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PubMed2001

Psychosocial job factors and return-to-work after compensated low back injury: a disability phase-specific analysis.

BACKGROUND: Job characteristics may constitute a barrier to return-to-work (RTW) after compensated disabling low back pain (LBP). This study examines the impact of psychosocial job factors on time to RTW separately during the acute and subacute/chronic disability phases. METHODS: This is a retrospective cohort study of 433 LBP workers' compensation claimants with 1-4 years of follow-up. The association of psychosocial job factors with duration of work disability was estimated with Cox regression models, adjusting for injury history and severity, physical workload, and demographic and employment factors. RESULTS: High physical and psychological job demands and low supervisory support are each associated with about 20% lower RTW rates during all disability phases. High job control, especially control over work and rest periods, is associated with over 30% higher RTW rates, but only during the subacute/chronic disability phase starting 30 days after injury. Job satisfaction and coworker support are unrelated to time to RTW. CONCLUSIONS: Duration of work disability is associated with psychosocial job factors independent of injury severity and physical workload. The impact of these risk factors changes significantly over the course of disability.

Adult↗
PubMed1991

Respiratory health status of 3098 Canadian grain workers studied longitudinally.

Analyses of data on 3098 male individuals surveyed twice by the Labour Canada Medical Surveillance Program for the Grain Industry are presented. The program collects information on respiratory symptoms, job description, and smoking habits of these workers. In addition, each worker performs pulmonary function tests obtainable through spirometry. Chronic sputum production and chronic wheezing were more prevalent during the latest testing period (rising to 17 percent and 13%, respectively), while the prevalence of chronic cough (16%) and dyspnea (10%) did not change significantly. Eighty-two percent of these workers, in each time cycle, had normal pulmonary function despite an additional 3 years of work exposure. In each cycle, obstructive dysfunction (less than or equal to 12% of workers) was more prevalent than restrictive dysfunction (less than or equal to 5%) or combined obstructive/restrictive dysfunction (less than or equal to 2.4%). It is unknown unknown whether this demonstrated dysfunction is due to previous workplace exposure, as Labour Canada and the Canadian grain industry have cooperated in lowering the grain dust levels found in grain elevators and terminals. In addition, the prevalence of current cigarette smoking has declined. (decreases 5%) among these grain handlers, and there is suggestive evidence that those continuing to smoke have reduced their consumption (mean pack-years changed only from 15.3 to 17.4). Knowledge of environmental dangers and educational programs have contributed to these encouraging results.

Adult↗
PubMed2007

Measurement of process as quality control in the management of acute surgical emergencies.

BACKGROUND: Quality of care measured by adverse events cannot address errors of process that have no adverse outcomes. The aim of this study was to determine whether process could be used to assess quality of care and whether process analysis could be used to assess interventions designed to improve quality. METHODS: A single-centre prospective cohort study was performed over 12 weeks in an acute surgical admission unit. Data were collected prospectively for the first 24 h of admission on three aspects of process: documentation, general management and presentation-specific criteria. After a period of observation, the impact of three interventions (active observation, increasing awareness and issuing a job description) on the mean number of process errors per patient (process score) was compared. RESULTS: The analysis was based on 566 patients admitted with general surgical pathology. Awareness of being observed failed to improve the process score. Interventions that increased awareness of process reduced the overall process score from 4.79 to 2.38 errors per person (P < 0.001). The mean overall process score in patients with an adverse event was twice that of patients who did not have an adverse event (5.74 (95 per cent confidence interval 4.03 to 7.45) versus 3.43 (3.19 to 3.66)). CONCLUSION: Process can be measured objectively and used as a measure of quality of care. Interventions to increase awareness reduced process error rates and adverse events.

Acute Disease↗
PubMed2007

Employment-contingent health insurance, illness, and labor supply of women: evidence from married women with breast cancer.

We examine the effects of employment-contingent health insurance (ECHI) on married women's labor supply following a health shock. First, we develop a theoretical framework that examines the effects of ECHI on the labor supply response to a health shock, which suggests that women with ECHI are less likely to reduce their labor supply in response to a health shock, relative to women with health insurance through their spouse's employer. Second, we empirically examine this relationship based on labor supply responses to breast cancer. We find that health shocks decrease labor supply to a greater extent among women insured by their spouse's policy than among women with health insurance through their own employer, suggesting that ECHI creates incentives to remain working when faced with a serious illness.

Breast Neoplasms↗
PubMedDate not supplied

Voices from the inside: managing district health services in Nepal.

Apparent inconsistencies and irrational decisions can be found in all organizations and they often point to underlying attitudes and assumptions among staff, about the organization and the way it works. Concepts such as 'negotiated order' and 'values in use' have been suggested in recent literature on organization theory to describe the important role of individual, and social, needs and expectations upon the functioning of organizations. This article presents the apparently common assumptions made about government service, as encountered during research into the management of district public health services in Nepal. It argues that, when taken together, these form a wide and coherent system of 'values in use', or an 'implicit theory' which appears to guide many of the bureaucracy's actions. The way in which staff are selected and promoted, common attitudes towards work, the shortcomings of the reporting systems, all appear to be part of an 'implicit' theory which is based on the fundamental belief that it is the main purpose of the district public health service to provide incomes for its staff. Thus, most posts do not have job descriptions and staff are recruited to them on the basis of factors other than the skills or knowledge required. Training and supervision are seen commonly as means of earning extra allowances, and service quality is not seen as a priority. This contrasts with the 'official' theory which is that the organization exists to provide health services to the community and that it is the purpose of the staff to provide those services. Such an implicit 'theory', recognized and accepted by staff but never acknowledged, and based on very different values and expectations to those assumed in a 'rational', task-oriented bureaucracy, obviously has implications for the success of development programmes. It explains why training so rarely results in improved performance and why the bureaucracy is so resistant to change which does not satisfy the implicit theory. While the implicit theory described here is specific to Nepal, the phenomenon may be widespread. The failure to take account of such 'theories in use', guiding the actions of staff and hence organizations, could explain the failure of many attempts to improve government health services.

Attitude of Health Personnel↗
PubMed2002

An analysis of the relationship between job satisfaction and job stress in correctional nurses.

Stamps and Piedmonte's Index of Work Satisfaction and Harris's Nurse Stress Index were completed by 287 registered nurses employed in state prison health care facilities in order to assess job satisfaction and job stress among correctional nurses. Correctional nurses' expectations about job satisfaction were influenced by pay and autonomy. This finding was consistent with studies of hospital nurses. Important sources of job satisfaction were professional status and interaction with employees. Analysis of differences between expectations and sources of job satisfaction may provide understanding of career benefits and sources of dissatisfaction. Time pressures and organizational support and involvement were sources of stress. Multivariate analyses showed an inverse relationship between stress and job satisfaction. Information about job satisfaction and work stress and their correlates may be used to develop strategies to improve the recruitment and retention of correctional nurses.

Adult↗
PubMed1993

The moderating effects of dispositional affectivity on relationships between job characteristics and nurses' job satisfaction.

Using the job satisfaction model embedded in the Price-Mueller nurse turnover model, the moderating effects of positive affectivity (PA) and negative affectivity (NA) on the relationships between the seven independent variables in the model and job satisfaction were examined. Multiple regression procedure was used to analyze data collected from 162 nursing employees of a 327-bed Veterans Administration Medical Center. The major determinants of job satisfaction were found to be routinization, instrumental communication, and PA. The impact of participation, instrumental communication, integration, distributive justice on job satisfaction were found to be moderated by PA. NA moderated the impact of promotional opportunity on job satisfaction. These predictors, in conjunction with demographic variables, explained 45% of the variance of job satisfaction.

Adult↗
PubMed1996

The job satisfaction of physical therapists.

Ten statements were created for the purpose of measuring job satisfaction in the practise of physiotherapy. The subjects consisted of 96 of the 106 (90%) of the physical therapists licensed with the Texas State Board of Physical Therapy Examiners, and listed as residing in El Paso, Texas, USA. To indicate their job satisfaction, subjects indicated on a seven-point scale their level of agreement or disagreement with each statement. They then indicated on a different seven-point scale how important they thought each statement was to their job satisfaction. The results indicated that subjects thought that their jobs were challenging in a positive sense; enabled them to use their abilities; and were interesting. They also thought that they had sufficient independence in decision-making; were learning and improving in their work; and were given significant autonomy. The most dissatisfying aspect of their work was the amount of paperwork. In addition, the results suggest that some subjects may feel overworked, and think their jobs may be too physically demanding and mentally stressful. The subjects felt that all the statements had validity and measured important aspects of job satisfaction in physical therapy.

Burnout, Professional↗
PubMed1999

The role of community pharmacists in health education and disease prevention: a survey of their interests and needs in relation to cardiovascular disease.

BACKGROUND: Recently there has been increased interest in broadening the role of community pharmacists to include more health education and disease prevention activities such as patient counseling for risk management and interventions to improve compliance. However, to date, there is little information on interest in prevention among community pharmacists or on their current prevention practices. METHOD: Data on current health education and disease prevention practices, as well as interest in expanding their role in prevention, were collected in a cross-sectional mail survey of a random representative sample of community pharmacists currently practicing in the province of Quebec. RESULTS: Among 597 eligible subjects, 455 (76.2%) completed the questionnaire. Few pharmacists practice prevention routinely. Independent correlates of engaging in prevention included working in a smaller pharmacy (odds ratio (OR) 3. 2 (95% confidence interval 2.0-5.3)), owning the pharmacy (OR 1.9 (1. 2-3.0)), moderate/high job satisfaction (OR 2.1 (1.4-4.3)), and history of prevention activities in the pharmacy (OR 2.2 (1.4-3.6)). Over 90% of respondents reported that integrating prevention into their practices was important. Independent correlates of high perceived importance included working as a salaried pharmacist (OR 2. 3 (1.4-3.8)), high job satisfaction (OR 4.1 (1.7-9.7)), and currently practicing prevention (OR 2.0 (1.2-3.2)). The most important perceived barriers to integrating prevention included lack of time and lack of skills/instrumentation for practicing prevention. CONCLUSIONS: There is considerable interest among community pharmacists in expanding their role to include more prevention, but there are many barriers to actualizing this role. Further work should focus on ways to overcome these barriers because pharmacists are particularly well-situated to make an important contribution to prevention.

Adult↗
PubMed1990

Cardiovascular malformations and maternal exposure to video display terminals during pregnancy.

The possible effects of working with video display terminals (VDTs) during pregnancy on the occurrence of cardiovascular malformations in the offspring was studied in 500 cases and 1055 controls. The cases represented all registered cardiovascular malformations reported in Finland during 1982-84, excluding those with chromosomal anomaly or known genetic syndrome. The controls were randomly selected from all babies born during the same period. Both the case and control mothers were interviewed by midwives using a structured questionnaire approximately three months after delivery. In this interview the mother's occupation, job description and employer during the first trimester were noted, as were large number of other exposures to chemical and physical factors. An industrial hygienist examined all these records for information indicating exposure to VDTs, unaware of case/control status. Work with VDTs during the first trimester of pregnancy was ascertained for 30 case mothers (6.0%, 30/500) and 53 control mothers (5.0%, 53/1055). In logistic regression analysis maternal exposure to VDTs for at least 20h a week during the first trimester of pregnancy showed a point estimate of odds ratio of 1.4 with 95% confidence limits of 0.5 and 3.8, when adjusted for age and alcohol use. Maternal exposure to VDTs was not associated with indicators of fetal growth such as birthweight, placental weight or length of gestation.

Computer Systems↗
PubMed1987

Musculoskeletal load of municipal employees aged 44 to 58 years in different occupational groups.

This study is part of a comprehensive multidisciplinary project aimed at determining criteria for retirement ages in municipal occupations in Finland. Musculoskeletal load at work was studied in eight different occupational groups to see what differences between occupational groups exist. A job analysis of the work of 116 subjects was made with the ergonomic job description analysis method (AET). The work of 116 men and women, mean age 52 years, was studied in the work place. The study revealed three levels of overall musculoskeletal load. The groups with high musculoskeletal load worked in installation, auxiliary, home care and transport groups, with an assessed load of on average about one third of the maximal on the AET scale. Both quantitative and qualitative loading problems were concentrated in these groups. In contrast, teaching and administration groups had low musculoskeletal load averaging about 10% of the maximal. The nursing and office groups were between these two levels with a load of approximately 20% of the maximal. However, with the same overall quantity, the quality of the musculoskeletal load varied. In the transport group, monotonous static work with both arms (about 60% of workshift) and legs (30%) was most common, while the musculoskeletal load of the auxiliary and home care groups consisted of heavy dynamic muscular work with arms (60% of workshift) and legs (70%). On the other hand, the administration group alone had a static load of the arms (about 15% of workshift) and legs (2%) and also a low dynamic load with arms (0%) and legs (33%), which could have hypokinetic effects. In conclusion, there are significant differences between the profile groups in both the quantitative and qualitative load of the musculoskeletal system. The differences are even more pronounced when aging employees are studied. These facts support different retirement ages for the profile groups, at least when the musculoskeletal system is concerned.

Biomechanical Phenomena↗
PubMed1983

[Development of demands with increasing technology in text processing].

Text-processing task demands are inquired about by means of an Ergonomic Job Description Questionnaire. The tasks are related to 5 steps of technologies and demands are documented for each of the technologies. With increasing technology demands on visual perception and work organisation dominate, while some demands on energetic work and environmental conditions decrease.

Computers↗
PubMed1988

Effects of musculoskeletal work load and muscle strength on strain at work in women and men aged 44 to 58 years.

The effects of musculoskeletal work load and muscle strength on strain at work were analysed among 60 women and 69 men (mean age 52 +/- 3.4) in municipal jobs in Finland. The musculoskeletal work load was determined by analysing the jobs by a job description method. The maximal isometric hand grip strength was assessed with a manometer, trunk flexion and trunk extension strength with a dynamometer, and dynamic trunk flexion endurance strength with a sit-up test. Heart rate was registered continuously and ratings of perceived exertion were determined 4 times during the work shift. The results revealed that high musculoskeletal work load was systematically and significantly related to high strain at work in both sexes. A high mean heart rate related to an individual's range in women was an interaction effect of high work load and low hand grip strength or low trunk flexion strength. Among men, both high mean and maximal heart rates in relation to the heart rate range was due to the interaction effects of high work load and low trunk extension strength. The interaction of work load and strength was not systematically related to the ratings of perceived exertion during work. It was concluded that the musculoskeletal work load exerted the main effects on the cardiorespiratory and perceived strains at work. The interaction effects of work load and strength on strain depended on the sex and the muscle group in the studied work load level of elderly municipal employees.

Female↗
PubMed1980

An analysis of the effects of personal background and work setting variables upon selected job characteristics of physician assistants.

This study describes the effects of personal background and work setting variables upon the job characteristics of a national sample of 939 physician assistants. These data were obtained from a 1974 survey of members of the physician assistant profession and were assessed by means of path analysis. The analysis yielded the following major findings: (1) job characteristics became more favorable with increasing experience as a physician assistant, (2) employment in primary care fields resulted in job characteristics at least as favorable as those found in employment in other specialties, (3) military physician assistants reported greater patient care responsibility but lower levels of occupational prestige and career opportunities, and (4) women physician assistants earned less (even after controlling for number of hours worked) and knew of fewer available alternative job opportunities than their male colleagues.

Attitude of Health Personnel↗
PubMed1975

Training the secretary in community mental health: a second model for integrating secretaries into the therapeutic team in community mental health.

The secretaries in community mental health centers have functions that transcend their job descriptions. Their performance of these functions contributes to the success or failure of their centers' therapeutic programs. The Mental Health Training Institute of North Carolina initiated two separate pilot training programs within 1971-1972, aimed at heightening the secretaries' appreciation of their role within their centers and at facilitating their integration into the therapeutic team. This paper is a discussion of the second of these two programs.

Community Mental Health Services↗
PubMed1993

The importance of training and supervision in quality of care.

Training of family planning service providers requires identification and selection of service providers, knowledge of their functions in the overall health team, provision of job descriptions and assessment of training needs. These can assist in the definition of training objectives and the establishment of program content. Varied teaching methodologies and aids can enrich the program and maximize learning and the venue and facilities provided for training should be accessible, appropriate in setting (using primary, secondary or tertiary facilities as necessary) and should provide an adequate standard of care. Evaluation of training performance should be regular and ongoing, with final assessment leading to recognition of training. The program should be evaluated by trainers and trainees to assist in improving the quality of the training and competence of the trainers. Finally, supervision and monitoring of performance in the workplace can be achieved by direct internal or external supervision, by indirect supervision using standing orders or guidelines, and by evaluation by managers, service providers and clients.

Education, Medical↗
PubMed1979

[Theater nurse and midwife in Cameroon. Impressions and experiences in the grasslands (Northwest Cameroon) during a six-and-a-half month stay in a hospital situated at a height of 1800 m].

The author describes the circumstances of the hospital and out-of-hospital situation in the region she worked in, in focussing on the relevant practical features of the daily life of patients and staff. She deals among other things with the maternity ward (including the separate "camp" devoted to prenatal stays) and the operating theatre. As regards health activities outside the hospital, she mentions those of the existing health centres and of auxiliary personnel called first-aiders (whose job description is close to the one of the village health workers advocated by WHO and others). A health team, usually led by a physician, makes periodic visits to bush villages. The importance of the contacts thus created, for health work itself (including collaboration with traditional health practitioners) as well as for community development, is underlined.

Cameroon↗
PubMed2001

Managed care in the public sector: lessons learned from the Los Angeles PARTNERS program.

PARTNERS is the Los Angeles County Department of Mental Health's capitated managed care treatment program. To explore the context in which public sector managed care reforms are occurring and to understand the obstacles to implementing such programs, qualitative data were collected from administrators, case managers, and clients. Administrators were found to need assistance in negotiating managed care contracts and in tracking costs. Case managers, although concerned about increased clinical demands, enjoyed the flexibility and creativity their new roles allowed. Clients were satisfied with their increased independence, even though many had to change their site of care. Beyond considering these concerns, the range of community stakeholders who may be affected by such interventions must be addressed.

Attitude of Health Personnel↗