Search

Background: Northern Ontario, Canada has a larger elder population, more resource-based employment, and limited access to physicians and specialists compared to southern Ontario. Given these important differences, it is possible that work disability rates will vary between the two Ontario jurisdictions. Objective: To determine the association between time lost due to workplace injuries and illnesses occurring in northern vs southern Ontario and work disability duration from 2006-2011. Methods: The study base included all lost-time claims approved by the Workplace Safety and Insurance Board in Ontario, Canada for workplace injury or illness compensation occurring between January 1, 2006 and December 31, 2011. All eligible participants had to be 18 years of age or older at the time of making the claim and participants were excluded if one of the three variables used to determine location (claimant home postal code, workplace geographical code, and WSIB firm location) were missing. Multivariable proportional hazards regression models were used to estimate hazard ratios and 95% confidence intervals adjusted for sex, age, occupation, part of body, and nature of injury relating Ontario geographical location to compensated time off work. Results: A total of 156 453 lost-time claims were approved over the study period. Injured and ill workers from northern Ontario were 16% less likely to return to work than those from southern Ontario. Adjustment for potential confounding factors had no effect. Conclusion: The disability duration in northern Ontario is longer than that in southern Ontario. Future research should focus on assessing the relevant factors associated with this observation to identify opportunities for intervention. [ABSTRACT FROM AUTHOR]

Abstract Background Mild traumatic brain injury (MTBI) is a major public-health concern and represents 70-90% of all treated traumatic brain injuries. The last best-evidence synthesis, conducted by the WHO Collaborating Centre for Neurotrauma, Prevention, Management and Rehabilitation in 2002, found few quality studies on prognosis. The objective of this review is to update these findings. Specifically, we aim to describe the course, identify modifiable prognostic factors, determine long-term sequelae, and identify effects of interventions for MTBI. Finally, we will identify gaps in the literature, and make recommendations for future research. Methods The databases MEDLINE, PsychINFO, Embase, CINAHL and SPORTDiscus were systematically searched (2001 to date). The search terms included 'traumatic brain injury', 'craniocerebral trauma', 'prognosis', and 'recovery of function'. Reference lists of eligible papers were also searched. Studies were screened according to pre-defined inclusion and exclusion criteria. Inclusion criteria included original, published peer-reviewed research reports in English, French, Swedish, Norwegian, Danish and Spanish, and human participants of all ages with an accepted definition of MTBI. Exclusion criteria included publication types other than systematic reviews, meta-analyses, randomized controlled trials, cohort studies, and case-control studies; as well as cadaveric, biomechanical, and laboratory studies. All eligible papers were critically appraised using a modification of the Scottish Intercollegiate Guidelines Network (SIGN) criteria. Two reviewers performed independent, in-depth reviews of each eligible study, and a third reviewer was consulted for disagreements. Data from accepted papers were extracted into evidence tables, and the evidence was synthesized according to the modified SIGN criteria. Conclusion The results of this study form the basis for a better understanding of recovery after MTBI, and will allow development of prediction tools and recommendation of interventions, as well as informing health policy and setting a future research agenda.

Purpose: Labour market integration is a widely accepted strategy for promoting the social and economic inclusion of persons with disabilities. But what kinds of jobs do persons with disabilities obtain following their integration into the labour market? In this study, we use a novel survey of workers to describe and compare the employment quality of persons with and without disabilities in Canada., Methods: We administered an online, cross-sectional survey to a heterogeneous sample of workers in Canada (n = 2,794). We collected data on sixteen different employment conditions (e.g., temporary contract, job security, flexible work schedule, job lock, skill match, training opportunities, and union membership). We used latent class cluster analysis to construct a novel typology of employment quality describing four distinct 'types' of employment: standard, portfolio, instrumental, and precarious. We examined associations between disability status, disability type, and employment quality., Results: Persons with disabilities reported consistently lower employment quality than their counterparts without disabilities. Persons with disabilities were nearly twice as likely to report low-quality employment in the form of either instrumental (i.e., secure but trapped) or precarious (i.e., insecure and unrewarding) employment. This gap in employment quality was particularly pronounced for those who reported living with both a physical and mental/cognitive condition., Conclusion: There are widespread inequalities in the employment quality of persons with and without disabilities in Canada. Policies and programs aiming to improve the labour market situation of persons with disabilities should emphasize the importance of high-quality employment as a key facet of social and economic inclusion., (© 2023. The Author(s).)

Men with HIV have highlighted the importance of understanding their fertility desires. However, most research has focused on women. We aimed (1) to develop a survey instrument to assess fertility desires and intentions among HIV-positive men and (2) to assess its face, content, and construct validity, as well as test-retest reliability and internal consistency. Principal component analysis was used for construct validity analysis in a sample of 60 men with HIV. The test-retest reliability and internal consistency were assessed using Spearman correlation and Cronbach α, respectively. The initial and the final version of the questionnaire consisted of 10 domains and 14 constructs. We found a one-component model for the 3 constructs analyzed and Cronbach α values were ≥.70. Test-retest statistic was stable with Spearman correlation >0.70. In conclusion, a reliable and valid questionnaire was developed for determining the fertility desires and intentions of men with HIV.

Purpose To explore supervisors' perspectives and decision-making processes in the accommodation of back injured workers. Methods Twenty-three semi-structured, in-depth interviews were conducted with supervisors from eleven Canadian organizations about their role in providing job accommodations. Supervisors were identified through an on-line survey and interviews were recorded, transcribed and entered into NVivo software. The initial analyses identified common units of meaning, which were used to develop a coding guide. Interviews were coded, and a model of supervisor decision-making was developed based on the themes, categories and connecting ideas identified in the data. Results The decision-making model includes a process element that is described as iterative "trial and error" decision-making. Medical restrictions are compared to job demands, employee abilities and available alternatives. A feasible modification is identified through brainstorming and then implemented by the supervisor. Resources used for brainstorming include information, supervisor experience and autonomy, and organizational supports. The model also incorporates the experience of accommodation as a job demand that causes strain for the supervisor. Accommodation demands affect the supervisor's attitude, brainstorming and monitoring effort, and communication with returning employees. Resources and demands have a combined effect on accommodation decision complexity, which in turn affects the quality of the accommodation option selected. If the employee is unable to complete the tasks or is reinjured during the accommodation, the decision cycle repeats. More frequent iteration through the trial and error process reduces the likelihood of return to work success. Conclusion A series of propositions is developed to illustrate the relationships among categories in the model. The model and propositions show: (a) the iterative, problem solving nature of the RTW process; (b) decision resources necessary for accommodation planning, and, ((c) the impact accommodation demands may have on supervisors and RTW quality.)

Purpose: To describe the health care utilization of injured workers who made a workers' compensation claim for neck pain., Methods: We conducted a cohort study of injured workers who made an incident claim involving neck pain to the Ontario Workplace Safety and Insurance Board between 1997 and 1998. We linked their workers' compensation and Ontario Health Insurance Plan files to collect all health care services accrued during the year prior to and 2 years after the claim was initiated. We report the 7 day simple moving average of health care services per 1,000 claimants per day. We stratified our analysis by age, sex, the pre-claim level of health care utilization, diagnostic category and health care specialty., Results: 58.1 % of claimants were males and 35.1 % were between the ages of 35 and 44 years. The cumulative rate of health care utilization was stable (mean = 60.80 services/1,000 claimants/day; 95 % CI: 59.7-62.0) throughout the year prior to the claim. However, it peaked during the first 4 days following the onset of the claim (mean = 473.3 services/1,000 claimants/day) and remained on average 311 % higher than baseline during the first month post-claim. On average in our sample, the health care utilization remained 11 % higher in the second year after the claim compared to the pre-claim level. This sustained increase was attributable to 6 % of claimants., Conclusions: We report a long-term increase in the average number of health care services utilized by injured workers who make a workers' compensation claim involving neck pain. This increase was attributable to a minority of claimants. The health reasons for this increase deserve further investigation.

Loss to follow-up is problematic in most cohort studies and often leads to bias. Although guidelines suggest acceptable follow-up rates, the authors are unaware of studies that test the validity of these recommendations. The objective of this study was to determine whether the recommended follow-up thresholds of 60-80% are associated with biased effects in cohort studies. A simulation study was conducted using 1000 computer replications of a cohort of 500 observations. The logistic regression model included a binary exposure and three confounders. Varied correlation structures of the data represented various levels of confounding. Differing levels of loss to follow-up were generated through three mechanisms: missing completely at random (MCAR), missing at random (MAR) and missing not at random (MNAR). The authors found no important bias with levels of loss that varied from 5 to 60% when loss to follow-up was related to MCAR or MAR mechanisms. However, when observations were lost to follow-up based on a MNAR mechanism, the authors found seriously biased estimates of the odds ratios with low levels of loss to follow-up. Loss to follow-up in cohort studies rarely occurs randomly. Therefore, when planning a cohort study, one should assume that loss to follow-up is MNAR and attempt to achieve the maximum follow-up rate possible.