human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To investigate 1 ) the magnitude of indirect costs , 2 ) changes in cost components , and 3 ) correlations between changes in cost and social , clinical , and occupational variables within the first 3 years of rheumatoid arthritis ( RA ) . METHODS We evaluated the indirect costs  per person-year in 133 consecutive gainfully employed out- patients with early RA , in a prospect i ve multicenter followup study . Costs due to RA-related sick leave , work disability , and other work loss were assessed using the human capital approach . Variables associated with reduction in lost productivity were tested by multivariate logistic regression analysis . RESULTS Mean + /- SEM annual indirect costs were $ 11,750 + /- 1,120 per person . During the 3-year period of observation , a marked reduction in the costs associated with sick leave was seen , which exceeded the increase in costs due to work disability and other work loss . This phenomenon result ed in an overall reduction in indirect costs of 21 % . The final logistic regression model of reduced loss of productivity included 3 variables : no problems with st and ing ( odds ratio [ OR ] 7.1 ) , no problems with working speed ( OR 4.1 ) , and no problems with outdoor work ( OR 3.1 ) . CONCLUSION High indirect costs in early RA were demonstrated . An overall decrease of costs can be seen in the first 3 years , due to the reduction in sick leave . Since the absence of problems due to strenuous working conditions was found to be associated with a reduction in indirect costs , it is assumed that early intensified vocational rehabilitation , apart from controlling disease activity by adequate treatment , might help to reduce indirect costs OBJECTIVE To assess separate and combined effects of work factors and behavioural coping in relation to withdrawal from the labour force among patients with rheumatoid arthritis ( RA ) . METHODS A cross sectional study was conducted in a Dutch nationwide r and om sample of 720 patients with RA . Information about work factors and behavioural coping was collected by a self-administered postal question naire . A broad variety of work factors and coping styles were evaluated separately and in combination using multivariate logistic regression analyses , controlling for sociodemographic and disease related variables . Attributable and preventable fractions were calculated from the combined analyses to assess the relative importance of the contributing factors . RESULTS Additional job training , equal career opportunities , letting the disease influence the choice of the current job position , and informing colleagues about having the disease were negatively associated with withdrawal from the labour force . The most relevant factor in terms of decreasing the risk was adjusting job dem and s which accounted for 63 % of the patients still in the labour force . Decreasing activities and diverting attention in order to cope with pain , and pacing in order to cope with limitations were the coping styles which were positively associated with withdrawal from the labour force . The most relevant factor in terms of increasing the risk of withdrawal was pacing which accounted for 67 % of the withdrawals . CONCLUSION Work factors are potentially important modifiable risk factors for withdrawal from the labour force in patients with RA .  Behavioural coping is also relevant OBJECTIVE To explore baseline risk factors for productivity loss and work disability over 5 years in patients with early , active RA . PATIENTS AND METHODS In the FIN-RACo trial , 195 patients with recent onset RA were r and omised to receive either a combination of DMARDs with prednisolone or a single DMARD for 2 years . At baseline , 162 patients were working or available for work . After 5 years ' follow up , data on sick leave and retirement were obtained from social insurance registers or case records . The cumulative duration of sick leaves and RA related disability pensions was counted for each patient . To analyse predictors of productivity loss , the patients were divided into four groups according to duration of work disability per patient year . RESULTS Patient 's and physician 's global assessment of RA severity > or = 50 and HAQ score > or = 1.0 were risk factors for extension of productivity loss ( OR ( 95 % ( CI ) 1.77 ( 1.00 to 3.16 ) , 1.85 ( 1.03 to 3.32 ) , and 1.78 ( 1.01 to 3.14 ) , respectively ) . Additional risk factors were low education level ( 2.40 ( 1.18 to 4.88 ) ) and older age ( 1.03 ( 1.00 to 1.06 ) ) ; combination treatment was a protective factor ( 0.59 ( 0.35 to 0.99 ) ) . CONCLUSION At baseline , the risk of future productivity loss is best predicted by education level , age , global assessment s of RA severity , and HAQ score Learning Objectives Recall the overall magnitude of lsot  productive time ( LPT ) and its dollar cost as found in the American Productivity Audit , and the respective contributions of absenteeism and decreased producitivity at work . Be aware of how LPT varies with a number of demographic and workrelated factors . Compare the factors predisposing to LPT for personal and family-related reasons . The American Productivity Audit ( APA ) is a telephone survey of a r and om sample of 28,902 U.S. workers design ed 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/year ( $ 1685/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 ( ≥1 pack/day ) versus nonsmokers . Workers in high-dem and , low-control jobs had the lowest average LPT/week versus the highest LPT for those in low-dem and , 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 OBJECTIVE To evaluate the efficacy and safety of repeated administration of infliximab plus methotrexate ( MTX ) over a 2-year period in patients with rheumatoid arthritis ( RA ) who previously experienced an incomplete response to MTX .  METHODS Four hundred twenty-eight patients were r and omly assigned to receive MTX plus placebo or infliximab at a dose of 3 or 10 mg/kg plus MTX for 54 weeks , with an additional year of followup . The protocol was later amended to allow for continued treatment during the second year . Of 259 patients who entered the second year of treatment , 216 continued to receive infliximab plus MTX for 102 weeks . Ninety-four of these 259 patients experienced a gap in therapy of > 8 weeks before continuing therapy . Infusions were administered at weeks 0 , 2 , and 6 , followed by treatment every 4 weeks or every 8 weeks ( alternating with placebo infusions in the interim 4-week visits ) at a dose of 3 or 10 mg/kg for a total of 102 weeks ( including the gap in therapy ) . For safety and efficacy assessment s , data on the patients who were r and omized to receive treatment , irrespective of whether treatment was administered for 102 weeks , were evaluated using all actual observations available . The efficacy measures included the Health Assessment Question naire ( HAQ ) ( physical function ) , Short Form 36 health survey ( SF-36 ) ( health-related quality of life ) , total radiographic scores ( structural damage ) , and the American College of Rheumatology 20 % improvement criteria ( ACR20 ) ( signs and symptoms ) . RESULTS The infliximab plus MTX regimens result ed in significantly greater improvement in HAQ scores ( P < or = 0.006 ) and SF-36 physical component summary scores ( P < or = 0.011 ) compared with the MTX-only group . There also was stability in the SF-36 mental component summary score among patients who received the infliximab plus MTX regimens . Median changes from baseline to week 102 in the total radiographic score were 4.25 for patients who received the MTX-only regimen and 0.50 for patients who received the infliximab plus MTX regimen . The proportion of patients achieving an ACR20 response at week 102 varied from 40 % to 48 % for the infliximab plus MTX groups compared with 16 % for the MTX-only group . CONCLUSION Throughout 102 weeks of therapy , infliximab plus MTX provided significant , clinical ly relevant improvement in physical function and quality of life , accompanied by inhibition of progressive joint damage and sustained improvement in the signs and symptoms of RA among patients who previously had an incomplete response to MTX alone This paper traces the work history of patients with rheumatoid arthritis ( RA ) from the year of diagnosis to 1985 . The paper also describes the risk factors for work loss among patients with RA . It uses data from a panel of 698 RA patients , observed for 4 years , from the practice s of a r and om sample of northern California rheumatologists . Of these 698 , 353 had worked for pay at some point in their lives . Three hundred six of the 353 had worked when diagnosed as having RA . Of these 306 , 157 ( 51 % ) were no longer working in 1985 . Forty-seven individuals started working after the onset of illness , but of these , approximately one-third had stopped working by 1985 . In all , 50 % of RA patients with some work experience stopped working within a decade of diagnosis , 60 % within 15 years , and 90 % within 30 years . We found that the probability of work loss is lessened among persons in jobs that have few physical requirements , among those with high levels of discretion over the pace and activities of work , and among those who were able to stay on the job held when the diagnosis was made . The probability of work loss is increased among service workers . The findings of this longitudinal study , showing that work characteristics profoundly alter the probability of work loss among persons with RA , are consistent with the findings of our earlier cross-sectional studies of work outcome and RA OBJECTIVE Work disability is a common outcome of rheumatoid arthritis ( RA ) . Yet there have been no longitudinal , longterm , prospect i ve studies of work disability in this illness . This 18 year longitudinal study investigates the rate of work disability , its concomitants , and its predictors , using a large series of clinical , laboratory , and self-report measures . METHODS In 1974 , a computerized data base was developed for the contemporaneous entry of all patient visits . Data included clinical , laboratory , and self-report information . Patients were also assessed by mailed question naires at 6 month intervals . In 1994 , patients with RA were interviewed in detail about lifetime work status and work disability . RESULTS Work disability was estimated to occur in 25 % at 6.4 years and 50 % at 20.9 years after disease onset , and most disability occurred late in the course of disease . Work disability was predicted by almost every demographic and clinical variable . Education level , body mass index ( BMI ) , erythrocyte sedimentation rate , rheumatoid factor , pain , Health Assessment Question naire ( HAQ ) disability , and physical dem and s of the job were independently associated with disability . Over the course of their illness , the work disabled had a 35 % reduction in family income , and had more abnormal scores for joint counts , grip strength , sedimentation rate , pain , global severity , HAQ disability , and anxiety and depression . Except for BMI , the results were essentially similar in a subset of 156 patients seen first with a disease duration of less than one year . CONCLUSION Work disability can be predicted by patient and work characteristics present at the first clinic visit , but it is persistent abnormalities of sedimentation rate , HAQ disability , and pain , which may be detected in longitudinal followup , that best predict work disability after work and demographic characteristics are accounted for Objective : To develop a systematic set of German cost data in rheumatoid arthritis ( RA ) based solely on valid healthcare payer ’s cost data sources . Methods : Retrospectively one year cost data of 338 patients with RA were generated and analysed . The cost data were derived from a major statutory health insurance plan ( “ Allgemeine Ortskrankenkasse Niedersachsen ” ) and the regional physicians ’ association ( “ Kassenärztliche Vereinigung Niedersachsen ” ) . The recently published matrix of cost domains in RA was applied to structure the analysis . Descriptive statistics were used to analyse the data . Results : The total direct costs for the 338 patients during one year ( third quarter 2000 to second quarter 2001 ) were € 3815 per patient-year . RA related direct costs were € 2312 per patient-year . Outpatient costs accounted for 73.7 % , inpatient costs for 24.0 % , and other disease related costs for 2.3 % of RA related direct costs . Out patients cost drivers were RA related drugs ( € 1019 per patient-year ) , physician visits ( € 323 per patient-year ) , diagnostic and therapeutic procedures and tests ( € 185 per patient-year ) , and devices and aids ( € 168 per patient-year ) . 98 patients were retired prematurely owing to RA related work disability and incurred costs of € 8358 per retired patient-year . 96 patients were gainfully employed and incurred sick leave costs of € 2835 per employed patient-year . Conclusion : Micro-costing based on healthcare payer ’s data provides a relatively conservative albeit highly accurate estimate of costs in RA . Both RA related and non-RA related costs must be taken into account . In gainfully employed patients and in patients who receive RA related retirement payments productivity costs exceed direct costs OBJECTIVE To evaluate the development of h and icap in patients with rheumatoid arth 
    Output:
    
agent
RA-related work-disability rates were similar in the USA and European countries .
An apparent decrease in the prevalence of RA-related work disability since the 1970s may be related to a decrease in physically dem and ing work rather than to epidemiologic changes in RA .
The majority of the literature addresses permanent disability and temporary work loss ; none of the studies review ed reported the effect of RA on presenteeism , i.e. work limitation from the employer perspective , and there are few published studies of the effectiveness of disease-modifying anti-rheumatic drugs in reducing work-related productivity loss
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To investigate 1 ) the magnitude of indirect costs , 2 ) changes in cost components , and 3 ) correlations between changes in cost and social , clinical , and occupational variables within the first 3 years of rheumatoid arthritis ( RA ) . METHODS We evaluated the indirect costs  per person-year in 133 consecutive gainfully employed out- patients with early RA , in a prospect i ve multicenter followup study . Costs due to RA-related sick leave , work disability , and other work loss were assessed using the human capital approach . Variables associated with reduction in lost productivity were tested by multivariate logistic regression analysis . RESULTS Mean + /- SEM annual indirect costs were $ 11,750 + /- 1,120 per person . During the 3-year period of observation , a marked reduction in the costs associated with sick leave was seen , which exceeded the increase in costs due to work disability and other work loss . This phenomenon result ed in an overall reduction in indirect costs of 21 % . The final logistic regression model of reduced loss of productivity included 3 variables : no problems with st and ing ( odds ratio [ OR ] 7.1 ) , no problems with working speed ( OR 4.1 ) , and no problems with outdoor work ( OR 3.1 ) . CONCLUSION High indirect costs in early RA were demonstrated . An overall decrease of costs can be seen in the first 3 years , due to the reduction in sick leave . Since the absence of problems due to strenuous working conditions was found to be associated with a reduction in indirect costs , it is assumed that early intensified vocational rehabilitation , apart from controlling disease activity by adequate treatment , might help to reduce indirect costs OBJECTIVE To assess separate and combined effects of work factors and behavioural coping in relation to withdrawal from the labour force among patients with rheumatoid arthritis ( RA ) . METHODS A cross sectional study was conducted in a Dutch nationwide r and om sample of 720 patients with RA . Information about work factors and behavioural coping was collected by a self-administered postal question naire . A broad variety of work factors and coping styles were evaluated separately and in combination using multivariate logistic regression analyses , controlling for sociodemographic and disease related variables . Attributable and preventable fractions were calculated from the combined analyses to assess the relative importance of the contributing factors . RESULTS Additional job training , equal career opportunities , letting the disease influence the choice of the current job position , and informing colleagues about having the disease were negatively associated with withdrawal from the labour force . The most relevant factor in terms of decreasing the risk was adjusting job dem and s which accounted for 63 % of the patients still in the labour force . Decreasing activities and diverting attention in order to cope with pain , and pacing in order to cope with limitations were the coping styles which were positively associated with withdrawal from the labour force . The most relevant factor in terms of increasing the risk of withdrawal was pacing which accounted for 67 % of the withdrawals . CONCLUSION Work factors are potentially important modifiable risk factors for withdrawal from the labour force in patients with RA .  Behavioural coping is also relevant OBJECTIVE To explore baseline risk factors for productivity loss and work disability over 5 years in patients with early , active RA . PATIENTS AND METHODS In the FIN-RACo trial , 195 patients with recent onset RA were r and omised to receive either a combination of DMARDs with prednisolone or a single DMARD for 2 years . At baseline , 162 patients were working or available for work . After 5 years ' follow up , data on sick leave and retirement were obtained from social insurance registers or case records . The cumulative duration of sick leaves and RA related disability pensions was counted for each patient . To analyse predictors of productivity loss , the patients were divided into four groups according to duration of work disability per patient year . RESULTS Patient 's and physician 's global assessment of RA severity > or = 50 and HAQ score > or = 1.0 were risk factors for extension of productivity loss ( OR ( 95 % ( CI ) 1.77 ( 1.00 to 3.16 ) , 1.85 ( 1.03 to 3.32 ) , and 1.78 ( 1.01 to 3.14 ) , respectively ) . Additional risk factors were low education level ( 2.40 ( 1.18 to 4.88 ) ) and older age ( 1.03 ( 1.00 to 1.06 ) ) ; combination treatment was a protective factor ( 0.59 ( 0.35 to 0.99 ) ) . CONCLUSION At baseline , the risk of future productivity loss is best predicted by education level , age , global assessment s of RA severity , and HAQ score Learning Objectives Recall the overall magnitude of lsot  productive time ( LPT ) and its dollar cost as found in the American Productivity Audit , and the respective contributions of absenteeism and decreased producitivity at work . Be aware of how LPT varies with a number of demographic and workrelated factors . Compare the factors predisposing to LPT for personal and family-related reasons . The American Productivity Audit ( APA ) is a telephone survey of a r and om sample of 28,902 U.S. workers design ed 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/year ( $ 1685/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 ( ≥1 pack/day ) versus nonsmokers . Workers in high-dem and , low-control jobs had the lowest average LPT/week versus the highest LPT for those in low-dem and , 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 OBJECTIVE To evaluate the efficacy and safety of repeated administration of infliximab plus methotrexate ( MTX ) over a 2-year period in patients with rheumatoid arthritis ( RA ) who previously experienced an incomplete response to MTX .  METHODS Four hundred twenty-eight patients were r and omly assigned to receive MTX plus placebo or infliximab at a dose of 3 or 10 mg/kg plus MTX for 54 weeks , with an additional year of followup . The protocol was later amended to allow for continued treatment during the second year . Of 259 patients who entered the second year of treatment , 216 continued to receive infliximab plus MTX for 102 weeks . Ninety-four of these 259 patients experienced a gap in therapy of > 8 weeks before continuing therapy . Infusions were administered at weeks 0 , 2 , and 6 , followed by treatment every 4 weeks or every 8 weeks ( alternating with placebo infusions in the interim 4-week visits ) at a dose of 3 or 10 mg/kg for a total of 102 weeks ( including the gap in therapy ) . For safety and efficacy assessment s , data on the patients who were r and omized to receive treatment , irrespective of whether treatment was administered for 102 weeks , were evaluated using all actual observations available . The efficacy measures included the Health Assessment Question naire ( HAQ ) ( physical function ) , Short Form 36 health survey ( SF-36 ) ( health-related quality of life ) , total radiographic scores ( structural damage ) , and the American College of Rheumatology 20 % improvement criteria ( ACR20 ) ( signs and symptoms ) . RESULTS The infliximab plus MTX regimens result ed in significantly greater improvement in HAQ scores ( P < or = 0.006 ) and SF-36 physical component summary scores ( P < or = 0.011 ) compared with the MTX-only group . There also was stability in the SF-36 mental component summary score among patients who received the infliximab plus MTX regimens . Median changes from baseline to week 102 in the total radiographic score were 4.25 for patients who received the MTX-only regimen and 0.50 for patients who received the infliximab plus MTX regimen . The proportion of patients achieving an ACR20 response at week 102 varied from 40 % to 48 % for the infliximab plus MTX groups compared with 16 % for the MTX-only group . CONCLUSION Throughout 102 weeks of therapy , infliximab plus MTX provided significant , clinical ly relevant improvement in physical function and quality of life , accompanied by inhibition of progressive joint damage and sustained improvement in the signs and symptoms of RA among patients who previously had an incomplete response to MTX alone This paper traces the work history of patients with rheumatoid arthritis ( RA ) from the year of diagnosis to 1985 . The paper also describes the risk factors for work loss among patients with RA . It uses data from a panel of 698 RA patients , observed for 4 years , from the practice s of a r and om sample of northern California rheumatologists . Of these 698 , 353 had worked for pay at some point in their lives . Three hundred six of the 353 had worked when diagnosed as having RA . Of these 306 , 157 ( 51 % ) were no longer working in 1985 . Forty-seven individuals started working after the onset of illness , but of these , approximately one-third had stopped working by 1985 . In all , 50 % of RA patients with some work experience stopped working within a decade of diagnosis , 60 % within 15 years , and 90 % within 30 years . We found that the probability of work loss is lessened among persons in jobs that have few physical requirements , among those with high levels of discretion over the pace and activities of work , and among those who were able to stay on the job held when the diagnosis was made . The probability of work loss is increased among service workers . The findings of this longitudinal study , showing that work characteristics profoundly alter the probability of work loss among persons with RA , are consistent with the findings of our earlier cross-sectional studies of work outcome and RA OBJECTIVE Work disability is a common outcome of rheumatoid arthritis ( RA ) . Yet there have been no longitudinal , longterm , prospect i ve studies of work disability in this illness . This 18 year longitudinal study investigates the rate of work disability , its concomitants , and its predictors , using a large series of clinical , laboratory , and self-report measures . METHODS In 1974 , a computerized data base was developed for the contemporaneous entry of all patient visits . Data included clinical , laboratory , and self-report information . Patients were also assessed by mailed question naires at 6 month intervals . In 1994 , patients with RA were interviewed in detail about lifetime work status and work disability . RESULTS Work disability was estimated to occur in 25 % at 6.4 years and 50 % at 20.9 years after disease onset , and most disability occurred late in the course of disease . Work disability was predicted by almost every demographic and clinical variable . Education level , body mass index ( BMI ) , erythrocyte sedimentation rate , rheumatoid factor , pain , Health Assessment Question naire ( HAQ ) disability , and physical dem and s of the job were independently associated with disability . Over the course of their illness , the work disabled had a 35 % reduction in family income , and had more abnormal scores for joint counts , grip strength , sedimentation rate , pain , global severity , HAQ disability , and anxiety and depression . Except for BMI , the results were essentially similar in a subset of 156 patients seen first with a disease duration of less than one year . CONCLUSION Work disability can be predicted by patient and work characteristics present at the first clinic visit , but it is persistent abnormalities of sedimentation rate , HAQ disability , and pain , which may be detected in longitudinal followup , that best predict work disability after work and demographic characteristics are accounted for Objective : To develop a systematic set of German cost data in rheumatoid arthritis ( RA ) based solely on valid healthcare payer ’s cost data sources . Methods : Retrospectively one year cost data of 338 patients with RA were generated and analysed . The cost data were derived from a major statutory health insurance plan ( “ Allgemeine Ortskrankenkasse Niedersachsen ” ) and the regional physicians ’ association ( “ Kassenärztliche Vereinigung Niedersachsen ” ) . The recently published matrix of cost domains in RA was applied to structure the analysis . Descriptive statistics were used to analyse the data . Results : The total direct costs for the 338 patients during one year ( third quarter 2000 to second quarter 2001 ) were € 3815 per patient-year . RA related direct costs were € 2312 per patient-year . Outpatient costs accounted for 73.7 % , inpatient costs for 24.0 % , and other disease related costs for 2.3 % of RA related direct costs . Out patients cost drivers were RA related drugs ( € 1019 per patient-year ) , physician visits ( € 323 per patient-year ) , diagnostic and therapeutic procedures and tests ( € 185 per patient-year ) , and devices and aids ( € 168 per patient-year ) . 98 patients were retired prematurely owing to RA related work disability and incurred costs of € 8358 per retired patient-year . 96 patients were gainfully employed and incurred sick leave costs of € 2835 per employed patient-year . Conclusion : Micro-costing based on healthcare payer ’s data provides a relatively conservative albeit highly accurate estimate of costs in RA . Both RA related and non-RA related costs must be taken into account . In gainfully employed patients and in patients who receive RA related retirement payments productivity costs exceed direct costs OBJECTIVE To evaluate the development of h and icap in patients with rheumatoid arth 
    Output:
    