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AIMS: People living with heart disease are at elevated risk of hospitalization during the last years of their life. The aim of this study was to describe hospitalization-related usage patterns, and associated cost burden, for patients living with heart disease in the last 6 years of their life. METHODS AND RESULTS: The study was an observational cohort study, using routinely collected and linked data from hospital admission (HA), emergency department (ED) presentation and death registry data in Queensland, Australia. The study sample included 1000 randomly selected patients who died in 2017 due to any cause who had been living with heart disease for at least the prior 6 years. The two main outcomes of interest in this study were cost of HAs and cost of ED presentation in the last 6 years before death. Total cost was calculated as a sum of direct and overhead costs from each of the hospital presentations. The mean HA per patient in the sixth year, second year, and last year prior to death was 5.3, 6.6, and 7.5, respectively, with a similar pattern observed for ED presentations. The associated costs per patient from HA followed a similar trajectory increasing gradually from $17 711 in the sixth year to $26 658 in the second last year prior to death. A similar pattern was observed for ED presentation costs. CONCLUSION: The large increase cost in the last year of life was primarily attributable to higher treatment cost per HA at end of life.

Aims: This study described emergency department (ED) resource use patterns and associated costs among patients with heart disease in their last 3 years of life in a high-income country. Methods: This study used linked data from ED and death registry databases in Australia. A random sample of 1000 patients who died due to any cause in 2017, and who had been living with heart disease for at least the prior 10-years were included. The outcomes of interest were number of ED presentations over each of the last 3 years prior to death and relative cost contributions of ED-related items. Results: The number of patients needing ED care and number of ED presentations per patient increased as patients were closer to death, with 85% experiencing at least one ED presentation in their last year of life. Mean per patient ED presentation cost increased with each year closer to death. Costs related to labor, pathology, patient travel, and goods and services contributed more than 85% of the total cost in each of the 3 years. Conclusion: The increase in cost burden as patients neared death was attributable to more frequent ED presentations per person rather than more expensive ED presentations. The scope of this study was limited to ED presentations, and may not be representative of heart-disease-related end-of-life care more broadly.

Objective: To identify risk factors for the development of interfering neck pain in office workers including an examination of the interaction effects between potential risk factors. Background: The 1-year incidence of neck pain in office workers is reported as the highest of all occupations. Identifying risk factors for the development of neck pain in office workers is therefore a priority to direct prevention strategies. Methods: Participants included 214 office workers without neck pain from two cultures. A battery of measures evaluating potential individual and workplace risk factors were administered at baseline, and the incidence of interfering neck pain assessed monthly for 12 months. Survival analysis was used to identify relationships between risk factors and the development of interfering neck pain. Results: One-year incidence was 1.93 (95% CI [1.41, 2.64]) per 100 person months. Factors increasing the risk of developing interfering neck pain were older age, female gender, increased sitting hours, higher job strain, and stress. A neutral thorax sitting posture, greater cervical range of motion and muscle endurance, and higher physical activity were associated with a decreased risk of neck pain. The effects of some risk factors on the development of neck pain were moderated by the workers’ coping resources. Conclusion: Multiple risk factors and interactions may explain the development of neck pain in office workers. Therefore, plans for preventing the development of interfering neck pain in office workers should consider multiple individual and work-related factors with some factors being potentially more modifiable than others.

Objective: In this study, the reliability of measures of upper body postural behavior (head, thorax, neck, and arm) during sustained office work was evaluated. Background: Although there has been a substantial body of research examining the technical aspects of posture measurement in office workers using motion sensors, there is a paucity of literature examining whether posture-related behaviors are actually consistent among office workers in the field on different days and times. Method: Thirty one office workers performed their usual work for three, 1-hr sessions (two morning sessions and one afternoon session) while wearing wireless motion sensors. Reliability coefficients of the derived measures of postural behavior were calculated. Results: Most (30/31) of the postural behavior measures demonstrated modest to excellent reliability (ICC 2.1: 0.48–0.84). Reliability appeared to be mildly affected by factors such as the time of day recordings were taken and variations in desk setups. Conclusion: The findings suggest these measures may be a reliable method for evaluating postural behavior in the office work environment in future studies. Application: Postural measurement using a technical motion sensor described an acceptable reliability to be used for risk assessment in the workplace. Consideration of assessment time and desk setting would increase the accuracy of postural measurement.

BACKGROUND: Work-related psychosocial factors such as job strain are thought to contribute to elevated psychological stress in office workers. One factor that may impact the relationship between job strain and psychological distress is the individual's coping resources. OBJECTIVE: The purpose of this study is to examine the interaction effect of coping resources on the relationship between job strain and psychological distress in office workers. METHODS: 220 office workers in Australia and Korea completed the Job Content Questionnaire (to evaluate job strain and social support at work), the Depression, Anxiety, and Stress Scale, (DASS-21, a measure of psychological distress), and the Coping with Job Stress Scale to assess control and escape coping. Hierarchical regression analyses were executed to examine the interaction and moderating effect of coping resources. RESULTS: Job strain had a direct positive relationship with all three domains of psychological distress. The relationship between job strain and depression was positively moderated by escape coping, but negatively moderated by social support. Use of higher levels of escape coping predicted higher levels of depression and anxiety symptoms when higher levels of job strain were perceived. CONCLUSIONS: Findings suggest there may be a direct relationship between job strain and psychological distress in office workers. This relationship, however, may be moderated by the office workers coping resources (coping strategies and social support). It is suggested that the evaluation of coping might be a key consideration in the elements of the assessment of psychological distress in office workers.