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PubMed2004

Quality of care in the nursing home: effects of staff assignment and work shift.

PURPOSE: The purpose of this study was to compare a variety of resident and staff outcomes across two types of staffing patterns, permanent and rotating assignment, and work shift. Although studies have examined these staffing patterns as part of multicomponent intervention packages, few studies have examined the isolated effects of staffing pattern by using an experimental design. DESIGN AND METHODS: A between-groups comparison design was used to compare residents and certified nursing assistants (CNAs) from four nursing homes; two self-identified as using permanent assignment (PA) staffing and two as using rotating assignment (RA) staffing. Measures yielded data on verbal interaction among residents and staff, resident disruptive behavior, and specific aspects of resident-staff behavior during care routines. Other assessments included resident personal appearance and hygiene, expressed affect, and CNAs' job satisfaction, burnout, absenteeism, and turnover rates. A treatment fidelity check was conducted to confirm PA and RA staffing patterns. RESULTS: Staffing patterns were significantly different between self-identified PA and RA nursing homes. Residents in PA nursing homes and on morning shifts received significantly higher ratings of personal appearance and hygiene. Rates of expressed sadness and interest among residents differed by staffing patterns and shift. However, these differences do not appear to be clinically significant. Although absenteeism was higher in PA nursing homes, these CNAs reported greater job satisfaction than CNAs from RA nursing homes. As expected, evening shifts across nursing homes had significantly higher turnover rates and significantly more resident disruptive behavior. IMPLICATIONS: Quality-of-care outcomes were similar among the two types of nursing homes, despite significantly different staffing patterns. Though staff permanency rates in PA nursing homes (50%) were twice that of RA nursing homes (26%), more research is needed to determine feasibility of higher rates of staff permanency (i.e., > 50%) and effects on resident and CNA outcomes.

Aged↗
PubMed1996

Comparison of US inactivated split-virus and Russian live attenuated, cold-adapted trivalent influenza vaccines in Russian schoolchildren.

In a blinded, placebo-controlled study, the reactogenicity, immunogenicity, and clinical efficacy of single doses of US inactivated split-virus and Russian live attenuated, cold-adapted influenza vaccines were compared in 555 schoolchildren in Vologda, Russia. Serial serum samples were collected and school absenteeism was assessed. Systemic reactions were rare, but local reactions (primarily erythema at the injection site) were observed in 27% of the inactivated vaccine group, and coryza (12%) and sore throat (8%) were observed in the attenuated vaccine group. At 4 weeks after vaccination a > or = 4-fold rise in titer of hemagglutination inhibition antibody to A (H1N1), A (H3N2), and B was noted, respectively, among 78%, 88%, and 53% of children who received inactivated vaccine and among 55%, 79%, and 30% of children who received attenuated vaccine. The vaccine efficacy for preventing school absenteeism due to respiratory illness during the period of peak influenza activity was 56% for inactivated vaccine and 47% for attenuated vaccine.

Antibodies, Viral↗
PubMed1989

The quality of care of the elderly.

During this century, the number of people over 65 years of age increased 4-fold, and that of 85 year olds, 7-fold in England. In Sweden, 80% of those over 85 live alone, and those over 65 use 60% of the health care resources. One hospital bed is required for 28 nonagenarians, of whom 20% live in institutions in America and 50% in Sweden. Of institutional residents, 90% need help dressing, bathing, and/or moving, and 69% have difficulty seeing. Of octagenarians, 20% are senile, and every fourth woman over 65 has suffered fractures caused by osteopenia, the incidence of which increases by 6% per year. The Swedish staff of nurses aids employed for the care of the elderly was 95,000 in 1984 and 123,000 in 1988. An increase of between 40,000 and 70,000 is going to be needed in the future. In addition, the annual staff turnover of 25% has to be replaced, and replacements have to be found for the annual sick absenteeism of 45 days per employee. The cost for absenteeism and turnover in this category of staff alone amounts to 3% of the total Swedish health care budget. Even though the present quality of the care for the elderly is frequently considered unsatisfactory in Sweden, both in institutions and at home, the task to improve or even only to maintain this quality is monumental.

Aged↗
PubMed1983

Influenza B virus infections in the community and the family. The epidemics of 1976-1977 and 1979-1980 in Houston, Texas.

Influenza B virus epidemics occurred in Houston, Texas, in 1976-1977 and 1979-1980. Among families with young children followed longitudinally in the Houston Family Study, 112 infections were detected during 511 person-years of observation. The infection rates for the two epidemics were similar--24 per cent and 20 per cent--although the two epidemics differed greatly in the community. The first epidemic was much more intense with a mid-winter peak that produced school absentee rates above 12 per cent for four consecutive weeks. The indolent epidemic of 1979-1980 smoldered from late September to mid-April with a peak during the second week of March for which school absenteeism did not exceed 8 per cent. In the Houston Family Study population, the combined infection rate for the two outbreaks was highest at 35 per 100 person-years for school children aged 6-19 years. Preschool children aged 7 months-5 years and adults had infection rates of 31 and 16 per 100 person-years, respectively. Preexisting neutralizing antibody titers greater than or equal to 3.5 log2 protected against influenza B infection and illness. Preschool children above 6 months of age, school age children, and parents introduced infection into the family at rates of 15, 15, and 9 per 100 person-years, respectively. Three second introductions were observed. The secondary infection rate was highest among school aged children at 61 per 100 persons at risk.

Adolescent↗
PubMedDate not supplied

The effects of cognitive-behavioral and physical therapy preventive interventions on pain-related sick leave: a randomized controlled trial.

OBJECTIVE: Recent recommendations suggest that reassuring patients with an acute bout of low back pain and encouraging a return to normal activities may be helpful in preventing the development of chronic disability. There is also a question as to whether psychologic or physical therapy interventions actually add anything to such reassurance and advice in terms of preventing chronicity. This study aimed to ascertain the preventive effects on future sick leave and health-care utilization of adding on a cognitive-behavioral group intervention or a cognitive-behavioral group intervention and preventive physical therapy (focused on activity and exercise) relative to a minimal treatment group (examination, reassurance, and activity advice). SUBJECTS: A total of 185 patients seeking care for nonspecific back or neck pain who were employed and at risk for developing long-term disability volunteered to participate in the study. Of these 185, 158 (85%) completed the pre- and 1-year follow-up assessments. RESULTS: Significant differences were observed on the key outcome variables of future health-care utilization and work absenteeism. For health-care utilization, the cognitive-behavioral intervention group and preventive physical therapy group had significantly fewer healthcare visits than did the Minimal Treatment Group. For work absenteeism, the cognitive-behavioral intervention group and cognitive-behavioral intervention and preventive physical therapy group had fewer days during the 12-month follow-up than did the Minimal Treatment Group. The risk for developing long-term sick disability leave was more than five-fold higher in the Minimal Group as compared with the other 2 groups. However, there was no difference between the cognitive-behavioral intervention group and cognitive-behavioral intervention and preventive physical therapy group on sick leave. CONCLUSION: Taken as a whole, this study shows that adding cognitive-behavioral intervention and cognitive-behavioral intervention and preventive physical therapy can enhance the prevention of long-term disability. There was no substantial difference in the results between the cognitive-behavioral intervention group and cognitive-behavioral intervention and preventive physical therapy group.

Back Pain↗
PubMedDate not supplied

A comparison of school performance and behaviors among working and nonworking high school students.

To evaluate the effect of after-school employment on Grade Point Average, absenteeism, school tardiness, extracurricular activities, and class-cutting, a cross-sectional anonymous questionnaire was completed by 7,506 high school students in May 2002. Working students did not report lower grades, higher absenteeism, or more school tardiness than their nonworking peers. However, students who worked were significantly more likely to cut classes and not take part in extracurricular activities than were students who were not employed. Factors associated with lower Grade Point Average among working students included working before 8:00 AM (adjusted odds ratio [AOR] = 1.73, 95% CI = 1.18-2.52), being injured at work (AOR = 1.47, 95% CI = 1.10-1.96), and feeling that the job was more important than school (AOR = 2.74, 95% CI = 2.08-3.60).

Achievement↗
PubMed1999

Incidence and impact of childhood and adolescent injuries: a population-based study.

BACKGROUND: The study of disabilities, use of health services, and absenteeism of parents among 0- to 17-year-old residents of Jerusalem (n = 432) hospitalized for unintentional injuries. METHODS: Telephone interviews with parents, 6 months after hospitalization. Disabilities among 4 to 17 year olds were measured by a 25-item scale derived from the International Classification of Impairments, Disabilities, and Handicaps and by limitations of activities. RESULTS: Six months after the injury, limitations ranged from 8.3% (daily activities) to 19.4% (sport activities). About one in three presented at least one disability in the 25-item scale. All disabilities were present in higher proportions among adolescents. The more severe injuries whether to the head or other parts of the body presented higher percentages of disabilities. Burns and traffic crashes were associated with higher proportions of disabilities than other causes and with more frequent work absenteeism by their parents. CONCLUSION: A relatively large proportion of children remain with long-term disabilities irrespective of cause and body part injured. Because the sequelae of injuries is multifaceted, rehabilitation should include coordination between health and other services.

Activities of Daily Living↗
PubMed1998

A population-based study of spinal pain among 35-45-year-old individuals. Prevalence, sick leave, and health care use.

STUDY DESIGN: A questionnaire was mailed to 3000 randomly selected 35-45-year-old individuals in three communities in central Sweden. OBJECTIVES: To study the 1-year prevalence of spinal pain and its ramifications in the form of pain, function, sick leave, and health care use. SUMMARY OF BACKGROUND DATA: Previous researchers have used a variety of definitions and populations, but primarily have investigated the occurrence of pain. Comprehensive data are needed concerning health care use, the degree of the pain problem, functional disturbances, and sick leave. METHOD: Participants in the study completed a questionnaire regarding spinal pain during the past year including the degree of their experienced pain, functional impairment, lost work days, and health care use. RESULTS: A total of 2305 people (78.5%) responded to the questionnaire. Nonrespondents had similar characteristics but a slightly lower 1-year prevalence rate than did respondents. For respondents, the prevalence of spinal pain during the past year was 66.3%, with women having a slightly higher prevalence than men. Approximately 25% of the respondents indicated that they had a substantial problem based on ratings of pain, functional impairment, and sick leave. Work absenteeism reported to the Public Social Insurance Office involved 19% of those with pain, but an additional 15% indicated unreported absenteeism. On average, those with pain visited health care providers three times during the past year, but a small number of those who experienced pain consumed large amounts of health care and illness benefits. An important gender difference was shown, such that when pain was at its worst, men took sick leave, whereas women sought health care. CONCLUSIONS: Taken together, these data indicate that spinal pain is common among 35-45-year-old men and-women, and that it is related to marked problems for approximately one fourth of those who experience pain. Gender differences exist in the pattern of sick leave and health care use, and a small proportion of those with pain consume very large amounts of the resources. Consequently, there is a need for early, effective, preventive treatments.

Adult↗
PubMed2001

Long-term assessment of a sanitary education and lumbar rehabilitation program for health care workers with chronic low back pain at the University Hospital of Lille.

A back school was established in 1992 at the University Hospital of Lille (France) for employees with low back pain. We report its medical and socioeconomic benefits with a mean time to follow-up of 4 years. Our retrospective study included 108 health care workers and provides objective data (absenteeism, use of health care) and subjective information (progression of pain and disorder, social and professional impact) before training and a mean of 4 years after training. We found that 92% of the participants were satisfied with the training and that back pain had regressed or resolved for 55% of them. Both the frequency and duration of pain had decreased significantly. Seventy percent continue to apply the advice they received in their everyday life. Dealing with the problems specific to professional activities contributed to reduce the strain experienced on the job by the health care workers and improved their satisfaction at work. Global absenteeism was reduced by 57.8%, whereas it was reduced by 33% for back pain alone 4 years after implementing this program. Our study provides evidence of the positive impact of this type of training on the way back pain is perceived and on everyday life. The assessment of the cost/efficiency ratio completes the list of durable benefits reported here.

Adult↗
PubMed2006

Information and low back pain management: a systematic review.

STUDY DESIGN: A systematic search of three electronic databases was done to identify randomized controlled trials on the effect of written or audiovisual information in low back pain. OBJECTIVES: To determine whether information is an effective preventive action and/or therapy for low back pain and which type of information is most effective. SUMMARY OF BACKGROUND DATA: Information is commonly used in the primary care of low back pain and mostly delivered by booklets. METHODS: A systematic computer-aided search of the Medline, PsyclInfo, and Embase database. A rating system was used to assess the strength of the evidence, based on the methodologic quality of the randomized controlled trials, the relevance of the outcome measures, and the consistency of the results. RESULTS: Eleven randomized controlled trials were selected, including seven trials of high methodologic quality, as well as one parallel group controlled survey and one longitudinal study. Only three of the seven high-quality studies showed favorable results for information. There is strong evidence that a booklet increases knowledge and moderate evidence that physician-related cues increase the confidence in a booklet and adherence to exercises. There is limited evidence that a biopsychosocial booklet is more efficient than a biomedical booklet to shift patient's beliefs about physical activity, pain, and consequences of low back trouble. There is strong evidence that booklets are not efficient on absenteeism and conflicting evidence that they are efficient on healthcare use. There is no evidence that e-mail discussion or video programs alone are effective to reduce low back pain, disability, and healthcare costs. CONCLUSIONS: Information based on a biopsychosocial model is recommended in primary care to shift patient beliefs on low back pain. Nevertheless, information delivery alone is not sufficient to prevent absenteeism and reduce healthcare costs.

Databases, Factual↗
PubMed2006

Systematic review: the impact of gastro-oesophageal reflux disease on work productivity.

BACKGROUND: Gastro-oesophageal reflux disease has wide-ranging effects on patients' lives. AIM: To review systematically the effects of gastro-oesophageal reflux disease on work productivity. METHODS: Studies of gastro-oesophageal reflux disease and work productivity were identified in a systematic literature search and their results were valued in US dollars using the human capital method. Work productivity loss was defined as absence from work (absenteeism) plus reduced effectiveness while working (presenteeism). RESULTS: Eight eligible studies were included. Reported work productivity loss among individuals with gastro-oesophageal reflux disease ranged from 6% to 42% and was primarily because of presenteeism (6-40%) rather than absenteeism (<1% to 7%). Reported losses were greatest in patients experiencing sleep disturbance because of gastro-oesophageal reflux disease, and lowest in individuals from the general population taking appropriate prescription medication. Work productivity impairment correlated with symptom severity and responded to acid-suppressive therapy. Assuming a 40-h working week and average wages in the US, the weekly mean productivity loss per employee with gastro-oesophageal reflux disease can be estimated between 2.4 (62 dollars) and 16.6 h (430 dollars), depending on the population studied. CONCLUSIONS: Gastro-oesophageal reflux disease has a substantial impact on employee productivity, primarily by impairing productivity while working. Further studies are needed to confirm that this impact can be decreased by acid-suppressive therapy.

Adult↗
PubMed2006

Burden of Atopic dermatitis in Canada.

BACKGROUND: Atopic dermatitis (AD) is relatively common worldwide; costs associated with the disease have been reported recently for various countries, but no estimates of costs in Canada are currently available. The objective of this study was to estimate the costs associated with AD in Canada, assessed from resource use determined for a Canadian setting. METHODS: Seventy-six patients in Ontario with AD were surveyed to determine information about severity of disease, healthcare practitioner visits, over-the-counter medication use, household expenses and absenteeism relating to their condition. Based on this information, costs were determined based on the Ontario billing schedule, estimated prescription use, reported out-of-pocket expenses and stated family income. Data about sleep disturbance and concern over topical corticosteroid use were also obtained. RESULTS: Patients reported an average of 3.6 publicly funded doctor visits per year for AD; 58% of these visits were to general practitioners and 28% to dermatologists. The annual per patient expenditure was estimated to be 282, 454 Canadian dollars and 1242 Canadian dollars for patients with mild, moderate and severe AD, respectively. The total cost of AD in Canada was estimated to be 1.4 billion Canadian dollars annually. More than half of the patients experienced sleep disturbances owing to their condition, and 71% reported having concerns about topical corticosteroid use. CONCLUSIONS: Although the cost per patient of AD in Canada is relatively low, owing to the prevalence of the disease, the total cost to society is large. Most of the cost is borne by patients and their employers, primarily owing to indirect costs associated with absenteeism.

Adolescent↗
PubMed2005

Chronic daily headache in children and adolescents.

OBJECTIVE: To describe the clinical features of children with chronic daily headache (CDH) and examine the usefulness of the International Classification of Headache Disorders-II. BACKGROUND: Few data are available on chronic daily headache and analgesic overuse in children and adolescents and there are no specific criteria for headache in children. METHODS: We retrospectively reviewed all charts of 79 children and adolescents (<16 years) with headache on > or =15 days/month presenting to the outpatient clinic of the Department of Neurology of the Leiden University Medical Center between 1994 and 2001. We classified their headaches according to the International Classification of Headache Disorders-II. RESULTS: Fifty-seven (72%) children had chronic daily headache for more than 6 months, with a duration of more than 4 hours a day in 60% of them. Quality, severity, and location of pain varied. Sixty patients (76%) used analgesics, 10 patients more than one type. Thirteen patients (16%) used analgesics daily. In one-third of patients, headache led to frequent school absenteeism and sleeping problems. Twenty-eight (35%) patients could be classified, 17 patients (22%) as chronic tension-type headache, 5 patients (6%) as chronic migraine, and 6 patients (8%) as probable medication overuse headache. Fifteen patients (19%) did not fit into any category and 36 (46%) could not be classified due to insufficient data. CONCLUSIONS: Chronic daily headache in children is a serious disorder. A relatively large number of patients overuse medication and it leads to frequent school absenteeism and sleeping problems. It remains difficult to classify their headaches with the new criteria for headache disorders.

Adolescent↗
PubMed2006

A multidisciplinary health care team's efforts to improve educational attainment in children with sickle-cell anemia and cerebral infarcts.

The primary objective of this study was to improve the educational success of children with sickle-cell disease (SCD) and cerebral infarcts. A prospective intervention trial was conducted; a multidisciplinary team was created to maximize educational resources for children with SCD and cerebral infarcts. Students were evaluated systematically before and after the intervention. A baseline evaluation was completed assessing the presence of an Individualized Education Plan (IEP), grade retention in school, and days absent from school in the year preceding the intervention. A postintervention assessment occurred 2 years later for these same measurements. At baseline, 74% (17 of 23) of the students were receiving IEPs. Two years later, 87% (20 of 23) students received IEPs (p = .34). Despite the intervention, the rate of children retained in their school grade increased from 0.6 per 100 years in school at baseline to 1.7 per 100 years, 95% CI (-3.86, 1.49). The school absenteeism rate did not significantly change after the intervention; the average days absent per student rose from 15.5 to 22.5, (p = .05). The multidisciplinary team effort alone was insufficient to decrease grade retention and absenteeism rate. Further support, from either the parents or school administration, is needed to increase education attainment of students with cerebral infarcts.

Adolescent↗
PubMed2003

Effects of educational interventions for self management of asthma in children and adolescents: systematic review and meta-analysis.

OBJECTIVE: To determine the effectiveness of educational programmes for the self management of asthma in children and adolescents. DATA SOURCES: Databases of the Cochrane Airways Group, PsychINFO, reference lists of review papers, and eligible studies. REVIEW METHODS: Eligible studies were published randomised controlled trials or controlled clinical trials of educational programmes for the self management of asthma in children and adolescents that reported lung function, morbidity, self perception of asthma control, or utilisation of healthcare services. Eligible studies were abstracted, assessed for methodological quality, and pooled with fixed effects and random effects models. RESULTS: 32 of 45 identified trials were eligible, totalling 3706 patients aged 2 to 18 years. Education in asthma was associated with improved lung function (standardised mean difference 0.50, 95% confidence interval 0.25 to 0.75) and self efficacy (0.36, 0.15 to 0.57) and reduced absenteeism from school (-0.14, -0.23 to -0.04), number of days of restricted activity (-0.29, -0.33 to -0.09), and number of visits to an emergency department (-0.21, -0.33 to -0.09). When pooled by the fixed effects model but not by the random effects model, education was also associated with a reduced number of nights disturbed by asthma. The effect on morbidity was greatest among programmes with strategies based on peak flow, interventions targeted at the individual, and participants with severe asthma. CONCLUSIONS: Educational programmes for the self management of asthma in children and adolescents improve lung function and feelings of self control, reduce absenteeism from school, number of days with restricted activity, number of visits to an emergency department, and possibly number of disturbed nights. Educational programmes should be considered a part of the routine care of young people with asthma.

Adolescent↗
PubMed2001

Actual and perceived impacts of tobacco regulation on restaurants and firms.

OBJECTIVE: To examine the actual and anticipated costs of a law regulating workplace smoking and smoking in restaurants, taking into consideration observed and anticipated infrastructure costs, lost productivity, increased absenteeism, and loss of clientele. SETTING AND DESIGN: A survey of 401 Québec restaurants and 600 Québec firms conducted by the Québec Ministry of Health before the enactment of the law was used to derive costs incurred by those who had already complied and anticipated by those that did not. RESULTS: Direct and indirect costs associated with tobacco regulation at work and in restaurants were minimal. Annualised infrastructure costs amounted to less than 0.0002% of firm revenues and 0.15% of restaurant revenues. Anticipated costs were larger and amounted to 0.0004% of firm revenues and 0.41% of restaurant revenues. Impacts on productivity, absenteeism, and restaurant patronage were widely anticipated but not observed in currently compliant establishments. CONCLUSION: Firms and restaurants expected high costs to result from strict tobacco regulation because of infrastructure costs, decreased productivity, and decreased patronage. That none of these were actually observed suggests that policy makers should discount industry claims that smoking regulations impose undue economic hardship.

Canada↗
PubMed2004

Unemployment, job retention, and productivity loss among employees with depression.

OBJECTIVE: This study comprehensively assessed the work outcomes of employees with depression. METHODS: We collected baseline and six-month follow-up survey data from 229 employees with depression and two employee comparison groups: a group of healthy patients for the control group (N=173) and a group with rheumatoid arthritis (N=87), a frequent source of work disability. Outcomes included new unemployment and, within the employed subgroup, job retention (versus job turnover), presenteeism (that is, diminished on-the-job performance and productivity), and absenteeism. RESULTS: At the six-month follow-up, persons with depression had more new unemployment--14 percent for persons in the dysthymia group, 12 percent for persons in the major depression group, and 15 percent for persons in the group with both dysthymia and major depression, compared with 2 percent for persons in the control group and 3 percent for persons in the rheumatoid arthritis group. Among participants who were still employed, those with depression had significantly more job turnover, presenteeism, and absenteeism. CONCLUSIONS: In addition to helping employees with depression obtain high-quality depression treatment, new interventions may be needed to help them to overcome the substantial job upheaval that this population experiences.

Adaptation, Psychological↗
PubMed2003

Health-related quality of life deficits associated with varying degrees of disease severity in type 2 diabetes.

BACKGROUND: Diabetes is a chronic medical condition accompanied by a considerable health-related quality of life (HRQL) burden. The purpose of this analysis was to use generic measures of HRQL to describe HRQL deficits associated with varying degrees of severity of type 2 diabetes. METHODS: The RAND-12 physical and mental health composites (PHC and MHC, respectively) and Health Utilities Index Mark 3 (HUI3) were self-completed by 372 subjects enrolled in a prospective, controlled study of an intervention to improve care for individuals with type 2 diabetes in rural communities. Analysis of covariance was used to assess differences in HRQL according to disease severity and control of blood glucose. Disease severity was defined in terms of treatment intensity, emergency room visits and absenteeism from work specifically attributable to diabetes. To control for potential confounding, the analysis was adjusted for important sociodemographic and clinical characteristics. RESULTS: The PHC and MHC were significantly lower for individuals treated with insulin as compared to diet alone (PHC: 41.01 vs 45.11, MHC: 43.23 vs 47.00, p < 0.05). Individuals treated with insulin had lower scores on the vision, emotion and pain attributes of the HUI3 than individuals managed with oral medication or diet. The PHC, MHC, pain attribute and overall score on the HUI3 captured substantial decrements in HRQL associated with absenteeism from work due to diabetes, while the burden associated with emergency room utilization for diabetes was seen in the PHC and HUI3 pain attribute. CONCLUSIONS: We concluded that generic measures of HRQL captured deficits associated with more severe disease in type 2 diabetes.

Aged↗