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PubMed2003

The prevalence, patterns and impact of irritable bowel syndrome: an international survey of 40,000 subjects.

AIM: To determine the prevalence, symptom pattern and impact of the irritable bowel syndrome, across eight European countries, using a standardized methodology. METHODS: A community survey of 41 984 individuals was performed using quota sampling and random digit telephone dialing to identify those with diagnosed irritable bowel syndrome or those meeting diagnostic criteria, followed by in-depth interviews. RESULTS: The overall prevalence was 11.5% (6.2-12%); 9.6% had current symptoms, 4.8% had been formally diagnosed and a further 2.9%, 4.2% and 6.5% met the Rome II, Rome I or Manning criteria, respectively. Bowel habit classification varied by criteria: 63% had an 'alternating' bowel habit by Rome II vs. 21% by self-report. On average, 69% reported symptoms lasting for 1 h, twice daily, for 7 days a month. Irritable bowel syndrome sufferers reported more peptic ulcer (13% vs. 6%), reflux (21% vs. 7%) and appendectomy (17% vs. 11%), but not hysterectomy, cholecystectomy or bladder procedures. Ninety per cent had consulted in primary care and 17% in hospital; 69% had used medication. Irritable bowel syndrome substantially interfered with lifestyle and caused absenteeism. CONCLUSIONS: Irritable bowel syndrome is common with major effects on lifestyle and health care. The majority of cases are undiagnosed and the prevalence varies strikingly between countries. Diagnostic criteria are associated with varying prevalences and bowel habit sub-types. This limits their utility in clinical practice and the transferability of research findings using them.

Absenteeism↗
PubMed1993

Leadership in the nursing unit: relationships with nurses' well-being.

The head nurse occupies an important position in the nursing unit. Concerning leadership style, a distinction is traditionally made between consideration and initiating structure. Sometimes a third style is distinguished as well, namely 'production-orientated' leadership. In a study of 561 nurses from 16 general hospitals in The Netherlands, the influence of two leadership styles upon the reactions of nurses (job satisfaction, experienced meaningfulness, health complaints and absenteeism) to their work situations was examined, namely the styles of social (i.e. consideration) and instrumental leadership (a combination of the styles initiating structure and production-orientated). The separate effects of the two styles were studied, as well as the connection between combinations of leadership styles and reactions. The results indicate that social leadership contributes positively to nurses' reactions to their job. Instrumental leadership, on the other hand, leads to health complaints. From the analyses of combinations of leadership styles it appears that nurses are most satisfied if the head nurse pays much attention to both dimensions of leadership. For health complaints, a tendency in this direction is also found. Finally, it becomes clear that nurses with a great need for autonomy prefer a different type of leadership from nurses with little need for autonomy.

Absenteeism↗
PubMed1999

Treatment costs and loss of work time to individuals with chronic lymphatic filariasis in rural communities in south India.

This year-round case-control study investigated treatment costs and work time loss to people affected by chronic lymphatic filariasis in two rural communities in south India. About three-quarters of the patients sought treatment for filariasis at least once and 52% of them paid for treatment, incurring a mean annual expenditure of Rs. 72 (US $2.1; range Rs. 0-1360 (US $39.0)). Doctor's fees and medicines constituted 57% and 23% of treatment costs. The proportion of people seeking treatment was smaller and treatment costs constituted a higher proportion of household income in lower income groups. Most patients did not leave work, but spent only 4.36+/-3.41 h per day on economic activity compared to 5.25+/-3.52 h worked by controls; the mean difference of 0.89+/-4.20 h per day was highly significant (P<0.01). This loss of work time is perpetual, as chronic disease manifestations are mostly irreversible. An estimated 8% of potential male labour input is lost due to the disease. Regression analyses revealed that lymphatic filariasis has a significant effect on work time allotted to economic activity (P<0.05) but not on absenteeism from work (P>0.05). Female patients spent 0.31+/-1.42 h less on domestic activity compared to their matched controls (P<0.05). The results clearly show that the chronic form of lymphatic filariasis inflicts a considerable economic burden on affected individuals.

Absenteeism↗
PubMed2002

The economic payoffs of integrated malaria control in the Zambian copperbelt between 1930 and 1950.

It has long been suggested that malaria is delaying the economic development of countries that are most severely affected by the disease. Several studies have documented the economic consequences of malaria at the household level, primarily in communities engaged in subsistence farming. A missing element is the appraisal of the economic impact of malaria on the industrial and service sectors that will probably become the backbone of many developing economies. We estimate the economic effects of integrated malaria control implemented during the colonial period and sustained for 20 years in four copper mining communities of the former Northern Rhodesia (now Zambia). Integrated malaria control was characterized by strong emphasis on environmental management, while part of the mining communities also benefited from rapid diagnosis and treatment and the use of bednets. The programmes were highly successful as an estimated 14,122 deaths, 517,284 malaria attacks and 942,347 work shift losses were averted. Overall, 127,226 disability adjusted life years (DALYs) were averted per 3-year incremental period. The cumulative costs of malaria control interventions were 11,169,472 US dollars (in 1995 US dollars). Because the control programmes were so effective, the mining companies attracted a large reservoir of migrant labourers and sustained healthy work forces. The programmes averted an estimated 796,622 US dollars in direct treatment costs and 5,678,745 US dollars in indirect costs as a result of reduced work absenteeism. Within a few years of programme initiation, Northern Rhodesia became the leading copper producer in Africa, and mining generated the dominant share of national income. Copper production and revenues, which increased dramatically during malaria control interventions, amounted to the equivalent of 7.1 billion US dollars (in 1995 US dollars). Integrated malaria control in copper mining communities was a sound investment. It had payoff for public and occupational health, generally, and without it copper extraction and social and economic development would have been impossible.

Absenteeism↗
PubMed1992

Prevalence of adult migraine in general practice.

In 1988 the International Headache Society presented new criteria for the diagnosis of migraine. We used these criteria in a questionnaire to assist in the diagnosis of migraine. The questionnaire was answered by 230 patients in four general practices. We found a migraine prevalence of 11.7%. More than 70% of migraine patients had 12 or more attacks per year, and the length of attack varied between 4 and 24 h in 80% of them. The majority of migraineurs went to bed during the attack and 55% had stayed away from work due to migraine during the last year. The results of this study are in agreement with others. Migraine is an appreciable economic concern due to frequent short absenteeism from work.

Absenteeism↗
PubMed1999

Validation of a migraine work and productivity loss questionnaire for use in migraine studies.

Migraine symptoms and therapy side effects cause significant functional disability that can result in work and productivity losses. Effective, well-tolerated migraine therapy with rapid onset of relief could decrease work and productivity losses. The Migraine Work and Productivity Loss Questionnaire (MWPLQ) evaluates the impact of migraine and migraine therapy on paid work. Data from a randomized, open-label extension study were collected over 3 months. Migraineurs were randomized to either rizatriptan (5HT1B/1D receptor agonist) or their usual migraine therapy. Data were analyzed from 164 patients who experienced at least one work-related migraine. Internal consistency (Cronbach's alpha) for the work difficulty domains ranged from 0.80 to 0.95. Work loss and work difficulty were moderately correlated (r = 0.39-0.58) with migraine severity and functional ability. Differences were found favoring rizatriptan for absenteeism (1.3 vs 2.4 h), effectiveness at work (62% vs 49%), and difficulty with work-related tasks (p < 0.01). The MWPLQ demonstrated favorable measurement characteristics in this study and could be an important research tool for future evaluations of migraine-related work disability.

Absenteeism↗
PubMed1998

Societal and personal costs of obesity.

The economic costs of obesity can be broken down into three levels: 1. DIRECT COSTS: Costs to the community, related to the diversion of resources to the diagnosis and treatment of diseases directly related to obesity, as well as the treatment of obesity itself. These costs have been estimated to vary between 1-5% of total healthcare costs for various countries. Usually, the cost of obesity alone has been calculated, although it is known that the costs associated with being overweight [body mass index (BMI) 25-30 kg/m2] are also substantial because of the large proportion of individuals involved. These constitute costs to the health service (visits to general practitioners, consultations with medical specialists, hospital admissions and medication). 2. SOCIETAL OR INDIRECT COSTS: These costs are related to the loss of productivity caused by absenteeism, disability pensions and premature death. There is a lack of good economic analysis on this subject, although research from Sweden, Finland and the Netherlands has clearly shown that obesity is associated with increased sick leave and disability pensions. 3. PERSONAL COSTS: Obese subjects may earn less than their lean counterparts because of job discrimination (related to the stigma associated with obesity, or due to diseases and disabilities caused by obesity). Many insurance companies (particularly life insurance) charge higher premiums with increasing degrees of overweight. Obesity is further related to poor physical functioning and limitations in daily life. Some of these require assistance or adaptations which may be costly for an individual. In conclusion, there is much indirect information that obesity and overweight contribute substantially to healthcare-related costs. Data on aspects such as societal costs and personal costs are too fragmentary to allow calculation of the expenses involved. An appropriate analysis of all costs associated with obesity is important in order to persuade responsible bodies to develop strategies towards the prevention and long-term management of obesity.

Absenteeism↗
PubMed1986

How many days of bed rest for acute low back pain? A randomized clinical trial.

Bed rest is usually recommended for acute low back pain. Although the optimal duration of bed rest is uncertain, a given prescription may directly affect the number of days lost from work or other activities. In a randomized trial, we compared the consequences of recommending two days of bed rest (Group I) with those of recommending seven days (Group II). The subjects were 203 walk-in patients with mechanical low back pain; 78 percent had acute pain (less than or equal to 30 days), and none had marked neurologic deficits. Follow-up data were obtained at three weeks (93 percent) and three months (88 percent). Although compliance with the recommendation of bed rest was variable, patients randomly assigned to Group I missed 45 percent fewer days of work than those assigned to Group II (3.1 vs. 5.6 days, P = 0.01), and no differences were observed in other functional, physiologic, or perceived outcomes. For many patients without neuromotor deficits, clinicians may be able to recommend two days of bed rest rather than longer periods, without any perceptible difference in clinical outcome. If widely applied, this policy might substantially reduce absenteeism from work and the resulting indirect costs of low back pain for both patients and employers.

Absenteeism↗
PubMed2006

Effectiveness of school-based influenza vaccination.

BACKGROUND: Vaccination of children in school is one strategy to reduce the spread of influenza in households and communities. METHODS: We identified 11 demographically similar clusters of elementary schools in four states, consisting of one school we assigned to participate in a vaccination program (intervention school) and one or two schools that did not participate (control schools). During a predicted week of peak influenza activity in each state, all households with children in intervention and control schools were surveyed regarding demographic characteristics, influenza vaccination, and outcomes of influenza-like illness during the previous 7 days. RESULTS: In all, 47% of students in intervention schools received live attenuated influenza vaccine. As compared with control-school households, intervention-school households had significantly fewer influenza-like symptoms and outcomes during the recall week. Paradoxically, intervention-school households (both children and adults) had higher rates of hospitalization per 100 persons than did control-school households. However, there was no difference in the overall hospitalization rates for children or adults in households with vaccinated children, as compared with those with unvaccinated children, regardless of study-group assignment. Rates of school absenteeism for any cause (based on school records) were not significantly different between intervention and control schools. CONCLUSIONS: Most outcomes related to influenza-like illness were significantly lower in intervention-school households than in control-school households. (ClinicalTrials.gov number, NCT00192218.)

Absenteeism↗
PubMed2001

School attendance and school performance: a population-based study of children with asthma.

OBJECTIVE: To analyze school attendance and school achievement as outcomes of the care of children with asthma. METHODS: A previously identified Rochester, Minnesota, cohort of children with asthma and age- and sex-matched children without asthma were studied. School attendance, standardized achievement test scores, grade point average, grade promotion, and class rank of graduating students for children with asthma and control subjects were obtained from the Rochester Public School system. RESULTS: Children with asthma (n = 92) and age- and sex-matched non-asthmatic control subjects with 640 school-years of observation were studied. Children with asthma had 2.21 (95% CI, 1.41 to 3.01) more days absent than children without asthma. There was no significant difference in standardized achievement test scores (reading percentile difference 1.22% [95% CI, -3.68 to 6.12], mathematics percentile difference 2.36% [95% CI, -2.89 to 7.60], language percentile difference 2.96% [95% CI, -4.03 to 7.15]). There was no significant difference in grade point average, grade promotion, or class rank of graduating students. CONCLUSION: In this community, although children with asthma had 2 excess days of absenteeism, the school performance of children with asthma was similar to that of children without asthma.

Absenteeism↗
PubMed1998

Association of spatial distribution of childhood respiratory morbidity with environmental dust pollution.

The objective of this study was to investigate the spatial distribution of respiratory morbidity and asthma in children in relation to high levels of airborne dust pollution. A cross-sectional survey of 2035 children (aged 5-11 yr) by parent-completed questionnaire, with concurrent monitoring of dust deposition rates in the vicinity of children's homes, was performed in 15 primary schools (5 in each of 3 areas of Merseyside). The main outcome measures were (1) doctor-diagnosed asthma, (2) parent-reported respiratory symptoms of recent excess cough, wheeze, and breathlessness, and (3) school absenteeism due to respiratory ill health. Proximity to the source of dust pollution was associated with increased prevalence of excess cough, breathlessness, school absence due to respiratory ill health, and doctor-diagnosed asthma, after adjusting for a range of socioeconomic, environmental, and other confounding factors. The adjusted odds for excess cough and breathlessness for children living within 2 km of the source (dock area) are estimated to be almost twice those for children living more than 2 km away: excess cough 1.9 (95% CI 1.4-2.6); breathlessness 1.9 (1.3-2.7); school absence 1.5 (1.2-1.9); and doctor-diagnosed asthma 1.5 (1.1-2.0). Excess cough was significantly associated with the mean annual dust deposition recorded in the vicinity of the child's home. The adjusted odds ratio for excess cough corresponding to an increase in mean annual dust deposition of 50 mg/m2/d was 3.1 (95% CI 1.1-8.2). These results suggest that airborne dust was associated with respiratory morbidity in these children, which could relate to the high prevalence of childhood doctor-diagnosed asthma in this community.

Absenteeism↗
PubMed2006

Association of medication adherence with workplace productivity and health-related quality of life in patients with asthma.

OBJECTIVE: Examine the association of medication adherence with workplace productivity and health-related quality of life (HRQL) in asthma patients. METHODS: Adult patients with asthma in a state health insurance program identified from medical claims (July 2001-June 2003) were mailed a three-part survey to measure HRQL (St. George's Respiratory Questionnaire), workplace productivity (Workplace Productivity Short Inventory), and self-reported medication adherence (Morisky Scale). RESULTS: The symptoms domain had the worst HRQL scores, followed by the activity and impacts domains; 39% of the participants reported themselves as "high" adherent, whereas 19% were "medium," and 42% were "low" adherent. Asthma resulted in productivity losses of 597 +/- 1,024 US dollars (absenteeism) and 658 +/- 1,808 US dollars (presenteeism) per enrollee per year. CONCLUSIONS: Asthma was associated with HRQL detriments and workplace productivity losses.

Absenteeism↗
PubMedDate not supplied

Characteristics of menstrual cycles in Moroccan girls: prevalence of dysfunctions and associated behaviours.

Population studies on normal and dysfunctional characteristics of menstrual cycles are scarce for western populations and practically non-existent for non-western ones. Recent data suggest that the type of menstrual cycle can be relevant for later gynaecological problems in several ways. The type of menstrual cycle is related to menarcheal age in a way that those with early maturation show more menstrual disorders which are the largest diagnosis category accounting for hysterectomies in adult women. On the other hand menstrual pain is often cited as the main single cause of school absenteeism among adolescent girls. The aim of this study is to describe characteristics of menstrual cycles, prevalence of main dysfunctions and their relationship to the age of maturity. The sample comprises 495 adolescent girls from Marrakech (Morocco) aged 12-19 years. At 13 years, 40% of these girls had reached menarche. The median age at menarche is 13.04. The prevalences of abdominal pain, premenstrual symptoms and irregularity are 69.60, 51.20 and 23.03 respectively. Abdominal pain is significantly more frequent in girls with early menarche.

Abdominal Pain↗
PubMed2005

Promoting mental well-being in the workplace: a European policy perspective.

The nature of the workplace continues to change as Europe adapts to the challenges of competing in a global marketplace. Across the European Union there is a trend of increasing absenteeism and early retirement due to mental health problems, particularly stress and depression. The social and economic costs of lost productivity in Europe are substantial. Moreover, the sustainability of social protection systems may be challenged further by increases in the levels of disability benefits paid to people who have left work on grounds of poor mental health. Yet despite these significant consequences, at both national and pan-European levels, decision-makers have been slow to recognise the importance of promoting mental health within the workplace, although recently there have been some positive developments. This paper outlines some of the socio-economic arguments for the promotion of good mental well-being in the labour force and identifies how they link with different national and European policy agendas around four key issues: economic growth and development, the promotion of a high level of public health, sustainability of social welfare systems and social inclusion. The role and activities to promote mental well-being in the workplace undertaken by both national and international organizations in Europe are outlined along with important gaps and challenges that need to be addressed.

Absenteeism↗
PubMed1998

Burden of illness in functional gastrointestinal disorder--the consequences for the individual and society.

OBJECTIVE: To review the consequences of functional gastrointestinal disorders (FGD), i.e. heartburn without esophagitis, dyspepsia and IBS for the individual and society. RESULTS: Current publications indicate that functional gastrointestinal disorders are more prevalent than organic gastrointestinal disorders in the population. Symptoms, not the organic finding per se, are most important to the individual. Functional disorders are furthermore linked to somatic symptoms, from other parts of the body, as well as to mental health. Together they constitute a large medical burden on society in terms of consultations, drug consumption and surgery. Social costs are further increased by problems at work and a considerable increase in absenteeism. CONCLUSIONS: Functional gastrointestinal disorders should be taken more seriously by the medical community and society, since the burden of illness seems much larger than earlier anticipated.

Absenteeism↗
PubMed1994

The analysis of work-related injuries in a tractor factory.

An analysis of work-related injuries and absenteeism was carried out in a steel production and tractor manufacturing factory from 1982 to 1986. During that period there were 1152 injuries and 16,798 working days lost. Foundry workers were the most frequently injured; fists and fingers were the most frequently affected parts of the body. The number of injuries at work as well as the number of lost working days were highly influenced by the low socio-economic position of workers and by a general recession.

Absenteeism↗
PubMed2003

Use of, effectiveness of, and attitudes regarding influenza vaccine among house staff.

OBJECTIVE: To determine influenza vaccination rates, vaccine effectiveness, and factors influencing vaccination decisions among house staff. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: All residents registered at the University of Toronto were surveyed after the 1999-2000 influenza season. Of the 1,159 questionnaires mailed, 670 (58%) could be evaluated. RESULTS: Influenza-like illnesses were reported by 36% of house staff. The vaccination rate was 51% among respondents, being highest for community and occupational medicine and pediatric staff (77% and 75%) and lowest for psychiatry, surgery, and radiology staff (32%, 36%, and 36%). Vaccinees reported significantly fewer episodes of illness (42 vs 54 per 100 subjects; P = .03) and fewer days of illness (272 vs 374 per 100 subjects; P = .02); absenteeism was not different (63 vs 69 per 100 subjects; P = .69). Self-protection was the most common reason for vaccination. Vaccinees believed the vaccine was more effective than did non-vaccinees (P < .01). Non-vaccinees considered influenza-like symptoms the most important side effect of the vaccine. Busy schedules and inconvenience were the most common reasons for not getting vaccinated. Overall, 44% of house staff believed the influenza vaccine should be mandatory. CONCLUSIONS: Influenza-like illness was common among house staff. They tended to work through their illnesses, potentially putting patients at risk. They were motivated mostly by self-protection and did report a benefit. Despite busy schedules and an unfounded fear of getting influenza symptoms from the vaccine, many thought the vaccine should be mandatory.

Absenteeism↗
PubMed2004

Incidence and risk factors for sexually transmitted infections among women in an Alabama HIV clinic.

The objectives of this study were to assess the prevalence and incidence of curable sexually transmitted infections (STI), i.e., gonorrhea, chlamydial infection, or trichomoniasis, in a cohort of HIV-infected women. The study population was derived from women seeking primary care at an outpatient university HIV clinic who were participants in a women's natural history study. Enrollees (n = 225) were predominantly African-American, heterosexually infected, with mean age 35 years. Mean entry CD4+ T cell count was 405 cells/mm3. Over 6% were STI positive at initial screening. Subsequently, the combined curable STI incidence was 4.82/1000 woman-months over a median of 33 months of observation. Of 36 incident STIs, trichomoniasis was most common (n = 32). Predictors for acquisition of a curable STI included absenteeism at scheduled clinic appointments, RR = 1.99 (1.28, 3.08), and a higher CD4+ T cell count, RR = 1.15 (1.0028, 1.3115) for 100 cells. Interventions to prevent curable STI in HIV-infected women are warranted in primary care settings.

Absenteeism↗