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PubMed2005

Employment across chronic inflammatory rheumatic diseases and comparison with the general population.

OBJECTIVE: To compare labor force participation across chronic inflammatory rheumatic diseases in order to assess the influence of the disease, disease duration, sex, education, and labor market conditions on employment. METHODS: Data from the German rheumatological database on outpatients of working age (20-59 yrs) between 1993 and 2001 were analyzed. The patients had rheumatoid arthritis (RA; n = 26,071), ankylosing spondylitis (AS; n = 5564), psoriatic arthritis (PsA; n = 6041), systemic lupus erythematosus (SLE; n = 4603), systemic sclerosis (SSc; n = 802), or Wegener's granulomatosis (WG; n = 385). Using population data, standardized employment ratios (SER) and part-time employment ratios of observed versus expected cases with 95% CI were calculated by means of indirect standardization for age and year of documentation. RESULTS: Across all diseases the overall employment rates were significantly lower than in the general population. Significant differences in SER were found between the diseases. The lowest SER of 0.76 to 0.81 (1.0 = population) were found in patients with RA, SLE, SSc, and WG. Higher SER were seen in AS (0.94) and PsA (0.92). In patients with a disease duration > 10 years the relative risk of being employed compared to RA, was 1.42 for AS, 1.26 for PsA, and 1.15, 1.03, 0.62 for PsA, SLE, SSc and WG, respectively. Comparing areas with low and high unemployment rates, a highly significant influence of labor market conditions on the SER was observed. The SER were significantly lower in patients with < 10 years of school education. CONCLUSION: Differences between employment rates in the population and the rates for the diseases under study are smaller than assumed by most clinical studies, especially in AS and PsA. However, these differences increase with longer disease duration. Specific measures to prevent patients from losing their job are needed, especially in areas with overall high unemployment.

Absenteeism↗
PubMed2005

Different development trends in working life and increasing occupational stress require new work environment strategies.

This article has a two-fold purpose. First, it provides an explanation for the increase in occupational stress and sick leaves in Sweden in terms of the structural and organizational conditions. Second, it discusses measures that address these issues. Results of a study of 72 establishments are presented. The study investigated these establishments at both the organizational and individual employee level. It examined management strategies and working conditions in the establishments, classifying these elements by type of operations and company position. Both classifications point to differences in how work is organized and in working conditions. The results indicate that management technologies distribute risks between segments of the labor market, thus, also between different groups of the labor force. The developments were most favorable in high tech and knowledge-based operations. The situation was least favorable in labor-intensive services and, the most negative development had taken place in human services. Establishments serving as contractors appeared to organize their work differently from those with core activities. Working conditions in contracting businesses were particularly problematic. Since organizational changes work differently from one company to the next, there is a need to develop a variety of strategies for enacting change in the work environment. This article proposes strategies for different segments of the labor market. These strategies are adapted to the particular problems facing each segment.

Absenteeism↗
PubMed1997

Do training programs help AFDC recipients leave the welfare rolls? An evaluation of New York City's BEGIN (Begin Employment Gain Independence Now) program.

Guided by the Federal Family Support Act of 1988 and the Job Opportunity and Basic Skills Program (JOBS), welfare reform initiatives on state and local levels were designed to foster employability among the public assistance population. Reform has focused on enhancing the supply of labor rather than the demand for labor as a route to labor force participation for the public assistance population. Program reforms assume that, by providing job training, educational services, and training-related expenses, labor market entry of the participating clientele would be facilitated while caseloads and public expenditures would decline. To date, analysis of similar programs in many states indicates that the impact of such programs in reducing public assistance caseloads is marginal. In New York City, despite the large investment of public funds in such programs, prior to this study the outcome of program implementation remained largely unknown. This study evaluates New York City's BEGIN program outcome target defined as the ability of the program to move welfare clients off public assistance and into the labor market. While the results of the study indicate that New York City's BEGIN program does not improve client's odds of leaving welfare, when compared to the odds of a non-participation client, there are several significant findings. The impact of program participation can be distinguished among distinct age groups. While older clients responded positively to BEGIN participation, access to day care was the only factor that significantly improved the probability that clients younger than 36 years of age would leave the welfare rolls within a two-year period. In response to the findings, the researchers suggest that future welfare reform efforts should grant localities broader flexibility to determine their own target population so that resources can be allocated to those groups that are most likely to benefit from specific programs.

Adolescent↗
PubMed2003

The aging of Israel's Arab population: needs, existing responses, and dilemmas in the development of services for a society in transition.

The Arab population of Israel is relatively young. However, a significant increase is expected in the number of elderly Arabs in the coming years. At the end of 2001 there were 38,500 Arab elderly, but their number is expected to reach 92,100 by 2020. This will represent a nearly 2.5-fold increase in absolute numbers. As the population ages, the number and percentage of people with chronic diseases and related disabilities will rise significantly. While the Arab elderly are much younger than the Jewish elderly, they are more disabled and therefore have greater medical and nursing needs. An extremely important measure of the need for formal services is an elderly person's functional ability, especially the ability to live independently. The percentage of Arab elderly who are disabled and need help with activities of daily living is twice as high as that of the Jewish elderly population. At present, 30% of the Arab elderly (39% of the women and 20% of the men), compared to 14% of Jewish elderly (17% of the women and 11% of the men), need help in at least one ADL (bathing, dressing, eating, mobility in the home, rising and sitting, getting in and out of bed). Concomitant with demographic changes are forces that affect the ability of informal support systems to provide care. For example, the rising number of Arab women in the labor force together with changes in elderly peoples' living arrangements have increased the need for formal services to share responsibility for the elderly with families. As services are developed, questions arise regarding the extent to which they have been adapted to the culture and norms of Arab society and meet that society's unique needs. This paper elaborates on some of these issues.

Aged↗
PubMed1992

The perceived impact of child care costs on women's labor supply and fertility.

In a sample of Detroit-area mothers of preschool-aged children interviewed in 1986, one-third reported that child care problems had constrained their employment. Such reports were relatively prevalent among poor women, those without relatives nearby, and those willing to entrust the care of their children to nonfamily members. Only one-tenth of the sample reported a similar child care constraint on fertility, a phenomenon unrelated to income but relatively prevalent among women with strong labor force attachment. The results suggest that policies to increase the supply of child care or to lower its cost could increase female labor supply by a substantial fraction, with an even greater rise among women most at risk of poverty and reliance on public assistance, but probably would not raise fertility significantly.

Adolescent↗
PubMed1994

Beverage alcohol spending in Singapore: an empirical update.

Data on Singapore suggest strongly that consumer spending on imported and locally produced beverage alcohol was on the rise from 1986 through 1991 just as it had been from 1978 through 1986. Although not alarming in contrast to countries such as South Korea, the rise could signal an emerging problem with both public health and economic growth implications. In terms of economic growth, Singapore's continued economic success and its future plans require a highly skilled labor force, but skilled local workers are in very short supply. Continued rises in spending on beverage alcohol could pose a potential constraint to labor availability and therefore continued material progress. On the public health side, a rise in spending on beverage alcohol could lead to illness and accidents that cause chronic absenteeism, decrease on-the-job productivity, and lead to the permanent loss of valuable workers through alcohol-related motor car and other fatal accidents. A minimalist intervention strategy featuring education and rehabilitation might therefore be a reasonable policy option for government to consider pursuing, both on economic development and public health grounds.

Alcoholic Beverages↗
PubMed1994

Managing diversity.

The U.S. work force is becoming increasingly diverse as the 20th century approaches. Statistics prove that most organizations are experiencing gender, culture, and age diversity within their labor forces. All managers and leaders must accept this diversity and work to handle it effectively. This article examines the current literature concerning management of diversity and its implications for the health care profession. Gender, culture, and age diversity and the potential problems that may arise with each are also addressed. Reasons to manage diversity are offered, as well as methods of managing diversity for both the manager and the chief executive officer.

Adolescent↗
PubMed1990

Metropolitan America: beyond the transition.

Americans have always gravitated toward cities, and for most of this century, urban growth has continued at a fast pace. During the 1970s, however, nonmetropolitan area grew at the expense of many large metropolitan areas, especially those in the industrial Northeast and Midwest. New patterns of population distribution appeared to be emerging. This Bulletin analyzes the trends of the 1970s, the shifting patterns of the 1980s, and likely prospects for future growth in metropolitan areas. The "rural renaissance" resulted from a combination of forces, including improved infrastructure in nonmetropolitan area, growing demand for retirement and recreation spots, the entrance of the large baby-boom cohort into the labor force, and the economic situation both at home and abroad. Some of these same forces have shifted settlement patterns in the 1980s, helping create "World Cities," like New York and San Francisco, and regional "Command and Control Centers" such as Atlanta and Minneapolis-St. Paul, that will continue to gain in both population and influence. Yet nonmetropolitan areas still attract retirees and other former urbanites. The distribution of minority groups among metropolitan populations is also undergoing significant change. The heavy immigration of Hispanics and Asians in the 1980s has increased the proportion of these groups, particularly in metropolitan areas in the South and West. More black Americans are moving to the suburbs formerly dominated by whites. Yet large pockets of poverty--of both black and whites--remain in both suburban and central city areas.

Black or African American↗
PubMed1995

Health problems of Maryland's migrant farm laborers.

The health problems of Maryland's agricultural migrant labor force are presented for the information of Maryland's health care providers. Maryland's problems are placed in the context of U.S. and worldwide migrant labor practices.

Adolescent↗
PubMed1990

Generational equity and the politics of the welfare state.

The concept of generational equity--that the nation is squandering its wealth on entitlements to the elderly while children remain impoverished--has received considerable media attention. The author traces the source of that message to an organization, Americans for Generational Equity, which is dedicated to restructuring the Social Security system along the lines of a social assistance program: reduced benefits available at later ages only to those who qualify through means tests. The impact of this agenda would be to increase the labor force participation of older people, particularly women and minorities, those presently without private pension coverage and already heavily represented in that sector of the economy where labor shortage is developing. Defining national spending priorities in terms of intergenerational conflict obscures the fact that Social Security is the only U.S. welfare program that has been successful in reducing poverty levels.

Age Factors↗
PubMed1990

Partial and flexible retirement: the Swedish system.

This study examines the effects of the Swedish partial pension system, which has been in place for more than 10 years, on the pattern of work force participation among older workers. The findings suggest that implementation of the policy altered the pattern of work behavior among older men, but did not affect female labor force behavior. Changes in pension compensation rates appear to have affected several aspects of participation in the partial pension, including the number of participants and hours of work.

Aged↗
PubMed2002

Impact of primary care depression intervention on employment and workplace conflict outcomes: is value added?

BACKGROUND: Depression causes significant functional impairment in sufferers and often leads to adverse employment outcomes for working individuals. Recovery from depression has been associated with better employment outcomes at one year. AIMS OF THE STUDY: The study s goals were to assess a primary care depression intervention s impact on subsequent employment and workplace conflict outcomes in employed patients with depression. METHODS: In 1996-1997, the study enrolled 262 employed patients with depression from twelve primary care practices located across ten U.S. states; 219 (84%) of the patients were followed at one year. Intent-to-treat analyses assessing intervention effects on subsequent employment and workplace conflict were conducted using logistic regression models controlling for individual clinical and sociodemographic characteristics, job classification and local employment conditions. To meet criteria for subsequent employment, persons working full-time at baseline had to report they were working full-time at follow-up and persons working part-time at baseline had to report working part-/full-time at follow-up. Workplace conflict was measured by asking patients employed at follow-up whether, in the past year, they had arguments or other difficulties with people at work . RESULTS: Findings showed that 92.1% of intervention patients met criteria for subsequent employment at one year, versus 82.0% of usual care patients (c2=4.42, p=.04). Intervention patients were less likely than usual care patients to report workplace conflict in the year following baseline (8.1% vs. 18.9%, respectively; c2=4.11; p=.04). The intervention s effect on subsequent employment was not mediated by its effect on workplace conflict. DISCUSSION: The intervention significantly improved employment outcomes and reduced workplace conflict in depressed, employed persons at one year. Economic implications for employers related to reduced turnover costs, for workers related to retained earnings, and for governments related to reduced unemployment expenditures and increased tax receipts may be considerable. LIMITATIONS: Although similar primary care depression interventions have been shown to produce comparable effects on subsequent employment at one year, replications in larger samples of depressed, employed patients in different economic climates may be necessary to increase the generalizability and precision of estimates. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Primary care interventions that enhance depression treatment and improve clinical outcomes can contribute meaningful added value to society by improving employment and workplace outcomes. IMPLICATIONS FOR HEALTH POLICIES: Federal/state governments may realize economic benefits from reduced unemployment expenditures and increased tax receipts should primary care depression interventions that improve employment outcomes be broadly disseminated. Policy initiatives to increase the dissemination of such interventions may be an innovative approach for improving labor force participation by depressed individuals. IMPLICATIONS FOR FURTHER RESEARCH: Formal cost-benefit analyses are needed to explore whether economic benefits to societal stakeholders from these and other labor outcomes equal or exceed the incremental costs of disseminating similar primary care interventions nationally. Researchers in other nations may wish to consider investigating the impact primary care depression interventions might have on employment and workplace outcomes in their countries.

Adult↗
PubMed1995

Links between early childhood programs and maternal employment in three countries.

Early childhood programs are usually viewed as a service that promotes children's development. In addition, these programs often serve a broader purpose of enabling mothers with young children to join the paid labor force. Therefore, government policies relating to the provision and use of child care programs reflect such economic and social factors as the demand for women workers in the labor market; expectations of the relationship among government, family, and the private market; and the value placed on maintaining traditional family structures with a breadwinner, a homemaker, and children. This article examines the evolution of policies toward maternal employment and child care provision in the United States, Sweden, and the Netherlands--three countries that differ sharply in the extent of government involvement in child and family policy, and in the emphasis government leaders place on promoting or discouraging maternal employment. This analysis shows that child care policy is best viewed as but one element among many that make it more or less likely that mothers of young children will be employed and will need to rely on early childhood programs to care for their youngsters. The design of tax codes, labor laws, parental leave policies, and cash assistance programs combines with child care policies to shape women's choices about employment.

Adolescent↗
PubMed1994

A feminist perspective on divorce.

Feminist perspectives on divorce proceed from the ways in which women's positions at divorce systematically differ from men's positions. Although there has been a large-scale increase in mothers' labor force participation, there has been no corresponding increase in fathers' domestic contributions, and women continue to bear the overwhelming responsibility for child rearing. In substantial part because of this division of labor within the family, divorcing women, on average, face bleaker financial prospects and enjoy closer emotional ties to their children than do their former husbands. Existing divorce law, with its emphasis on each party's self-sufficiency, limited provision for child support, and gender-neutral custody principles, does not fully recognize or address these differences. Feminists differ in the responses they propose to these issues. "Liberal feminists" believe that women's domestic responsibilities will inevitably place them at a disadvantage and favor policies that encourage men to assume a proportionate share of family responsibilities. "Cultural feminists," or "feminists of difference," believe that it is not the fact that women care for children but that child rearing is so undervalued which is the source of the problem. "Radical feminists" believe that it is impossible to know whether women's involvement in child rearing would differ from men's in a different society and focus on the ways in which marriage and work force policies perpetuate male dominance. All agree, however, that existing law contributes to the relative impoverishment of many women and children and that, even when the rules purport to be gender-neutral, they are administered in systematically biased ways.

Child↗
PubMedDate not supplied

[Changes in factors associated with the nutrition transition in Mexico].

OBJECTIVES: To describe the demographic and socioeconomic changes, food availability and food expense in Mexico during 1980-2000. METHODS: From official statistics (Population Census, FAO Food Balance Sheets, Family Income and Expense National Survey and Economic Census) we estimated the evolution of population distribution according to locality size, occupational structure, woman participation in the wage-earning labor force, minimum wage, availability of food establishments and expense in food. RESULTS: The percentage of the population that lives in urban areas has increased, they are employed in the tertiary sector, womens participation in the labor market has increased but real minimum wages have decreased. Vegetables, oleaginous, oils, fish and seafood availability have decreased whereas animal fat, vegetables, fruits, softdrinks, meats and egg availability have increased. The number of inexpensive restaurants (cocinas económicas and fondas) has also increased. Food expenses have decreased while amount of money spent in food consumed away from home has increased. CONCLUSIONS: In Mexico, the growth in urban areas and the tertiary job sector shows a parallel growth in the availability of high fat and protein food, a greater diet variety and more opportunities to consume food not prepared in the home. On the other hand, the sale of equipment and places designed for recreational physical activity have increased. By reducing employment in the primary sector it is foreseeable that labor intensive physical activity will become less important overtime.

Female↗
PubMed1978

Health policy and the underserved.

Historically, the provision of health benefits and health services has been wedded to the needs of an industrial society to maintain a productive labor force. The casual observer will note that since the late 19th century the role of government as a participant either in the provision for health services or the delivery of health services has been strongly tied to the labor movement in Western Europe. Overtime benefits, initially procured for the worker, were expanded to include the dependents of the worker and, finally, to include the former worker who was no longer able to work due to age or infirmity. The provision of health care to the poor was considered an act of charity and was never liberal enough to reward poverty nor was it essentially humane, for poverty was a condition to be punished. The rise of "alms houses" and public hospitals for the poor provided constant physical reassurance to the worker that he was, indeed, successful. Such institutions were also warnings to the worker lest he slip into the numbers of the poor.

Community Health Services↗
PubMed1999

PROFILE: Urban Stream Rehabilitation: A Design and Construction Case Study.

/ This paper describes the fundamental design features, and construction methods and sequence, of a rehabilitation project on a small suburban creek in Moscow, Idaho, USA. A meandering channel pattern was reestablished for approximately 280 m of straightened, dredged channel, a new floodplain was excavated, and the new riparian zone was replanted. The new stream channel was sized to accommodate an estimated natural bankfull discharge ( approximately 5.6 cms), and floodplain design attempted to match the conveyance of the old enlarged channel (14-20 cms). The project was coordinated by a local nonprofit environmental organization, and the design and construction were tailored to donated materials and a largely volunteer labor force. A high-magnitude flood event (ca. 50-year recurrence interval) six months after construction had no significant impact on the newly constructed channel and revetments, but underscored the need for important detailing of the structures. The use of volunteer labor, while entailing certain benefits, complicates project planning and construction. The most general lesson learned from this project is that sponsoring agencies and clients need to be informed of the many steps and sequencing of properly constructed, complex stream rehabilitation projects as well as the high time and cost requirements for these tasks. KEY WORDS: Stream corridor restoration; Channel design; Streambank revetments

Journal Article↗
PubMed2001

The political context of social inequalities and health.

This analysis reflects on the importance of political parties, and the policies they implement when in government, in determining the level of equalities/inequalities in a society, the extent of the welfare state (including the level of health care coverage by the state), the employment/unemployment rate, and the level of population health. The study looks at the impact of the major political traditions in the advanced OECD countries during the golden years of capitalism (1945-1980) -- social democratic, Christian democratic, liberal, and ex-fascist -- in four areas: (1) the main determinants of income inequalities, such as the overall distribution of income derived from capital versus labor, wage dispersion in the labor force, the redistributive effect of the welfare state, and the levels and types of employment/ unemployment; (2) levels of public expenditures and health care benefits coverage; (3) public support of services to families, such as child care and domiciliary care; and (4) the level of population health as measured by infant mortality rates. The results indicate that political traditions more committed to redistributive policies (both economic and social) and full-employment policies, such as the social democratic parties, were generally more successful in improving the health of populations, such as reducing infant mortality. The erroneous assumption of a conflict between social equity and economic efficiency, as in the liberal tradition, is also discussed. The study aims at filling a void in the growing health and social inequalities literature, which rarely touches on the importance of political forces in influencing inequalities. The data used in the study are largely from OECD health data for 1997 and 1998; the OECD statistical services; the comparative welfare state data set assembled by Huber, Ragin and Stephens; and the US Bureau of Labor Statistics.

Adolescent↗