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PubMed2004

[Medico-legal aspects of occupational lumbar back accidents. About 242 cases].

Industrial accidents causing lumbar back strain are frequent and are of major causes of absenteeism. For this purpose, we tried in this study to assess the prevalance of such accidents, to determine the circumstances of their occurence and to point out the various risk professions. For this, we analysed 242 files of lumbar back pathology industrial accidents related. The latter files have been examined by the Tunis medical board authorized to set out the permanent disability rate resulting from industrial accidents and occupational diseases. We noticed a marked male predominance 58% of patients were aged between 41 and 50 years. We observed a predisposition in 19% of all cases. The professional category of operators is mainly concerned. These accidents most frequently occur in the morning at the site of work, often due to the handling of heavy loads. They cause lesions of variable importance, such as slipped disc hernia in 40% of cases. The average duration of absenteeism resulting from lumbar strain is of 237 days a year per patient. After-effects are frequent, notably those of spinal pains and lumbar stiffness. The average rate of permanent partial disability is of 8% (0-45%).

Accidents, Occupational↗
PubMedDate not supplied

Influenza vaccination of healthcare workers: institutional strategies for improving rates.

The nosocomial transmission of influenza has been well documented since the 1970s with both direct and indirect effects of outbreaks in healthcare settings. Outbreaks can directly increase morbidity among patients and residents of long-term care facilities. Indirect effects include disruption of normal operations of healthcare institutions, shortages of healthcare workers (HCWs), fewer elective admissions, and income loss due to absenteeism. Influenza vaccination of United States HCWs remains below 40% despite the availability of a safe, effective vaccine and a long-standing recommendation for vaccination of HCWs. New strategies to improve the rate of influenza vaccination among HCWs are needed as the percentage of those receiving yearly vaccination has changed little in the past 20 years. Increasing HCW influenza vaccination coverage calls for a paradigm shift, institutions should view vaccination of HCWs as a crucial part of a comprehensive infection control program designed to protect patients and staff. Administrators of hospitals, long-term care facilities, and other health agencies should respond to this challenge by developing programs to improve yearly influenza vaccination of their staff Such efforts would put these employees into compliance with national recommendations and also benefit the institution by reducing absenteeism, nosocomial influenza transmission, and the associated economic losses and disruption of routine operations.

Cross Infection↗
PubMed2005

[Risk of disability pension among young persons on long-term sick leave].

BACKGROUND: In the late 1990s the incidence of new disability pensioners in Norway increased, especially among young people. This study assessed the risk and possible predictors of a transition to disability among long-term sickness absentees below 40. MATERIAL AND METHODS: The study was carried out in a county with 10 % of Norway's population. All new long-term (i.e. more than 8 weeks) sickness absentees below 40 years over a six-month period in 1994 were included and followed up until year-end 1999. Socio-demographic and medical information were used as independent variables in Cox regression analysis with disability as the outcome variable. RESULTS: The five-year risk of disability was 7.9 % (95 % CI 5.8 % - 10.0 %) for men and 10.3 % (95 % CI 8.5 % - 13.1 %) for women. Among young persons on long-term sickness absence with psychiatric diagnoses the rate of disability was 24 % (95 % CI 15 - 33 %) for men and 11 % (95 % CI 6 - 16 %) for women. In musculoskeletal disorders the risk of disability was 5 % (95 % CI 3 - 7 %) for men and 11 % (95 % CI 8 - 14 %) for women. Women had higher rates of disability among all subgroups of musculoskeletal disorders. Regression analysis showed no gender effect. The following variables increased the risk of disability pension: psychiatric diagnosis (only for men), low income (both genders), increasing age (only women) and previous long-term absence (only for men). INTERPRETATION: A moderate risk of disability pension was found among young people on long-term sick leave. Special interventions targeted at men with psychiatric diagnoses and women with musculoskeletal disorders should be considered.

Adolescent↗
PubMedDate not supplied

[Reducing the risk of tuberculosis in children vaccinated with BCG].

In 1973, of 1774192 children aged 18 months to 6 years, 82,2% had to be revaccinated with BCG, 10.7% presented tuberculin reactions larger than 10 mm and 7.1% were absentees. In 1974 a number of 485 children belonging to the respective age group contracted tuberculosis. Analysis of these cases showed that the risk of tuberculosis was of 10.9 per 100,000 revaccinated subjects and of 74.6 per 10,000 absentees. BCG vaccination not only lowered the risk of the disease but also reduced the risk of a severe evolution and death.

BCG Vaccine↗
PubMedDate not supplied

[Shift-work and housekeeping interference].

In Italy, within the last ten years, an increasing number of women have been involved on shift and night-work not only in the tertiary sector, but also in the industrial one. This has been made possible by the promulgation of Law 903/1977, concerning parity in treatment of both men and women in questions of employment. The work agreements for women night-work have gradually increased over the period 1980-1986 passing from 194 in 1980 to 357 in 1986, with approximately 10000 more women involved each year. The sectors mostly involved in these last years have been the textile, food and mechanical ones. The present study reports the major problems complained by the women shiftworkers as concerns their difficulties in family and social life, and refers the case of a group of women abruptly introduced to night work in a food industry, where they had been previously engaged only on day-work for many years. During the first year of night-work the absenteeism among this group tripled (29.8 days per year on average) with respect to the previous years. The impact on shift and night-work appeared to have been the most disruptive of the whole condition of this group of women, with negative effects on their personal, family and working life. High absenteeism, increasing psychosomatic complaints, worsening of the subjective health status, sleep disturbances, difficulties in family relationships were the main consequences. The women with heavier family commitments, namely those married with children, showed the worst effects.

Adult↗
PubMed1989

A double-blind cross-over study comparing flurbiprofen with naproxen-sodium for the treatment of primary dysmenorrhea.

The efficacy of flurbiprofen (100 mg, twice daily) and naproxen-sodium (500 mg, twice daily) for the treatment of primary dysmenorrhea was evaluated in a double-blind cross-over study. All the women (n = 57) complained of severe (23%) or very severe (77%) dysmenorrhea which interfered with their daily life. Frequent absenteeism due to dysmenorrhea was reported by 39% of the women. The severity of pain was reduced (p less than 0.001) during treatment with both flurbiprofen and naproxen-sodium compared with the pain severity before the first dose. There was, however, no significant difference in mean pain relief achieved by the two drugs studied. During the study period, absenteeism was reported by only 6 (11%) and 3 (5%) women when treated with flurbiprofen or naproxen-sodium respectively. More than 60% of the women reported no or only mild interference with daily activities during treatment. No serious side effects were reported and none of the patients was obliged to terminate treatment because of side effects. Flurbiprofen and naproxen-sodium, at the dosages indicated, were both shown to be effective in relieving pain in patients suffering from severe primary dysmenorrhea and markedly improved their capacity for normal activities during menstruation.

Adult↗
PubMed1989

[Respiratory health of children and atmospheric pollution. I. Respiratory symptoms].

The impact on the respiratory system of complex industrial pollution (dust, sulphur dioxide, nitrogen oxides, hydrocarbons) was assessed by an analytical epidemiological study in a population of school children in the northeast of France. The parents of 375 children aged from 9-12 (middle school course 1 and 2) from the polluted zone and 523 children of the same age in a neighboring zone which was not polluted have filled in standardised questionnaires (respiratory symptoms, previous infections and allergies, frequency of infection in infancy; tobacco habits, professional and educational attainments of the parents, domestic environment). In the exposed children the majority of respiratory symptoms were more frequent (e.g., respiratory sounds in the boys, 15.6% against 7.9% p less than 0.01) and the absenteeism from school was more numerous (66.9% against 59.1% p less than 0.01). However, the interpretation of the results had to take into account the existence of confusing factors: parental smoking habits and the use of coal fires increased the prevalence of symptoms in the polluted zone, whereas a less crowded population worked in the inverse direction; likewise the educational level of the parents was higher in the polluted zone. After adjusting for these confusing factors, the frequency of rhinitis and absenteeism from school was significantly higher in exposed children.

Air Pollution↗
PubMed1988

Screening for non-insulin-dependent diabetes mellitus.

The major obstacle to a recommendation for screening adults for NIDDM is the conflicting evidence that early detection and treatment reduce future complications. Because obesity is a risk factor for NIDDM, and hypertension in conjunction with NIDDM leads to early atherosclerosis, treatment is indicated for both hypertension and obesity whether or not NIDDM is present concurrently. It is clear that there are those who accept and those that reject the use of oral hypoglycemic agents. Accordingly, there are those who believe that the goal of NIDDM treatment is zealous glycemic control and those who are not so inclined. Whether or not to screen for NIDDM ultimately depends upon which view is adopted. While it may seem prudent to screen for and insist upon "tight" control of NIDDM, we should consider the effect of labeling asymptomatic persons from a positive test result. What are the repercussions regarding status of employment and insurance eligibility as compared to benefits of treatment? What is the psychosocial impact? Although no studies on the effect of labeling patients non-insulin-dependent diabetics could be located, a study of hypertension in an industrial setting demonstrated that patients labeled hypertensive had an increased absenteeism from work. Interestingly, the main factors associated with increased absenteeism were awareness of the condition and low compliance with treatment. Although the parallel to NIDDM is evident, additional studies are needed.

Blood Glucose↗
PubMed1987

Occupational class, psychosocial stress and morbidity.

The association between stress and morbidity was studied in an industrial population, which consisted of both white-collar and blue-collar workers (n = 902). Information about living and working conditions, health behaviour, mental well-being and morbidity were obtained by questionnaires, interviews, clinical examinations, and physiological and biochemical measurements. The same cohort was re-examined after five and ten years. Comparison of occupational classes showed consistently that living and working conditions, psychosocial stress, and health and sickness behaviour were more deleterious among blue-collar workers and their morbidity and mortality rates were higher than among white-collar workers. The effect of stress on health was examined both cross-sectionally and longitudinally. Psychosocial stressors at work were related to mental strain, perceived health, and absenteeism. Stress symptoms were strongly associated with perceived health, locomotor symptoms, smoking, drinking, and absenteeism. None of the stress indicators were related to blood pressure. In the follow-up the baseline indicators of stress predicted future chronic illness and angina pectoris, but not hypertension or myocardial infarction. Blood pressure changes were not related to psychosocial factors. Stress did not predict mortality in the ten year follow-up. The study suggests that psychosocial stress is mostly related and may be causally linked to such indicators of morbidity as perceived health, bodily symptoms and sickness behaviour. The aetiological contribution of stress to biologically defined morbidity may be weak.

Attitude to Health↗
PubMed1981

Teaching self-management skills to asthmatic children and their parents in an ambulatory care setting.

A program designed to teach self-management skills to asthmatic children and their parents was performed by a nurse-educator utilizing health education techniques. Goals included: (1) reduce frequency and severity of asthma; (2) reduce emergency room visits and hospitalizations; (3) reduce school absenteeism; (4) develop positive family self-help attitudes; and (5) incorporate patient-parent education in an office. After informed consent was obtained, 26 asthmatic children, aged 2 to 14 years, were selected and evaluated. Appropriate asthma management including avoidance, medications, and immunotherapy, if indicated, was initiated for both a study group (13 patients) and a comparison group (13 patients). Symptom and medication diaries were kept for six to 18 months. Educational intervention by a nurse-educator, including four hours of individual instruction, group classes, telephone access, and monitoring for the study patients, resulted in fewer hospitalizations and emergency room visits as compared to control patients, tenfold less school absenteeism, and fewer asthma attacks. Estimated hospital and emergency room costs were much less in the educated group. These results were accomplished by improving comprehension of and compliance with the medical management program by the study patients and their families; more medications were used and therapy for asthma was initiated earlier.

Adolescent↗
PubMed1978

[Lower limb varicose veins in textile workers].

441 women working in various textile industry plants were examined to detect possible varicose veins, ulceration of shins, post thrombotic syndrome and active thrombotically inflammable changes. Frequency of the above mentioned changes was evaluated withthe following criteria: age, duration of employment in textile industry and work-post. Additionally, sickness absenteeism analysis was done in patients treated preventively and by operation. Investigations carried out indicate that the frequency of varicose veins in lower limbs, of trophic changes, shin ulceration, thrombotically inflamed processes increases with age and duration of employment in textile industry, resulting in considerable sickness absenteeism. The surgeon working in a given plant should detect varicose veins in lower limbs as early as possible and send his patients for an operation. Operation prevents many complications and shortens duration of disablement for work.

Adult↗
PubMed1981

Fitness program participation: its effect on worker performance.

The effects of an employee fitness program upon absenteeism and productivity were investigated in a controlled trial involving two large offices. During the six-month experimental program, the test company developed substantial gains of fitness. However self-reports and supervisor evaluations showed small and relatively similar gains of productivity, with reduction of absenteeism at both test and control companies. Further studies on a large scale are warranted. The presently observed changes probably reflect (1) sample attenuation, (2) seasonal trends, and (3) a "Hawthorne" effect. If the last factor is substantiated, employee fitness programs may be of economic interest, despite the nonspecific nature of the resultant gains in productivity.

Adult↗
PubMedDate not supplied

[Disability and attitude to preventive measures in patients with acute and chronic diseases of the musculoskeletal system].

The steady increase in the number of patients with musculoskeletal disorders has increased correspondingly the importance of prevention and health promotion in this area. Under the new health reform laws for health promotion we developed a concept of health counselling for persons suffering from acute or chronic musculoskeletal (rheumatic) disorders. In the context of the formative evaluation we surveyed in 1992 the insured persons via a questionnaire classifying them into three different groups of healthy persons and persons with acute and chronic complaints (criterion: accumulated days of work absenteeism). We asked the patients about frequency of rheumatic complaints, subjective and functional injuries. We also investigated the attitudes towards preventive interventions. Parameters like days of work absenteeism and cluster of diagnosis from the database of the health insurance company complete the subjective data.

Adult↗
PubMed2003

The economic burden of non-influenza-related viral respiratory tract infection in the United States.

BACKGROUND: Viral respiratory tract infection (VRTI) is the most common illness in humans. Despite the high incidence, the economic impact of non-influenza-related VRTI has not been rigorously explored. Our objectives were to obtain an updated incidence of non-influenza-related VRTI in the United States and to quantify the health care resource use (direct costs) and productivity losses (indirect costs) associated with these infections. METHODS: A nationwide telephone survey of US households (N = 4051) was conducted between November 3, 2000, and February 12, 2001 to obtain a representative estimate of the self-reported incidence of non-influenza-related VRTI and related treatment patterns. Direct treatment costs measured included outpatient clinician encounters, use of over-the-counter and prescription drugs, and associated infectious complications of non-influenza-related VRTI. Absenteeism estimates for infected individuals and parents of infected children were extrapolated from National Health Interview Survey data. RESULTS: Of survey respondents, 72% reported a non-influenza-related VRTI within the past year. Respondents who experienced a self-reported non-influenza-related VRTI averaged 2.5 episodes annually. When these rates are extrapolated to the entire US population, approximately 500 million non-influenza-related VRTI episodes occur per year. Similarly, if the treatment patterns reported by the respondents are extended to the population, the total economic impact of non-influenza-related VRTI approaches $40 billion annually (direct costs, $17 billion per year; and indirect costs, $22.5 billion per year). CONCLUSIONS: Largely because of the high attack rate, non-influenza-related VRTI imposes a greater economic burden than many other clinical conditions. The pending availability of effective antiviral therapies warrants increased attention be paid to this common and expensive illness.

Absenteeism↗
PubMed2003

The economic consequences of irritable bowel syndrome: a US employer perspective.

BACKGROUND: The objective of this study was to measure the direct costs of treating irritable bowel syndrome (IBS) and the indirect costs in the workplace. This was accomplished through retrospective analysis of administrative claims data from a national Fortune 100 manufacturer, which includes all medical, pharmaceutical, and disability claims for the company's employees, spouses/dependents, and retirees. METHODS: Patients with IBS were identified as individuals, aged 18 to 64 years, who received a primary code for IBS or a secondary code for IBS and a primary code for constipation or abdominal pain between January 1, 1996, and December 31, 1998. Of these patients with IBS, 93.7% were matched based on age, sex, employment status, and ZIP code to a control population of beneficiaries. Direct and indirect costs for patients with IBS were compared with those of matched controls. RESULTS: The average total cost (direct plus indirect) per patient with IBS was 4527 dollars in 1998 compared with 3276 dollars for a control beneficiary (P<.001). The average physician visit costs were 524 dollars and 345 dollars for patients with IBS and controls, respectively (P<.001). The average outpatient care costs to the employer were 1258 dollars and 742 dollars for patients with IBS and controls, respectively (P<.001). Medically related work absenteeism cost the employer 901 dollars on average per employee treated for IBS compared with 528 dollars on average per employee without IBS (P<.001). CONCLUSION: Irritable bowel syndrome is a significant financial burden on the employer that arises from an increase in direct and indirect costs compared with the control group.

Absenteeism↗
PubMed2004

Benefits of a school-based asthma treatment program in the absence of secondhand smoke exposure: results of a randomized clinical trial.

BACKGROUND: Daily maintenance medications are recommended for all children with mild persistent to severe persistent asthma; however, poor adherence to these medications is common. OBJECTIVE: To evaluate the impact of school-based provision of inhaled corticosteroids on asthma severity among urban children with mild persistent to severe persistent asthma. DESIGN: Children aged 3 to 7 years with mild persistent to severe persistent asthma were identified at the start of the 2000-2001 and 2001-2002 school years in Rochester. Children were assigned randomly to a school-based care group (daily inhaled corticosteroids provided through the school) or a usual-care group (inhaled corticosteroids not given through school). MAIN OUTCOME MEASURE: Improvement in parent-reported symptom-free days. RESULTS: Of 242 eligible children, 184 were enrolled from 54 urban schools. Data for 180 children were available. Parents of children in the school-based care group had a greater improvement in quality of life compared with parents of children in the usual-care group (change score, 0.63 vs 0.24; P =.047); also, children in the school-based care group vs the usual-care group missed less school because of asthma (mean total days missed, 6.8 vs 8.8; P =.047) and experienced more symptom-free days during the early winter months (mean days per 2-week period, 9.2 vs 7.3; P =.02). A post hoc analysis revealed that all significant findings were produced by differences among children who were not exposed to secondhand smoke. Furthermore, among children not exposed to smoke, those in the school-based care group vs the usual-care group had more symptom-free days overall (11.5 vs 10.5; P =.046), had fewer days needing rescue medications (1.6 vs 2.3; P =.03), and were less likely to have had 3 or more acute visits for asthma (6 [13%] of 47 children vs 17 [31%] of 54 children; P =.03). CONCLUSIONS: School-based provision of inhaled corticosteroids significantly improved symptoms, quality of life, and absenteeism among urban children with mild persistent to severe persistent asthma. This effect was seen only among children not exposed to secondhand smoke.

Absenteeism↗
PubMed1987

Factors related to school absence among children with cardiac conditions.

This study compared psychosocial and health factors related to school absence among 62 children with cardiac disease and 62 age-, sex-, and race-matched peers without chronic health conditions. Parents of children with cardiac conditions perceived their children as more vulnerable and rated themselves and their children as having less control over improving their children's health status than did parents of the well children. Increased school absentee rates for the cardiac group were associated with measures of illness severity, parental patterns of absenting their child from school for minor illnesses, and decreased belief in their child's ability to improve his or her health status. For the well comparison group, increased absence was related to external health locus of control beliefs, increased maternal sick days, and demographic factors. School absence was not significantly related to social adaptation, self-esteem, or school achievement for either the well or cardiac groups.

Absenteeism↗
PubMed1989

Determinants of school performance in children with chronic asthma.

We have documented performance on standardized academic achievement tests for reading and mathematics in 99 children with moderately severe to severe chronic asthma. Academic performance and intelligence test scores indicated that, overall, the academic capabilities of the children with asthma were average to above average. A stepwise regression analysis was used to examine relationships between the dependent variables of reading and mathematics and the independent variables of socioeconomic status, school attendance, medical factors relating to asthma, age, and emotional and behavioral problems of the children. Factors that were associated significantly with low performance scores were low socioeconomic status, older age, history of continuous oral steroid use (prednisone or methyl prednisolone taken at least every other day for the year prior to evaluation), and presence of emotional and behavioral problems. School absenteeism, use of medical resources, oral steroid dosage, other medications used to treat asthma, and pulmonary functions were not associated with academic performance. Investigation of poor classroom performance of a child with chronic asthma should include investigation of the roles of socioeconomic status, oral steroid therapy, and emotional and behavioral problems.

Absenteeism↗