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PubMed1986

The economics of informal care. Labor market effects in the National Hospice Study.

This article analyzes the labor market-related effects of informal care provision in the National Hospice Study on the individual providing this care. The results indicate that voluntary providers of patient care who were employed at the onset of the care-giving episode experienced considerable loss of earnings. These losses were partly caused by the fact that over one-fourth of initially employed caregivers left the labor force because of care obligations. This exit probability increased with the caregiver's age and female gender, and decreased with the caregiver's reported annual family income. Of the caregivers who continued in paid employment during the informal care episode, 60% reported losses of income because of care-related increased absenteeism from work. These two types of income loss are quantified using an indirect valuation method. This quantification indicates that some of the cost savings which have been attributed to the home-centered hospice modality in the National Hospice Study may have resulted from the shifting of costs from the formal health care sector to the informal care sector.

Absenteeism↗
PubMedDate not supplied

Developing a worksite lactation program.

This article describes the literature about worksite lactation programs and how such a service might be established to enhance breastfeeding success and lead to healthful outcomes for the mother and the baby. Because studies have demonstrated consistently that breastfeeding is associated with lower rates of infant illness, and that full-time maternal employment decreases breastfeeding duration, establishing an onsite lactation program within a corporation or organization could assist employees in maintaining ideal nutrition for their infants. Net gains for the organization, such as decreased absenteeism and fewer healthcare benefit claims can occur. The author suggests that the establishment of such a program by a nurse can be a successful nursing intervention.

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PubMed2002

Capacity for change.

Follow absenteeism and turnover rates from two outpatient clinics that underwent a period of major organizational change marked by multiple ownership.

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PubMed2000

Can chronic disability be prevented? A randomized trial of a cognitive-behavior intervention and two forms of information for patients with spinal pain.

STUDY DESIGN: A randomized controlled design superimposed on treatment as usual was used to compare the effects of a cognitive-behavior intervention aimed at preventing chronicity with two different forms of information. OBJECTIVE: To develop a coping-oriented preventive intervention applicable in primary care, and to compare its impact with educational information. SUMMARY OF BACKGROUND DATA: Preventing long-term disability resulting from spinal pain has proved difficult. The information provided by health care professions and early interventions aimed at preventing long-term disability may be important, but little scientific evidence exists concerning their use. METHODS: A protocol for a six-session cognitive-behavior group intervention was developed on the basis of earlier research. The main focus was to prevent long-term disability by changing patients' behaviors and beliefs so they can cope better with their problems. Comparison groups received either a pamphlet shown earlier to have an effect, or a more extensive information package consisting of six installments. All the groups continued to receive treatment as usual in primary care. There were 243 patients with acute or subacute spinal pain who perceived that they were at risk for developing a chronic problem. These patients were randomized to the cognitive-behavioral intervention or one of the two information groups. Because the aim was to prevent long-term disability, the key outcome variables at the 1-year follow-up assessment were sick absenteeism and health care use. Other variables were pain, function, fear-avoidance beliefs, and cognitions. RESULTS: The comparison groups reported benefits. However, the risk for a long-term sick absence developing was lowered ninefold for the cognitive-behavior intervention group as compared with the risk for the information groups (relative risk, 9.3). Participants in the cognitive-behavior group also reported a significant decrease in perceived risk. In addition, the cognitive-behavior group demonstrated a significant decrease in physician and physical therapy use as compared with two groups receiving information, in which such use increased. All three groups tended to improve on the variables of pain, fear-avoidance, and cognitions. CONCLUSIONS: This study demonstrates that a cognitive-behavior group intervention can lower the risk of a long-term disability developing. These findings underscore the significance of early interventions that specifically aim to prevent chronic problems. This approach might be applied to primary care settings.

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PubMed1992

Occupational reintegration of long-term cancer survivors.

To determine the long-term psychosocial consequences of cancer related to work, a postal survey was conducted among 849 long-term survivors of cancer in the southwest Netherlands. Forty-four percent of the responders who worked at the time of the diagnosis of cancer returned to their job, 24% of them part-time. Fourteen percent experienced impediments at work after return. Absenteeism in this group does not differ from that in the year prior to the moment of diagnosis. There is a small decrease in promotional and financial prospects.

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PubMed1998

The economic costs associated with body mass index in a workplace.

This study was undertaken to determine if a progressive correlation exists between body mass index (BMI), health care costs, and absenteeism and to identify an economically optimal BMI. We studied 3,066 First Chicago NBD employees by using health risk appraisals and personnel data. Analysis was completed for those employees with and without a risk for BMI. People at risk for BMI are more likely to have additional health risks, short-term disability and illness absence, and higher health care costs than those not at risk for BMI. A "J-shaped" curve between health care costs and BMI exists, with the low point occurring at about 25 to 27 kg/m2. We concluded that indirect and direct costs to an employer increase with increasing BMI. Employers may benefit from helping employees achieve a healthy weight. The initial target population should be those who are at highest risk of complications from obesity.

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PubMed2001

Health and productivity management: establishing key performance measures, benchmarks, and best practices.

Major areas considered under the rubric of health and productivity management (HPM) in American business include absenteeism, employee turnover, and the use of medical, disability, and workers' compensation programs. Until recently, few normative data existed for most HPM areas. To meet the need for normative information in HPM, a series of Consortium Benchmarking Studies were conducted. In the most recent application of the study, 1998 HPM costs, incidence, duration, and other program data were collected from 43 employers on almost one million workers. The median HPM costs for these organizations were $9992 per employee, which were distributed among group health (47%), turnover (37%), unscheduled absence (8%), nonoccupational disability (5%), and workers' compensation programs (3%). Achieving "best-practice" levels of performance (operationally defined as the 25th percentile for program expenditures in each HPM area) would realize savings of $2562 per employee (a 26% reduction). The results indicate substantial opportunities for improvement through effective coordination and management of HPM programs. Examples of best-practice activities collated from on-site visits to "benchmark" organizations are also reviewed.

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PubMed2001

Health and productivity: a role for occupational health professionals.

The impressive economic gains achieved by many nations within the past decade have been attributed primarily to improvements in productivity from technological changes. The resultant low unemployment levels, however, emphasize the importance of human capital in the success of any enterprise. Concurrently, some economists have proposed an alternative economic view regarding the relationship between health and income, postulating that improvements in the health of the nation's population have a substantial effect on its economic viability. Such a view directly pertains to occupational health professionals, who are often charged with promoting the health of the worker. Although studies relating the beneficial impact of occupational health on productivity and human performance are limited, some efforts have shown impressive effects, as measured primarily by reduced absenteeism. The prompt, assertive management of occupational injuries and illnesses and their treatment have been well documented. Illnesses not considered traditional occupational ailments, such as migraine headaches, allergic disorders, infectious diseases, and depression, offer opportunities for occupational health professionals to ensure an accurate diagnosis and proper treatment for minimizing the impact on work performance. Considerable opportunities exist for occupational health professionals to demonstrate the importance of certain services to productivity.

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PubMed2002

Stanford presenteeism scale: health status and employee productivity.

Workforce productivity has become a critical factor in the strength and sustainability of a company's overall business performance. Absenteeism affects productivity; however, even when employees are physically present at their jobs, they may experience decreased productivity and below-normal work quality--a concept known as decreased presenteeism. This article describes the creation and testing of a presenteeism scale evaluating the impact of health problems on individual performance and productivity. A total of 175 county health employees completed the 34-item Stanford Presenteeism Scale (SPS-34). Using these results, we identified six key items to describe presenteeism, resulting in the SPS-6. The SPS-6 has excellent psychometric characteristics, supporting the feasibility of its use in measuring health and productivity. Further validation of the SPS-6 on actual presenteeism (work loss data) or health status (health risk assessment or utilization data) is needed.

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PubMedDate not supplied

Pediatric orthopaedic injuries: the effect of treatment on school attendance.

This study aims to determine whether children experience difficulty attending school after an acute orthopaedic injury and, if so, what the barriers are to attendance. Seventy-eight school-aged patients receiving treatment of acute orthopaedic injuries or conditions at the authors' institution were enrolled in this prospective study. Follow-up interviews were conducted with children who could not return to school. Fifty-three percent of the children were able to return to school immediately; those who were not were absent for 35.9 days on average. Nearly three quarters of absentees attributed the nonattendance to refusal by the school, and only 36.7% received home instruction during their absence. A regression model showed that children using crutches were five times less likely to attend school than children without crutches. This study indicates that orthopaedic injuries and their treatments contribute to school absence. Refusal by the school to accommodate the injured child was the primary barrier to attendance.

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PubMed2003

Work restrictions and outcome of nonspecific low back pain.

STUDY DESIGN: Retrospective cohort study was conducted. OBJECTIVE: To evaluate the association of prescribed work restrictions with work absenteeism and recurrence in cases of nonspecific low back pain. SUMMARY OF BACKGROUND DATA: The efficacy of commonly prescribed work restrictions in limiting sickness-related absence because of back pain has not been evaluated. METHODS: Employees who had back pain-related sickness absence were identified from medical records of a utility company. The workers were grouped into those who had received a work restriction for their back pain and those who had not. The duration of work disability was compared between the two groups. Employees who returned back to regular, full duty within 1 year of onset were followed for one additional year to determine rates of recurrence. The Cox Proportional Hazards model was used to generate hazard ratios adjusted for age, gender, and job category. RESULTS: Restrictions were given to 43% of the workers. Sickness absence duration did not differ between those who had received restrictions and those who had not (adjusted hazard ratio, 1.12; P = 0.41). The median duration of restricted duty was 32.5 days. For 22% of the workers, restricted duty was never lifted. Recurrence appeared less likely to occur among those who had work restrictions in their initial episode. However, this difference was not statistically significant (adjusted hazard ratio, 0.77; P = 0.48). CONCLUSIONS: No evidence of an association between a prescription of work restriction and early return to work was found. More research is needed to clarify the utility of restricted duty in promoting a positive outcome for work-related low back pain.

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PubMed2004

Low back pain in a representative sample of Greek population: analysis according to personal and socioeconomic characteristics.

STUDY DESIGN: A cross-sectional study of low back pain and its related aspects in a representative sample of Greek population. OBJECTIVES: To estimate the prevalence of low back pain in the Greek population and to study the association of low back pain frequency and severity with socioeconomic and demographic characteristics. SUMMARY OF BACKGROUND DATA: Several prevalence studies carried out in different populations suggest a high frequency of this condition in the general population. Socioeconomic and demographic factors are likely to influence frequency and severity of low back pain. In Greece, there have been no previous studies investigating low back pain frequency and severity and its related aspects in the general population. Studies carried out in selected Greek populations suggest a 3-month prevalence of about 50%. METHODS: A 2000-person sample of the Greek population older than 15 years was selected by multiple-stage sampling, with definition of sample quotas based on demographic characteristics. Information about low back pain and its related aspects, as well as about socioeconomic and demographic characteristics, was collected by personal interviews. The study was carried out between March 10 and April 12, 2000. RESULTS: A total of 635 persons (31.7%) reported low back pain the last month. Among them 126 (19.9%) stayed in bed for some time, with a mean duration of staying in bed of 5.5 days. Work absenteeism represented a 19.1% of people younger than 65 years (54 persons) with a mean duration of 4.52 days. Low back pain frequency and severity were related to several socio-demographic factors at a statistically significant level. Sex, age, and kind of job presented a significant association with risk of low back pain independently from other socioeconomic factors. CONCLUSIONS: According to the results of the study, low back pain is a frequent symptom in the general Greek population. Low back pain frequency and severity are associated with several socio-demographic factors, especially with age, sex, and kind of job.

Absenteeism↗
PubMed2006

Back pain exacerbations and lost productive time costs in United States workers.

STUDY DESIGN: Cross-sectional with follow-up case-control component. OBJECTIVES: To measure the prevalence of back pain (BP) and back pain exacerbations, describe BP features and functional impairment, estimate BP-related lost productive time (LPT) and costs, and assess the relation between pain exacerbations and lost productive time. SUMMARY OF BACKGROUND DATA: BP is associated with substantial lost work time. However, little is known about the extent to which BP with or without exacerbation explains lost work time. METHODS: A national telephone survey of the U.S. workforce identified 320 workers 40 to 65 years of age with BP defined by NHANES I criteria and 91 matched non-BP controls. Participants self-reported pain characteristics, lost productive time (absenteeism and presenteeism) in the previous 2 weeks, activity limitations, and demographics. A population-weighting adjustment was applied to estimates to account for selection bias and ensure that estimates of certain sample demographic subgroups' totals conformed to the Current Population Survey. RESULTS: The 2-week period prevalence of BP was 15.1%; 42% of workers with BP experienced pain exacerbations. BP prevalence was associated with demographic factors, but BP exacerbations were not. BP was reported by 42.6% of all workers. Workers with exacerbations reported more days with BP than those without exacerbations. Workers with exacerbations were significantly more likely than those without such exacerbations to report activity limitation (88.4% vs. 60.7%; P < 0.0001) and BP-related LPT (22.1% vs. 13.0%; P = 0.0259). BP in workers 40 to 65 years of age costs employers an estimated $7.4 billion/year. Workers with BP exacerbations account for 71.6% of this cost. CONCLUSIONS: Workers with BP exacerbations account for a disproportionate share of the cost of BP-related lost productive time.

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PubMed2003

Organizational climate, perceived work-related symptoms and sickness absence: a population-based survey.

Very few reports have been published on organizational climate, health, and sickness absence in a representative sample of the entire workforce. The aim of this study was to determine how the perceived organizational climate of a workplace is related with work-related symptoms and sickness absence and how these factors vary according to sociodemographic and work-related characteristics. Data were collected in computer-assisted telephone interviews of a random sample of 4209 currently employed Finns drawn from the population register. A tense and prejudiced climate was associated with a higher risk of work-related symptoms than a relaxed and supportive climate (odds ratio [OR] 3.0 (95% CI = 2.4-3.7). The corresponding ORs were 4.3 (95% CI = 3.3-5.6) for psychological symptoms, 1.6 (95% CI = 1.2-2.0) for musculoskeletal symptoms, and 1.6 (95% CI = 1.3-2.1) for more than the average number of sick-leave days. Part of the impact of organizational climate on sickness absence is not caused by an increase in work-related symptoms. Thus, organizational climate seems not only to correspond with organizational practices and leadership but also occupational health. Organizational climate could be used as a research tool in attempts to reduce work-related ill health and sickness absenteeism.

Absenteeism↗
PubMed2003

The World Health Organization Health and Work Performance Questionnaire (HPQ).

This report describes the World Health Organization Health and Work Performance Questionnaire (HPQ), a self-report instrument designed to estimate the workplace costs of health problems in terms of reduced job performance, sickness absence, and work-related accidents-injuries. Calibration data are presented on the relationship between individual-level HPQ reports and archival measures of work performance and absenteeism obtained from employer archives in four groups: airline reservation agents (n = 441), customer service representatives (n = 505), automobile company executives (n = 554), and railroad engineers (n = 850). Good concordance is found between the HPQ and the archival measures in all four occupations. The paper closes with a brief discussion of the calibration methodology used to monetize HPQ reports and of future directions in substantive research based on the HPQ.

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PubMed2003

Health-related workplace productivity measurement: general and migraine-specific recommendations from the ACOEM Expert Panel.

An establishment of health-related productivity measurements and critical evaluation of health-related productivity tools is needed. An expert panel was created. A literature search was conducted to identify health-related productivity measurement tools. Each instrument was reviewed for: 1) supporting scientific evidence (e.g., reliability and validity); 2) applicability to various types of occupations, diseases, and level of severity of disease; 3) ability to translate data into a monetary unit; and 4) practicality. A modified Delphi technique was used to build consensus. The expert panel recommended absenteeism, presenteeism, and employee turnover/replacement costs as key elements of workplace health-related productivity measurement. The panel also recommended that productivity instruments should: 1) have supporting scientific evidence, 2) be applicable to the particular work setting, 3) be supportive of effective business decision-making, and 4) be practical. Six productivity measurement tools were reviewed. The panel recommended necessary elements of workplace health-related productivity measurement, key characteristics for evaluating instruments, and tools for measuring work loss. Continued research, validation, and on-going evaluation of health-related productivity instruments are needed.

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PubMed2004

Health, absence, disability, and presenteeism cost estimates of certain physical and mental health conditions affecting U.S. employers.

Evidence about the total cost of health, absence, short-term disability, and productivity losses was synthesized for 10 health conditions. Cost estimates from a large medical/absence database were combined with findings from several published productivity surveys. Ranges of condition prevalence and associated absenteeism and presenteeism (on-the-job-productivity) losses were used to estimate condition-related costs. Based on average impairment and prevalence estimates, the overall economic burden of illness was highest for hypertension ($392 per eligible employee per year), heart disease ($368), depression and other mental illnesses ($348), and arthritis ($327). Presenteeism costs were higher than medical costs in most cases, and represented 18% to 60% of all costs for the 10 conditions. Caution is advised when interpreting any particular source of data, and the need for standardization in future research is noted.

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PubMed2004

Change in health risks and work productivity over time.

We sought to examine the relationship between changes in health risks and changes in work productivity. Pre- and postanalysis was conducted on 500 subjects who participated in a wellness program at a large national employer. Change in health risks was analyzed using McNemar chi-square tests, and change in mean productivity was analyzed using paired t tests. A repeated measures regression model examined whether a change in productivity was associated with a change in health risks, controlling for age and gender. Individuals who reduced one health risk improved their presenteeism by 9% and reduced absenteeism by 2%, controlling for baseline risk level, age, gender, and interaction of baseline risk and risk change. In conclusion, reductions in health risks are associated with positive changes in work productivity. Self-reported work productivity may have utility in the evaluation of health promotion programs.

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