RESUMEN

The original version of this article, published on 22 July 2020, unfortunately contained a mistake.

RESUMEN

A hip fracture liaison service that was implemented in 2 hospitals in Alberta, Canada, co-managed by a nurse and physician, was cost-effective and improved initiation of osteoporosis medication following hip fracture. PURPOSE/INTRODUCTION: To determine cost-effectiveness of a 3i hip fracture liaison service (H-FLS) with 12-month follow-up, co-managed by a nurse and physician, when implemented into standard practice. METHODS: The cost-effectiveness analysis compared those receiving the H-FLS to a simulated usual care group using a decision analytic model that incorporated Markov processes. We estimated incremental costs and effectiveness (based on quality-adjusted life years (QALYs) gained) using a lifetime horizon and a healthcare payer perspective. The H-FLS program provided data regarding population at risk, treatment rates, persistence, and intervention costs. We also performed deterministic and probabilistic sensitivity analyses. RESULTS: One thousand two hundred fifty-two patients were included in the H-FLS between June 2015 and March 2018; 69% were female; the average age was 80 ± 11 years. Anti-absorptive treatment following fracture was initiated in 59.6% (95% CI: 55.7-63.5) H-FLS patients relative to 20.9% (95% CI: 13.3-28.5%) receiving usual care (from our published work). Based on modeled cohort simulation cost-effectiveness analysis (CEA), every 1000 H-FLS patients would experience 12 fewer hip fractures and 37 fewer total fragility fractures than patients receiving usual care. Over the study horizon, the H-FLS led to only a $54 incremental cost/patient with a modest gain of 8 QALYs/1000 patients. The incremental cost-effectiveness ratio (ICER) of $6750/QALY gained was less than the $27,000 cost-effectiveness threshold. Eliminating the 9-month follow-up resulted in incremental savings of $218/patient while also reducing 6-month follow-ups increased cost-savings to $378/patient. Probabilistic sensitivity analyses suggested that the H-FLS would either be cost-saving (60%) or cost-effective (40%). CONCLUSION: A H-FLS implemented into standard practice significantly improved anti-absorptive medication use; a cohort simulation cost-effectiveness analysis (CEA) suggested that the H-FLS was cost-effective with potential to become cost-savings.

Asunto(s)

RESUMEN

A hip fracture liaison service that was implemented in 2 hospitals in Alberta, Canada, co-managed by a nurse and physician, was effective for improving initiation of osteoporosis medication following hip fracture. PURPOSE: To examine implementation of an in-patient hip fracture liaison service (H-FLS) to improve osteoporosis medication use after hip fracture using the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance). METHODS: Using population-based administrative data from 7 quarters before and up to 7 quarters after H-FLS implementation, we examined new starts, continued use, and overall use (new starts + continued use) of osteoporosis medication after hip fracture. A total of 1427 patients 50 years and older that underwent hip fracture surgery at 1 of 2 tertiary hospitals in a Canadian province and survived to 12 months post-fracture were included. We also compared treatment initiation rates by sex and hospital. RESULTS: Of the 1427 patients, 1002 (70.2%) were female (mean age = 79.3 ± 11.9 years) and 425 (29.8%) were male (mean age = 73.8 ± 13.8 years). Based on pre-fracture residence within the health zone, 1101 (69%) were considered eligible (Reach). New starts of osteoporosis medication increased from 24.7% pre- to 43.9% post-implementation of the H-FLS (p < 0.001) (effectiveness). The proportion of patients prescribed osteoporosis medication prior to a hip fracture remained consistent (15.1% pre-; 14.7% post-implementation; p = 0.88) with a resultant improvement in overall medication use from 39.8% pre- to 58.6% post-implementation (p < 0.001). Both sites significantly improved medication initiation (site 1: 27.9% pre- to 40.3% post-implementation; site 2: 19.6% pre- to 50.0% post-implementation; p < 0.001 for both) (adoption). Medication initiation in females improved from 26.0% pre- to 43.4% post-implementation while initiation in males improved from 21.7% pre- to 45.1% post-implementation (p < 0.001[females]; p = 0.001[males]) (implementation). Post-implementation, elevated initiation rates were retained over the 7 quarters (p = 0.81) (maintenance). CONCLUSIONS: An H-FLS based in two tertiary hospital sites significantly improved use of osteoporosis medications after hip fracture in both males and females.

Asunto(s)

RESUMEN

BACKGROUND: The increase in computer and mouse use has been associated with an increased prevalence of disorders in the neck and upper extremities. Furthermore, poor workstation design has been associated with an increased risk of developing these symptoms. Aim The aims of this study were (i) to estimate the prevalence of musculo-skeletal disorders among full-time visual display unit (VDU) users; (ii) to examine how the prevalence varies by work environment; and (iii) to explore the association with work factors. METHOD: A survey was carried out on the effect of work with VDUs on musculo-skeletal disorders in workers in the office environment of 56 workplaces. Office workers (n = 298), customer service workers (n = 238) and designers (n = 247) were studied. RESULTS: For all the occupations combined, the 12 month prevalences of musculo-skeletal symptoms in the neck, shoulders, elbows, lower arms and wrists, and fingers were 63, 24, 18, 35 and 16%, respectively. The study indicated that musculo-skeletal pain is common among computer workers in offices. There was no strong association between the duration of computer work and pain or between the duration of mouse use and pain, but workers' perception of their workstation as being poor ergonomically was strongly associated with an increased prevalence of pain. CONCLUSIONS: Musculo-skeletal symptoms are common, but the duration of daily keyboard and mouse use had no connection with musculo-skeletal symptoms. Instead, more consideration should be paid to the ergonomics of workstations, the placing of the mouse, the postures of the upper extremities and the handling of the mouse.

Asunto(s)

Asunto(s)

RESUMEN

A matched case-referent study was undertaken to assess whether rheumatoid factor (RF) is associated with repeating tenosynovitis or peritendinitis and whether HLA-B27 predisposes to epicondylitis. The study subjects consisted of 25 workers in manually strenuous jobs with a history of at least two episodes of tenosynovitis or peritendinitis in the wrist or forearm, or humeral epicondylitis, and their matched referents. The latex agglutination test was positive in seven of the 23 cases with tenosynovitis and in one of the referents (p = 0.03). The corresponding figures for IgM-RF by enzyme immunoassay were ten and two, respectively (p = 0.008). HLA-B27 antigen was found in five of the 13 workers with epicondylitis and in one worker with no such history (p = 0.13). It is possible that RF-positive repeating tenosynovitis represents an incomplete form of rheumatoid disease.

Asunto(s)

RESUMEN

A 31-month follow-up study on the incidence of clinically ascertained tenosynovitis or peritendinitis in the hand and forearm regions and epicondylitis was conducted among 377 workers in strenuous manual jobs and 338 employees in manually nonstrenuous work in a large meat-processing factory. The clinical diagnosis of tenosynovitis or peritendinitis occurred 143 times and epicondylitis 68 times during the follow-up. The annual incidence of tenosynovitis or peritendinitis was less than 1% for employees in nonstrenuous jobs, 25.3% for female packers, 16.8% for female sausage makers, and 12.5% for male meatcutters. The annual incidence of epicondylitis was about 1% for employees in nonstrenuous jobs, 11.3% for female sausage markers, 7.0% for female packers, and 6.4% for male meatcutters. Workers typically resumed their jobs after returning from sick leave, and job transfers were rare.

Asunto(s)

RESUMEN

Awkward work posture is associated with the development of musculo-skeletal disorders. Previous workplace investigations in new building construction have shown that physical work affects workers' health in 46% of jobs. There is, however, a need for detailed analysis of jobs having physical workload and ergonomics problems. OWAS (Ovako Working Posture Analysing System) is a simple observation method for postural analysis, but there has been no study of its use in the building construction industry. The work described here examined (a) the use of the OWAS method to analyse work postures in building construction, (b) the development of a portable computer system for the OWAS method, (c) improvement of work postures identified as poor, and (d) use of the results as part of the ergonomics training programme of the company. Suggestions for work redesign measures are given.

RESUMEN

In this study a systematic method for workplace investigation was developed and then tested as part of the regular occupational health care procedures in the building trade. Workplace investigation is a concept which entails the analysis of hazards inherent in the work as well as assessment of their effects on workers' well-being. The aim of this paper is to evaluate the effectiveness of the workplace investigation method. The newly developed method, called Job Load and Hazard Analysis, has the following characteristics: a job analytic approach; the application of group problem-solving; and cooperation between occupational health professionals, occupational safety personnel, and line management. The method comprises the identification of health hazards, their assessment, and conclusions and proposals as to their prevention and follow-up. The method was tested as part of one constructor's actual occupational health care programme, over a 2.5-year period. The method worked well as a central component of preventive occupational health care. It yielded concrete data that could be applied to make the occupational health care programme better suited to preventing the hazards inherent in the building trade. The contents of the occupational health care programme were clearly enhanced, the number of preventive measures increased, and the organizational climate improved; the workers praised the increased emphasis on safety. More research is needed, eg in other production settings and to determine the most effective utilization of the data gathered by the method.

Asunto(s)

RESUMEN

The prevalence of epicondylitis and tenosynovitis was assessed among 90 meatcutters and 77 referents (construction foremen). All the participants filled out a self-administered questionnaire about subjective symptoms of the upper extremities. The questionnaire was part of the Nordic standardized questionnaire for rheumatic symptoms. The subjects were examined by the authors, who did not have prior knowledge of the subjects' occupations. The prevalence of epicondylitis and tenosynovitis among the meatcutters was 8.9 and 4.5%, respectively. One referent had epicondylitis, and none suffered from tenosynovitis. The results indicate that the meatcutters had a higher risk for epicondylitis in comparison with the referents. The risk increased with age and number of exposure years.

Asunto(s)

RESUMEN

This study, which dealt with occupational rheumatic disorders associated with repetitive monotonous working movements, is based on the reports received by the National Board of Labour Protection during the 5-year period 1975-79. Altogether 3 090 cases were analysed. Of these, 2 139 (69.2%) were females and 951 (30.8%) males. The mean age of the patients was 40.7 years; the majority (82.2%) were 30-59 years old. The upper limb was involved in 93% and especially the forearm in 63% of cases. Tenosynovitis and peritendinitis of the hand was present in 58% and epicondylitis in 24%. Other disorders, such as shoulder disorders, neck and low back pain, and disorders of the lower extremities were much less frequent. The incidence of occupational musculoskeletal disorders was highest among female workers in the textile, leather and food industries. On comparing different occupations, butchers and meat cutters had the highest incidences. The patients were treated mostly at occupational health centres (66.2%) and local health centres (27.1%). The data on exposure time was rather meagre. This factor was estimated in only 77% of cases. In these the average exposure time was 2.4 years.

Asunto(s)

RESUMEN

The etiology of humeral epicondylitis and three different conservative methods of treatment were prospectively studied during two years in patients visiting a large occupational health center. Eighty-eight workers, 50 male and 38 female, out of 7600 suffered from humeral epicondylitis. The annual incidence was 59 per 10 000 workers. The mean age was 43 years. The main cause (61.4%) of tennis elbow was over-exertion of the finger and wrist extensors in trained workers. Forty-seven patients were treated with local corticosteroid and anesthetic injections (beta-methasone + lidocaine), 20 patients with methylprednisolone injections and 21 patients with wrist immobilization in combination with indomethacin. The result of therapy was excellent or good in 82% of the cases after six months and in 90% after one year. No significant differences (p greater than 0.1) in results were observed between patients treated with different therapies. Two patients (2.3%) were operated on after conservative treatment had failed.

Asunto(s)

Asunto(s)

Asunto(s)

Asunto(s)