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Adolescent violence: concepts for a new millennium.

Violence is a form of aggressive behavior that has a debilitating effect on the optimal growth and development of our youth. Violence pervades the lives of a significant proportion of all adolescents in the U.S., but has a particularly devastating impact on males and minority youth. Adolescent males are more likely to be victimizers and victims of violence and aggression, except in cases of sexual victimization and suicide attempts. For all adolescents, exposure to violence at home, school, or in the community is associated with aggression later in life, the development of supportive attitudes toward aggression and violence, psychological distress, school absenteeism, academic dysfunction, and subsequent injury. Violence has historical, cultural, and societal roots in our world. Until and unless we begin to understand where violence fits on the continuum of aggressive behavior and until we address the politics of violence, we will remain conflicted and paralyzed by the dangers our youth face. By understanding the social, political, and developmental aspects of violence and understanding the nature and characteristics of resilient children, we can better prepare our youth for life. We may not be able to protect our adolescents from exposure to violence, but we most certainly can help them develop the necessary skills to survive such exposure and work to enhance and strengthen their access to protective factors so that they can experience a healthy transition from adolescence to adulthood in this new millennium.

Absenteeism↗

Psychological distress and somatisation as prognostic factors in patients with musculoskeletal illness in general practice.

BACKGROUND: Musculoskeletal illness is a common cause of absenteeism from work, workers' compensation, and disability retirement, and accounts for 9.3% to 17% of patient contacts in general practice. To understand the increase in self-reported musculoskeletal illness and to improve treatment and prevention, it is important to know which factors to target when dealing with these patients. AIM: To investigate whether the prognosis for patients with musculoskeletal illness referred to physiotherapy from general practice can be predicted by the presence of psychological distress and somatisation identified by a general practitioner (GP) and standard questionnaires. METHOD: A multi-practice survey based on questionnaires (index and three-month follow-up). Nine hundred and five consecutive patients referred to physiotherapy from 124 different general practices in Denmark were included. Outcome measures were physical health change, sick leave, patient self-rated improvement, and change in use of medication. RESULTS: Psychological distress and somatisation rated by both GPs and standard questionnaires acted with almost no exception as significant predictors of all four outcome measures. CONCLUSION: Psychological distress and somatisation are important factors when considering preventive initiatives and treatment of patients with musculoskeletal illness in general practice.

Absenteeism↗

Underestimating the value of women: assessing the indirect costs of women with systemic lupus erythematosus. Tri-Nation Study Group.

OBJECTIVE: Indirect costs result from diminished productivity and are incorporated in cost-benefit analysis to guide health resource allocation. Valuing the productivity impairment of those not involved in labor market activities is controversial but important for diseases affecting predominantly women if allocation decisions are to be economically efficient and equitable. We compared indirect costs incurred by women with systemic lupus erythematosus (SLE), a prototypical women's disease, calculated under varying assumptions for the value of diminished labor market and non-labor market activity. METHODS: Six hundred forty-eight female patients with SLE reported on employment status and time lost by themselves and their caregivers from labor market and non-labor market activities over a 6 month period. RESULTS: Average annual indirect costs ranged from $1,424 to $22,604 (1997 Canadian dollars) dependent on the value assigned to labor market and non-labor market activity. CONCLUSION: Indirect cost estimates that fail to consider longterm labor market absenteeism and diminished non-labor market productivity and do not use gender neutral wages to value labor market activity may lead to decisions that jeopardize resources for women's diseases.

Absenteeism↗

The foam mattress-back syndrome.

BACKGROUND: Many medical residents used to sleeping on cotton mattresses at home complain of mild to moderate back pain after sleeping on foam mattresses provided in the hospital and hostel rooms. OBJECTIVE: To determine the relationship of sleeping on foam mattress with the appearance of back pain in a 500 bedded multispecialty tertiary care hospital. METHODS: One hundred medical residents were interviewed for the appearance of backache after sleeping on 10 cm thick foam mattress provided to them in the hostels. Pain was scored over a visual analog scale of 10 cm. Effect of sleeping on a regular cotton mattress was assessed. RESULTS: Sixty-three (5 female residents) developed back pain on the morning of a night of sleep over the foam mattress. The pain was mostly of lower back and was not associated with any objective neurodeficit. Four residents on account of the backache reported thirteen episodes of absenteeism. Sixty-one residents had a relief of the pain on going home where they would sleep on regular cotton mattresses, only to recur after sleeping again on the foam mattress in the hospital/hostel. CONCLUSION: Sleeping on foam mattress is associated with the appearance of backache in medical residents which is reproducible and gets relieved after using regular cotton mattresses.

Absenteeism↗

Workplace costs associated with acute exacerbation of chronic bronchitis: a comparison of moxifloxacin and levofloxacin.

Past research on acute exacerbation of chronic bronchitis (AECB) has not quantified related work loss. This exploratory study used data from a comparative trial of moxifloxacin versus levofloxacin to examine and compare workplace-related indirect costs. Both groups reported considerable absenteeism and lowered work productivity. However, patients taking moxifloxacin reported significantly higher work productivity than those taking levofloxacin (70% vs. 50%; P = .03). This translated into substantial indirect cost savings with moxifloxacin of $726/patient/year. Antibiotic choice in AECB can affect worker productivity and workplace-related indirect costs. Both insurers and employers should consider workplace-related indirect costs in addition to direct medical expenses when making formulary selections.

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Resource utilization and cost of rheumatic fever.

OBJECTIVE: The socioeconomic effects of rheumatic fever (RF) in Brazil, including direct and indirect costs to patients and their families and to society, are largely unknown. We evaluated the utilization of resources and costs related to RF in a tertiary center caring for low income patients in the city of São Paulo, Brazil. METHODS: One hundred patients with RF, younger than 18 yrs, with followup of at least one year, were sequentially selected to provide complete information on a questionnaire. Additional data were collected from patients' charts. The utilization of resources was evaluated for each patient throughout the entire disease course. Costs were determined for patients and their families as well as for the society, using variables from 3 different systems: the national public health system, used by most lower income groups; the Brazilian Medical Association, which regulates charges and fees utilized by health plans and insurance companies; and costs charged by private practitioners, paid directly by patients. RESULTS: The RF population studied belonged to a low socioeconomic level. The mean monthly family income was $625.20 US. The mean disease duration was 3.9 yrs (range 1-10). Patients had a total of 1657 medical consultations, 22 hospital admissions, and 4 admissions to intensive care unit. Work absenteeism among parents was calculated as 22.9%, equivalent to 901 days of missed work; about 5% of the parents lost their jobs. Patients showed a high rate of school failure (22%). Considering the public system as a reference, direct, indirect, and total costs to society per 100 patients throughout the entire disease duration were $105,860 US ($271/patient/yr), $18,803 US ($48/patient/yr), and $124,663 US (US $319/patient/yr), respectively. When health care plan and private systems were taken as reference, the total costs were $423,550 US and $684,351 US, respectively. CONCLUSION: RF and rheumatic heart disease have an important socioeconomic impact in Brazil; costs of RF made up roughly 1.3% of annual family income. The estimated annual cost of RF for society in Brazil is $51,144,347.00 US.

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Vascular diseases in employed males: a perspective on preventive and remedial programs in industry.

Simple morbidity and mortality surveillance procedures have been applied at a large steel mill for several years. Analyses arising from these data are presented demonstrating, as a case in point, that vascular diseases are among the leading causes of absenteeism and are the leading cause of death among male employees. Furthermore, the strong association of hypertension with vascular mortality is clearly displayed. Finally, attempts to initiate treatment for hypertensive employees through referral to their family physicians met with rather disappointing success as only 22 of 200 referrals resulted in patient-physician interactions. Several suggestions and conclusions can be drawn from this work. First, simple surveillance procedures can be easily implemented in occupational settings and meaningful results derived. Industrial sites offer unique opportunities for epidemiologic studies. Second, vascular diseases have a devastating effect on working age males and it would appear that hypertension, as a controllable "risk factor", is a logical target for intervention programs. Third, while our information is rather limited, it would seem that traditional referrals of patients "at risk" to their family physicians is not an effective way to arrange for their treatment. For much the same reasons that industrial sites may be useful in epidemiologic studies, they may also provide a base for intervention programs for certain disease conditions. Before such programs are undertaken, however, research into their feasibility and effectiveness is required and we are hopeful that our own studies, now underway, will provide some insight in this area.

Absenteeism↗

[Influenza: prevention and treatment].

Prevention of influenza for persons at risk with inactivated vaccine remains the best way for attenuating the impact of influenza epidemics if persons to be vaccinated are correctly identified. In current recommendations, the lower cut off age is controversial, but new arguments on mortality associated with influenza suggest to lower the age to 45 for vaccination. Moreover immunization of health care workers is essential by decreasing transmission to susceptible patients and by reducing absenteeism of essential people during epidemics. Intranasal attenuated live vaccine seems to be of particular importance essentially in children and could replace the current vaccine in a near future. The role of chemoprophylaxis by inhibitors of neuraminidase needs further studies, but preliminary controlled trials have demonstrated a certain efficacy by controlling outbreaks in health care institutions. Treatment of influenza by these latter antivirals already has defined indications and a larger use currently lies on convincing arguments. By reducing inappropriate use of antibiotics, an extended use of neuraminidase inhibitors is of particular interest even if it is not a valuable argument, stricto sensu, for good medical practices.

Absenteeism↗

Indicators of intimate partner violence in women's employment: implications for workplace action.

The study examined the indicators and consequences of intimate partner violence on women's employment and associated types and levels of violence. Interviews were conducted with a consecutive sample of 90 women seeking a protective order. Actual and threatened violence was measured with the Severity of Violence Against Women Scales (46 items). Eight questions were asked about type of harassment experienced at the worksite. The results found most of the abused women had been employed at one time (87%) and had also experienced harassment from an intimate partner related to their work (89%). Findings indicated lost productivity and reduced performance. The researchers concluded poor work performance, tardiness, and absenteeism may indicate an employee is suffering from intimate partner violence.

Absenteeism↗

The mental health paradox.

The authors review the evidence that mental health coverage pays for itself by reducing overall health care costs, satisfies and helps patients who receive it, reduces employee absenteeism and improves employee functioning. They then explain the factors contributing to the decline in mental health services valuations and what employers can do to minimize them.

Absenteeism↗

Consultations for work related low back pain in Argentina.

OBJECTIVE: Low back pain (LBP) is a common cause of disability among people of working age. We investigated the incidence of consultation for work related LBP and of work absence, and determined the prevalence of continued work disability due to LBP in Argentina. METHODS: Our study population comprised 139,740 fulltime workers (mean age 34.4 yrs, range 17-79). An episode of work related LBP was defined as patient consulting because of acute LBP while at work or while traveling to/from work. RESULTS: In a 6 month period 360 episodes of acute LBP were reported in 69,329 worker-years of exposure to risk; thus the episode incidence rate was 5.2/1000 worker-years. This was the third most frequent work related injury. Twenty-one patients (5.8% of episodes) were lost to followup. Those with LBP were significantly older than the population at risk (p < 0.001) and were predominantly men (p < 0.001). In 244 episodes (72%) pain onset was related to heavy physical work and in 46 (13.6%) it followed trauma to the back. Surgery was performed in 9 (2.7%) cases. In total, 322 (98%) patients were absent beyond the day of the injury (median number of days of work absence, 7 days; range 0-422 days). Surgical patients lost significantly more days of work (p < 0.01). Seven patients (2%) remained off work more than 180 days: 2 were declared disabled, 3 moved to lighter jobs, and only 2 (28.5%) returned to their previous job. CONCLUSION: The incidence of consultation for work related LBP was 5.2/1000 worker-years. This was the third most frequent work related injury. Most patients had some work absenteeism. Surgery did not shorten recovery times. Only a minority of patients off work for 6 months or more were able to return to their previous job.

Absenteeism↗

Economic cost and epidemiological characteristics of patients with fibromyalgia claims.

OBJECTIVE: Fibromyalgia (FM) is characterized by widespread pain that can lead to significant patient disability, complex management decisions for physicians, and economic burden on society. We investigated the total costs of FM in an employer population. METHODS: Administrative claims data of a Fortune 100 manufacturer were used to quantify direct (i.e., medical and pharmaceutical claims) and indirect (i.e., disability claims and imputed absenteeism) costs associated with FM. A total of 4699 patients with at least one FM claim between 1996 and 1998 were contrasted with a 10% random sample of the overall beneficiary population. Employee-only subsets of both samples also were drawn. RESULTS: Medical utilization, receipt of prescription drugs, and annual total costs were proportionately similar yet significantly greater among FM claimants than the overall sample (all p < 0.0001). Total annual costs for FM claimants were $5945 versus $2486 for the typical beneficiary (p < 0.0001). Six percent of these costs were attributable to FM-specific claims. The prevalence of disability was twice as high among FM employees than overall employees (p < 0.0001). For every dollar spent on FM-specific claims, the employer spent another $57 to $143 on additional direct and indirect costs. CONCLUSION: Hidden costs of disability and comorbidities greatly increase the true burden of FM. Regardless of the clinical understanding of FM, when a claim for FM is present, considerable costs are involved. Findings suggest that within the management of FM there may be large cost-offset opportunities for reductions in patient, physician, and employer burdens.

Absenteeism↗

The employment of elderly persons.

Not every old person is fit for employment, and consequently employment agencies must reserve the right of selection. Retirement at the customary age with, if desired, re-employment for defined periods seems to offer the best method of employing old people, avoiding damaging loss of dignity and the blocking of promotion of younger people.Under suitable conditions, old persons are capable of a high level of employment. The possibilities of employment, however, vary very much with different types of industries and industrial regions. The elderly usually have a higher sickness absenteeism than young people, but have fewer absences for other reasons than sickness. Elderly workers seem to be able to carry out manual labour with efficiency if they are put into jobs without time-stress. If retraining is necessary, the utmost possible use should be made of already established skills. Heavy work does not seem to be necessarily harmful for old people.Little knowledge is yet available on the health problems of professional workers or executives at increasing age. Lack of decisiveness, failure of critical judgement, and increasing irritability-resulting from difficulty in organizing new information-will call for transfer to less responsible positions.Many more studies of old age are needed before the circumstances under which they may best be employed in present-day industry can be determined. Full employment and the need for production make this problem still more urgent.

Absenteeism↗

Supporting the elderly: workplace programs for employed caregivers.

An aging population and extended longevity are increasing the number of older people needing informal and family support. At the same time, women, the traditional caregivers, have entered the work force in record numbers. Consequently, concerns about how to care for dependent family members have become workplace issues. In response to the needs of employees who care for family members, employers have produced an array of policies, benefits, and programs, including flexible work schedules and information and referral services. Although these programs are a valuable complement to community services and government initiatives, relatively few employers have recognized the potential effects of caregiving on absenteeism, productivity, and turnover; even fewer have responded with workplace programs directed to the needs of their caregiving employees. To fill the gap, the government is considering mandating employee benefits, such as leave time for family illness. Community services are increasingly being directed to the needs of older people and their caregivers.

Absenteeism↗

A benefit-to-cost analysis of a work-site health promotion program.

An analysis of the benefit-to-cost ratio of a major health promotion program was conducted for the years 1986 through 1990, with projections to the year 2000. Program costs for personnel, capital expenses, materials, and rent were determined and compared with program benefits (discounted to account for increasing pension liability) for heath care cost savings, increased productivity, decreased absenteeism, decreased life insurance claims, and program-generated income. After adjusting future monies to net present value, a benefit-to-cost ratio of 3.4 was estimated for the program. Despite the limitations of the study design, the authors concluded that the program realizes a positive return on its investment. Several program recommendations are presented to increase the probability of achieving positive benefit-to-cost ratios in future program offerings.

Absenteeism↗

Managing migraine.

Absenteeism by migraine sufferers is treated with little sympathy by employers and fellow workers even though it is a condition that affects nearly eight per cent of the population. Helen Kogan looks at how an understanding of its debilitating effects can reduce the stigmatisation of employees.

Absenteeism↗

Managing workplace depression: an untapped opportunity for occupational health professionals.

Depression is one of the most prevalent and costly health issues affecting the American work force. Despite well established research demonstrating the association between employee depression and reduced on-the-job productivity, increased absenteeism, and higher health care use, most employers remain largely unresponsive to the need for company based depression initiatives. Organizational and individual barriers can prevent companies from effectively managing employee depression. Organizational barriers include information gaps, lack of data to justify increased investment in employee mental health programs, and employers' ambiguous roles in addressing depression. Individual barriers such as an inability to recognize signs and symptoms; stigma; confidentiality and privacy concerns; and unavailability of easily accessible, quality resources can keep employees who are depressed from seeking treatment. Many occupational health professionals may feel ill prepared or uncomfortable taking the lead in creating more aggressive worksite responses to depression, but they are, perhaps, in the best of all possible positions within an organization to succeed. Occupational health professionals have the credentials, credibility, training, and experience necessary to build a strong case for business leaders for why investing in workplace depression programs is so important. Occupational health professionals are the most qualified to design and deliver destigmatized, customer friendly programs and services for employees to access for help with depression, and to integrate their services with other departments such as benefits, health promotion, EAP, and human resources, to create an effective, organization-wide depression initiative.

Absenteeism↗