RESUMO
BACKGROUND: No study to our knowledge has explored physical therapy utilization following lumbar spine surgery in a workers' compensation setting. OBJECTIVES: Describe physical therapy utilization and costs, and return-to-work status in patients following lumbar spine surgery under a workers' compensation claim. METHODS: Using data from the New South Wales (NSW) State Insurance Regulatory Authority (Australia), we audited physical therapy billing codes for patients who received lumbar spine surgery from 2010 to 2017. We summarised, by fusion versus decompression, the number of physical therapy sessions patients received up to 12 months post-operatively, total cost of physical therapy and time to initiation of physical therapy. Number of physical therapy sessions and physical therapy utilization at 12 months were summarised by return-to-work status at 12 months. RESULTS: We included 3524 patients (1220 had fusion; 2304 decompression). On average, patients received 22 ± 22 physical therapy sessions to 12 months post-operatively (mean cost=AU$1902, US$1217); 24% were receiving physical therapy at 12 months. Most had 9-24 (31%) or 25-50 sessions (25%); 11% had > 50 sessions, whereas 11% had no physical therapy. Patients who had fusion (compared to decompression) had more physical therapy and incurred higher physical therapy costs. Time post-surgery to initiate physical therapy increased from 2010 to 2017. Patients with > 50 sessions and still having physical therapy by 12 months were least likely to be working. CONCLUSIONS: For most patients, physical therapy utilization following lumbar spine surgery aligns with the best available evidence. However, some patients may be receiving too much physical therapy or initiating physical therapy too early.
Assuntos
Fusão Vertebral , Indenização aos Trabalhadores , Austrália , Humanos , Vértebras Lombares/cirurgia , Modalidades de Fisioterapia , Estudos Retrospectivos , Retorno ao Trabalho , Fusão Vertebral/efeitos adversosRESUMO
BACKGROUND: It is unknown whether online information about the benefits and harms of surgery contains an accurate description of evidence. OBJECTIVE: To describe the proportion of webpages containing information about surgery for spinal pain (decompression and fusion) that accurately described the evidence on the benefits of surgery, described harms, and provided quantitative estimates of these harms. METHODS: We performed a content analysis of webpages containing information about spine surgery. Two reviewers identified webpages and extracted data. Primary outcomes were the proportion of webpages that accurately described the evidence on the benefits, described harms, and provided quantitative estimates of these harms. RESULTS: We included 117 webpages. Only 29 (25%) webpages accurately described the evidence on the benefits of spine surgery, and more webpages on decompression accurately described the evidence compared to webpages on fusion (31% vs 15%, difference in proportions = 16%; 95% CI: 2%, 31%). Harms of surgery were described in most webpages (n = 76, 65%), but a much smaller proportion of webpages (n = 18, 15%) provided a quantitative estimate for the mentioned harms. CONCLUSIONS: Most webpages failed to accurately describe the benefits and harms of decompression and fusion surgeries for spinal pain. Unbiased consumer resources and educating the public on how to critically evaluate health claims are important steps to improve knowledge on the benefits and harms of spine surgery.
Assuntos
Informação de Saúde ao Consumidor , Humanos , DorRESUMO
Knowledge of the distribution of total phosphorus (P) content in native soils provides information on the management of ecosystem, land capability for agriculture, environmental quality, and biodiversity conservation. We mapped the spatial distribution of total P concentrations in topsoils (0-30 cm) of uncultivated (native) areas in Brazil. We obtained data on native total P of the southern, south-eastern, and north-eastern regions from reports of exploratory projects developed between 1960s and 1970s by EMBRAPA and by the RADAM Brazil Project. We estimated data from the central-western and northern regions from the relationship between total P and soil properties (Fe, Al, C and clay content), based on the RADAM Brazil Project. Soil total P varied widely ( 500 mg kg1) in all regions in Brazil. Higher concentrations (> 500 mg kg-¹) were observed in southern region compared to most of the rest of the country (< 200 mg kg-¹), while the Cerrado (Central), Amazon (North) and Caatinga (Northeast) biomes are very poor in total P. This first national native soil total P map provides a valuable baseline for understanding the historical patterns of agriculture expansion in Brazil. It allows quantifying the effect of agriculture expansion and future cropping systems on soil available P content and legacy P, targeting regional soil-crop specific strategies for optimization of ecosystem services, and mitigating potential environmental risk due to P transference to water bodies.
Assuntos
Fósforo/análise , Fósforo/química , Solo/química , Agricultura , BiodiversidadeRESUMO
Knowledge of the distribution of total phosphorus (P) content in native soils provides information on the management of ecosystem, land capability for agriculture, environmental quality, and biodiversity conservation. We mapped the spatial distribution of total P concentrations in topsoils (0-30 cm) of uncultivated (native) areas in Brazil. We obtained data on native total P of the southern, south-eastern, and north-eastern regions from reports of exploratory projects developed between 1960s and 1970s by EMBRAPA and by the RADAM Brazil Project. We estimated data from the central-western and northern regions from the relationship between total P and soil properties (Fe, Al, C and clay content), based on the RADAM Brazil Project. Soil total P varied widely (< 25 to > 500 mg kg1) in all regions in Brazil. Higher concentrations (> 500 mg kg-¹) were observed in southern region compared to most of the rest of the country (< 200 mg kg-¹), while the Cerrado (Central), Amazon (North) and Caatinga (Northeast) biomes are very poor in total P. This first national native soil total P map provides a valuable baseline for understanding the historical patterns of agriculture expansion in Brazil. It allows quantifying the effect of agriculture expansion and future cropping systems on soil available P content and legacy P, targeting regional soil-crop specific strategies for optimization of ecosystem services, and mitigating potential environmental risk due to P transference to water bodies.(AU)
Assuntos
Solo/química , Fósforo/análise , Fósforo/química , Agricultura , BiodiversidadeRESUMO
South American (SA) societies are highly vulnerable to droughts and pluvials, but lack of long-term climate observations severely limits our understanding of the global processes driving climatic variability in the region. The number and quality of SA climate-sensitive tree ring chronologies have significantly increased in recent decades, now providing a robust network of 286 records for characterizing hydroclimate variability since 1400 CE. We combine this network with a self-calibrated Palmer Drought Severity Index (scPDSI) dataset to derive the South American Drought Atlas (SADA) over the continent south of 12°S. The gridded annual reconstruction of austral summer scPDSI is the most spatially complete estimate of SA hydroclimate to date, and well matches past historical dry/wet events. Relating the SADA to the Australia-New Zealand Drought Atlas, sea surface temperatures and atmospheric pressure fields, we determine that the El Niño-Southern Oscillation (ENSO) and the Southern Annular Mode (SAM) are strongly associated with spatially extended droughts and pluvials over the SADA domain during the past several centuries. SADA also exhibits more extended severe droughts and extreme pluvials since the mid-20th century. Extensive droughts are consistent with the observed 20th-century trend toward positive SAM anomalies concomitant with the weakening of midlatitude Westerlies, while low-level moisture transport intensified by global warming has favored extreme rainfall across the subtropics. The SADA thus provides a long-term context for observed hydroclimatic changes and for 21st-century Intergovernmental Panel on Climate Change (IPCC) projections that suggest SA will experience more frequent/severe droughts and rainfall events as a consequence of increasing greenhouse gas emissions.