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PubMed1974

Effects of self-recording on attendance and performance in a competitive swimming training environment.

Swimmers' attendance at training and work rates were described by their coaches as being poor and irregular. Reinforcement contingencies were developed to remedy these unsatisfactory conditions. Two experiments were conducted. A multiple baseline design verified the effects of publicly marking attendance at practice as a sufficient solution for reducing absenteeism, tardiness, and leaving early. Follow-up analyses showed this contingency to have lasting effects. In the second experiment, a reversal design was used to assess the effects of employing program boards as a means of increasing work output during practice. Work rates in eight selected swimmers were elevated by an average of 27.1% when the boards were instituted. Follow-up evaluations showed that the use of the program boards had lasting effects. Publicly checking the completion of each training unit of work changed the nature of the swimming environment to produce a more productive use of time. The role of the coach was subsequently changed as less time was spent in directing and supervising behaviors.

Absenteeism↗
PubMed2002

Return-to-work interventions for low back pain: a descriptive review of contents and concepts of working mechanisms.

Low back pain is a major medical and social problem associated with disability, work absenteeism and high costs. Given the impact of the problem, there is a need for effective treatment interventions in occupational healthcare that aim at the prevention of chronic disability and the realisation of return to work. These so-called return-to-work (RTW) interventions are becoming increasingly popular. As well as questions concerning the effectiveness of RTW interventions, there are also important questions on the actual content and underlying concepts of these multifactorial intervention strategies. The purpose of this review is to examine the literature on the content and underlying concepts of RTW interventions for low back pain. A systematic literature search identified 14 randomised controlled trials (RCTs) evaluating the effects of 19 RTW interventions. The content and concepts of these RTW interventions are described, compared and discussed in this review. Further, the contents of the RTW interventions are classified by the use of predefined components (physical exercises, education, behavioural treatments and ergonomic measures). The identified RTW interventions varied with respect to the disciplines involved, the target population and the number and duration of sessions. The classification showed that physical exercises were a component of most of the selected interventions, followed by education, behavioural treatments and ergonomic measures. The most prevalent combination of components was the combination of physical exercises, behavioural treatment and education. However, the types of physical exercises, behavioural treatment and education varied widely among the RTW interventions. The described concepts for the physical exercises were an increase of muscle strength, coordination, range of motion of the spine and cardiovascular fitness, and a decrease of muscle tension. Education as a part of RTW interventions is believed to increase the understanding of patients regarding their disorder and treatment. Behavioural treatments were mainly based on the gate control theory of pain (psychophysiological processes are involved in pain perception) and/or the operant conditioning hypothesis (pain behaviour is determined by its consequences). No concepts were described for ergonomic measures. Finally, the plausibility of the described concepts is discussed. Future RCTs on this topic should evaluate the underlying concepts of the RTW intervention in addition to its effectiveness.

Absenteeism↗
PubMed1992

Economic costs of functional dyspepsia.

Dyspepsia is defined as chronic or recurrent symptoms believed to originate in the upper gastrointestinal tract. When routine investigation results in no identifiable explanation for those symptoms patients are labelled as having functional dyspepsia. In community-based surveys, approximately 30% of the otherwise apparently healthy population report dyspeptic symptoms and the majority are believed to have functional dyspepsia. Although only 1 in 4 or 5 patients make use of healthcare resources, this patient category is one of the largest in ambulatory care (1.6 to 5% of all consultations in general practice). The annual frequency of consultations for functional dyspepsia in Sweden has been estimated at 47 per 1000 population. In consequence of its high prevalence and associated absenteeism, the total costs of functional dyspepsia are considerable. In Sweden in 1981, the costs were estimated at $US55 000 per 1000 population ($US113 630 in 1991 dollars). The most cost-effective management strategy remains to be defined. Evidence is accumulating that the traditional 'wait-and-see' policy with initial empirical therapeutic trials without investigation may not be the most cost conserving strategy.

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PubMed2005

Comorbidities and costs of adult patients diagnosed with attention-deficit hyperactivity disorder.

INTRODUCTION: The purpose of this retrospective study was to examine the prevalence of comorbidities, resource use, direct medical costs, and the costs associated with missed work for adults diagnosed with attention-deficit hyperactivity disorder (ADHD). STUDY DESIGN: From a large claims database that captures inpatient, outpatient and prescription drug services, individuals diagnosed with ADHD between the years 1999 and 2001 were retrospectively identified. The ADHD cohort (n = 2252) were matched with a non-ADHD cohort (n = 2252) on a 1 : 1 ratio, based upon age, gender, metropolitan statistical area and type of insurance coverage. The ADHD cohort was compared with the non-ADHD cohort for differences in comorbidities and direct medical costs (inpatient, outpatient and prescription drug costs) using year 2001 prices. Using data from six Fortune 200 employers, time missed from work and costs associated with absenteeism, short-term disability and worker's compensation was examined for a subsample (n = 354) of the employees diagnosed with ADHD. Chi-square and t-statistics were used to compare the ADHD population with the control group with regards to comorbidites and service use. Analysis of covariance and multivariate regressions were used to examine differences in days missed from work, direct medical costs and costs associated with missed work. RESULTS: Adults diagnosed with ADHD were significantly more likely to have a comorbid diagnosis of asthma (p = 0.0014), anxiety (p < 0.0001), bipolar disorder (p < 0.0001), depression (p < 0.0001), drug or alcohol abuse (p < 0.0001), antisocial disorder (p = 0.0081) or oppositional disorder (p = 0.0022) compared with the control group. Controlling for the impact of comorbidities, adults diagnosed with ADHD had significantly higher outpatient costs (USD 3009 vs USD 1492; p < 0.0001), inpatient costs (USD 1259 vs USD 514; p < 0.0001), prescription drug costs (USD 1673 vs USD 1008; p < 0.0001), and total medical costs (USD 5651 vs USD 2771; p < 0.0001) compared with the non-ADHD cohort. Employees diagnosed with ADHD missed significantly more days due to 'unofficial' absences (4.33 days vs 1.13 days; p < 0.0001). CONCLUSIONS: The results demonstrate that adults diagnosed with ADHD have a higher prevalence of comorbidities, higher medical costs and more absences than matched individuals without ADHD. These findings suggest that there may be an opportunity for the effective treatment of ADHD to lead to cost-offsets.

Absenteeism↗
PubMed2005

Do antidepressants reduce the burden imposed by depression on employers?

The ability to perform paid or unpaid work is integral to an individual's quality of life. Therefore, we performed a systematic literature review to examine the impact of depression and its treatment on occupational outcomes. This review found absenteeism from work to be markedly higher among depressed employees and productivity to be dramatically undermined by some symptoms of depression. Gaps in the published literature point to the need for future economic and clinical analyses to include work-related outcomes. Published studies showed that antidepressants can enhance work-related outcomes by alleviating affective symptoms. However, the pharmacological properties of antidepressants may produce differential effects that influence work-related outcomes in other ways. For example, TCAs, but not SSRIs, produce sedation and impair cognitive function in ways that could undermine work-related outcomes. Formal analyses are required to quantify whether the improved social functioning, motivation and vigilance that may be associated with some newer antidepressants translate into improved work-related outcomes. Although few published studies have directly quantified the cost benefit of managing depression and associated lost productivity, existing studies that directly assessed work-related outcomes have suggested that treating depression is cost effective. Gaps in the published literature imply that the impact of depression and antidepressants on occupational outcomes has been understudied. This reflects, in part, the fact that antidepressant studies lasting 4 or 6 weeks are unlikely to capture the impact of treatment on work-related measures. In addition, the current evidence base is fraught with other methodological limitations. The effect of depression on non-paid employment also requires further assessment. In conclusion, the efficacy of antidepressants on work-related outcomes should be measured in clinical trials that have an adequate design and a suitable follow-up period, and included in health technology assessments. Until such studies are available, the evidence base supporting the use of antidepressants will remain incomplete.

Absenteeism↗
PubMed2005

The impact of two organizational interventions on the health of service sector workers.

Studies focusing on interactive service work that involves face-to-face interactions between employees and customers/clients have shown that employees tend to show symptoms of job dissatisfaction, stress, and emotional exhaustion because they are expected to display or suppress certain emotions in the performance of their jobs. To meet the health challenges and reduce sickness absenteeism among employees in this sector, two organizational interventions were implemented among service workers employed by the municipality and in a shopping mall in a medium-sized Norwegian city. In a field experiment, the authors evaluated the effect of this type of intervention on employee health. The experiment combined survey measures (pre- and post-intervention) with observations and unstructured interviews. The survey data showed positive changes on only two of the measured variables among the shopping mall employees, and no effect on the municipal employees. This article focuses on the qualitative data, which show how constraints related to time and to interactional and organizational practices impeded full involvement of the employees during implementation of the interventions. The authors discuss the results from the perspective of the general challenges of implementing interventions in the service sector.

Absenteeism↗
PubMed1989

Employment spectrum of IDDM.

Occupational issues in 158 insulin-dependent diabetes mellitus (IDDM) individuals and 158 matched nondiabetic siblings were examined in a case-control design to evaluate the role of diabetes in the employability of people with IDDM. Overall, the IDDM cases were more likely to report refusal for a job at some point in their lives (56 vs. 42%, P = .02) than were the nondiabetic control siblings. Surprisingly, individuals who told job interviewers about their diabetes were more likely to report job refusal than their siblings (64 vs. 42%, P = .005), whereas individuals who did not mention their diabetes reported rates of refusal similar to their siblings (44 vs. 41%). IDDM cases were also less likely to be employed full time compared with siblings (55 vs. 73%, P = .001). Reduced employment in IDDM respondents was related to work disability. Reported work disability was more than seven times greater in the IDDM than the sibling group. The presence of diabetic complications was the primary factor related to work disability. Although 13% of IDDM respondents were unable to work because of disability, absenteeism among IDDM cases currently working did not differ from that of the nondiabetic siblings. Diabetes was not significantly associated with career levels or household income levels reported by the IDDM group. Disability, however, had a strong detrimental influence on these variables. The results suggest that hiring practices by employers may still be discriminatory toward individuals with IDDM. Once hired, the employment experiences of the IDDM population appear to be similar to the experiences of the nondiabetic population, provided the development of disabling diabetic complications has not taken place.

Absenteeism↗
PubMed2000

Methods to decrease attrition in longitudinal studies with adolescents.

A summary of methods to decrease attrition in longitudinal school-based studies conducted with adolescents beginning junior high schools or middle schools is presented. These include collection of contact information about students, additional days to collect data from absentee students, data collection in new high schools once students graduate from junior high schools or middle schools, sending questionnaires by mail, and conducting telephone or home interviews.

Absenteeism↗
PubMed1999

Sickness absence due to mental disorders in Japanese workforce.

This study was conducted to elucidate sickness absence due to mental disorders in Japanese companies. Data on sickness absence taken for seven consecutive days or more at eight companies (total number of employees: 44,816) was used for the analysis. Diagnosis of mental disorders was based on medical certificates prepared by physicians. The frequency of absence due to all diseases and mental disorders was 3.0% and 0.3%, respectively. The proportion of frequency absence due to mental disorders compared to that for all diseases was 9.4%. Figures for absence prevalence were almost the same as those for frequency absence. The average length of absence due to mental disorders and non-mental disorders was 119.5 days and 47.3 days, respectively. Rate of absence days due to mental disorders compared to that for all diseases was 21.0%. Percent of sickness absenteeism was 0.4%. In one company, the proportion of frequency absence and rate of absence days due to mental disorders compared to those for all diseases had an increasing tendency over the last six years.

Absenteeism↗
PubMed2005

Socioeconomic impact of insomnia in working populations.

To determine whether insomnia impact the professional life of patients and have an economical weight, this review article focused on the socioeconomic impacts of sleep related problems in working populations. The goal is to summarise the work that has been accomplished in that field. Several occupational factors have an impact on insomnia: the work schedules (shift work and night work), the physical environment at work and the occupational stressors. Insomnia is also a common problem in daytime workers. The daytime functioning of insomniacs is a key point to understand the impact of insomnia on workers. Absenteeism is one major target in the evaluation of severe insomnia at the workplace. Most of the studies find a higher rate of work accidents in insomniacs. The economic impact is severe in term of direct and indirect costs. Insomnia is a common problem at the workplace. The negative impact is not only on individual but also at the societal levels. More epidemiological studies appear warranted to demonstrate a reciprocal link between work conditions and sleep disorders.

Absenteeism↗
PubMed1988

Economic assessment of peptic ulcer disease treatments.

The cost and economic outcomes of peptic ulcer disease (PUD) treatments are important but uncommonly assessed by clinical researchers in gastroenterology. There is a growing interest in these assessments because of their implications for patient management and health care planning. Also, cost assessments offer the clinical researcher a powerful method to analyze the socioeconomic impact of different therapies in randomized prospective studies. The purposes of this paper are 1) to present methods and results of cost and economic assessment of PUD and 2) to consider the impact of H2 receptor antagonists on PUD cost. As with any chronic disease, PUD has direct and indirect costs. Direct costs are for hospital and clinic care, physicians' and surgeons' services, pharmacy fees, and nursing home care. Indirect costs of PUD affect society and include costs of absenteeism from work, disability, and mortality. Direct and indirect costs can be estimated prospectively in short-term and maintenance PUD clinical research studies. Several cost and economic analyses of PUD have been reported by clinical investigators and medical economists of different countries. They report a significant change in the direct and indirect costs of peptic ulcer treatment after the introduction of the H2 receptor antagonists.

Absenteeism↗
PubMed1988

Living with Asthma. I. Genesis and development of a self-management program for childhood asthma.

This paper traces the roots of Living with Asthma, a self-management program for childhood asthma, from the Children's Asthma Research Institute and Hospital (CARIH), a residential treatment center in Denver, Colorado. The basic components of the program were developed and tested over the 40-year history of CARIH; the findings of an educational unit were added to this accumulated knowledge and expertise to complete the system. The program rests heavily on social learning theory, particularly two major tenets: 1) the concept of reciprocal determinism and 2) the learning/performance dichotomy. The crucial role of these concepts is described here, especially with respect to the design of the program and the selection of dependent variables. The remainder of this article describes the essentials of Living with Asthma, particularly the skills taught and performed by patients in a formal evaluation of the system. The design of the study, characteristics of patients enrolled in the program, and results obtained with the system are discussed. The program proved highly effective in significantly improving the knowledge of asthma in parents and their children, and in developing positive attitudes in both groups. It also produced significant reductions in the number of attacks experienced by the youngsters and improved their peak flow values. Participation in the program resulted in changes in morbidity indices of asthma, including significant reductions in school absenteeism and health-care costs incurred because of the disorder. These changes, it was concluded, reflected the result of the performance by patients of the self-management skills taught in Living with Asthma, coupled with the exceptional medical treatment they received.

Absenteeism↗
PubMed1990

Effects of a behavioral treatment program on children with asthma.

Twenty children with severe asthma using continual oral beta 2 agonists were randomized equally into either a behavioral intervention group or a control group. The behavioral intervention consisted of: symptom discrimination of asthma signals, self-management techniques of breathlessness, and contingency management of asthma-related behavior. The purpose of the study was to evaluate the effects of the behavioral treatment when superimposed on a regular medical treatment. The design consisted of a four-week baseline period, a four-week intervention period, and a four-week follow-up period. Results showed that the group receiving the behavioral intervention significantly reduced their use of beta 2 agonist spray doses and days of school absenteeism without increasing the number of asthma symptoms compared with the control group. It was concluded that children with severe asthma may benefit substantially from a behavioral program in addition to their regular medical treatment.

Absenteeism↗
PubMed1995

Evaluation of an asthma self-management education program.

The goal of this study was to evaluate a self-management education program for asthmatics. This was a case-controlled retrospective study with a "1 year before and 1 year after" assessment of the proposed education program. It was carried out in the Quebec City metropolitan area, tertiary-center setting. The intervention group included 42 patients, 14 men and 28 women, aged 15-71 years. A control group of 42 patients was matched for age, sex, and medication needs. Neither of the 2 groups had previously received structured asthma education. The intervention group received 3 training sessions on asthma and its treatment, the use of action plans and self-measurement of peak expiratory flow, and was offered individual teaching by a specialized educator or telephone consultation. Evaluation of asthma knowledge was made before and after the teaching sessions and 1 year later. The control group received their usual care. The primary clinical outcome measures included frequency of asthma-related emergency-room (ER) visits, hospitalizations, absenteeism from work, and quality of life, measured 1 year prior to initiation of the educational program and for 1 year after, using questionnaires, chart reviews, and interviews. The control group was evaluated only during the last year of the study. Knowledge of asthma and its management was significantly improved immediately after the program and 1 year later (both p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Absenteeism↗
PubMed1992

Conceptions of alcoholism.

Alcoholism educators have assumed that endorsement of the disease concept of alcoholism would reduce the moral stigma associated with the condition, thereby promoting a more humanitarian approach to the alcoholic. The present study presents data relevant to these assumptions. Measures of beliefs about the medical and moral nature of alcoholism were collected from 1,446 work supervisors in federal agencies. Additionally, social acceptance, tolerance of the alcoholic's absenteeism, and charitable responses to the alcoholic were measured. Results indicated that beliefs about the moral character of the alcoholic and beliefs about the medical nature of alcoholism are significant predictors of social acceptance of the alcoholic, tolerance of work behavior of the alcoholic, and a charitable response to the alcoholic. Findings are discussed in terms of the importance of educational efforts aimed at dispelling beliefs about the moral nature of alcoholism.

Absenteeism↗
PubMed2003

Value of preemployment medical assessments for white-collar workers.

Employee absenteeism as a result of illness, as well as the need to enhance worker efficiency, are areas of increasing concern to employers. Given that preemployment medical assessments are expensive, the authors believe it is prudent to evaluate the cost-effectiveness of such procedures. Medical literature was reviewed, and relevant studies on preemployment assessments were analyzed in terms of yield and methodology. The authors found no clear guidelines for preemployment medical evaluations for white-collar applicants, who typically work in low-risk environments; however, they did conclude that laboratory testing and imaging methods are likely overused. Clear criteria should exist for medical assessment of job applicants, with an emphasis on cost-effectiveness. On the basis of recommendations contained in the literature, the authors suggest use of a self-administered questionnaire, with evaluation by an occupational health staff member when necessary, as the method(s) of choice for preemployment assessment of white-collar workers.

Absenteeism↗
PubMed2003

Annual report of the National Influenza Surveillance Scheme, 2002.

Surveillance for influenza in Australia in 2002 was based on notifications to the National Notifiable Diseases Surveillance system from all states and territories, national and state-based sentinel practice consultations for influenza-like illness and reports of influenza virus isolations from a laboratory network. The impact of influenza was assessed by absenteeism data from a major national employer. Influenza A was the dominant type, 99 per cent of which were subtype H3N2 with only a single H1 isolate, which was identified as H1N2. The H3N2 isolates were closely related to the vaccine strain A/Moscow/10/99 and the A/Panama/2007/99, with less than one per cent showing genetic variation. Influenza B made up 21 per cent of circulating influenza and the majority of B strains were of the B/Victoria lineage, but had a haemagglutinin closely related to the B/Hong Kong/330/2001 strain. This strain was associated with two outbreaks but a proportion of vaccinees with the 2002 vaccine showed protective antibody titres. The 2002 influenza vaccine was given to 77 per cent of Australians over 65 years.

Absenteeism↗
PubMedDate not supplied

Sexual harassment: perspectives from the past, present practice, policy, and prevention.

During the times of Florence Nightingale, elements of sexual harassment were evident and were addressed in her writings. The more recent Anita Hill-Clarence Thomas judicial hearings brought more attention to the issue. It is imperative that hospitals and their staff development departments have a clear understanding of what constitutes sexual harassment so that effective policies can be implemented. Preventive training can be implemented to avoid absenteeism, staff turnover, lost productivity, decreased quality of patient care, and exorbitant legal costs.

Absenteeism↗