Does recall period matter? Comparing PROMIS® physical function with no recall, 24-hr recall, and 7-day recall.

PURPOSE: To evaluate the influence of recall periods on the assessment of physical function, we compared, in cancer and general population samples, the standard administration of PROMIS Physical Function items without a recall period to administrations with 24-hour and 7-day recall periods. METHODS: We administered 31 items from the PROMIS Physical Function v2.0 item bank to 2400 respondents (n = 1001 with cancer; n = 1399 from the general population). Respondents were randomly assigned to one of three recall conditions (no recall, 24-hours, or 7-days) and one of two "reminder" conditions (with recall periods presented only at the start of the survey or with every item). We assessed items for potential differential item functioning (DIF) by recall time period. We then tested recall and reminder effects with analysis of variance controlling for demographics, English fluency, and co-morbidities. RESULTS: Based on conservative pre-set criteria, no items were flagged for recall time period-related DIF. Using analysis of variance, each condition was compared to the standard PROMIS administration for Physical Function (no recall period). There was no evidence of significant differences among groups in the cancer sample. In the general population sample, only the 24-hour recall condition with reminders was significantly different from the "no recall" PROMIS standard. At the item level, for both samples, the number of items with non-trivial effect size differences across conditions was minimal. CONCLUSIONS: Compared to no recall, the use of a recall period has little to no effect upon PROMIS physical function responses or scores. We recommend that PROMIS Physical Function be administered with the standard PROMIS "no recall" period.

Quality of life and disability in patients with treatment-failure gout.

OBJECTIVE: The relationship between self-reported quality of life and disability and disease severity was evaluated in subjects with treatment-failure gout (n = 110) in a prospective, 52-week, observational study. METHODS: Subjects had symptomatic crystal-proven gout of at least 2 years' duration and intolerance or refractoriness to conventional urate-lowering therapy. Serum uric acid (sUA) concentration, swollen and tender joint counts, frequency and severity of gout flares, tophus assessments, comorbidities, and patient-reported outcomes data [Medical Outcomes Study Short Form-36 (SF-36), Health Assessment Questionnaire-Damage Index] were collected. Analyses included correlations of patient-reported outcomes with clinical variables and changes in clinical status. RESULTS: Mean age of study subjects was 59 years. Mean scores on SF-36 physical functioning subscales were 34.2-46.8, analogous to persons aged >or= 75 years in the general population. Subjects with more severe gout at baseline had worse health-related quality of life (HRQOL) in all areas (p < 0.02 for all measures), compared to patients with mild-moderate disease. Number of flares reported in past year, number of tender joints, swollen joints, and tophi correlated significantly with some or all HRQOL and disability measures. sUA was not significantly correlated with any HRQOL or disability measure. Subjects with comorbidities experienced worse physical, but not mental, functioning. CONCLUSION: Severe gout is associated with poor HRQOL and disability, especially for patients who experience more gout flares and have a greater number of involved joints. Subject perceptions of gout-related functioning and pain severity appear to be highly sensitive indicators of HRQOL and disability.

Factors associated with retirement-related job lock in older workers with recent occupational injury.

PURPOSES: Job lock (inability to leave a job due to financial or benefits needs) has been found to significantly restrict job mobility. However, it has not been studied in terms of inability to retire. This study evaluated the relationship between health, work environment, and retirement-related job lock in workers > or =55 with recent occupational injuries. METHODS: Workers completed a mailed, self-report survey about their pre- and post-injury health and functioning, work environment, and retirement plans. Bivariate and multivariate analyses determined those factors associated with retirement-related job lock. RESULTS: Over half of the respondents wanted to retire but could not because they needed job-related income or benefits. Factors associated with retirement-related job lock were indicative of poorer health and mental function and dissatisfaction with the workplace social environment. No injury-related factors were significant. CONCLUSIONS: Retirement-related job lock was common in older workers with occupational injuries, and appears to be primarily due to difficulties at work, combined with health conditions that may impair work abilities. Workers wishing to retire but unable to do so may be at risk for work-related injuries, as well as decrements in work function and premature retirement resulting in insufficient income and health benefits.

A historical look at alcohol abuse trends in army and civilian populations, 1980-1995.

OBJECTIVES: The purpose of this study was to compare civilian and Army alcohol-related hospitalization trends and to plot temporal changes in rates relative to alcohol-related legislation and social policies. METHOD: We compared population-based civilian and Army annual hospitalization rates for overall alcohol-related diagnoses and for alcohol-related diagnostic subgroups (1980-1995) and plotted them against civilian and military substance abuse regulations. Civilian data were adjusted to Army age, gender, and race. RESULTS: Although overall civilian and Army alcohol hospitalization rates were similar, alcohol subgroup rates varied. Simultaneous drug and alcohol abuse (polyabuse) rates were higher among civilians (16.6 per 10,000) than Army soldiers (5.1 per 10,000). Army rates for dependent alcohol-related disorders were higher and increased. Army nondependent alcohol disorders tracked with alcohol-related regulations as rates fell 69% between 1985 and 1995. CONCLUSION: Army and civilian alcohol abuse trends vary by abuse type. Without longitudinal, diagnosis-specific subgroup analyses, these trends would not have emerged. Army policies and screening may explain divergent nondependent alcohol abuse and lower polyabuse rates.

Factors affecting the organizational responses of employers to workers with injuries.

The organizational responses of employers to work-related injuries is one of several significant influences on return-to-work outcomes. Thus, understanding the factors that lead to better or worse organizational responses to work injuries may ultimately help to improve success in this area. The purpose of this study was to systematically explore factors that might influence the organizational responses of employers to injured workers, based on employee perceptions. Cross-sectional survey data were collected from 2,943 subjects with work-related injuries which had occurred less than eight weeks prior to survey completion. Measured variables included pre-injury demographic and job factors, injury circumstances, and a measure of post-injury events that comprised the organizational response. Multivariate linear regression results show that age, gender, job dissatisfaction before injury, prior difficulty performing job tasks, injury severity, back injury and lost time were all associated with negative organizational responses, suggesting potential opportunities for intervention.

Early retirement due to occupational injury: who is at risk?

BACKGROUND: As the workforce is rapidly ageing, research on the consequences of occupational injuries in older workers is becoming more important. One adverse outcome unique to older workers, early retirement, has significant negative social and economic consequences for workers and employers. Although linked to poor worker health, the roles of workplace factors and occupational injury have not been well-defined. METHOD: Changes in retirement plans attributed to an occupational injury were studied in a population-based sample of 1,449 New Hampshire workers aged

The use of sentinel injury deaths to evaluate the quality of multiple source reporting for occupational injuries.

PURPOSE: This study sought to develop an efficient method for evaluating the validity and completeness of routinely available sources of occupational injury fatality data. METHODS: Deaths due to falls from elevations, machinery, and electrocutions were selected as sentinel injuries likely to have occurred at work. Deaths from these injuries were identified from Maryland vital statistics over 7 years. The work-relatedness of these injuries and sensitivity of reporting were determined from death certificates, medical examiner reports, the National Traumatic Occupational Fatality System (NTOF), the Maryland Occupational Safety and Health Administration (MOSH), and Workers' Compensation (WC) data. RESULTS: A total of 527 deaths were identified for ages 16 and above, of which, 45% were work-related. Identification of work-related deaths varied by source: medical examiner (100%), death certificates (89%), NTOF (68%), MOSH (59%), and WC (44%). Reporting differed by age, cause of injury, year, occupation, and industry. CONCLUSIONS: Examination of work-relatedness for deaths from certain causes is an efficient means of evaluating the quality of occupational injury reporting source data. These sentinel injuries uncovered significant underreporting in sources used by national surveillance systems, resulted in improved NTOF reporting, and suggest the need to make more use of medical examiner data when available.

Outcomes in work-related injuries: a comparison of older and younger workers.

BACKGROUND: The "graying of the workforce" has generated concerns about the physical capacity of older workers to maintain their health and productivity on the job, especially after an injury occurs. There is little detailed research on age-related differences in work outcomes after an occupational injury. METHODS: A self-report survey about occupational, health, and financial outcomes, and related factors was administered 2-8 weeks post-injury to workers aged < 55 and > or = 55 who had lost time due to a work injury. RESULTS: Despite more severe injuries in older workers, most outcomes were similar in both age groups. In multivariate models, age was unrelated or inversely related to poor outcomes. Injury severity, physical functioning, and problems upon return to work were associated with adverse work injury outcomes. CONCLUSIONS: Older workers appear to fare better than younger workers after a work injury; their relative advantage may be primarily due to longer workplace attachment and the healthy worker effect.