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The Evidence Speaks (February 2017)

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We’re proud to introduce our Evidence Speaks series, a recurring feature highlighting the latest in CHÉOS research. This series features summaries of select publications as well as in-depth features on the latest work from our investigators.

In the early days of CHÉOS, the Centre had a series known as “The Evidence Speaks,” a monograph series to keep media and the research community up-to-date with CHÉOS’ current research results in the health outcomes field.

Vogel M, Frank A, Choi F, Strehlau V, Nikoo N, Nikoo M, Hwang SW, Somers J, Krausz MR, Schütz CG. Chronic pain among homeless persons with mental illness. Pain Med. 2017 Feb 8 epub ahead of print.

CHÉOS Scientists Drs. Schütz, Krausz, and Strehlau published the first paper to report the prevalence of chronic pain in homeless people living with mental illness. This work joins the long list of publications from the At Home/Chez Soi Study, a study which investigated the effect of a Housing First intervention in homeless people with mental illness. Of the 1,287 participants included in these analyses, almost 60 per cent reported experiencing chronic pain, with 40 per cent of participants reporting clinically significant (moderate to severe) chronic pain. Major depressive disorder, mood disorder with psychotic features, panic disorder, and PTSD were all associated with an increase in chronic pain. Chronic pain was also more common in people with higher levels of suicidal ideation. Ninety-four per cent of participants that reported experiencing significant chronic pain said that it interferes with their daily lives. Although more than one-third of participants reported using street drugs to reduce pain, no association between clinically significant chronic pain and substance dependence was found. This study highlights the importance of addressing chronic pain clinically and along the continuum of care.

Campbell N, Ordunez P, Jaffe MG, Orias M, DiPette DJ, Patel P, Khan N, Onuma O, Lackland DT. Implementing standardized performance indicators to improve hypertension control at both the population and health care organization levels. J Clin Hypertens. 2017 Feb 13 epub ahead of print.

Hypertension (defined as a BP of ≥140/90 mmHg) is major global health issue and the leading risk factor for death and disability internationally. The WHO has set a target of reducing the prevalence of increased blood pressure by 25 per cent by 2025. CHÉOS Scientist Dr. Nadia Khan co-authored a policy statement from the World Hypertension League, U.S. Centers for Disease Control, the Pan American Health Organization, and other partners to supplement the single clinical indicator proposed by the WHO. The publication makes recommendations for indicators to be used in population surveys and in clinical registries. For population data, these indicators include: mean systolic and diastolic BP and the prevalence of awareness of hypertension, treatment for hypertension, and successfully treated or controlled hypertension. From a health care organization perspective, the group suggests that the prevalence of diagnosed hypertension be compared to population expectations, a cardiovascular risk assessment, and that the prevalence of successfully controlled hypertension, lack of BP measurement in the past year, and missed hypertension-related appointments be recorded. Continual revision and input from around the world are essential to maintain and improve this hypertension monitoring framework.

Zhang W, Sun H, Woodcock S, Anis AH. Valuing productivity loss due to absenteeism: firm-level evidence from a Canadian linked employer-employee survey. Health Econ Rev. 2017;7(1):3. doi:10.1186/s13561-016-0138-y. Epub 2017 Jan 19.

CHÉOS Director Dr. Aslam Anis and Health Economics Program Head Dr. Wei Zhang recently collaborated on an economic evaluation of the impact of absenteeism on productivity loss in team and non-team workers. Understanding the burden of absenteeism related to an illness is important for policy makers who want to measure the impact of a health intervention on productivity. This study used data from the Workplace and Employee Survey, a Statistics Canada survey of employers and employees conducted over a 10-year period. Team workers were considered those who reported “frequently” or “always” participating in a self-directed work group responsible for a particular product or service; non-team workers were those who reported doing so “occasionally” or “never”. Drs. Anis and Zhang’s analyses show that team workers are both more productive and earn more than non-team workers. The impact of absenteeism on productivity, however, is underestimated by a team worker’s wage loss, especially in smaller organizations. No wage-productivity gap was found for large organizations or for absenteeism in non-team workers. This work helps to identify situations in which a worker’s wage could be used to estimate the economic burden of a specific illness and situations in which a multiplier may be appropriate to adjust for the wage-productivity gap.

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