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PubMed1994

AIDS in the workplace: implementing an AIDS policy.

Much needless anxiety and misinformation about AIDS exists today. Many people are concerned that they can "catch" AIDS in the workplace through casual contact with co-workers. AIDS is hard to get. It is not spread by nonsexual, person-to-person contact among workers, clients, and consumers in offices, schools, factories, or other workplaces. Managers of corporations should institute AIDS policies, addressing discrimination, confidentiality, infection control, and education, before the first cases of the disease emerge in the organization. It is predicted that about 90 percent of HIV-positive individuals are presently in the labor force; every American employer will have to come in contact with HIV/AIDS-infected employees in the near future. Any attempt to communicate positive messages--and reduce fear and confusion--leads to a more productive work environment, less discrimination, and more sensitivity regarding AIDS issues.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Managing our way to higher service-sector productivity.

In the two decades following World War II, U.S. productivity grew at an annual rate of 3%. But since the beginning of the 1970s, it has grown at only about 1%. Had the earlier rate been sustained, the gross domestic product would now be about $11 trillion instead of about $6.5 trillion. That extra $4.5 trillion per year in economic output would have had a profound impact on a wide range of social and economic problems. What is preventing a productivity revival in the U.S. economy? Clearly not the manufacturing sector, which has rebounded since the early 1980s. The service sector, on the other hand, has seen productivity growth rates stagnate during the same period. Why? Michael van Biema and Bruce Greenwald believe that the usual explanations are incomplete and have resulted in some serious misconceptions. The authors point out the limitations of those explanations and offer one of their own. They lay the blame in two places: the ineffectiveness of many service-sector managers at improving productivity and the inherent complexity of the sector itself. The authors argue that the problem is not a lack of resources; rather, it is that service sector companies operate below their potential. If managers focused on putting the existing technologies, labor force, and capital stock to work, rapid productivity growth would follow. Although the service sector is complex, the authors believe that managers would do well to apply the same tools, techniques, and policies that have been so effective in manufacturing sector. Doing so would help them keep their eye on the ball - the efficiency of basic operations.

Administrative Personnel↗
PubMedDate not supplied

Beware! Reengineering has arrived in health care.

This latest management fad can bring dramatic cost savings, but the savings often are through reduction in head count. Experience in other industries shows that the damage too much downsizing can cause occurs in short-term benefits, as well as over the long run. Readers are advised to participate actively in reengineering rather than to be content with others doing it for them. Research now underway in a number of New York City hospitals is exploring the effects of greater labor-force participation as a cost-effective and humane alternative to downsizing.

Consultants↗
PubMed1994

Bridge employment and job stopping: evidence from the Harris/Commonwealth Fund Survey.

This article analyzes a 1989 Louis Harris and Associates survey designed to elicit information on the employment histories and job-stopping behavior of men and women who then were approaching or had recently reached retirement age. The results indicate that retirement often occurs gradually and includes a substantial period of "bridge employment." Most bridge jobholders work full-time, by choice, and report high levels of job enjoyment. Occupational mobility occurring late in life typically involves upward movement, although the pattern of change is quite different when it takes place outside, rather than within, the longest job. The principal concern identified in this article is the limited ability of some groups of workers (nonwhites, females, the less educated, and those in poorly compensated occupations) to either retain longest jobs or to obtain acceptable bridge employment. Health problems also frequently lead to early departures from the labor force.

Aged↗
PubMed1976

Women's worklives and future social security benefits.

More women will earn social security benefits in their own right in the next 30 years than do so at present; their benefits will not necessarily rise in relation to men's benefits. For this to occur, the ratio of women's earnings to men's would have to rise markedly or young women would have to work most of their lives. The earnings ratio has stayed nearly constant, for 25 years at least. In this article, worklives of younger women are estimated from their own early experience plus the completed careers of women now retired. Though their total labor-force activity before retirement age will be greater than that of these older women, the increase will not be sufficient to compensate for the lengthening benefit-computation period. Benefits earned on their own records therefore will not supplant dependent and survivor benefits.

Age Factors↗
PubMed1976

Demographic characteristics of disability applicants: relationship to allowances.

This article highlights some of the causes underlying differences in disability allowances by sex and race. Among the causes are differences in labor-force patterns, the educational background, and the age distributions of the insured and applicant populations. More than half of the differences between the black and white applicants in the proportion of claims allowed is explained by differences in their age distributions. The lower proportion of claims allowed for black applicants may reflect the greater tendency fo the black insured population to apply for disability insurance benefits.

Adult↗
PubMed1983

Japanese productivity: adapting to changing comparative advantage in the face of lifetime employment commitments.

This article examines one of the possible sources of Japan's productivity growth--industrial policy. The policy actively encourages the transfer of resources, including labor, out of what are considered to be declining industries and sectors, and into industries and sectors considered to be expanding. At the same time, job security is guaranteed for a significant proportion of the labor force, and the article seeks to explain how Japanese "lifetime employment" can be maintained in the presence of the country's industrial policy.

Efficiency↗
PubMed1987

Proverbs provides guidelines for management in next century.

Management in the next century will require skills and techniques that focus on technology, financial planning, information processing, and other technical areas, but other critical management concerns cannot be ignored. The Chief of Naval Operations' Commission on Personal Excellence and National Security has defined education, health, and ethical behavior as the three critical national security issues in the next century. Certain trends in the United States--the shrinking size of the entry-level labor force, shortfall in high school graduates' ability to succeed in the workplace, escalating healthcare expenditures, and failure of training to produce its intended results--increase the need for managers to focus on these issues. Organizing people, groups, and organizations to achieve excellence requires a set of guidelines with proven sensitivity, truth in many situations, strength, and durability. The book of Proverbs, although 2000 years old, provides such rules that address the issues of education, health, and ethical behavior. These guidelines can be used to strengthen managers' ability to meet the challenges of the twenty-first century.

Administrative Personnel↗
PubMed1988

Estimates of the direct and indirect costs of acquired immunodeficiency syndrome in the United States, 1985, 1986, and 1991.

This study presents three estimates ranging from low to high of the direct and indirect costs of the acquired immunodeficiency syndrome (AIDS) epidemic in the United States in 1985, 1986, and 1991, based on prevalence estimates provided by the Centers for Disease Control (CDC). According to the author's best estimates, personal medical care costs of AIDS in current dollars will rise from $630 million in 1985 and $1.1 billion in 1986 and $8.5 billion in 1991. Nonpersonal costs (for research, screening, education, and general support services) are estimated to rise from $319 million in 1985 to $542 million in 1986 to $2.3 billion in 1991. Indirect costs attributable to loss of productivity resulting from morbidity and premature mortality are estimated to rise from $3.9 billion in 1985 to $7.0 billion in 1986 to $55.6 billion in 1991. While estimated personal medical care costs of AIDS in 1985 and 1986 represent only 0.2% and 0.3%, respectively, of such estimated expenditures for the U.S. population in these 2 years, they represent 1.4% of these estimated costs in 1991. Similarly, while estimated indirect costs of AIDS represent 1.2% in 1985 and 2.1% in 1986 of the estimated indirect costs of all illness, they are projected to rise to almost 12% in 1991. For estimating the indirect costs, the human capital method was used, and it was assumed that average wages and labor force participation rates of persons with AIDS were the same as those for the general population by age and sex.

Acquired Immunodeficiency Syndrome↗
PubMed1995

Empirical Dimensions of Discrimination Against Disabled People.

Where at one time professionals viewed disability as a condition inherent in a person, there now is widespread acceptance that, in large measure, disability is a social construct with roots in societal attitudes. Specifically, the case has been made by disabled people that they are the victims of discrimination. This paper reviews some of the empirical evidence of discriminatory practices in the areas of: access to education; meaningful participation in the labor force; and, physical and sexual assault. There is ample evidence of discriminatory practices in education and employment which further disadvantage disabled people. Disabled people receive less education and are much less likely to find a job than are non-disabled people and are much more vulnerable than the non-disabled to sexual or physical assault. Promoting and protecting the rights and dignity of disabled people will require a combination of legal approaches, attention to the concrete realities of disability and societal barriers, and changes in the perception of and societal attitudes towards disabled people.

Journal Article↗
PubMed1999

Fin-de-siècle Philadelphia and the founding of the Medical Library Association.

Philadelphia at the time of the founding of the Medical Library Association (MLA) is described. Several factors that promoted the birth of the association are discussed, including the rapid increase in the labor force and the rise of other health related professions, such as the American Hospital Association and the professionalization of nursing. The growth of the public hygiene movement in Philadelphia at the time of Sir William Osler's residency in the city is discussed. Finally, the rapid growth of the medical literature is considered a factor promoting the development of the association. This article continues the historical consideration of the MLA begun in the author's article on the three founders of the association. The background information is drawn from the items listed in the bibliography, and the conclusions are those of the author.

Health Occupations↗
PubMed1999

Trajectories of fetal loss in the Czech Republic.

Using data for 555,038 pregnancies conceived in the Czech Republic in 1987-1990, we show that pronounced differences in fetal survival in the middle trimester of pregnancy by marital status, educational level, and labor force attachment become much smaller at full term; survival differences by age at conception and number of previous deliveries show relatively constant proportional hazards throughout gestation. Social inequalities in postpartum life chances have been documented previously, but we show that similar inequalities exist before birth.

Abortion, Induced↗
PubMed1999

[Breast feeding in Puerto Rico: traditional patterns, national trends and future strategies].

The Puerto Rican society has gone through profound transformations during the past 50 years. Industrialization and the incorporation of women into the labor force have been accompanied by medicalization of the reproductive process and a progressive reduction in the prevalence of breastfeeding as the cultural norm for nutrition of infants. The data base for 1990 places Puerto Rico significantly below Latin America and the United States in the percentage of breastfed infants. The authors report their experience in the promotion of breastfeeding during the last 5 years. The principal negative factors which hinder the beginning and maintenance of successful breastfeeding are of a social nature. The orientation of physicians towards technology underrates the benefits of breastfeeding. The marketing strategies of the corporations which manufacture artificial milk continuously violate the International Code for Marketing of Breast Milk Substitutes and disfigure the community's perception on the benefits of breastfeeding. The lack of social and legal support for the breastfeeding working mother frequently prevents her from carrying out successful breastfeeding for the recommended period of time. Strategies are presented for the overturn of the existent barriers which have reduced breastfeeding in Puerto Rico to the present precarious levels.

Breast Feeding↗
PubMed2000

Alcohol consumption, alcohol dependence, and all-cause mortality.

BACKGROUND: This study examined the effects of alcohol consumption and DSM-IV alcohol dependence on the risk of mortality. METHODS: Data from the 1988 National Health Interview Survey Alcohol Supplement were matched to the National Death Index for the years 1988 to 1995 (baseline n = 37,682 U.S. adults age > or =25 linked to 3,586 deaths). All mortality analyses were based on proportional hazards models that adjusted for age, sex, race/ethnicity, marital status, education, income, labor force status, body mass index, smoking status, and poor health indicators at baseline. RESULTS: When dependence was not considered and all past-year abstainers were used as the reference group, both light and moderate drinkers exhibited a reduced risk of mortality, with hazards ratios of 0.76 (0.68-0.84) and 0.84 (0.74-0.96). Heavy drinkers had about the same risk of dying as did past-year abstainers, and very heavy drinkers had an increased risk that was not significant (OR = 1.17, CI = 0.93-1.47). When lifetime abstainers were used as the reference category, the protective effect of moderate drinking fell short of significance, and there were nearly significant increased risks among former drinkers and very heavy drinkers. When dependence was considered, light and moderate drinkers without dependence had a reduced mortality risk regardless of reference group, and there was no significant effect among heavy or very heavy drinkers without dependence. Among dependent drinkers, there was no protective effect of light or moderate drinking, and very heavy drinkers had a significantly increased risk (OR = 1.56 relative to past-year abstainers and 1.65 relative to lifetime abstainers). CONCLUSIONS: Because alcohol dependence nullifies the protective effect of light and moderate drinking, it is important to understand its role as an independent risk factor for mortality. Differences between dependent and nondependent drinkers who drank comparable amounts suggest that this risk may result from longer and heavier drinking histories before baseline, more severe health problems at baseline, more heavy episodic drinking, and, possibly, differences in beverage preference.

Adult↗
PubMed2000

The declining significance of race among American men during the latter half of the twentieth century.

The extent to which racial minority groups face discrimination in the labor market is the subject of considerable debate. Using William J. Wilson's thesis of the declining significance of race as our theoretical context, we provide further empirical evidence about labor market discrimination by investigating wages among African American, American Indian, Chinese American, Hispanic white, Japanese American, and non-Hispanic white men. We find, during the period before the civil rights movement, that a substantively significant wage disadvantage is evident for these minority groups with controls for observed labor force characteristics. In recent data, these net disadvantages are reduced substantially for each of these groups except Hispanics. With the exception of Hispanics, the results support Wilson's thesis.

Civil Rights↗
PubMed2000

Social roles as process: caregiving careers and women's health.

Is involvement in multiple roles beneficial for women's health or do the often noted health benefits of multiple roles reflect an ongoing process of role management? We address this question by looking at two roles, caregiving and employment, and by investigating changes in women's health as they move into and out of both roles. We examine changes in physical health limitations and psychological distress over a two-year period with data from a nationally representative sample of 2,929 late-midlife women. Looking first at health changes associated with caregiving, we find that psychological distress increases as women move into and continue caring for an ill or disabled person in their household. Caregiving has a weaker effect on physical health, but increases in physical limitations prompt exists from caregiving. Increases in physical limitations also appear to be greater for non-employed women, but some or all of this difference reflects selection out of the labor force for women having difficulty combining both roles. Our findings provide further evidence that care work has implications for women's health, while also suggesting a need for further attention to the ways that women actively manage problematic role combinations.

Aged↗
PubMed1999

Projecting retirement income of future retirees with panel data: results from the modeling income in the near-term (MINT) project.

Cross-sectional data capture only a point in time and miss individual changes in earnings, labor force participation, marriage, fertility, and health. Because panel data follow individuals over time, they do not have this problem. The problems or concerns with cross-sectional data may be compounded when these data are used to make projections. Iams and Sandell (1997) found that using panel data on earnings explained much more variation in future earnings than using cross-sectional survey data. Panel data are also needed to estimate Social Security benefits, especially for women. Because of auxiliary benefits paid to spouses, ex-spouses, and widow(er)s of entitled workers, an individual's Social Security retirement benefit depends not only on his or her earnings history, but also on his or her marital history and the earnings histories of current and previous spouses. When we compare projected unreduced Social Security benefits with what they would be if we didn't have marital history or earnings history data for men, we find that: Benefits computed using only earnings histories are not very different from benefits computed using both earnings and marital histories. Benefits computed using only current earnings and marital histories underestimate benefits for those in earlier birth cohorts and overestimate benefits for those in the most recent birth cohort. Benefits computed without either marital or earnings histories underestimate benefits for all birth cohorts, but by much more for earlier cohorts than for more recent cohorts. For women we find that benefits computed without marital or earnings histories underestimate benefits in all birth cohorts. The largest differences are for women in earlier birth cohorts. Using both marital and earnings histories to estimate unreduced Social Security benefits, we find that men are projected to continue receiving higher benefits than women, although the gap is expected to narrow as the baby boomers near retirement age. We also look at the composition of projected total income available at retirement for those with incomes in the 45th-55th percentiles of the income distribution and find that: Total income at retirement is projected to be larger for men than for women in every birth cohort. Women are projected to receive the largest share of their total income from Social Security benefits. Men are projected to receive the largest share of their total income from other income sources, although this share declines as the baby boomers near retirement age.

Cohort Studies↗
PubMed2000

Impact of health system factors on changes in human resource and expenditures levels in OECD countries.

In order to gain further insight into the system factors responsible for changes in the health workforce, this study undertook an empirical examination of the determinants of the size of the health workforce and overall health expenditures across fifteen OECD countries. Specifically, using the latest release of OECD data, the analysis estimated and evaluated the effects of variables such as the proportion of female physicians and the elderly, expenditures on ambulatory care, enrollment levels in training programs, level of public financing, and per capita income on the size of the health workforce and level of health spending between 1970-1991. The findings of this study help to place the problem of the changing health workforce within the context of the complexity of health systems. It confirms any understanding of what accounts for changes in the size of the health labor force and expenditures require disentangling the effects of variables which needs to be taken into account when considering health system reforms.

Australia↗