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PubMed1998

Trend of psychological distress in a Swedish population from 1989 to 1995.

The economic recession which began in Sweden in 1991 was followed by a large increase in the unemployment rate, especially in the younger labour force. The main purpose of the present study was to examine whether this recession has resulted in an increase in psychological distress in the population. Self-reported symptoms of anxiety, anguish, depression and sleeplessness have been analysed in repeated cross-sectional surveys conducted every other year from 1989 to 1995 in the County of Ostergötland. The study was confined to the 20-39 years age group and includes 3122 male and 3440 female respondents. The analysis was restricted to symptoms reported as occurring often or constantly. There was a significant increase in the 12-month prevalence of psychological distress among both men and women. At the beginning of the period 5% of the men in the 20-29 years age group reported frequent symptoms of psychological distress. By 1995 this had increased to 10%. The largest increase in prevalence, however, was found in men in the 30-39 years age group and women in the 20-29 years group Interestingly, when the non-employed groups were excluded from the analysis, the increasing trends of reported distress remained statistically significant with the exception of women aged 30-39 years.

Adult↗
PubMed1986

Parasuicide and unemployment.

The current economic recession in Europe and North America has led to a renewal of interest in the possible consequences of mass unemployment for the nation's health. This annotation assesses the relationship between unemployment and one indicator of morbidity: parasuicide (non-fatal deliberate self-harm). A previously published review of the literature is supplemented by more recent research, particularly from Edinburgh and Oxford.

Adult↗
PubMed1983

Report from Germany: current conditions and controversies in the health care system.

This paper presents a structured survey of the West German health care and health insurance system, and analyzes major developments of current German health policy. In order to make the analysis more accessible to a largely American audience, brief historical remarks, comparisons with U.S. experience, and considerable data and tabular information are provided. The German statutory health insurance scheme is known as a very comprehensive and generous one. However, under the pressure from rapidly expanding health care expenditures and a severe economic recession, the German governments under Helmut Schmidt and his successor Helmut Kohl imposed a number of cost-containment measures, namely a change in the mode of remuneration for physician services, certain regulations of the drug market, and increased cost-sharing. Cost-sharing is especially favored by the new conservative-liberal government. The article concludes with a summary of striking similarities between the American and German health care schemes, and an outlook on proposals for reform which are currently under investigation by the German government.

Cost Control↗
PubMed2005

Work, unemployment and life satisfaction among patients with diisocyanate induced asthma--a prospective study.

Occupational asthma has been found to be associated with lowered socio-economic outcomes, an increased unemployment rate and a decreased quality of life. The compensation of occupational diseases is comparatively favourable in Finland. Our aim was to follow-up the working status and life satisfaction of patients with diisocyanate-induced asthma in 245 cases diagnosed during 1976-1992. A questionnaire was sent out on average 10 (3-19) yr after the diagnosis to the surviving 235 patients. The questionnaire was validated by re-examining 91 of them clinically, and with spirometry, histamine challenge test and peak flow surveillance. Of the 213 responding patients, 14% were unemployed, and for 50% of them unemployment was caused by asthma. Unemployment was associated with nocturnal asthma symptoms (OR 10.93; CI 2.69-44.452), increased PEF variability (OR 8.46; CI 1.52-46.97) and with the use of short-acting beta-sympathomimetic medication (p=0.045). Satisfaction with life was associated with present working (OR 3.50; CI 1.73-7.06) and with good condition of asthma as assessed by the use of asthma medication (OR 0.49; CI 0.27-0.89) and objective measurements of the asthma condition, e.g. PEF variability (OR 0.21; CI 0.08-0.59). As a conclusion, unemployment was remarkably low as compared with earlier reports and related to the period of simultaneous economic recession. Unemployment, as well as dissatisfaction with life were associated with poor conditions of asthma. Unemployment was associated with improper asthma care favouring the use of short-acting beta-sympathomimetic medication. Proper follow-up of asthma is essential for minimizing the social complaints of occupational asthma, as well as for enhancing life satisfaction.

Adult↗
PubMed2000

[Stress management in the workplace in the era of industrial and economic change].

The globalization of the economy and the recent economic recession in Japan has accelerated down-sizing or restructuring of corporations and has resulted in the induction of a wage system according to achievement instead of the traditional seniority wage system, break-down of the life-long employment system, excess labor and increased unemployment. These rapid changes in the labor situation have increased job stress. It was reported in the survey conducted by the Ministry of Labor in 1997 that 62.8 percent of 16,000 workers had anxiety, worry and stress regarding their working life. The need for effective stress management at work has been increasing in this situation, but in the survey mentioned above only 26.5 percent of 12,000 companies replied that they had incorporated mental health measures. The characteristic features of the approaches for stress management in Japan are summarized as follows: 1) The most popular approaches are education and consultation for individual workers. 2) Systematic preventive approaches such as work control, working environment control, organizational change in the health management system, and systematic and continuous educational programs for managers are inadequate. 3) Systems to evaluation the effectiveness of these interventional approaches are also inadequate. Considering the current situation in which there is increasing job stress and a need for the occupational mental health promotion, we propose a series of mini-reviews regarding stress management at work and mention the composition of this series.

Health Promotion↗
PubMedDate not supplied

[Restructuring of production and occupational accidents in Brazil: structure and trends].

During the last two decades, incidence rates of occupational accidents have been decreasing in Brazil. Mortality has also decreased, but not as sharply as incidence. Changes in reporting of occupational accidents have been the main argument used to explain such trends. This time-series study covering occupational accidents from 1970 to 1995 clearly shows the link between occupational accidents and social and economical determinants. Comparing 14 Brazilian States, a positive linear regression (r=0.80) was detected between proportion of workers in industrial production and accidents. In the 1980s, Brazil's economic recession led to an increase in unemployment. The decline in industrial jobs - those with a higher risk of accidents ( was accented by the restructuring of production and increased use of computer and robotics technologies in various manufacturing sectors. The result was a heavy shift of the work force from industry to commerce and services - jobs entailing lower risk of accidents. These factors influenced trends in occupational accidents in Brazil during this 25-year period.

Accidents, Occupational↗
PubMed1993

Reorganization of craniofacial/cleft care delivery: the Massachusetts experience.

Until 1989, the Commonwealth of Massachusetts operated a mandated care program known as Services for Handicapped Children (SHC) for children with cleft lip/palate or craniofacial anomalies. During the mid 1980s, the federal government reduced its block grant funds and encouraged the Commonwealth of Massachusetts to develop Project SERVE to address this changing fiscal reality. The principal outcome of Project SERVE was the recommendation that the SHC direct care programs, including all craniofacial and cleft palate clinics, should be dismantled over a number of years. However, due to the economic recession, all government funding was suddenly withdrawn from cleft palate teams and the state-run SHC clinics were abruptly dissolved. To treat patients left without coordinated care, former team members reassembled and began a new craniofacial team based at the University of Massachusetts Medical Center. Difficulties with the transition of the clinic included recruiting and retaining team members; remuneration procedures for team members; maintenance of patient records previously kept by the state; coordination of clinical/clerical responsibilities; identifying a physical locale to hold the clinics; and solicitation of referring health care provider referrals and follow-up. All these issues required specific interventions that are presented in this paper. Project SERVE, begun under federal auspices, in the Commonwealth of Massachusetts, has recently been promoted as a model for a new and improved approach to the management of cleft palate and craniofacial care delivery nationwide. Awareness of the potential for abrupt, radical change in funding for federally mandated cleft/craniofacial care is essential, and a successful transition to a medical center-based model is possible using the procedures established at our center.

Child↗
PubMed1984

An evaluation of subsidized rural primary care programs: III. Stress and survival, 1981-82.

Surveys of a national sample of 193 subsidized rural primary care programs were conducted in 1981 and 1982 to determine what adaptations the programs might anticipate making given a reduction in their subsidy and what actual changes they made after the implementation of new federal policies and in the face of severe economic recession. During the period between the two surveys, nine of the 193 programs closed. The remaining programs changed elements of their operation, finances, and staffing, but these changes do not, in all cases, appear to be a direct response to subsidy reductions or increases. The programs exhibited adaptiveness and strength in the face of a potentially hostile environment.

Financing, Government↗
PubMed1987

Asbestos and asbestos-related disease: the South African case.

The asbestos industry in South Africa has suffered a decline in production, employment, and sales over the last few years. This mirrors the state of the industry internationally. In South Africa this has more to do with the economic recession than with legislative restrictions on asbestos use. New information has become available on the extent of asbestos-related diseases in South Africa. In this article, we outline developments in labor organization in the asbestos industry, and discuss the marked lack of control of asbestos, the inadequate state compensation system, and the difficulties facing labor. After describing recent improvements won by trade unions, mainly in the transnational corporation sector, we discuss the implications for industry, labor, and control of the asbestos hazard.

Asbestos↗
PubMed2001

The trend in airborne asbestos concentrations at plants manufacturing asbestos-containing products in Japan.

In Japan, chrysotile is still permitted to use under the Ordinance on Prevention of Hazards due to Specified Chemical Substances. In recent years many countries have introduced a policy of prohibiting the use of asbestos, based on clinical and epidemiological studies. In light of this, it is important to evaluate the airborne asbestos concentrations in workplaces and also estimate the number of related disease cases in order to discuss the ban of asbestos use. The survey covered 528 workplaces in 145 plants and included 2795 asbestos handling workers from 1985 to 1998. These plants were belonging to the Japan Asbestos Association (JAA) as member companies. In Japan, nearly all of the asbestos using manufacturing companies are members of JAA. In our study, all of the workplaces were divided under each separate manufacturing process and classified into 3 categories of Control Classes. Of the 454/528 (86.0%) workplaces classified as Control Class 1 are improved to 376/378 (99.5%). Though in the cases of small enterprises, other factors such as a shift in product lines, and the economic recession, as well as efforts, contributed to improvements in working conditions. JAA recommended self-administered concentrations of 1.0 f/ml (compatible to <0.3 f/ml in personal exposure level) in 1991 to promote further improvements of the work environment. From this point of view, exposure limits can almost be technically achieved in Japan, and it is expected that asbestos related disease could be expected to decrease in 20 to 30 years later. This survey will become basic material for verifications whether we could control asbestos related diseases enough in such well-controlled work environment.

Air Pollutants, Occupational↗
PubMed1996

Paths to recovery from substance misuse: change of lifestyle and the role of treatment.

Controlled outcome studies have, on the whole, failed to demonstrate more than rather weak and short-lived effects of substance misuser treatment. There is, at the same time, growing evidence that people often recover from substance misuse problems without the help of formal treatment. This state of affairs has, not least in times of economic recession, been taken as an argument for cutting fundings of treatment facilities and other forms of formal help. This article questions that present knowledge necessarily justifies such conclusions. We do know that even severe misusers are sometimes capable of changing their way of life. We do not, however, know very much about the circumstances and situations-planned or not and designated as "treatment" or something else-that contribute to such change processes. A closer integration of two research areas-outcome research and research on "spontaneous recovery"-is proposed as a way of learning more about the possible interplay between "real life" events, various formal interventions, and change of life style.

Convalescence↗
PubMed2000

Downsizing and industrial restructuring in related to changes in psychosocial conditions of work in British Columbia sawmills.

OBJECTIVES: This paper investigates changes in the psychosocial and physical work conditions of the sawmill industry in British Columbia, Canada, over the past 35 years. METHODS: Shifts in work conditions were examined within the context of historical changes in sawmill labor demography and job taxonomy as the industry was both downsized and restructured, largely in response to an economic recession in the early 1980s. RESULTS AND CONCLUSIONS: Downsizing eliminated approximately 60% of the work force and 1/4 of sawmill job titles. Although all the job categories in restructured sawmills showed increased levels of control, the gradient in control across job categories was steeper in 1997 than in 1965; this change may have important health implications particularly for the unskilled workers in the restructured mills.

British Columbia↗
PubMed2001

Integrating mental health services: the Finnish experience.

The aim of this paper is to give a short description of the most important developments of mental health services in Finland during the 1990s, examine their influences on the organisation and provision of services, and describe shortly some national efforts to handle the new situation. The Finnish mental health service system experienced profound changes in the beginning of the 1990s. These included the integration of mental health services, being earlier under own separate administration, with other specialised health services, decentralisation of the financing of health services, and de-institutionalisation of the services. The same time Finland underwent the deepest economic recession in Western Europe, which resulted in cut-offs especially in the mental health budgets. Conducting extensive national research and development programmes in the field of mental health has been one typically Finnish way of supporting the mental health service development. The first of these national programmes was the Schizophrenia Project 1981-97, whose main aims were to decrease the incidence of new long-term patients and the prevalence of old long-stay patients by developing an integrated treatment model. The Suicide Prevention Project 1986-96 aimed at raising awareness of this special problem and decreasing by 20% the proportionally high suicide rate in Finland. The National Depression Programme 1994-98 focused at this clearly increasing public health concern by several research and development project targeted both to the general population and specifically to children, primary care and specialised services. The latest, still on-going Meaningful Life Programme 1998-2003 which main aim is, by multi-sectoral co-operation, to improve the quality of life for people suffering from or living with the threat of mental disorders. Furthermore, the government launched in 1999 a new Goal and Action Programme for Social Welfare and Health Care 2000-2003, in which mental health has been chosen as one of the eight priority areas.

Journal Article↗
PubMed1994

Health service provision in rural and remote areas: a needs analysis.

OBJECTIVES: To assess the health service needs of rural and remote populations and to examine the relationship between these needs as obtained from available data and as perceived by community general practitioners (GPs) and other health providers. DESIGN: Existing census and research data were used to study the Huon and Channel health district of South-East Tasmania. Primary data collection consisted of structured interviews with medical practitioners and community representatives. RESULTS: Serious health problems are widespread in rural and remote areas as a result of socioeconomic conditions arising from economic recession and unemployment and pre-existing lifestyle and cultural attitudes towards health, low educational levels, isolation and lack of transport. General practice and primary health care provision follow urbanisation and decrease with increasing distance from a major rural centre, as do the incidence of poverty and worsening health problems. CONCLUSIONS: Most primary health care in rural and remote areas is provided by GPs, with curative services predominating. The health service patterns conform to lower socioeconomic patterns in that preventive health is given in low priority. Preventive health programs should tie in with curative health service provision, making use of the resources already available within the communities. The primary role taken by rural GPs in health service provision demands that they take a pivotal role in preventive health service delivery.

Adult↗
PubMed1994

The history of euthanasia debates in the United States and Britain.

Debates about the ethics of euthanasia and physician-assisted suicide date from ancient Greece and Rome. After the development of ether, physicians began advocating the use of anesthetics to relieve the pains of death. In 1870, Samuel Williams first proposed using anesthetics and morphine to intentionally end a patient's life. Over the next 35 years, debates about the ethics of euthanasia raged in the United States and Britain, culminating in 1906 in an Ohio bill to legalize euthanasia, a bill that was ultimately defeated. The arguments propounded for and against euthanasia in the 19th century are identical to contemporary arguments. Such similarities suggest four conclusions: Public interest in euthanasia 1) is not linked with advances in biomedical technology; 2) it flourishes in times of economic recession, in which individualism and social Darwinism are invoked to justify public policy; 3) it arises when physician authority over medical decision making is challenged; and 4) it occurs when terminating life-sustaining medical interventions become standard medical practice and interest develops in extending such practices to include euthanasia.

Beneficence↗
PubMedDate not supplied

Nurses vulnerable to lawsuits.

With the modern expansion of malpractice insurance among nurses, economic recession and the potential to garnish wages has encouraged attorneys to bring suit against nurses. The cases illustrated stagger the imagination.

Liability, Legal↗
PubMed1985

Measuring the impact of health interventions: a review of available instruments.

Interest in the measurement of the impact of health services has been increasing for three main reasons. Policy makers and service providers wish to be reassured that they are: (i) benefitting the public for whom the service is provided; (ii) in times of economic recession and limited resources, achieving the 'best value for money'; and (iii) given the need to make economies in health expenditures, maintaining standards of the health care. Recent developments in information for the evaluation of health services have tended to emphasis the control and monitoring of expenditure in preference to the control and monitoring of quality. There is concern that this might lead to adverse consequences for patients and for the health service as a whole in that the quality of services provided might deteriorate. Health interventions are considered to be successful if they result in a beneficial change in the health of the population for whom they are provided. If the health of the population is not improved, or maintained, questions are raised about either the appropriateness of the intervention in relation to health policies which have been selected, or about the quality of the care which has been provided. Because of this, it is necessary to monitor both the outcome of a heath intervention in terms of the change in the level of health of the population, and also to measure the quality and the effectiveness of the care provided. Health services research has, over the years, developed a number of different types of measures which can be applied to health services and has suggested a number of applications for such measures in terms of the impact on the health of patients and the general population and the quality and effectiveness of health services. The first section of this paper reviews a selection of measures for both health and the effects of health interventions and discusses their applicability as management tools. The use to which such measures are put obviously depends upon the type of decisions which they are to inform, which in turn are dependent upon the organisational level at which the decision is to be made, and the policy objectives of the service to which they relate. The second part of the paper discusses factors which must be taken into account when choosing measures to monitor the impact of the health services. In examining the suitability of a management tool, a measure must be proven to provide information which is universally acceptable and which conforms to a number of scientific standards.(ABSTRACT TRUNCATED AT 400 WORDS)

England↗
PubMed1985

Medicaid program characteristics: effects on health care expenditures and utilization.

Relationships between State Medicaid program characteristics and program outputs are analyzed in this statistical report, using 1980 cross-sectional data from a variety of sources. The year 1980 furnishes a baseline against which program changes following the Omnibus Budget Reconciliation Act of 1981 and the 1982 economic recession can be evaluated. Utilization and expenditures are modeled separately for each aid category and each major service category. This use of multiple models allows for measurement of the effect of program controls that might not appear in models of total utilization and expenditures.

Adult↗