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PubMed1988

Nonsteroidal anti-inflammatory drugs and changing attitudes toward dysmenorrhea.

Dysmenorrhea, which may be primary or secondary, is the occurrence of painful uterine cramps during menstruation. Until a decade ago, medical and social attitudes toward dysmenorrhea were shrouded with folklore, psychoanalytical profiles, or psychosomatic bases. In secondary dysmenorrhea, there is a visible pelvic lesion to account for the pain, whereas only a biochemical abnormality is responsible for primary dysmenorrhea. Recent advances in the biochemistry of prostaglandins and their role in the pathophysiology of primary dysmenorrhea and intrauterine device (IUD)-induced dysmenorrhea have now firmly established a rational basis for the disorder. In primary dysmenorrhea, menstrual prostaglandin release is significantly increased but can be readily suppressed to normal levels when nonsteroidal anti-inflammatory drugs (NSAIDs) capable of inhibiting cyclo-oxygenase are given during menstruation. Many clinical trials (controlled and uncontrolled) have demonstrated the efficacy of NSAIDs such as the fenamates, indole-acetic acid derivatives, and arylpropionic acid derivatives in relieving primary dysmenorrhea as well as IUD-induced dysmenorrhea that is also due to elevated prostaglandin levels. With a few of these NSAIDs, it has been shown that the relief of pain is associated with a significant decrease in menstrual fluid prostaglandin levels. Cumulative data of clinical trials indicate that with the effective NSAIDs, 80 percent of patients with significant primary dysmenorrhea can be adequately relieved. Ongoing studies suggest that in some women, endometrial leukotriene, but not PGF2a production, is increased. With the official approval and availability of several effective NSAIDs for the specific treatment of primary dysmenorrhea in the United States, women who have primary dysmenorrhea have been greatly relieved and their productivity increased. Primary dysmenorrhea affects 50 percent of postpubescent women and absenteeism among the severe dysmenorrheics has been estimated to cause about 600 million lost working hours or 2 billion dollars annually. Thus, an effective, simple, and safe treatment of primary dysmenorrhea for two to three days during menstruation will not only have a positive economic impact but will also enhance the quality of life. The availability of effective dysmenorrhea therapy with NSAIDs has induced greater expectations of relief by the patient, as well as greater willingness to seek medical help, a more rational approach to patient management by physicians, changes in attitude toward women with primary dysmenorrhea, and the debunking of myths about dysmenorrhea that often have been perpetuated as fact.(ABSTRACT TRUNCATED AT 400 WORDS)

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PubMed1982

An epidemiologic study of young women with dysmenorrhea.

The prevalence of dysmenorrhea was studied in a random sample of 19-year-old women from an urban Swedish population. Dysmenorrhea was reported by 72% of the women. Fifteen percent suffered from dysmenorrhea which limited daily activity and was unimproved by analgesics. Dysmenorrhea occurred significantly (p less than 0.01) more often in women not using oral contraceptives. A significant correlation (p less than 0.01) was found between early menarche and an increased severity of dysmenorrhea. There was a significant correlation (p less than 0.01) between the severity of dysmenorrhea and the amount of menstrual flow. Parous women had significantly (p less than 0.01) less dysmenorrhea than women who had never been pregnant or women who had experienced a legal or spontaneous abortion. Smokers as compared to nonsmokers had significantly (p less than 0.01) less dysmenorrhea. The severity of dysmenorrhea was not affected by height, weight, or regularity of the menstrual cycle. Absenteeism as a result of dysmenorrhea was evaluated.

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PubMed1994

Cost of anxiety disorders: impact of comorbidity.

The aim of this study was to assess the relative impact of co-mobidity and of symptom severity on the costs of caring for patients with generalized anxiety disorders (GAD). One thousand and forty-two patients with GAD according to DSM III-R were observed by psychiatrists using a cross-sectional methodology. Demographic, clinical, therapeutic as well as health care utilization data were collected at a single point in time. Patients were stratified according to prevalence of co-morbidity. An economic analysis was performed based on a societal perspective. Hospitalizations and losses of productivity were the two major components of costs both in patients with and without co-morbidity. On the other hand costs of pharmaceuticals remain a marginal component of costs associated with GAD in the two groups. Controlling for confounding variables, the prevalence of health care utilisation was found to be significantly higher in patients with co-morbidity for hospitalization, laboratory tests, medications and absenteeism from work. Most of cost components were found to be significantly higher in patients with co-morbidity. The relative risk of health care utilization was higher in patients with co-morbidity, past history of anxiety, high level of anxiety as well as in older patients. Overall our findings suggest that both co-morbidity and symptom severity play a role in cost generation in GAD patients.

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PubMed1979

Job stress and employee behaviors.

The relationship between four job stresses (role ambiguity, role overload, underutilization of skills, and resource inadequacy) and two employee withdrawal behaviors (absenteeism and turnover) was investigated. The joint prediction of employee withdrawal from measures of job stress and selected backgroundd variables was also investigated. Data were obtained regarding 651 employees in five organizations through personal interviews and company records. Analysis indicated that job stress is related to employee withdrawal behaviors, that prediction of subsequent behaviors is stronger than prediction of prior behaviors, and that the predictive power of job stress and background variables taken together is as strong as, or stronger than, the predictive power of background variables alone. Confidence in the strength of the findings is enhanced by the use of multiple data sources and multiple data points.

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PubMed1982

Prevalence of asthma and health service utilization of asthmatic children in an inner city.

To determine the prevalence of asthma and to examine the pattern of health service utilization of asthmatic children in Baltimore, we sent questionnaires randomly to 4096 first and sixth graders attending Baltimore City public schools; 2898 completed the questionnaire. Asthma was defined as "a condition which causes difficulty in breathing, with wheezing noises in the chest." On the basis of this definition, we found that the cumulative prevalence of asthma was 10.5% and the 12 mo period prevalence was 7.2%. The prevalence was significantly higher for boys (male:female = 1.6:1) and for blacks (black:white = 1.5:1). Nearly 50% of the children with active asthma missed 6 days or more out of the school year because of illnesses due to asthma. Almost half the asthmatic children obtained their care of asthma in the emergency room, and twice as many blacks as whites used the emergency room as their primary source of care. Moreover, emergency room users had a higher school absentee rate than non-emergency room users.

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PubMed1983

Employee health and fitness: the state of the art.

Health care and health promotion measures currently are undergoing critical cost/benefit or cost/effectiveness scrutiny. An employee fitness program offers a convenient means for realizing community goals of lifestyle change but also has the potential to augment worker productivity. The costs of exercise testing and program development for an employee program ($100-$350 per participant year, measured in 1982 U.S. dollars) compare favorably with nonoccupational approaches to the promotion of fitness and a healthy lifestyle. The combined savings from a reduction of appraised age, improvement in lifestyle, decreased use of hospital and physician services, decrease in absenteeism and employee turnover, improved productivity, and decreased need for geriatric care substantially exceed the likely outlay. Given a 20% participation rate, the order of benefit from these factors is over $700 per year for each member of the labor force. In a company employing 1,000 people, a cost of perhaps $40,000 for 200 participants would yield a dividend of $650-$700,000 per year. Arguments continue on the specificity of exercise-induced gains in health and performance, but the burden of proof rests with those who maintain that equal benefits could be obtained from other tactics.

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PubMed1983

How much can business expect to profit from smoking cessation?

The data reviewed in this article, drawn from well-known, published sources; offer an estimate of the annual costs of smoking to the average employer. These costs range from +336 to +601 in January 1980 dollars per average smoking employee. The analysis is largely based on aggregate epidemiological data and, in general, the emphasis is on the under-estimating of the costs to business. It reports "averages" true for large populations and, therefore, is not individually predictive. The cost centers dealt with are insurance, medical, and others such as absenteeism, productivity, involuntary smoking, and occupational health risk. Included is a discussion of employer-sponsored smoking cessation programs and the benefits therefrom.

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PubMed1994

The impact of child sexual abuse--a study of a random sample of Norwegian students.

The long-term impact of child sexual abuse (CSA) has most typically been concentrated on the psychological outcomes. The aim of the present study was to examine the relationship between CSA and self-reported complaints including both psychological and psychosomatic problems as well as absenteeism. A random sample of 510 female and 486 male students completed a questionnaire that included questions about CSA. The overall response rate was 75.3%. A symptom scale was constructed by asking the respondents to rate themselves on a three-category scale for 13 items concerning both psychological and somatic health problems. They were also asked to indicate how many days the problem had caused them to be absent from class or work during the year prior to the study. CSA was reported by 116 of the students (11.7%). CSA was associated with a broad range of health problems; including genital pain/infections and headache/abdominal/muscular pain as well as psychological disorders such as anxiety and suicidal ideations. A linear relationship was demonstrated between the severity of CSA and the symptom score, as well as between the severity of CSA and days absent from work. Postpubertal onset of abuse and close relationship with the offender were positively associated with the number of sick-leave days.

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PubMed1984

A cost-benefit analysis of a smoking cessation program.

Smoking cessation programs are usually evaluated in terms of the percentage of participants who have stopped smoking at least 6 months after the program's completion. This paper shows how a relatively low rate of behavior change may actually result in a high ratio of benefits to costs. Cost-benefit analysis is done for a specific program but the procedures and cost estimates are generalizable to other smoking cessation programs. Benefits to the firm included reduced costs of insurance and the savings due to employee absenteeism and disability. Costs included the program costs as well as the opportunity costs of the participants. Data from the literature and from the specific program are combined to form conclusions about the effectiveness of the program.

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PubMed1989

A survey of adolescent dysmenorrhea and premenstrual symptom frequency. A model program for prevention, detection, and treatment.

Eighty-eight female high school adolescents in two separate physical education classes were surveyed for the prevalence of dysmenorrhea and premenstrual symptoms. Each group answered a questionnaire requesting age; presence, severity, and nature of dysmenorrhea and premenstrual symptoms; and course of treatment. Questions were also asked to determine the perceived impact of these symptoms on academic performance, ability to concentrate, study, or take tests, and classes missed. The results showed that the majority of the female adolescents identified dysmenorrhea and premenstrual symptoms as problems that significantly affected their academic performance and were responsible for school absenteeism. Contradictory to common belief, premenstrual symptoms in these adolescents (76 of 88, 86%) were found to be as prevalent as symptoms of dysmenorrhea (80 of 88, 91%), and most of the girls were unaware of the causes and treatments of these symptoms. Subsequently, we designed a model for use by health professionals to educate girls in self-help methods and to screen for and detect these problems.

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PubMed1989

Menstrual pain, health and behaviour in girls.

Prevalence of menstrual pain, use of medication and school absenteeism due to the pain were studied by means of a mailed questionnaire in a sample representing 12-18-year-old girls in Finland (n = 3370, response rate 87%). Prevalence of menstrual pain was 48% among 12-year-old post-menarcheal girls and 79% among 18-year-olds. Thirty percent of the 16-year-old girls had used medication and 21% had stayed at home due to menstrual pain in the last 6 months; 3% had both been absent and used medication several times. Three types of factors were associated with menstrual pain: (1) physiological (gynaecological age, duration of menstrual flow); (2) indicators of poor self-rated health (not feeling active in the morning, bad physical condition, number of common colds); (3) unhealthy practices (consumption of alcohol, low physical activity, smoking). The prevalence of menstrual pain did not correlate with the variables describing the place of residence or the socio-economic status of the family. The determinants of menstrual pain are supposed to lie more in the biological construct and micro-environment of the girls than in macro-level structures of the society. The experience of pain seems to be related to self-rated health as a whole and to lifestyle rather than to specific disorders and health practices.

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PubMed1994

Mental first aid.

This paper reports a survey of staff of Oslo Sporveier who had been involved in serious incidents such as accidents resulting in severe personal injuries and death, suicide, robbery and assault. The survey was carried out to evaluate the efficacy of Mental First Aid in a retrospective study. The introduction of Mental First Aid was based on the beneficial effects from early intervention reported from follow-up studies after previous disasters, so for ethical reasons there was no control group. When help was given within the first few days without the use of any external specialists, and with strong support from colleagues during the first days back at work, there was little absenteeism. The beneficial effects of early intervention are stressed as is the use of non-professionals in forming a social network around employees who have been involved in traumatic incidents. Safety ombudsmen who have been given brief instruction are brought to the site of the incident to apply the principles of Mental First Aid. These secondary preventive measures are very effective and could be implemented by other medium-sized transport companies whose staff are exposed to the risk of suicide attempts.

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PubMed1989

The secondary prevention of low back pain: a controlled study with follow-up.

The current investigation studied the effectiveness of a secondary prevention program for nurses with back pain who were deemed at risk for developing a chronic problem. A 2 X 3 repeated measures design was employed with 2 groups and 3 assessment periods. The treatment group received an intervention designed to reduce current problems, but above all to prevent reinjury and minor pains from becoming chronic medical problems, and it included a physical and behavioral therapy package. The control group was placed on a waiting-list. Results indicated that the treatment group had significantly greater improvements than the control group for pain intensity, anxiety, sleep quality and fatigue ratings, observed pain behavior, activities, mood, and helplessness. These differences were generally maintained at the 6 month follow-up. In addition, the treatment group broke a trend for increasing amounts of pain-related absenteeism, while the control group did not. Taken as a whole, the results suggest that a secondary prevention program aimed at altering life style factors may represent an effective method for dealing with musculoskeletal pain problems.

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PubMed1985

Adaptation to work: an analysis of employee health, withdrawal and change.

J. Rosse and H. Miller (1984, in P. Goodman, R. Atkin et al., Absenteeism: New Approaches to understanding, measuring, and managing employee absence. San Francisco: Jossey-Bass) have proposed a model of employee adaptation that hypothesizes multiple withdrawal behaviors and attempts to change working conditions as alternative forms of adaptation to a dissatisfying work environment. Negative health outcomes are also hypothesized consequences of dissatisfaction with work. In this longitudinal study of 42 new hospital employees, intention to quit, turnover, absence, attempts to change the job, and heatlh disorders were negatively correlated with job satisfaction; lateness and self-report avoidance scale were not. Use of adaptive behaviors was also found to have remedial effects for employee health. Implications for a general model of adaptation are discussed.

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PubMed1996

Evaluation of comprehensive violence prevention education: effects on student behavior.

PURPOSE: This study evaluates the impact on student behavior of violence prevention education in school settings. METHODS: School records were obtained for three panels (1985, 1986, and 1987) of urban public high school students (n = 1,523) who were nonrandomly assigned to three different conditions of school-based violence prevention education: (1) in a class-specific comprehensive educational intervention, (2) as part of a school-wide violence prevention initiative, and (3) no exposure. Changes in suspension status from sophomore to junior year were tracked within exposure groups and the risk of junior year suspension was compared across exposure groups, controlling for age, gender, race, absenteeism, and previous year suspension. RESULTS: The class-specific exposure, compared to a not-exposed group from the same school showed a significant 71% reduction in suspension rates (RR = .286, CI .12, .66). The school-wide exposure school shows reductions in and maintenance of very low rates of junior year suspension in each cohort year, although these are not always statistically significantly different from not-exposed groups. CONCLUSION: Results indicate that violence prevention education can reduce negative school behaviors, particularly when other supportive curricula and activities are added.

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PubMed2006

Violence at the workplace--a questionnaire survey of nurses.

BACKGROUND: In the health sector, anywhere in the world nurses are one of the most exposed groups to violence. However, it is not obvious that psychiatric nurses (PNs) are more exposed to aggression and burnout. OBJECTIVES: To determine the nature and effects of aggressive acts towards nursing staff in psychiatric and other medical services in Poland. METHODS: Various questionnaires (Stress at Work Scale, General Health Questionnaire, Maslach Burnout Inventory, Work Satisfaction Scale), were distributed among psychiatric (N=78) and non-psychiatric nurses (N-PNs) (N=335). A 92.6% response rate was achieved. RESULTS: Significant differences were found between PNs and non-psychiatric counterparts with respect to their experiences of violence. The most frequently reported incident was verbal abuse, followed by threats and physical assault. Patients were significantly more frequent perpetrators in psychiatric wards than in others. The level of intra-staff aggression did not significantly vary between groups, neither did the level of work satisfaction and absenteeism. CONCLUSION: The frequency of violent acts and stress related to them point out the strong need for the development of preventive programs to address the issue of violence at work.

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PubMed2005

The child with asthma at school: results from a national asthma survey among schoolchildren in Israel.

PURPOSE: To evaluate school absence and restriction in school activities of children with asthma, and to estimate the involvement of the school staff in asthma disabilities. METHODS: A modified version of the International Study of Asthma and Allergies in Childhood written questionnaire was administered to a national sample of 13-14-year-old schoolchildren across Israel. Questions regarding social and demographic factors, school absence owing to asthma symptoms, and school staff involvement were added. RESULTS: There were 10,057 complete questionnaires available for analysis; 710 children reported having asthma. Children with asthma were absent on the average 7.3 +/- 9.8 days in the past school year compared with 3.9 +/- 6.3 days in children without (p = .0001). Absenteeism owing to respiratory symptoms was significantly more common in children with asthma and associated with a more severe asthmatic condition. Four percent of the children with asthma were absent from school more than 30 days. Of the children reporting asthma, 25.9% were not allowed to participate in one or more school activities for medical reasons, compared with 4.2% of children without asthma. Of the children with asthma, 44.3% reported that the school nurse knew about their asthma, and only 13.8% reported that the nurse discussed their asthmatic condition with them; 38.2% of children with asthma reported that no one at school knew about their illness. CONCLUSIONS: Children with asthma are absent annually on average 3.4 days more than children without asthma. School absence is associated with the severity of asthma. A significant percentage of asthmatic children participate less in school activities. School staff awareness of the children illness is not satisfactory.

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PubMed2006

Prevalence of self-reported specific phobia symptoms in an Israeli sample of young conscripts.

Specific phobia is a very prevalent disorder with high comorbidity rates. The aim of this study was to assess prevalence of specific phobia symptoms in a sample of Israeli young adults. Eight hundred fifty young Israeli soldiers participated in the study. Measures included a questionnaire on specific phobias and a socio-demographic questionnaire. Data on eight specific fears representing DSM-IV-TR specific phobias were analyzed to evaluate prevalence of phobic symptoms and find potential socio-demographic correlates. Prevalence of fears and specific phobic symptoms was 49.1 and 8.7%, respectively. Most frequent phobic symptoms were from animals, being alone, heights, injury and closed places. The following variables were accompanied by more phobic symptoms: male gender, role of mechanic, not having completed the matriculation exams, lack of friends and romantic relationships, therapy prior to enlistment or during the military service and having received psychotropic drugs in the past. Based on a stepwise regression analysis, the following variables contributed significantly to the prediction of phobic symptoms: lack of friends and romantic relationships, school absenteeism and role of mechanic. Our findings corroborate results from other studies in the Western world regarding the high prevalence of specific phobia symptomatology, as well as its distribution and socio-demographic correlates.

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