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PubMed2003

Effect of a multivitamin and mineral supplement on infection and quality of life. A randomized, double-blind, placebo-controlled trial.

BACKGROUND: Use of multivitamin and mineral supplements is common among U.S. adults, yet few well-designed trials have assessed the reputed benefits. OBJECTIVE: To determine the effect of a daily multivitamin and mineral supplement on infection and well-being. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Primary care clinics at two medical centers in North Carolina. PARTICIPANTS: 130 community-dwelling adults stratified by age (45 to 64 years or >or=65 years) and presence of type 2 diabetes mellitus. INTERVENTION: Multivitamin and mineral supplement or placebo taken daily for 1 year. MEASUREMENTS: Incidence of participant-reported symptoms of infection, incidence of infection-associated absenteeism, and scores on the physical and mental health subscales of the Medical Outcomes Study 12-Item Short Form. RESULTS: More participants receiving placebo reported an infectious illness over the study year than did participants receiving multivitamin and mineral supplements (73% vs. 43%; P < 0.001). Infection-related absenteeism was also higher in the placebo group than in the treatment group (57% vs. 21%; P < 0.001). Participants with type 2 diabetes mellitus (n = 51) accounted for this finding. Among diabetic participants receiving placebo, 93% reported an infection compared with 17% of those receiving supplements (P < 0.001). Medical Outcomes Study 12-Item Short Form scores did not differ between the treatment and placebo groups. CONCLUSIONS: A multivitamin and mineral supplement reduced the incidence of participant-reported infection and related absenteeism in a sample of participants with type 2 diabetes mellitus and a high prevalence of subclinical micronutrient deficiency. A larger clinical trial is needed to determine whether these findings can be replicated not only in diabetic persons but also in any population with a high rate of suboptimal nutrition or potential underlying disease impairment.

Diabetes Mellitus, Type 2↗
PubMed1987

Implementation and evaluation of a flexitime program involving pharmacy i.v. admixture technicians.

The purpose of this article is to describe the implementation of a flexitime program involving i.v. admixture personnel and to evaluate its impact on three work-related behaviors. Flexitime, also known as flex-time, is an alternative to the standard work schedule. Flexitime programs have been shown to have a positive effect on productivity, overtime, turnover, tardiness, absenteeism, and job satisfaction in various work settings. The i.v. admixture technicians and interns chose a flexitime program called the variable day. During both the baseline and the flexitime period, three work-related behaviors were measured: absenteeism, tardiness, and satisfaction. Tardiness was almost eliminated during the flexitime program; absenteeism decreased from 4.61% during the baseline period to 2.66% during the flexitime program, although this difference was not statistically significant. General job satisfaction did not significantly change during the flexitime program. Overall, all of the technicians favored the flexitime program and suggested that it be expanded to include the unit dose technicians. If future investigations support the usefulness of flexitime programs, pharmacy managers should consider its implementation as an additional strategy for reducing departmental costs.

Evaluation Studies as Topic↗
PubMed2000

[Detailed analysis of the societal costs of diabetes mellitus].

OBJECTIVE: Estimation of the societal costs of diabetes and related complications in support of the revision of the diabetes guidelines. DESIGN: Retrospective and descriptive cross-sectional study. METHODS: Relative risks (RRs) of diabetes complications, by age, were determined by comparing patients with and without diabetes. Using existing 1994 General Practitioner registry data on prevalence, on costs of illnesses and on absenteeism, the contribution of diabetes to the costs of other illnesses was estimated on the basis of aetiological fractions calculated with the RRs found. Cost due to absenteeism by diabetes complications were calculated using the friction method. RESULTS: In 1994, the societal cost of diabetes were 1.67 milliard Dutch guilders (1.55-1.87; range determined by applying the 95% confidence intervals of the RRs; in Euro: 758 million (703-848). The costs due to absenteeism from work were almost 0.2 milliard. The medical costs of diabetes were 2.5% of the health care budget. The contribution of diabetes to the medical costs of cardiovascular diseases was 14%.

Cost of Illness↗
PubMed2000

[Temporary work disability among firemen employed in rescue and fire brigades].

Workers of rescue and fire brigades participating in actions are exposed to harmful effect of toxic substances, chemicals or physical factors. They also experience enormous emotional shock evoked by direct threat or contact with victims of disasters and fires. The aim of the study was to define the pathology which increases the risk of temporary work disability among firemen. The study covered 150 firemen employed during the years 1994-97 in rescue and fire brigades selected at random. The data on the number of days and cases of work disability during the period of four years for each firemen covered by the study were analysed. In the group under study a mean annual number of work disability due to sickness accounted for 1443 days per 100 employed. The major causes of work disability were as follows: diseases of the respiratory system (22% of total sickness absenteeism); diseases of the nervous system and sense organs (19%); diseases of the musculoskeletal system (18%), diseases of the circulatory system (13%); mental disorders (8%); and diseases of digestive system (7%). Sickness absenteeism among workers of rescue and fire brigades was lower by 30% on average than that among men employed in the national economy. But in the 50-59 age group, it was higher by 68%. In this age group, the highest level of sickness absenteeism was associated with mental disorders (15 times higher than in other male occupational groups); diseases of the musculoskeletal system (higher by 53%); diseases of the respiratory system (2 times higher); neoplasms (7 times higher); diseases of the nervous system (higher by 46%). It should be stressed that the study revealed increased work disability due to lung (by 33%), bladder (6 times higher) and brain (over 3 times higher) cancers. The results of this study find their confirmation in many other epidemiological studies of this occupational group.

Adult↗
PubMed2002

Cost-outcome of anxiety treatment intervention in primary care in Hungary.

AIM OF THE STUDY: The purpose of this paper is to estimate the changes in health utilization and indirect costs of anxiety and affective disorders in primary care patients after initiation of mental health treatment. METHOD: This study was conducted in 12 general practices for the primary care of adult populations in Budapest, Hungary. Among 2,000 eligible patients aged 18 to 64 years, 1,815 gave written informed consent to participate in the study. The Hungarian version of the Diagnostic Interview Schedule (DIS) for anxiety and mood disorders was used to generate psychiatric diagnoses. For all patients, health care utilization data for the previous 12 months was collected including number of visits, specialist consultations, days spent in hospital, sick days in the last year and prescribed medication. Among the first 1,000 attenders, 151 patients were given DIS/DSM-III-R diagnoses of current anxiety and/or mood disorder or uncomplicated bereavement. Fifty-one patients who agreed to psychiatric treatment were assigned to the treatment group. After the first 1,000 participants, 75 patients were given DIS diagnoses and were considered as controls. In the treatment group, five psychiatrists administered treatment on an outpatient basis for one year. Patients in the control group received as-usual treatment from their primary care physicians. After one year, health care utilization data for the study period was collected. For the purposes of this study, the direct costs considered were limited to health care expenses and the indirect costs were limited to lost workdays. Statistical significance was calculated using a paired-samples T-test procedure comparing the means of two variables for a simple group. RESULTS: In the treatment group, the total cost of prescription drugs increased sharply due to psychiatric drug treatment, thus increasing the direct overall costs of care. In this same group the cost of non-psychiatric drugs showed a 37% decrease, suggesting that a reduction in general medical treatment partially offset the costs of anxiety and depression treatment. The number of hospital days showed marked decrease in the treatment group and a slight, insignificant increase in the control group. Absenteeism fell sharply in the treatment group (-56%) and in the group of patients who received psychiatric treatment elsewhere (-62%). In the control group, there was a large upturn (+182%) in the number of days spent on sick leave. DISCUSSION: Among primary care patients diagnosed with anxiety or affective disorders, psychiatric treatment led to higher direct costs, but this was offset by a decline in indirect costs due to reduced absenteeism compared with ordinary primary care. LIMITATIONS: Patients were not assigned randomly to the different groups because of ethical concerns. There were also significant differences in the baseline characteristics of the groups. Differences in the severity of illness and reasons not attributable to treatment effects may play a role in the change in the rate of service use. IMPLICATIONS FOR HEALTH POLICY: Limiting anxiety patients access to psychiatric treatment causes an increase in absenteeism, thus resulting in higher indirect costs.

Adolescent↗
PubMed2005

Asthma and tobacco: double trouble for Wisconsin adolescents.

BACKGROUND: Environmental tobacco smoke (ETS) exposure has been identified as a cause of asthma and a trigger of asthma attacks in children. We examined the relation of demographic and tobacco-related risk factors to both lifetime asthma diagnosis and the asthma attack rate among Wisconsin adolescents. The impact of asthma on adolescent school absenteeism was also examined. METHODS: Data used were from the 2004 Wisconsin Youth Tobacco Survey (n=3125), which was administered in a sample of Wisconsin public middle and high schools. Multivariable logistic regression was used to examine risk factors simultaneously. RESULTS: Self-reported lifetime asthma prevalence was 19% among Wisconsin adolescents. Thirty-five percent of adolescents with asthma reported having an asthma attack in the past 12 months. Living with a smoker was a significant predictor of lifetime asthma diagnosis and, among adolescents with asthma, daily ETS exposure was associated with a 2-fold increased risk of having an asthma attack. Being diagnosed with asthma did not deter adolescents from smoking and was a significant predictor of school absenteeism. CONCLUSIONS: Asthma is an important health problem for Wisconsin adolescents. Tobacco-related risk factors contribute to the burden of the disease. Interventions to reduce smoking and ETS exposure targeted to adolescents and their guardians are needed. Better asthma control among adolescents could reduce school absenteeism.

Adolescent↗
PubMed2006

A randomized, double-blind, placebo-controlled, clinical trial of the impact of malaria prevention on the educational attainment of school children.

A double-blind, placebo-controlled trial of nine months duration was carried out to investigate the impact of malaria and its prevention on the educational attainment of school children in a malaria-endemic area in southern Sri Lanka where both Plasmodium falciparum and P. vivax infections are prevalent. A total of 587 children attending grades 1-5 in four schools and resident in the area were randomly allocated to chloroquine (n = 295) and placebo (n = 292) arms. Language and mathematics scores of end-of-term school examinations for 1998 and 1999 and number of days absent and reasons for absenteeism during seven months pre-intervention and nine months of the intervention were recorded. The results indicate that there were no differences in language (95% confidence interval [CI] = 48.44-53.78 in chloroquine group and 50.43-55.81 in placebo group) and mathematics (95% CI = 49.24-54.38 in chloroquine group and 51.12-56.38 in placebo group) scores between the two groups prior to the intervention. During the intervention, the malaria incidence rate decreased by 55% (95% CI = 49-61%) and school absenteeism due to malaria was reduced by 62.5% (95% CI = 57-68%) in children who received chloroquine compared with the placebo group. Post-intervention, children who received chloroquine scored approximately 26% higher in both language (95% CI = 21-31%) and mathematics (95% CI = 23-33%) than children who received placebo. In a multivariate model, educational attainment was significantly associated with taking chloroquine prophylaxis and absenteeism due to malaria (P < 0.001 for both) but not due to health causes other than malaria or non-health causes. Language scores were associated with number of malaria attacks (P < 0.022). Educational attainment was significantly better among children whose compliance to chloroquine prophylaxis was higher (P < 0.001). The data suggest that malarial attacks have an adverse impact on the educational attainment of the school child and prevention of these attacks significantly improves educational attainment of children living in malaria-endemic areas.

Achievement↗
PubMedDate not supplied

[Dyspepsia and Helicobacter pylori infection. A study of a population of workers].

We studied 102 workers in a mechanical factory. All subjects were tested by a questionnaire screening dyspeptic symptoms in the last three months, their frequency, absenteeism period, spontaneous drugs intake and a consultant gastroenterologist request. All subjects were tested for specific IgG against Helicobacter pylori with immunoassay Elisa. Dyspepsia was present in 61% of cases. Positivity for Helicobacter pylori infection was in 76%, absenteeism in 82%, consultant request in 21% of dyspeptic workers. Our results suggest, according to literature, the high frequency of Helicobacter pylori infection in dyspeptic patients: furthermore dyspepsia should be considered as an important cause of absenteeism.

Adult↗
PubMed1990

Individual differences in adrenaline/noradrenaline reactivity and self-perceived health status.

The excretion rate of adrenaline and noradrenaline in urine was tested at 168 male workers of various professions at the age of 20 years up to 60 years, during daily work and on a free Sunday. It has been shown that adrenaline and noradrenaline excretion rates increase with age. The differential reactivity of adrenaline and of noradrenaline are not related to age. The differential reactivity of adrenaline, but not noradrenaline is related to the self-reported health status of the subject, measured several weeks before the field study itself. It is not related to absenteeism. In special studies on busdrivers a differential reactivity in adrenaline was found with respect to absenteeism. The results of the present study indicate, that this effect is probably accounted for by the component of health and wellbeing that is incorporated in the absenteeism figures.

Adult↗
PubMed2003

Burden of asthma in inner-city elementary schoolchildren: do school-based health centers make a difference?

BACKGROUND: About 1400 school-based health centers (SBHCs) provide care to 1.1 million children. However, it is unknown if access to on-site services is associated with a better outcome. OBJECTIVE: To compare outcomes including hospitalizations, emergency department visits, and school absenteeism in elementary schoolchildren with asthma who were grouped according to their enrollment at schools that have or do not have SBHCs. SETTING: Six elementary schools in The Bronx, NY (4 schools with and 2 without SBHCs). PARTICIPANTS: Nine hundred forty-nine inner-city schoolchildren with asthma. DESIGN: To collect baseline data for a longitudinal study, we surveyed parents to identify children with asthma, and to obtain information about symptoms and the use of health services in the last 12 months. Participating schools provided absenteeism information. RESULTS: Of 6433 parents surveyed, 74% completed the questionnaires. The prevalence of asthma was 19.9% and the morbidity was high-during the previous year, 46.2% had been treated for asthma in an emergency department; 12.6% had been hospitalized. Emergency department use was not associated with SBHCs. However, in univariate and multivariate analyses, the rate of hospitalization was higher among children enrolled at schools without an SBHC (rate ratio, 1.5; 95% confidence interval, 1.1-1.9). In addition, schoolchildren with asthma enrolled in the schools without an SBHC missed more days of school than those enrolled in schools with an SBHC (mean [SD], 21.3 [15.4] vs 18.2 [13.0], respectively; P =.02). CONCLUSION: Access to SBHCs was associated with a reduction in the rate of hospitalization and a gain of 3 days of school for schoolchildren who have asthma.

Absenteeism↗
PubMed1989

Wife abuse as it affects work behavior in a center for mentally retarded persons.

This study examined differences between conjugally abused and nonabused female employees at a state-supported ICF/MR residential facility in relation to the potential for client abuse, absenteeism rates, and performance ratings. The research was conducted at a rural institution for mentally retarded persons at which approximately 72% of the workforce was female. A survey package composed of demographic questions, the Child Abuse Potential Inventory (Milner, 1980), and other self-report questions that concerned abuse was distributed to all permanent female employees. The survey return rate was 31.7%. Analysis of the data indicated a significant difference between CAP scores for emotionally and physically abused women and their nonabused counterparts (p less than .01). When a CAP score of 215 was used as a cut-off, 44% of the abused women were classified into the potential abuser category. No significant differences were revealed between categories of abuse and measures of absenteeism or performance appraisal scores.

Absenteeism↗
PubMed1988

Long-term sickness absence due to back disorders in crane operators exposed to whole-body vibration.

In a retrospective (10-year) follow-up study, the incidence of at least one spell of sickness absenteeism of 28 d or longer in crane operators exposed to whole-body vibration and a control group was investigated. In contrast to a previous study on permanent work disability in the same groups, no difference was observed in long-term sickness absenteeism because of lumbar disorders. Spells of sickness absence due to intervertebral disc disorders did last longer in the index group and also more disability pensions with this diagnosis were recorded in the index group. This indicates that these disorders particularly interfere with the work of a crane operator. Exposure to whole-body vibration and strained posture are considered to be responsible for this situation.

Absenteeism↗
PubMed2000

A randomized field trial of ACINDES: a child-centered training model for children with chronic illnesses (asthma and epilepsy).

UNLABELLED: A randomized field trial of a child-centered model of training for self-management of chronic illnesses was conducted of 355 Spanish-speaking school-aged children, between 6 and 15 years old, with moderate to severe asthma and epilepsy, in Buenos Aires, Argentina. The model, based on play techniques, consists of five weekly meetings of 8-10 families, with children's and parents' groups held simultaneously, coordinated by specially trained teachers and outside the hospital environment. Children are trained to assume a leading role in the management of their health; parents learn to be facilitators; and physicians provide guidance, acting as counselors. Group activities include games, drawings, stories, videos, and role-playing. Children and parents were interviewed at home before the program and 6 and 12 months after the program, and medical and school records were monitored for emergency and routine visits, hospitalizations, and school absenteeism. In asthma and epilepsy, children in the experiment showed significant improvements in knowledge, beliefs, attitudes, and behaviors compared to controls (probability of experimental gain over controls = .69 for epilepsy and .56 for asthma, with sigma2 = .007 and .016, respectively). Parent participants in the experiment had improved knowledge of asthma (39% before vs. 58% after) and epilepsy (22% before vs. 56% after), with a probability of gain = .62 (sigma2 = .0026) with respect to the control group. Similar positive outcomes were found in fears of child death (experimental 39% before vs. 4% after for asthma, 69% before vs. 30% after for epilepsy), as well as in disruption of family life and patient-physician relationship, while controls showed no change. Regarding clinical variables, for both asthma and epilepsy, children in the experimental group had significantly fewer crises than the controls after the groups (P = .036 and P = .026). Visits to physicians showed a significant decrease for those with asthma (P = .048), and emergency visits decreased for those with epilepsy (P = .046). An 18-item Children Health Locus of Control Scale (CHLCS) showed a significant increase in internality in experimental group children with asthma and epilepsy (P < .01), while controls did not change or performed worse 12 months after the program. School absenteeism was reduced significantly for those with asthma and epilepsy (for the group with asthma, fall/winter P = .006, and spring P = .029; for the group with epilepsy, P = .011). CONCLUSION: The program was successful in improving the health, activity, and quality of life of children with asthma and epilepsy. The data suggested that an autonomous (Piagetian) model of training is a key to this success, reinforcing children's autonomous decision making.

Absenteeism↗
PubMedDate not supplied

Do hospital employees benefit from the influenza vaccine? A placebo-controlled clinical trial.

Although current guidelines target hospital employees who contact high-risk patients as a high priority for influenza immunization, there are few data to support or refute this recommendation. Therefore, the authors enrolled 179 hospital employees in a randomized double-blind placebo-controlled clinical trial during the 1985-1986 influenza season. Influenza immunization was performed without serious adverse reactions and there was no increase in absenteeism attributable to the vaccination. Among those who developed clinical influenza, there was a trend toward fewer days of illness in the vaccinated group compared with the placebo group (6.0 vs. 8.0, p = 0.07). There were no statistically significant differences between subjects receiving influenza vaccine and those receiving the placebo when comparing incidences of influenza-like illness, severities of illness, and sick absenteeism. Influenza immunization of hospital employees was performed at minimal cost and risk but provided little benefit, most likely because of an unexpected drift of the prevalent influenza strain away from the vaccine type.

Absenteeism↗
PubMed2004

Low back pain in a cohort of 622 Tunisian schoolchildren and adolescents: an epidemiological study.

Low back pain (LBP) in children was considered for many years to be a rare condition revealing a serious disease, but in the last two decades, epidemiological studies have shown that the prevalence of nonspecific LBP in children is high. This study was aimed at analyzing the prevalence, severity, consequences and associated factors of LBP in children. A cross-sectional study was undertaken in two preparatory schools in the city of Monastir, Tunisia, in April 2002. This study included a total of 622 children and adolescents--326 females and 296 males--with a mean age of 14 years (range: 11-19 years). They completed the questionnaire in the presence of the physician. For the first 201 questionnaires collected, the corresponding children and adolescents underwent a spine medical examination, with evaluation of pain by visual analog scale if LBP was present. A stepwise logistic regression analysis was carried out to determine the risk factors associated with LBP and chronic LBP. The cumulative lifetime prevalence of LBP was 28.4%. Eight percent of the subjects suffered from chronic LBP. LBP was responsible for 23% of school absenteeism and 29% for sports absenteeism. Medical care requirement was observed in 32.2% and psychological symptoms in 75%. Stepwise logistic regression analysis showed that three factors were associated with LBP: school failure (held back 1 year), odds ratio (OR) =2.6 (95% confidence interval [CI], 1.96-3.44), family history of LBP (parental or sibling LBP), OR=3.80 (95% CI, 2.94-5.92), dissatisfaction with school chair (in height and comfort), OR=3.40 (95% CI, 2.24-5.29). Two factors were associated with chronic LBP: dissatisfaction with school chair, OR=1.62 (95% CI, 1.46-3.32) and football playing, OR=3.07 (95% CI, 2.15-5.10). The prevalence of LBP among Tunisian schoolchildren and adolescents is high. This requires preventive measures and longitudinal studies, which are very important from the standpoint of public health.

Absenteeism↗
PubMed2006

Evaluation of influenza vaccination in health-care workers, using rapid antigen detection test.

A study was conducted to assess the effectiveness of trivalent influenza vaccine in preventing influenza and reducing absenteeism in health-care workers of Gifu Red Cross Hospital during the 2002-2003 influenza season. Questionnaires were distributed to 370 health-care workers, and 366 were returned showing that 237 had received influenza vaccine and 129 were unvaccinated. The criterion for influenza was febrile episodes with a positive reaction on a rapid antigen detection test. Among vaccine recipients, the number of influenza infections was 3.4 per 100 subjects, compared with 8.5 per 100 subjects in nonrecipients (P = 0.034), and the number of days absent from work per 100 subjects was 9.5, compared with 15.1 per 100 subjects in nonrecipients (P = 0.0003). The prevalence of adverse reactions to the vaccine was rather low. No serious adverse reactions were recorded and no one was absent from work because of adverse reactions. It is concluded that influenza vaccine is effective in preventing influenza and reducing absenteeism in health-care workers. The results of this study support recommendations for influenza vaccination in health-care workers.

Absenteeism↗
PubMed1990

Cost-effectiveness of cimetidine maintenance therapy in chronic gastric and duodenal ulcer.

The effects of cimetidine maintenance therapy on the socioeconomic life of patients with peptic ulcers in the 3 years after healing and the extent to which treatment was cost-effective were studied. Three hundred eleven patients with healed ulcers (184 gastric, 127 duodenal) were studied for periods of up to 3 years; 261 patients (152 gastric ulcer, 109 duodenal ulcer) completed the 3-year follow-up. Cimetidine (400 mg at night) was compared with placebo in a double-blind, randomized prospective study. Intention-to-treat analysis was used. In the placebo group, the major costs of ulcer disease in gastric ulcer patients were attributable to endoscopic procedures and absenteeism; in duodenal ulcer patients, the major costs were endoscopic procedures, absenteeism, and surgery. Cimetidine was cost-effective in both gastric ulcer and duodenal ulcer patients in the first 2 years after healing. Over the 3-year period it was also cost-effective, but no benefit was seen in the third year.

Absenteeism↗
PubMed1984

Effects of labelling on income, work and social function among hypertensive employees.

Two hundred and thirty hypertensive Canadian steelworkers were followed for 5 years after screening and referral. Data on income, absenteeism and measures of work and social function were collected on these men and on a matched group of 230 normotensive employees. In the fifth year after screening, hypertensive employees earned an average of Can. $1093 less than normotensive employees despite similar incomes in the year before screening. This adverse effect on income was observed regardless of awareness of hypertension at the time of screening or compliance with treatment. Illness-related absenteeism among hypertensives rose in the year following screening and remained elevated for 4 years after screening. Normotensive and hypertensive employees reported similar levels of physical ability and psychological well-being. These findings need verification in other settings before inclusion in cost-effectiveness analyses of the management of hypertension.

Absenteeism↗