Author
Elsbeth Chee
Other affiliations: National Institutes of Health, Eastern Virginia Medical School, AdvancePCS
Bio: Elsbeth Chee is an academic researcher from Johns Hopkins University. The author has contributed to research in topics: Population & Relative risk. The author has an hindex of 24, co-authored 27 publications receiving 6363 citations. Previous affiliations of Elsbeth Chee include National Institutes of Health & Eastern Virginia Medical School.
Topics: Population, Relative risk, Migraine, Body mass index, Overweight
Papers
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TL;DR: Pain is an inordinately common and disabling condition in the US workforce and most of the pain-related lost productive time occurs while employees are at work and is in the form of reduced performance.
Abstract: ContextCommon pain conditions appear to have an adverse effect on work, but
no comprehensive estimates exist on the amount of productive time lost in
the US workforce due to pain.ObjectiveTo measure lost productive time (absence and reduced performance due
to common pain conditions) during a 2-week period.Design and SettingCross-sectional study using survey data from the American Productivity
Audit (a telephone survey that uses the Work and Health Interview) of working
adults between August 1, 2001, and July 30, 2002.ParticipantsRandom sample of 28 902 working adults in the United States.Main Outcome MeasuresLost productive time due to common pain conditions (arthritis, back,
headache, and other musculoskeletal) expressed in hours per worker per week
and calculated in US dollars.ResultsThirteen percent of the total workforce experienced a loss in productive
time during a 2-week period due to a common pain condition. Headache was the
most common (5.4%) pain condition resulting in lost productive time. It was
followed by back pain (3.2%), arthritis pain (2.0%), and other musculoskeletal
pain (2.0%). Workers who experienced lost productive time from a pain condition
lost a mean (SE) of 4.6 (0.09) h/wk. Workers who had a headache had a mean
(SE) loss in productive time of 3.5 (0.1) h/wk. Workers who reported arthritis
or back pain had mean (SE) lost productive times of 5.2 (0.25) h/wk. Other
common pain conditions resulted in a mean (SE) loss in productive time of
5.5 (0.22) h/wk. Lost productive time from common pain conditions among active
workers costs an estimated $61.2 billion per year. The majority (76.6%) of
the lost productive time was explained by reduced performance while at work
and not work absence.ConclusionsPain is an inordinately common and disabling condition in the US workforce.
Most of the pain-related lost productive time occurs while employees are at
work and is in the form of reduced performance.
1,501 citations
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TL;DR: The combined LPT burden among those with depression and the low level of treatment suggests that there may be cost-effective opportunities for improving depression-related outcomes in the US workforce.
Abstract: ContextEvidence consistently indicates that depression has adversely affected
work productivity. Estimates of the cost impact in lost labor time in the
US workforce, however, are scarce and dated.ObjectiveTo estimate the impact of depression on labor costs (ie, work absence
and reduced performance while at work) in the US workforce.Design, Setting, and ParticipantsAll employed individuals who participated in the American Productivity
Audit (conducted August 1, 2001–July 31, 2002) between May 20 and July
11, 2002, were eligible for the Depressive Disorders Study. Those who responded
affirmatively to 2 depression-screening questions (n = 692), as well as a
1:4 stratified random sample of those responding in the negative (n = 435),
were recruited for and completed a supplemental interview using the Primary
Care Evaluation of Mental Disorders Mood Module for depression, the Somatic
Symptom Inventory, and a medical and treatment history for depression. Excess
lost productive time (LPT) costs from depression were derived as the difference
in LPT among individuals with depression minus the expected LPT in the absence
of depression projected to the US workforce.Main Outcome MeasureEstimated LPT and associated labor costs (work absence and reduced performance
while at work) due to depression.ResultsWorkers with depression reported significantly more total health-related
LPT than those without depression (mean, 5.6 h/wk vs an expected 1.5 h/wk,
respectively). Eighty-one percent of the LPT costs are explained by reduced
performance while at work. Major depression accounts for 48% of the LPT among
those with depression, again with a majority of the cost explained by reduced
performance while at work. Self-reported use of antidepressants in the previous
12 months among those with depression was low (<30%) and the mean reported
treatment effectiveness was only moderate. Extrapolation of these survey results
and self-reported annual incomes to the population of US workers suggests
that US workers with depression employed in the previous week cost employers
an estimated $44 billion per year in LPT, an excess of $31 billion per year
compared with peers without depression. This estimate does not include labor
costs associated with short- and long-term disability.ConclusionsA majority of the LPT costs that employers face from employee depression
is invisible and explained by reduced performance while at work. Use of treatments
for depression appears to be relatively low. The combined LPT burden among
those with depression and the low level of treatment suggests that there may
be cost-effective opportunities for improving depression-related outcomes
in the US workforce.
1,332 citations
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TL;DR: Costs of lost productive time (LPT) vary significantly by worker characteristics, suggesting that intervention needs vary by specific subgroups.
Abstract: The American Productivity Audit (APA) is a telephone survey of a random sample of 28,902 U.S. workers designed to quantify the impact of health conditions on work. Lost productive time (LPT) was measured for personal and family health reasons and expressed in hours and dollars. Health-related LPT cost employers 225.8 billion US dollars/year (1685 US dollars/employee per year); 71% is explained by reduced performance at work. Personal health LPT was 30% higher in females and twice as high in smokers (> or =1 pack/day) versus nonsmokers. Workers in high-demand, low-control jobs had the lowest average LPT/week versus the highest LPT for those in low-demand, high-control jobs. Family health-related work absence accounted for 6% of all health-related LPT. Health-related LPT costs are substantial but largely invisible to employers. Costs vary significantly by worker characteristics, suggesting that intervention needs vary by specific subgroups.
425 citations
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TL;DR: Epidemiology of constipation (EPOC) study in the United States: relation of clinical subtypes to sociodemographic features and the role of smoking and alcohol in the development of chronic constipation is studied.
418 citations
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TL;DR: This study lends further support to proposals that claim the basal ganglia is involved in the pathogenesis of TS and also suggests that the comorbid problem of ADHD is related to regional changes that differ from those primarily associated with tics.
Abstract: To define the site of pathology in Tourette's syndrome (TS), we performed a volumetric MRI study of basal ganglia structures and lateral ventricles on 37 children with this disorder and 18 controls. There were no statistically significant differences in the size of the right or left caudate, putamen, globus pallidus, or ventricles in these populations. In contrast, there were significant differences for measures of symmetry in the putamen and the lenticular region. Virtually all controls (17 right- and one left-handed) had a left-sided predominance of the putamen, whereas in 13 of 37 TS subjects, a right predominance exceeded that of any control. Statistical comparisons among TS patients, with (n = 18) or without (n = 19) attention-deficit hyperactivity disorder (ADHD), and controls showed significant differences for the volume of the left globus pallidus and for lenticular asymmetry. Post hoc evaluations showed that in the TS + ADHD group, the volume of the left globus pallidus was significantly smaller than the volume of the right and that lenticular asymmetry was due to a greater right-sided predominance in the TS+ADHD group. This study lends further support to proposals that claim the basal ganglia is involved in the pathogenesis of TS and also suggests that the comorbid problem of ADHD is related to regional changes that differ from those primarily associated with tics.
366 citations
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TL;DR: Novel aspects of the new definition include a patient-centered approach that is independent of endoscopic findings, subclassification of the disease into discrete syndrome, and the recognition of laryngitis, cough, asthma, and dental erosions as possible GERD syndromes.
3,328 citations
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TL;DR: It is revealed that EF deficits are consistently found in both ADHD and autism but not in CD (without ADHD) or in TS, and both the severity and profile of EF deficits appears to differ across ADHD and Autism.
Abstract: In this paper, we consider the domain of executive functions (EFs) and their possible role in developmental psychopathologies. We first consider general theoretical and measurement issues involved in studying EFs and then review studies of EFs in four developmental psychopathologies: attention deficit hyperactivity disorder (ADHD), conduct disorder (CD), autism, and Tourette syndrome (TS). Our review reveals that EF deficits are consistently found in both ADHD and autism but not in CD (without ADHD) or in TS. Moreover, both the severity and profile of EF deficits appears to differ across ADHD and autism. Molar EF deficits are more severe in the latter than the former. In the few studies of more specific EF tasks, there are impairments in motor inhibition in ADHD but not in autism, whereas there are impairments in verbal working memory in autism but not ADHD. We close with a discussion of implications for future research.
3,108 citations
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TL;DR: The PHQ-8 is a useful depression measure for population-based studies, and either its diagnostic algorithm or a cutpoint > or = 10 can be used for defining current depression.
3,036 citations
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TL;DR: Substance use disorders and mood and anxiety disorders that develop independently of intoxication and withdrawal are among the most prevalent psychiatric disorders in the United States, suggesting that treatment for a comorbid mood or anxiety disorder should be withheld from individuals with substance use disorders.
Abstract: Background Uncertainties exist about the prevalence and comorbidity of substance use disorders and independent mood and anxiety disorders. Objective To present nationally representative data on the prevalence and comorbidity of DSM-IV alcohol and drug use disorders and independent mood and anxiety disorders (including only those that are not substance induced and that are not due to a general medical condition). Design Face-to-face survey. Setting The United States. Participants Household and group quarters' residents. Main Outcome Measures Prevalence and associations of substance use disorders and independent mood and anxiety disorders. Results The prevalences of 12-month DSM-IV independent mood and anxiety disorders in the US population were 9.21% (95% confidence interval [CI], 8.78%-9.64%) and 11.08% (95% CI, 10.43%-11.73%), respectively. The rate of substance use disorders was 9.35% (95% CI, 8.86%-9.84%). Only a few individuals with mood or anxiety disorders were classified as having only substance-induced disorders. Associations between most substance use disorders and independent mood and anxiety disorders were positive and significant ( P Conclusions Substance use disorders and mood and anxiety disorders that develop independently of intoxication and withdrawal are among the most prevalent psychiatric disorders in the United States. Associations between most substance use disorders and independent mood and anxiety disorders were overwhelmingly positive and significant, suggesting that treatment for a comorbid mood or anxiety disorder should not be withheld from individuals with substance use disorders.
2,617 citations
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Oregon Health & Science University1, Dartmouth College2, University of Utah3, Harvard University4, Seattle Cancer Care Alliance5, Kaiser Permanente6, University of Miami7, Memorial Sloan Kettering Cancer Center8, Albany College of Pharmacy and Health Sciences9, University of Wisconsin-Madison10, California Health and Human Services Agency11, Yale University12, Yeshiva University13, University of California, Davis14, University of California, San Francisco15
TL;DR: Safe and effective chronic opioid therapy for chronic noncancer pain requires clinical skills and knowledge in both the principles of opioid prescribing and on the assessment and management of risks associated with opioid abuse, addiction, and diversion.
2,051 citations