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PubMed2006

Written action plans for asthma in children.

BACKGROUND: While all asthma consensus statements recommend the use of written action plan (WAP) as a central part of asthma management, a recent systematic review of randomised trials highlighted the paucity of trials where the only difference between groups was the provision or not of a written action plan. OBJECTIVES: The objectives of this review were firstly to evaluate the independent effect of providing versus not providing a written action plan in children and adolescents with asthma, and secondly to compare the effect of different written action plans. SEARCH STRATEGY: We searched the Cochrane Airways Group Specialised Register (November 2004), which is derived from searches of CENTRAL, MEDLINE, EMBASE, CINAHL, as well as handsearched respiratory journals, and meeting abstracts. We also searched bibliographies of included studies and identified review articles. SELECTION CRITERIA: Randomised controlled trials were included if they compared a written action plan with no written action plan, or different written action plans with each other. DATA COLLECTION AND ANALYSIS: Two authors independently selected the trials, assessed trial quality and extracted the data. Study authors were contacted for additional information. MAIN RESULTS: Four trials (three RCTs and one quasi-RCT) involving 355 children were included. Children using symptom-based WAPs had lower risk of exacerbations which required an acute care visit (N = 5; RR 0.73; 95% CI 0.55 to 0.99). The number needed to treat to prevent one acute care visit was 9 (95% CI 5 to 138). Symptom monitoring was preferred over peak flow monitoring by children (N = 2; RR 1.21; 95% CI 1.00 to 1.46), but parents showed no preference (N = 2; RR 0.96; 95% CI 0.18 to 2.11). Children assigned to peak flow-based action plans reduced by 1/2 day the number of symptomatic days per week (N = 2; mean difference: 0.45 days/week; 95% CI 0.04 to 0.26). There were no significant group differences in the rate of exacerbation requiring oral steroids or admission, school absenteeism, lung function, symptom score, quality of life, and withdrawals. AUTHORS' CONCLUSIONS: The evidence suggests that symptom-based WAP are superior to peak flow WAP for preventing acute care visits although there is insufficient data to firmly conclude whether the observed superiority is conferred by greater adherence to the monitoring strategy, earlier identification of onset of deteriorations, higher threshold for presentation to acute care settings, or the specific treatment recommendations.

Adolescent↗
PubMed1985

The value of physical fitness in preventive medicine.

Physical conditioning induces many favourable changes in the body, including an increase of maximum oxygen transport, a decrease of body fat, a strengthening of muscles, tendons and bones, an improvement of blood lipid profile, and a better balance between oxygen demand and supply in the myocardium. The preventive value of such changes is often seen in measures of perceived health or their practical consequences. Industrial fitness programmes apparently reduce the use of medical services (physician visits and hospital days), with gains of productivity, a lessening of absenteeism, and a lower employee turnover. Techniques such as the Canadian Health Hazard Appraisal questionnaire suggest a general reduction in 'risk-taking' behaviour among exercise-class participants, with a substantial reduction in their 'appraised' age. There is little evidence that regular moderate exercise can alter the response to acute disease, but both theoretical considerations and epidemiological data suggest the value of physical activity in preventing manifestations of ischaemic heart disease, obesity and maturity onset diabetes, cholecystitis, hypertension, certain neuroses, and age-related pathologies. A fit individual is also at a lesser risk of industrial injury, and is capable of living independently for a longer fraction of his or her old age. It is concluded that physical activity is one of the more useful tactics of preventive medicine; the current challenge to both research workers and policy makers is to carry this message beyond the white-collar executive to such target groups as blue-collar workers, ethnic minorities, housewives, the elderly and the handicapped.

Acute Disease↗
PubMed2003

Participatory ergonomics as a return-to-work intervention: a future challenge?

BACKGROUND: Participatory ergonomics (PE) are often applied for prevention of low back pain (LBP). In this pilot-study, a PE-program is applied to the disability management of workers sick listed due to LBP. METHODS: The process, implementation, satisfaction, and barriers for implementation concerning the PE-program were analyzed quantitatively and qualitatively for 35 workers sick listed 2-6 weeks due to LBP and their ergonomists. RESULTS: Two-hundred-and-seventy ergonomic solutions were proposed to the employer. They were targeted more at work design and organization of work (58.9%) than at workplace and equipment design (38.9%). They were planned mostly on a short-term basis (74.8%). Almost half (48.9%) of the solutions for work adjustment were completely or partially implemented within 3 months after the first day of absenteeism. Most workers were satisfied about the PE-program (median score 7.8 on a 10-point scale) and reported a stimulating effect on return-to-work (66.7%). Main obstacles to implementation were technical or organizational difficulties (50.0%) and physical disabilities of the worker (44.8%). CONCLUSIONS: This study suggests that compliance, acceptance, and satisfaction related to the PE-program were good for all participants. Almost half of the proposed solutions were implemented.

Adult↗
PubMed1989

Drug testing: technical complications of a complex social issue.

To control the adverse effects of substance abuse, urinary drug testing has become common practice in some occupational settings. Although it is virtually impossible to assess accurately the impact of drug abuse at work, increased accidents and absenteeism as well as impaired productivity have been attributed to drug abuse. The major analytical techniques used to screen for illegal drug use are thin-layer chromatography and enzyme- and radioimmunoassays. Gas chromatography-mass spectrometry is uniformly recommended to confirm any positive screening test. The major technical problem in interpreting screening tests is that the presence of a substance in the urine indicates merely exposure to the drug, not necessarily intoxication, habituation, or addiction. Since no certifying criteria are available to insure quality control among laboratories performing urinary drug testing, results may vary widely. In fact, a study conducted by the Centers for Disease Control suggests that poor performance of some laboratories may adversely affect the treatment of drug abuse. The Federal Rehabilitation Act (1973, section 504) prohibits discrimination against the handicapped, which includes both drug abuse and alcoholism. Legal challenges to urinary drug testing have focused on issues related to the right to privacy and freedom from unreasonable searches. Because of the wide-ranging legal, ethical, and medical ramifications of drug-screening programs, careful review of these issues is recommended before an organization establishes such a program.

Alcoholism↗
PubMed2005

Arthritis and employment: an examination of behavioral coping efforts to manage workplace activity limitations.

OBJECTIVE: To examine ways in which individuals with arthritis manage their employment and health by focusing on the type and determinants of diverse behavioral coping strategies used to manage activity limitations, and to examine the relationship between coping behaviors and participation in employment. METHODS: The study group comprised 492 patients with osteoarthritis or rheumatoid arthritis. All participants were employed, and all participants were administered an in-depth, structured questionnaire. The study used an inductive approach and distinguished among 4 categories of coping behaviors as follows: adjustments to time spent on activities; receipt of help; modification of behaviors; and anticipatory coping. RESULTS: Fewer coping behaviors were reported at the workplace than outside of the workplace. Anticipatory coping was used most often in the workplace. Workplace activity limitations were related to increased reports of all types of coping. Women, those with more joints affected, and people expecting to remain employed reported more anticipatory coping. Expectations of continued employment were also related to modifications of activities, as was longer disease duration and discussing arthritis with one's employer. Help from others was associated with talking to an employer and positive job perceptions. Compared with work, reports of a greater number of coping behaviors used at home were associated with changes in overall work participation (e.g., absenteeism). CONCLUSION: These results expand our understanding of the experience of having a chronic illness and working and highlight the ways in which people accommodate to workplace limitations by using a variety of different behavioral coping efforts to remain employed.

Adaptation, Psychological↗
PubMed2003

Insomnia causes, consequences, and therapeutics: an overview.

There is growing interest in insomnia both from the perspective of recent advances in clinical management as well as research aimed at elucidating its pathophysiology. This theoretical overview of insomnia describes the negative impact, etiological considerations, and pharmacological and behavioral treatments for the disorder, with an emphasis on areas receiving increased research attention. Insomnia, the most prevalent sleep disorder, affects 10-15% of the general population. In population-based studies severe insomnia has been shown to last for a median of 4 years. In addition, insomnia has a significant negative impact on an individual's work, physical, and social performance as well as overall quality of life. Furthermore, the economic cost of insomnia related to lost productivity, work-related accidents, absenteeism, and health-care costs are enormous. There is increasing evidence linking the precipitation of insomnia to stress, and converging evidence from cognitive, endocrine, neurological, and behavioral domains provide clear evidence for hyper-arousal in insomnia. However, there remains no consensus regarding the specific etiological mechanisms of this disorder. Although the pathophysiology of primary insomnia remains an enigma, numerous treatments both pharmacological and behavioral have been developed and found to be efficacious in controlled studies. Despite the wide availability of pharmacological treatments and increased knowledge of behavioral interventions, the vast majority of individuals with insomnia do not appear to be receiving adequate treatment. The inadequate treatment of insomnia leads to several important and under-recognized consequences including subsequent development of psychiatric disease and increased substance use.

Aged↗
PubMed1990

Indoor air quality: what managers can do.

A significant number of workers suffer a variety of physical symptoms and illnesses associated with poor indoor air quality. These authors furnish employers with a guide for providing clean air in the workplace--an objective the achievement of which will reduce employee absenteeism and medical insurance costs, while increasing productivity and morale.

Air Pollutants, Occupational↗
PubMed2004

Long-term influences of a biopsychosocial rehabilitation programme for chronic pain patients.

OBJECTIVE: Chronic pain leads to high costs in the form of compensation for absence from work due to illness, production loss and health care utilization. Multidisciplinary treatment programmes at pain clinics can result in return to work and a decrease in doctor visits. The aim of this study was to evaluate the long-term influences of a rehabilitation programme in primary health care for chronic pain patients with regard to doctor visits, frequency of sick-leave and level of disability. DESIGN: A longitudinal, intervention study design was used over a three-year period. METHODS: A biopsychosocial rehabilitation programme based on ego-strengthening psychotherapy was used. An occupational therapist and a physiotherapist led the intervention, which comprised two meetings per week for six weeks. The study was performed in a primary health care area in the southwest of Sweden with 54 chronic pain patients. RESULTS: The results showed a significant decrease in the number of doctor visits as well as sick-leave days. The level of absenteeism due to occupational disability changed significantly from being on sick leave to receiving a disability pension. CONCLUSIONS: The rehabilitation programme reduced patient attendance at health care facilities but did not increase the numbers of patients returning to work.

Journal Article↗
PubMed2002

Evaluation of an asthma management program for Chinese children with mild-to-moderate asthma in Hong Kong.

There is inconclusive evidence on the efficacy of outpatient clinic-based asthma management programs (AMP) in children. We hypothesized that an AMP based on key symptoms could improve outcome measures of asthma in Chinese children in Hong Kong. This study involved an outpatient clinic-based prospective cohort of Chinese children with asthma. Each patient received one 2-hr session of AMP which was conducted by a pediatric nurse specialist. Asthma outcomes were measured at baseline and at 6 and 12 months after completion of AMP. Demographic data, family history of allergic diseases, and changes in inhaled steroid therapy were also recorded. A total of 106 asthmatic children were enrolled, and they showed a significant decrease in nocturnal cough, wheezing attacks, and subjective assessment of severity at 6 and 12 months following participation in AMP, compared with their baseline status. Acute asthmatic attacks, unscheduled outpatient attendance, emergency room visits, school absenteeism, and number and duration of hospitalizations were also reduced during the follow-up period. Significantly more (21%) children were reported to use inhaled beclomethasone at the end of the study. Nocturnal cough, wheeze, and symptoms due to rhinitis improved significantly after AMP. In conclusion, our cohort of Chinese children with mild-to-moderate asthma used significantly more inhaled corticosteroids and practiced more measures to control house dust mites at the end of the 1-year treatment period. The main reason for better asthma control appeared to be related to the increased use of inhaled steroids, although some additional decrease in nocturnal cough, wheeze, and allergic rhinitis was found after adjusting for the use of inhaled corticosteroids.

Ambulatory Care Facilities↗
PubMedDate not supplied

Physical exercise program for children with bronchial asthma.

A long-term physical exercise program was established for a large number of children with bronchial asthma. Asthmatic children were first taught to swim on their backs to prevent breathing problems customary for beginners using other strokes. They concurrently participated in gymnasium exercises, and the program was later completed with outdoor running. Program effectiveness was evaluated by monitoring asthmatic symptoms, changes in medication, and changes in the activity and physical fitness of the children. Data collected from 121 children showed that during the first year in the program the number of days with asthmatic symptoms decreased in a large majority of the patients while medication was decreased. School absenteeism and hospitalization dropped markedly. Parental evaluation of the children indicated much improvement in 51.2%, improvement in 40.5%, unchanged condition in 7.4%, and deterioration of general health was only reported in one child (0.8%). The same extent of improvement continued during the second year. The Cooper test was applied for the first time to such an exercise program and indicated that the participating asthmatic children performed as well as a control group of nonasthmatic children, and the cardiovascular efficiency of the asthmatics was actually better.

Adolescent↗
PubMed2006

Evaluating spatial surveillance: detection of known outbreaks in real data.

Since the anthrax attacks of October 2001 and the SARS outbreaks of recent years, there has been an increasing interest in developing surveillance systems to aid in the early detection of such illness. Systems have been established which do this is by monitoring primary health-care visits, pharmacy sales, absenteeism records, and other non-traditional sources of data. While many resources have been invested in establishing such systems, relatively little effort has as yet been expended in evaluating their performance. One way to evaluate a given surveillance system is to compare the signals it generates with known outbreaks identified in other systems. In public health practice, for example, public health departments investigate reports of illness and sometimes track hospital admissions. Comparison of new systems with extant systems cannot generate estimates of test characteristics such as sensitivity and specificity, since the actual number of positives and negatives cannot be known. However, the comparison can reveal whether a new or proposed system's signals match outbreaks detected by the existing system. This could help support or reject the new system as an alternative or complement to the extant system. We propose three methods to test the null hypothesis that the new system does not signal true outbreaks more often than would be expected by chance. The methods differ in the restrictiveness of the assumptions required. Each test may detect weaknesses in the new system, depending on the distribution of outbreaks and can be used to construct confidence limits on the agreement between the new system's signals and the outbreaks, given the distribution of the signals. They can be used to assess whether the new system works in that it detects the outbreaks better than chance would suggest and can also determine if the new systems' signals are generated earlier than an extant system.

Data Interpretation, Statistical↗
PubMedDate not supplied

Early drinking onset and its association with alcohol use and problem behavior in late adolescence.

OBJECTIVE: To examine the relationship between age of drinking onset and patterns of use, abuse of other substances, and the prevalence of other alcohol-related problems in a population of midwestern high school seniors. DESIGN: We analyzed self-report survey data on public school students' history of alcohol and other drug use and related problems from the Minnesota Student Survey conducted in 1989. The sample consisted of 2,650 male and female seniors, representing a 10% random sample of all white seniors in the study. RESULTS: The findings suggest that early onset of alcohol use (by age 12) is associated with subsequent abuse of alcohol and related problem behaviors in later adolescence, including alcohol-related violence, injuries, drinking and driving, and absenteeism from school or work, as well as increased risks for using other drugs. CONCLUSION: This paper identifies the preadolescent years from age 10 to 12 as a particularly vulnerable period for the development of early alcohol dependence and abuse. Delaying alcohol use onset to age 13 may significantly reduce the risk of severe alcohol abuse in later adolescence.

Adolescent↗
PubMed2001

Economic evaluation of alcohol treatment services.

The objective of this paper is to summarize and critically review the most recent literature on economic evaluation of alcohol treatment services, identify information gaps, and suggest a research agenda for the future. The focus of the review is research published after 1995, although some of the earlier economic studies are also included. Research findings in the literature provide evidence for the following. First, for many alcoholics, day hospital treatment or even less intensive outpatient services are cost-effective alternatives to inpatient treatment. Second, alcoholism treatment often results in declining health care costs for alcoholics who are covered by private health insurance. Third, though the use of alcoholics anonymous (AA) as an alternative to more structured alcohol treatment services may be cost-effective, substance abuse outcomes from AA are sometimes less favorable and the risk of relapse is higher. Fourth, methods have recently been developed to estimate the dollar value of alcohol treatment outcomes such as avoided absenteeism, increased productivity, improved health, and avoided crime. Based on these findings and developments, new treatment approaches and changes in service delivery systems require a fresh perspective on the costs and benefits of alternative treatment services. The findings from economic evaluation studies must be reported in clear and nontechnical terms to an audience of clinicians and politicians so that they can be used in the process of decision making.

Alcoholics Anonymous↗
PubMed1988

Commuting--a further stress factor for working people: evidence from the European Community. I. A review.

About 100 million workers in the European Community commute to and from work daily. A review of the available data shows that commuting has increased in recent decades as rising car ownership has produced a more dispersed pattern of residential and job locations. In general, average commuting durations are falling, although average commuting distances are increasing as a result of faster commuting modes. However, the number of very long duration journeys have also increased, albeit from a small level. Up to now most research has focused on transport and land use issues, while very few studies have dealt with its impact on health, safety and social life of the workers. The available data indicate commuting to be a stress factor not only because of transport modes, but also by its interference with living and working conditions: namely, reduction of time available for discretionary leisure activities and increased absenteeism at workplace. Long-term effects on health have not been adequately investigated. Well integrated policies and strategies concerning the different aspects of this problem (transport, health, work organization, residential planning) must be developed both at the local and international levels to facilitate adequate solutions for this stressful condition.

Employment↗
PubMed1994

Factors affecting long-term sick leave in an industrial population.

Factors affecting long-term absenteeism for non-accident-related sickness leave in a large, remotely located factory (Dead Sea Industry, Israel) were evaluated. About 10% (89 persons) of the workers were found to be on sick leave for more than 20 days/year. This group was designated as high absence workers (HAW). Most of the sickness absence were for repeated short-term leaves due to intercurrent diseases, rather than for continuous periods related to a major or single illness. Average cumulative duration of sick leave in this group was 54 days/year. The average number of spells was 11 per year (4.9 days/spell). There were significantly more HAW among skilled (relative risk, R.R. = 1.6) workers or shift workers (R.R. = 1.3), compared to white collar workers. There were significantly fewer HAW among workers 35-49 years of age (7.6%) than among younger (12.5%) or older workers (13.8%). Except for possible hearing loss in one worker, no occupationally related illness was identified. Sixty-six percent of the HAW took many sick leaves, over 20 days during the year following the study year, and 52% of this group took over 20 days in the preceding year (usually for minor diseases or complaints). This pattern of long-term sickness absence indicates that various socio-economic factors determine HAW to a greater extent than immediate occupational risks or health problems.

Adult↗
PubMed1993

Hypertensive labeling: does it have therapeutic implications.

Screening for hypertension within the proper setting potentially leads to the detection of numerous (mild) hypertensives, some of whom in due time may well qualify for treatment. One disadvantage of the procedure appears to be that hitherto unwitting hypertensives may develop some adverse psychological and physiological phenomena. Behavioral effects seem to be particularly obvious after screening on the worksite, where newly identified hypertensive employees tend to respond with increased absenteeism and allied symptoms of labeling. In the clinical setting, physiological studies in recently informed hypertensives have demonstrated a series of signs of increased sympathetic activity: heart rate, cardiac index, circulating catecholamines, and renin, and even blood pressure itself, tend to be higher in aware vs. unaware young hypertensives. Although some correlations between psychological and physiological sequelae have been observed, the true nature of such links is far from clear. Simple anxiety does not seem to be the main mechanism. Pending further research, the question is discussed as to whether these phenomena are harmful enough to warrant a need for counseling or treatment.

Awareness↗
PubMed1983

Correlates of depressed mood in normal children.

Two instruments which have been proposed as measures of clinical depression in children and an ad hoc teacher rating were given to a group of 109 normal children. The Children's Depression Inventory (CDI), the Peer Nomination Inventory for Depression (PNID), and a teacher rating of depression were given along with the Conners Teacher Rating Scale (TRS), teacher ratings of somatic complaints, peer popularity, and absenteeism, and peer ratings of popularity to examine the behavioral correlates of depressed mood in normal children. While few sex differences were found on mean depression scores, different patterns of correlations were found for the two sexes. For males, there were no significant correlations among the three depression measures, but all three depression measures were correlated with unpopularity and conduct problem ratings on the TRS. For females, the three depression measures were adequately intercorrelated. The teacher rating of depression was correlated with general deviance as measured by the TRS, but the CDI and PNID were correlated with TRS ratings of conduct problems, with peer ratings of unpopularity, and with teacher ratings of somatic complaints. Implications for the issue of the possible existence of a clinical syndrome of depression in children were discussed.

Child↗
PubMed1987

Work site group meetings and the effectiveness of a televised smoking cessation intervention.

At the work site, smoking accounts for increased health care expenses and worker absenteeism due to smoking-related illness and reduced productivity and lost wages. Developing comprehensive and accessible smoking cessation programs at the work site is an important objective for health care professionals. In this study, employees of 43 corporations participated in a televised smoking cessation program accompanied by self-help manuals. The media component involved presenting a smoking cessation program on a network television affiliate station during the 4:30 p.m. and 10:00 p.m. news for 20 days. Employees at half the corporations also had access to semiweekly self-help group meetings. Adding self-help support groups to a program involving self-help manuals and the media reports was found to significantly increase abstinence and its maintenance over time. The implications of using the media, self-help groups, and work site locations in large-scale community-based interventions are discussed.

Adult↗