Impact of Timing of Mental Health Interventions for Mild Traumatic Brain Injury Patients: A 10-year Matched Cohort Study of Workers' Compensation Claims.

OBJECTIVE: To examine the impact of timing of mental health interventions in workers' compensation claims for mild traumatic brain injury (MTBI). METHODS: A 10-year matched retrospective cohort study of MTBI claims. Cases who started treatment within 3 months of the date of injury were hard matched to cases who started treatment more than 3 months after the date of injury. Outcomes were incremental cost difference and loss of earnings benefit duration 1 year after first intervention. RESULTS: Seventeen percent (17%) of patients received mental health interventions. The early mental health intervention group had lower mean costs (incremental difference$1580 [95% CI: $5718 to $2085]) and shorter durations of disability (off loss of earnings) (59.2% versus 46.6%, NS). Sensitivity and stratified analyses demonstrated the same trend. CONCLUSIONS: Early mental health interventions for MTBI patients may lead to reduced health care costs and shorter durations of disability.

Pre-Post Evaluation of an Integrated Return to Work Planning Program in Workers' Compensation Assessment Clinics.

OBJECTIVE: The aim of this study was to assess the impact of a new workers' compensation medical assessment model on loss of earnings (LOE) benefits duration. METHODS: A medical assessment model was introduced incorporating return to work planning and inclusion of the worker's treating physician. Impact of the program on LOE benefit duration was assessed using a quasi-experimental pre-post study design. Cox PH multivariable regression was adjusted for age, gender, injury severity, time to referral, and industry. RESULTS: The study population comprised 3146 workers: 1794 assessed pre-intervention and 1574 assessed after introduction of the new model. There was a significant reduction in LOE benefit duration for workers assessed in the new model (hazard ratio 1.33, 95% confidence interval 1.23-1.43). CONCLUSIONS: The probability of being off LOE benefits for workers assessed in the new program was 33% greater than for workers assessed in the prior program.

Baseline repeated measures from controlled human exposure studies: associations between ambient air pollution exposure and the systemic inflammatory biomarkers IL-6 and fibrinogen.

INTRODUCTION: Systemic inflammation may be one of the mechanisms mediating the association between ambient air pollution and cardiovascular morbidity and mortality. Interleukin-6 (IL-6) and fibrinogen are biomarkers of systemic inflammation that are independent risk factors for cardio-vascular disease. OBJECTIVE: We investigated the association between ambient air pollution and systemic inflammation using baseline measurements of IL-6 and fibrinogen from controlled human exposure studies. METHODS: In this retrospective analysis we used repeated-measures data in 45 nonsmoking subjects. Hourly and daily moving averages were calculated for ozone, nitrogen dioxide, sulfur dioxide, and particulate matter