injury and illness among health and social care workers, with ambulance officers and social workers at highest risk. Notably, there are also high rates of psychological injury claims among these two occupations. What are the implications for policy makers? This study compares rates of compensable injury and illness in the Victorian health and social care sector by occupation. The study provides guidance on which occupations and which health conditions require greatest attention.
Publisher: Cold Spring Harbor Laboratory
Date: 08-03-2022
DOI: 10.1101/2022.03.06.22271884
Abstract: To determine the continuity of care (CoC) provided by general practitioners among workers with low back pain identify personal, workplace and social factors associated with CoC in this population and investigate if CoC is associated with working time loss. An administrative database containing accepted workers’ compensation claim and service level data, for workers with back pain from five Australian jurisdictions, injured between July 2010 and June 2015. A retrospective cohort study. Outcomes were CoC with a general practitioner, measured with the Usual Provider Continuity index, and working time loss, measured as the number of weeks for which workers’ compensation income support benefits were paid. Eligible workers had at least four general practitioner services, and greater than two weeks working time loss. Usual Provider Continuity index score was categorised as complete, high, moderate, or low CoC. Ordinal logistic regression models examined factors associated with Usual Provider Continuity category. Quantile regression models examined association between duration of working time loss and Usual Provider Continuity category, in four groups with different volumes of general practitioner services. Complete CoC was observed in 33.8% of workers, high CoC among 37.7%, moderate CoC in 22.1%, and low CoC in 6.4%. Higher Usual Provider Continuity was associated with fewer general practitioner services, older age, living in urban areas, an occupation as a Community and Personal Service Worker or Clerical and Administrative Worker, and the state of Victoria. In workers with more than two months of time loss, those with complete CoC consistently had shorter durations of time loss. Higher CoC with a general practitioner is associated with less working time loss and this relationship is strongest in the sub-acute phase of low back pain. Continuity of care is a key component of best practice primary care Low back pain is a condition that often requires ongoing management and care from a general practitioner The relationship between continuity of care and work disability duration, recovery and return to work in workers with low back pain is not known Workers with low back pain who see the same general practitioner for all services (i.e., have a greater continuity of care) generally have shorter durations of working time loss Higher continuity of care was observed in workers who had fewer PCP services, were aged over 45, lived in urban areas, and worked as a Community and Personal Service Worker or Clerical and Administrative Worker Workers’ compensation systems should consider policies and guidelines that increase continuity of care in injured workers
Publisher: Elsevier BV
Date: 07-2014
DOI: 10.1016/J.PUHE.2014.04.004
Abstract: Injury is a major public health problem. While the impacts of injury on the injured person are well documented, there is relatively little knowledge about the impacts of injury on those in iduals and groups in the community connected to the injured person. This study seeks to describe this breadth of research using a meta-review methodology. Systematic meta-review. To gain a better understanding of the known impacts of injury on family, community and society, a systematic meta-review of injury outcomes research literature was conducted. Seventy-eight peer-reviewed published literature reviews were included in the meta-review. Of these, 70 reported outcomes at the level of the injured person including mortality, body functions, activity and participation limitations. Nine reviews reported impacts at the level of the community including impacts on family members, work colleagues and carers. Six studies reported impacts at the societal level including economic, health system and injury compensation system impacts. In summary, the meta-review identified a substantial body of knowledge at the in idual level outcomes of injury, and a relative lack of information regarding the community and societal impacts of injury. An injury outcome framework is proposed on the basis of the findings of the meta-review to guide future research activity, particularly with regard to injury outcome domains where there is currently limited evidence. A comprehensive framework that takes account of all levels of impact is necessary for effective policies, systems and strategies to support recovery following injury.
Start Date: 2014
End Date: 2018
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2014
End Date: 2019
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2014
End Date: 2017
Funder: Canadian Institutes of Health Research
View Funded ActivityStart Date: 2014
End Date: 2019
Funder: National Health and Medical Research Council
View Funded ActivityStart Date: 2014
End Date: 2018
Funder: Canadian Institutes of Health Research
View Funded ActivityStart Date: 2019
End Date: 2021
Funder: Australian Research Council
View Funded ActivityStart Date: 2011
End Date: 2014
Funder: Australian Research Council
View Funded ActivityStart Date: 04-2019
End Date: 12-2022
Amount: $479,606.00
Funder: Australian Research Council
View Funded ActivityStart Date: 04-2020
End Date: 05-2024
Amount: $982,143.00
Funder: Australian Research Council
View Funded ActivityStart Date: 09-2011
End Date: 06-2016
Amount: $298,719.00
Funder: Australian Research Council
View Funded ActivityStart Date: 2023
End Date: 12-2025
Amount: $574,000.00
Funder: Australian Research Council
View Funded Activity