A review of functional status measures for workers with upper extremity disorders.

In order to identify functional status measures for epidemiological studies among workers with mild to moderate disorders of the neck and upper extremity, a literature search was conducted for the years 1966 to 2001. Inclusion criteria were: (1) relevance to neck and upper extremity; (2) assessment among workers; and (3) relevance to mild to moderate disorders. Of 13 instruments reviewed, six measures were tested among workers. The three best measures, depending on the purpose of research, included the standardised Nordic Musculoskeletal Questionnaire, the Upper Extremity Questionnaire, and the Neck and Upper Limb Instrument. Development of a functional protocol is regarded as a realistic enhancement for research of neck and upper extremity disorders in the workplace. For research and clinical practice, measures of functional status, sensitive enough to measure the subtle conditions in mild to moderate disorders, may provide prognostic information about the risk of developing musculoskeletal disorders in apparently healthy patients. Appropriate use of functional status questionnaires is imperative for a meaningful portrayal of health.

Disability management, employee health and fringe benefits, and long-term-disability claims for mental disorders: an empirical exploration.

Mental disorders account for a large share of claims and benefit costs in both private and public long-term-disability (LTD) insurance programs. This is the first empirical study to explore factors that may explain variations in private-sector LTD claims incidence and cost across groups of employees. Employee fringe-benefit arrangements, including patterns of coverage for mental health treatment, are found to be important predictors of incidence rates. Award rates for public disability insurance coverage (SSDI) are also strongly related to claims incidence, suggesting that private LTD is an important pathway to SSDI benefits. Some employee disability-management strategies, such as front-line manager involvement and provision of alternative jobs for employees returning from disability leave, are predictive of lower claims rates and/or costs.

Mental health benefit limits and cost sharing under managed care: a national survey of employers.

Mental health services experts suggest that managed care diminishes the need for arbitrary benefit limits and consumer cost-sharing. Data from 577 health plans were used to test the hypotheses that health maintenance organizations (HMOs) and carve-out plans are less likely to use benefit limits or service exclusions, have more generous limits, and have lower cost-sharing requirements than non-HMOs and non-carve-out plans. The results show that HMOs were more likely to use service exclusions and did not make less use of benefit limits. Carve-outs were less likely to use some coverage exclusions. Comparisons of the stringency of limits and cost-sharing provisions did not show consistent differences.

Effects of supplemental coverage on use of services by Medicare enrollees.

This article estimates the extent to which private insurance supplements affect use of services by Medicare enrollees. Three types of supplements to Medicare's coverage are examined--Health Maintenance Organizations (HMOs), medigap (MGP) plans, and employment-based indemnity (EBI) plans. While each kind of supplement reduces cost sharing on Medicare-covered services, only HMOs do so without increasing enrollees' overall use of services. Use of services by HMO enrollees is about 4 percent lower than use by similar Medicare enrollees with no insurance supplement. By contrast, use of services by enrollees with MGP coverage is 28 percent higher, and use of services by enrollees with EBI plans is 17 percent higher.

Effects of supplemental coverage on use of services by Medicare enrollees.

This article estimates the extent to which private insurance supplements affect use of services by Medicare enrollees. Three types of supplements to Medicare's coverage are examined--Health Maintenance Organizations (HMOs), medigap (MGP) plans, and employment-based indemnity (EBI) plans. While each kind of supplement reduces cost sharing on Medicare-covered services, only HMOs do so without increasing enrollees' overall use of services. Use of services by HMO enrollees is about 4 percent lower than use by similar Medicare enrollees with no insurance supplement. By contrast, use of services by enrollees with MGP coverage is 28 percent higher, and use of services by enrollees with EBI plans is 17 percent higher.

Aluminum effects on growth of brain microvessel endothelial cells in primary culture.

Aluminum salts have been shown to stimulate 3H-thymidine incorporation in primary cultures of bovine brain microvessel endothelial cells (BMECs). Aluminum chloride or sulfate salts in concentrations between 0.01 to 100 microM were, in general, most effective in stimulation of thymidine uptake by BMECs with maximal effects observed after a 24 hour exposure to the metal. Concentrations of aluminum salts greater than 100 microM inhibited thymidine incorporation. Cell numbers were not affected by exposure to concentrations of the aluminum salts less than approximately 100 microM. Concentrations producing half-maximal stimulation of BMEC thymidine incorporation were approximately, 0.3 microM and 0.5 microM, for aluminum chloride and aluminum sulfate, respectively. These findings indicate that BMECs are sensitive to lower concentrations of aluminum salts than other mammalian cell types. Hydroxyurea completely inhibited thymidine incorporation into BMECs in the presence and absence of aluminum suggesting that thymidine incorporation into BMECs is representative of DNA synthesis. Endothelial cell growth factor (ECGF) stimulated both increased DNA synthesis and BMEC cell numbers in the primary culture system. Aluminum had only slight effects on DNA synthesis in endothelial cell growth factor stimulated BMECs. In contrast to ECGF, aluminum then, appears to provide a stimulus for DNA synthesis but not subsequent mitosis in BMECs. Results from this study are consistent with previous studies in other cell types and with current knowledge of the effects of aluminum on the blood-brain barrier in vivo.