Persons released from prison are at an increased risk of mortality compared to the non-incarcerated population, particularly from drug- and opioid-related overdose. Contributors to overdose mortality ...vary with changing patterns of substance use and updating overdose and mortality statistics may help focus resources for persons released from prison.
In this retrospective cohort study, records for 33,811 people released from Washington State Department of Corrections prisons between 2014 and 2018 were linked to Washington State death records from 2014 to 2019. We calculated post-release mortality rates by cause of death, including overdose and substance-related mortality. Hazard ratios for risk factors for all-cause, non-overdose, and overdose mortality were estimated using Cox proportional hazards regression.
862 deaths were identified among persons released from prison. The all-cause mortality rate was 747 per 100,000 person-years (95 % CI: 699-800), and drug overdose was the leading cause of death (216 per 100,000 person-years; 95 % CI: 190-244). Psychostimulant-related mortality (152 per 100,000 person-years; 95 % CI: 131-177) and opioid-related mortality (138 per 100,000 person-years; 95 % CI: 118-161) were the most prevalent among substance-related causes of death, with the greatest mortality risk occurring within two weeks after release. Older age at most recent release, previous incarceration, and drug-related convictions were significant risk factors for all-cause and overdose mortality within six years after release.
Psychostimulants were the greatest contributors to substance-related mortality for persons released from Washington State prisons. Greater efforts to prevent psychostimulant- and opioid-related overdose are needed.
BACKGROUND:The Functional Comorbidity Index (FCI) was developed for community-based adult populations, with function as the outcome. The original FCI was a survey tool, but several International ...Classification of Diseases (ICD) code lists—for calculating the FCI using administrative data—have been published. However, compatible International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and ICD-10-CM versions have not been available.
OBJECTIVE:We developed ICD-9-CM and ICD-10-CM diagnosis code lists to optimize FCI concordance across ICD lexicons.
RESEARCH DESIGN:We assessed concordance and frequency distributions across ICD lexicons for the FCI and individual comorbidities. We used length of stay and discharge disposition to assess continuity of FCI criterion validity across lexicons.
SUBJECTS:State Inpatient Databases from Arizona, Colorado, Michigan, New Jersey, New York, Utah, and Washington State (calendar year 2015) were obtained from the Healthcare Cost and Utilization Project. State Inpatient Databases contained ICD-9-CM diagnoses for the first 3 calendar quarters of 2015 and ICD-10-CM diagnoses for the fourth quarter of 2015. Inpatients under 18 years old were excluded.
MEASURES:Length of stay and discharge disposition outcomes were assessed in separate regression models. Covariates included age, sex, state, ICD lexicon, and FCI/lexicon interaction.
RESULTS:The FCI demonstrated stability across lexicons, despite small discrepancies in prevalence for individual comorbidities. Under ICD-9-CM, each additional comorbidity was associated with an 8.9% increase in mean length of stay and an 18.5% decrease in the odds of a routine discharge, compared with an 8.4% increase and 17.4% decrease, respectively, under ICD-10-CM.
CONCLUSION:This study provides compatible ICD-9-CM and ICD-10-CM diagnosis code lists for the FCI.
Abstract Introduction Acute work-related trauma is a leading cause of death and disability among U.S. workers. Occupational health services researchers have described the pressing need to identify ...valid injury severity measures for purposes such as case-mix adjustment and the construction of appropriate comparison groups in programme evaluation, intervention, quality improvement, and outcome studies. The objective of this study was to compare the performance of several injury severity scores and scoring methods in the context of predicting work-related disability and medical cost outcomes. Methods Washington State Trauma Registry (WTR) records for injuries treated from 1998 to 2008 were linked with workers’ compensation claims. Several Abbreviated Injury Scale (AIS)-based injury severity measures (ISS, New ISS, maximum AIS) were estimated directly from ICD-9-CM codes using two software packages: (1) ICDMAP-90, and (2) Stata's user-written ICDPIC programme (ICDPIC). ICDMAP-90 and ICDPIC scores were compared with existing WTR scores using the Akaike Information Criterion, amount of variance explained, and estimated effects on outcomes. Competing risks survival analysis was used to evaluate work disability outcomes. Adjusted total medical costs were modelled using linear regression. Results The linked sample contained 6052 work-related injury events. There was substantial agreement between WTR scores and those estimated by ICDMAP-90 (kappa = 0.73), and between WTR scores and those estimated by ICDPIC (kappa = 0.68). Work disability and medical costs increased monotonically with injury severity, and injury severity was a significant predictor of work disability and medical cost outcomes in all models. WTR and ICDMAP-90 scores performed better with regard to predicting outcomes than did ICDPIC scores, but effect estimates were similar. Of the three severity measures, maxAIS was usually weakest, except when predicting total permanent disability. Conclusions Injury severity was significantly associated with work disability and medical cost outcomes for work-related injuries. Injury severity can be estimated using either ICDMAP-90 or ICDPIC when ICD-9-CM codes are available. We observed little practical difference between severity measures or scoring methods. This study demonstrated that using existing software to estimate injury severity may be useful to enhance occupational injury surveillance and research.
Background
Nonstandard employment arrangements are becoming increasingly common and could provide needed flexibility for workers living with disabilities. However, these arrangements may indicate ...precarious employment, that is, employment characterized by instability, powerlessness, and limited worker rights and benefits. Little is known about the role of nonstandard and precarious jobs in the well‐being of disabled persons during workforce reintegration after permanent impairment from work‐related injuries or illnesses.
Methods
We used linked survey and administrative data for a sample of 442 Washington State workers who recently returned to work and received a workers' compensation permanent partial disability award after permanent impairment from a work‐related injury. Multivariable logistic regression models were used to examine associations between nonstandard employment and outcomes related to worker well‐being and sustained employment. We also examined associations between a multidimensional measure of precarious employment and these outcomes. Secondarily, qualitative content analysis methods were used to code worker suggestions on how workplaces could support sustained return to work (RTW).
Results
Workers in: (1) nonstandard jobs (compared with full‐time, permanent jobs), and (2) precarious jobs (compared with less precarious jobs) had higher adjusted odds of low expectations for sustained RTW. Additionally, workers in precarious jobs had higher odds of reporting fair or poor health and unmet need for disability accommodation. Workers in nonstandard and precarious jobs frequently reported wanting safer and adequately staffed workplaces to ensure safety and maintain sustained employment.
Conclusions
Ensuring safe, secure employment for disabled workers could play an important role in their well‐being and sustained RTW.
Cognitive Decline and Older Driver Crash Risk Fraade‐Blanar, Laura A.; Ebel, Beth E.; Larson, Eric B. ...
Journal of the American Geriatrics Society,
June 2018, Letnik:
66, Številka:
6
Journal Article
Recenzirano
Odprti dostop
Objectives
To examine automobile crash risk associated with cognition in older drivers without dementia.
Design
Retrospective secondary analysis of longitudinal cohort study.
Setting
Our study used ...data from the Adult Changes in Thought (ACT) Study merged with Washington State crash reports and licensure records. Data were available from 2002 to 2015.
Participants
Group Health enrollees from Washington State aged 65 and older with active driver's licenses (N=2,615).
Measurements
Cognitive function was assessed using the Cognitive Abilities Screening Instrument scored using item response theory (CASI‐IRT). The study outcome was police‐reported motor vehicle crash. We used a negative binomial mixed‐effects model with robust standard errors clustered on the individual and considered associations between crash risk, level of cognition, and amount of decline since the previous study visit. Covariates included age, sex, education, alcohol, depression, medical comorbidities, eyesight, hearing, and physical function. Individuals were censored at dementia diagnosis, death, or failure to renew their license.
Results
Over an average of 7 years of follow‐up, 350 (13%) people had at least one crash. A 1‐unit lower CASI‐IRT score was associated with a higher adjusted incidence rate ratio of crash of 1.26 (95% confidence interval=1.08–1.51). Beyond level of cognition, amount of cognitive decline between study visits was not associated with crash risk.
Conclusion
This study suggests that, in older drivers, poorer performance on the CASI‐IRT may be a risk factor for motor vehicle crashes, even in individuals without diagnosed dementia. Further research is needed to understand driving behavior and inform driving decisions for older adults with poor cognitive function.
Background
Registered nurses (RNs) represent the largest segment of the health care workforce and have unique job demands and occupational health considerations. The purpose of this study was to ...describe the incidence, cost, and causes of occupational injuries among RNs in Washington State and to quantify the cumulative cost and burden of each type of injury, relative to all injuries among RNs.
Methods
Annual injury claims data covered under Washington State workers’ compensation (WC) fund were analyzed over a 13-year period (2007–2019). Annual mean incidence and cost of injuries were calculated and stratified by nature, source, and event/exposure. Negative binomial regression models were used to examine trends in injury incidence over time, for injury incidence overall, and by the most common injury classifications.
Results
Between 2007 and 2019, 10,839 WC claims were filed and accepted for Washington State RNs (annual M = 834), totaling more than US$65 million. No significant trend in overall injury incidence was observed (incidence rate ratio IRR: 0.99, 95% confidence interval CI = 0.94, 1.05). The most common injury exposures were bodily reaction and exertion, contact with objects and equipment, falls, and assaults and violent acts.
Discussion
To our knowledge, this is the first broad study of the incidence and costs of occupational injuries among RNs across all workplace settings. We identified high-cost, high-frequency incidence rates of musculoskeletal, sharp, and violence-related occupational injury claims, highlighting intervention targets. Implications for Occupational Health Practice: Policy makers, health systems, and occupational health nurse leaders can use this information to identify priority areas where evidence-based occupational health and prevention programs are most needed.
Background
Gut microbiota likely impact obesity and metabolic diseases. We evaluated the changes in gut microbiota after surgical versus medical weight loss in adults with diabetes and obesity.
...Methods
We performed 16S rRNA amplicon sequencing to identify the gut microbial composition at baseline and at 10% weight loss in adults with diabetes who were randomized to medical weight loss (MWL,
n
= 4), adjustable gastric banding (AGB,
n
= 4), or Roux-en-Y gastric bypass (RYGB,
n
= 4).
Results
All participants were female, 75% reported black race with mean age of 51 years. At similar weight loss amount and glycemic improvement, the RYGB group had the most number of bacterial species (10 increased, 1 decreased) that significantly changed (
p
< 0.05) in relative abundance. Alpha-diversity at follow-up was significantly lower in AGB group compared to MWL and RYGB (observed species for AGB vs. MWL,
p
= 0.0093; AGB vs. RYGB,
p
= 0.0093). The relative abundance of
Faecalibacterium prausnitzii
increased in 3 participants after RYGB, 1 after AGB, and 1 after MWL.
Conclusions
At similar weight loss and glycemic improvement, the greatest alteration in gut microbiota occurred after RYGB with an increase in the potentially beneficial bacterium,
F. prausnitzii
. Gut microbial diversity tended to decrease after AGB and increase after RYGB and MWL. Future studies are needed to determine the impact and durability of gut microbial changes over time and their role in long-term metabolic improvement after bariatric surgery in adults with type 2 diabetes.
Clinical Trial Registration
NCTDK089557—
ClinicalTrials.gov
Healthy work environments are critical to the stability and well-being of the nursing workforce, in addition to promoting optimal patient safety and patient outcomes and ensuring the viability of ...health care organizations.1 The National Academy of Medicine’s Future of Nursing 2020 to 2030 notes the importance of supporting the health and well-being of nurses, stating “…it is essential to address the systems, structures, and policies that create workplace hazards and stresses that lead to burnout, fatigue and poor physical and mental health among the nursing workforce.” 2 For years, unrealistic workloads, risk of infection and workplace violence, insufficient resources, and moral distress/injury have contributed to turnover, burnout, and poor professional quality of life—threatening the viability of nurses in the health care workforce.2 In addition, the ongoing pandemic disaster has intensified nurse exposures to occupational hazards, resulting in increased negative physical/mental health outcomes and a continuing exodus from the profession.3 As emergency clinicians, we are focused on achieving optimal patient outcomes, but who is focused on monitoring and improving our work-related well-being and occupational health outcomes? 4 In 1970, the National Institute for Occupational Safety and Health (NIOSH) was established as part of the US Centers for Disease Control and Prevention to function as a research agency with a mission of generating new knowledge in the field of occupational safety and health and to translate that knowledge to practice. The Emergency Nurses Association’s Healthy Work Environment in the Emergency Care Setting Position Statement recognizes the component of mutual responsibility between the leadership and health care workers in creating a healthy work environment.11 The National Academy of Medicine advocates for a systems approach to support professional well-being and address clinician burnout.13 Unit-based councils are composed of frontline staff, making this a setting where meaningful and impactful dialog can be exchanged to address unique strengths, barriers, and facilitators within a unit to optimize work environments and staff well-being.
The heavy economic burden of work-related injury/illness falls not only on employers and workers’ compensation systems, but increasingly on health care systems, health and disability insurance, ...social safety net programs, and workers and their families. We present a flow diagram illustrating mechanisms responsible for the financial burden of occupational injury/illness borne by social safety net programs and by workers and their families, due to cost-shifting and gaps in workers’ compensation coverage. This flow diagram depicts various pathways leading to coverage gaps that may shift the burden of occupational injury/illness-related health care and disability costs ultimately to workers, particularly the most socioeconomically vulnerable. We describe existing research and important research gaps linked to specific pathways in the flow diagram. This flow diagram was developed to facilitate more detailed and comprehensive research into the financial burden imposed by work-related injury/illness, in order to focus policy efforts where improvement is most needed.
Background
Patient enrollment levels at Veterans Health Administration (VHA) facilities change based on Veteran demand for care, potentially affecting demands on staff. Effects on burnout in the ...primary care workforce associated with increases or decreases in enrollment are unknown.
Objective
Estimate associations between patient enrollment and burnout.
Design
In this serial cross-sectional study, VHA patient enrollment and workforce data from 2014 to 2018 were linked to burnout estimates for 138 VHA facilities. The VHA’s annual All Employee Survey provided burnout estimates.
Participants
A total of 82,421 responses to the 2014–2018 All Employee Surveys by primary care providers (PCPs), including physicians, nurse practitioners, and physician assistants; nurses; clinical associates; and administrative clerks were included. Respondents identified as patient-aligned care team members.
Main Measures
Independent variables were (1) the ratio of enrollment to PCPs at VHA facilities and (2) the year-over-year change in enrollment per PCP. Burnout was measured as the annual proportion of staff at VHA facilities who reported emotional exhaustion and/or depersonalization. Each primary care role was analyzed independently.
Key Results
Overall enrollment decreased from 1553 enrollees per PCP in 2014 to 1442 enrollees per PCP in 2018 across VHA facilities. Forty-three facilities experienced increased enrollment (mean of 1524 enrollees/PCP in 2014 to 1668 in 2018) and 95 facilities experienced decreased enrollment (mean of 1566 enrollees/PCP in 2014 to 1339 in 2018). Burnout decreased for all primary care roles. PCP burnout was highest, decreasing from a facility-level mean of 51.7% in 2014 to 43.8% in 2018. Enrollment was not significantly associated with burnout for any role except nurses, for whom a 1% year-over-year increase in enrollment was associated with a 0.2 percentage point increase in burnout (95% CI: 0.1 to 0.3).
Conclusions
Studies assessing changes in organizational-level predictors are rare in burnout research. Patient enrollment predicted burnout only among nurses in primary care.
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