Health status,work limitations,and return-to-work trajectories in injured workers with musculoskeletal disorders

BACKGROUND: The purpose of this study was to describe the health status and work limitations in injured workers with musculoskeletal disorders at 1 month post-injury, stratified by return-to-work status, and to document their return-to-work trajectories 6 months post-injury. METHODS: A sample of 632 workers with a back or upper extremity musculoskeletal disorder, who filed a Workplace Safety and Insurance Board lost-time claim injury, participated in this prospective study. Participants were assessed at baseline (1 month post-injury) and at 6 months follow-up. RESULTS: One month post-injury, poor physical health, high levels of depressive symptoms and high work limitations are prevalent in workers, including in those with a sustained first return to work. Workers with a sustained first return to work report a better health status and fewer work limitations than those who experienced a recurrence of work absence or who never returned to work. Six months post-injury, the rate of recurrence of work absence in the trajectories of injured workers who have made at least one return to work attempt is high (38%), including the rate for workers with an initial sustained first return to work (27%). CONCLUSIONS: There are return-to-work status specific health outcomes in injured workers. A sustained first return to work is not equivalent to a complete recovery from musculoskeletal disorders.     

Disease Management and the Medical Home Model

For the past decade, US physicians have failed to embrace disease management (DM) approaches offered by private DM companies and health plans. Until recently, physicians have not offered an alternative, systematic approach to caring for patients with chronic illnesses and conditions.The medical home model has become the centerpiece of reforms proposed by associations that represent family medicine physicians (the American Academy of Family Physicians [AAFP]) and general internal medicine physicians (the American College of Physicians [ACP]). In February 2007, the AAFP and the ACP were joined by the American Academy of Pediatrics and the American Osteopathic Association in issuing joint principles for the patient-centered medical home. While the medical home model is promoted primarily as a comprehensive approach to primary care reform, there is one aspect where the medical home and DM overlap: care coordination.Medicare has been exploring alternative mechanisms to manage and reimburse chronic care and care-coordination activities. In 2003, the US Congress passed legislation to require pilot projects for chronic care improvement programs; the program implementing this legislation is Medicare Health Support (MHS). To date, very little information has been available about the progress of MHS projects. The three early announcements about MHS progress have not been encouraging: the expected financial results are not being achieved.In December 2006, Congress passed legislation authorizing the Medicare Medical Home Demonstration (MMHD) project. MHS and MMHD are directed at similar patient populations: high-cost, frail, elderly patients with multiple co-morbid conditions. The medical home concept being advanced by primary care physicians has the potential to be competitive with DM companies. Health plans that have built their own DM programs are more likely to be supportive of the medical home model. Do physicians have the ability to compete at providing care-coordination services? There are strong arguments suggesting ‘no’ and strong arguments suggesting ‘yes’.While the medical home model is focused on primary care reform, its effect could be competitive to DM companies and others. The medical home model could affect the flow of hundreds of billions of dollars — money that over time might flow either to physicians or to private companies.     

Effects of a community-based healthy heart program on increasing healthy women's physical activity: a randomized controlled trial guided by Community-based Participatory Research (CBPR)

Background  

Cardiovascular disease remains the leading killer of women in most developed areas of the world. Rates of physical inactivity and poor nutrition, which are two of the most important modifiable risk factors for cardiovascular disease in women, are substantial. This study sought to examine the effectiveness of a community-based lifestyle-modification program on increasing women's physical activity in a randomized trial guided by community-based participatory research (CBPR) methods.     

Income-related health inequality in Belgium: a longitudinal perspective

This paper provides new evidence on the degree of income-related inequality in self-assessed health in Belgium. First of all, we combine the time dimension, which has been shown to be very important in the analysis of inequality, and the use of the recently developed interval regression approach to transform a categorical health variable in a continuous one. Second, we measure how the long-run inequality differs from the short-run inequality. Finally, we decompose this health-related income mobility index as well as the long-run concentration index (CI) itself into its contributors. Using data from the panel survey of Belgian households (1994–2002), we find that health is pro-rich distributed and that its inequality is underestimated by 9.45% when neglecting the dynamics of individuals over time. Income, education, job status and age are the most important contributors in the CI and the difference between the short-run and long-run inequality.      

Effect of 5-Aminoisoquinolinone on the Adhesion of Colon Carcinoma

Objective： 5-Aminoisoquinolinone, a water-soluble, potent inhibitor of the activity of poly （adenosine 5＇-diphosphate ribose） polymerase, plays an important role in the tissue injury associated with ischaemia-reperfusion injury and inflammation by inhibiting the activity of poly （adenosine 5＇-diphosphate ribose） polymerase and the expression of cell adhesion molecules such as ICAM-1, P-selectin et al. But how about it in the tumor is not clear. The aim of the present study was to study the effects of 5-Aminoisoquinolinon on the adhesion of colon carcinoma line HT-29 cells to human umbilical vein endothelial cells; and the effects of 5-Aminoisoquinolinon on the expression of ICAM-1, P-selectin and the activity of poly （adenosine 5＇-diphosphate ribose） polymerase in colon carcinoma HT-29 cells. Methods： The adhesion of HT-29 cells to human umbilical vein endothelial cells was detected by adhesive experiment. Immunocytochemically Streptavidin-Peroxidase method was used to investigate the expression of ICAM-1, P-selectin and Poly （adenosine 5＇-diphosphate ribose）（ the product of poly （adenosine 5＇-diphosphate ribose） polymerase activation）. Results： the results of the adhesion assay of HT-29 cells to HUVEC showed that the OD570 value in each 5-AIQ-treated group was significant lower than that in the control group （5-AIQ-untreated） in a dose-dependent manner. The expression of ICAM-1, P-selectin and Poly （adenosine 5＇-diphosphate ribose） was significant lower in 5-Aminoisoquinolinone-treated HT-29 cell group than that in 5-Aminoisoquinolinoneuntreated groups. Conclusion： The data suggest that 5-Aminoisoquinolinone can inhibit the adhesion of HT-29 cells to human umbilical vein endothelial cells. 5-Aminoisoquinolinone also can inhibit poly （adenosine 5＇-diphosphate ribose） polymerase activation and the expressions of ICAM-1 and P-selectin in HT-29 cells. 5-Aminoisoquinolinone probably contributes to the prevention of tumor cell metastasis. Further study is needed.     

Plasma lyso-phosphatidylcholine concentration is decreased in cancer patients with weight loss and activated inflammatory status

Background  

It has been observed that ras-transformed cell lines in culture have a higher phosphatidylcholine (PC) biosynthesis rate as well as higher PC-degradation rate (increased PC-turnover) than normal cells. In correspondence to these findings, the concentrations of the PC-degradation product lyso-phosphatidylcholine (LPC) in cancer patients were found to be decreased. Our objective was the systematic investigation of the relationship between LPC and inflammatory and nutritional parameters in cancer patients. Therefore, plasma LPC concentrations were assessed in 59 cancer patients and related to nutritional and inflammatory parameters. To determine LPC in blood plasma we developed and validated a HPTLC method.     

Comparing health system performance assessment and management approaches in the Netherlands and Ontario,Canada

Background  

Given the proliferation and the growing complexity of performance measurement initiatives in many health systems, the Netherlands and Ontario, Canada expressed interests in cross-national comparisons in an effort to promote knowledge transfer and best practise. To support this cross-national learning, a study was undertaken to compare health system performance approaches in The Netherlands with Ontario, Canada.