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PubMed1997

Job Strain in Shift and Daytime Workers.

Cross-sectional questionnaire data were used to compare the levels of job strain in shift and daytime workers. Job strain was measured according to Karasek's Demands/Discretion model. Four occupational groups were included: drivers, industrial workers, policemen/watchmen, and cooks. The study subjects were a random sample of 508 daytime workers and 418 shift workers. Job demand did not differentiate between shift and daytime workers, comparing groups broken down by gender and by occupation. The daytime workers reported higher levels of job strain than the shift workers, and women experienced a higher level of job strain than did men. Multiple linear regression analysis showed that only occupational group and gender predicted job strain level. Shiftwork was not significantly associated with job strain in the regression model.

Journal Article↗

PubMed1998

Which workers smoke?

OBJECTIVES: This article examines differences by occupation in daily cigarette smoking prevalence and intensity among full-time workers, and how these differences are associated with smoking restrictions at work. DATA SOURCES: Most of the data are from a Health Canada-sponsored Supplement to the 1994/95 National Population Health Survey (NPHS). The analysis is based on 5,674 respondents aged 15 to 64 who were full-time workers at the time of their interview. Comparable information is presented from the 1978/79 Canada Health Survey and the 1986 Labour Force Survey Smoking Supplement. MAIN RESULTS: In 1994/95, 28% of full-time workers were daily smokers, and about a third of them smoked 25 or more cigarettes a day. Smoking prevalence and intensity were lowest among white-collar workers and highest among blue-collar workers. Since 1978/79, there has been an overall decline in smoking prevalence, and since 1986, a decline in smoking intensity among all workers except those in outdoor blue-collar occupations. About 6 in 10 full-time workers who smoked daily encountered restrictions at work.

Adolescent↗

PubMed1995

Case management by community health workers of children with acute respiratory infections: implications for national ARI control programme.

Health worker performance in the management of children with acute respiratory infections (ARI) was assessed in two local government areas (LGAs) in Nigeria. The data derived were utilized to identify training needs. Survey instruments included an inventory list for ARI-related equipment and supplies, observation checklists for children presenting to the health worker with ARI symptoms, a questionnaire for exist interviews with mothers, and a supervisor performance checklist. One hundred and twenty-three health workers in Ife Central LGA and 50 in Ojo were observed at selected public health facilities. Most health workers took a good general history, but specific ARI-related history and physical examination were frequently omitted. Symptomatic diagnosis and treatment were common. Drugs most commonly prescribed for treatment of ARI were chloroquine, paracetamol and antibiotics. Essential drugs and supplies for ARI management were not available in some facilities. Communication with mothers was generally unsatisfactory and instruction on home management incomplete. Many of the health workers had not attended a continuing education programme in the previous two years and supervision which could have provided on-the-spot training was irregular. Improvements in ARI case management will require attention to policy, logistics, training (including in-service education) and supervision. The possible role of an integrated approach to the management of the sick child in improving the quality of health worker performance is discussed.

Child Health Services↗

PubMed1995

Postoperative course after inguinal herniorrhaphy. A case-controlled comparison of patients receiving workers' compensation vs patients with commercial insurance.

OBJECTIVE: To confirm our observation that patients with work-related hernias, when compared with self-employed patients, had longer recovery times and prolonged pain after hernia repairs, we reviewed our recent experience in a series of patients undergoing inguinal hernia repairs. DESIGN: The study design was matched retrospective case-control. Each patient receiving workers' compensation was age and sex matched with a control patient with commercial insurance whose repair was done during the same year. SETTING: All inguinal herniorrhaphies were performed at a single clinic by one of seven surgeons. PATIENTS: Twenty-two consecutive patients receiving workers' compensation and 22 patients with commercial insurance were studied. MAIN OUTCOME MEASURES: The postoperative courses in 22 consecutive patients with workers' compensation were compared with those in 22 control patients with commercial insurance. The principal factors compared were indications for surgery, type of hernia, surgical repair performed, the duration of postoperative pain, and the number of days off daily work. RESULTS: The average age in both groups was 46 years. Hernias in the workers' compensation group were more frequently symptomatic. The duration of postoperative pain (mean +/- SE) was 111.0 +/- 42.2 days for patients with workers' compensation and 17.8 +/- 7.9 days for patients with commercial insurance (P < .05). The number of days off work (mean +/- SE) was 33.5 +/- 4.6 days for patients receiving workers' compensation and 12.6 +/- 2.3 days for patients with commercial insurance (P < .001). CONCLUSIONS: We believe our results confirm the observation that type of insurance coverage influences post-operative recovery time after inguinal herniorrhaphy. Other studies measuring a patient's outcome after surgical procedures such as herniorrhaphy should include type of insurance coverage as a factor that might affect early return to work. Using multivariate analysis, the only variable independently affecting the duration of pain after hernia repair was the type of insurance coverage (P < .005).

Case-Control Studies↗

PubMed2005

New workers' compensation legislation: expected pharmaceutical cost savings.

BACKGROUND: California Workers' Compensation (WC) system costs are under review. With recently approved California State Assembly Bill (AB) 749 and Senate Bill (SB) 228, an assessment of proposed pharmaceutical cost savings is needed. METHODS: A large workers' compensation database provided by the California Workers' Compensation Institute (CWCI) and Medi-Cal pharmacy costs obtained from the State Drug Utilization Project are utilized to compare frequency, costs and savings to Workers' Compensation in 2002 with the new pharmacy legislation. RESULTS: Compared to the former California Workers' Compensation fee schedule, the newly implemented 100% Medi-Cal fee schedule will result in savings of 29.5% with a potential total pharmacy cost savings of $125 million. Further statistical analysis demonstrated that a large variability in savings across drugs could not be controlled with this drug pricing system. CONCLUSIONS: Despite the large savings in pharmaceuticals, inconsistencies between the two pharmaceutical payment systems could lead to negative incentives and uncertainty for long-term savings. Proposed alternative pricing systems could be considered. However, pain management implemented along with other cost containment strategies could more effectively reduce overall drug spending in the workers' compensation system.

California↗

PubMed2006

How many work-related injuries requiring hospitalization in British Columbia are claimed for workers' compensation?

BACKGROUND: Workplace compensation claims datasets represent an important source of information on work-related injuries. This study investigated the concordance between hospital discharge records and workers' compensation records for work-related serious injuries among a cohort of sawmill workers in British Columbia (BC), Canada. It also examined the extent to which workers' compensation capturing patterns varied by cause, severity of injuries, and demographic characteristics of workers. METHODS: Work-related injuries were identified in hospitalization records between April 1989 and December 1998, and were matched by dates and description of injury to compensation records. RESULTS: The agreement between the hospital records and compensation records was good (kappa = 0.84, P < 0.01). A lower claim reporting rate for work-related hospitalization was observed for older and non-white workers. More serious injuries defined by longer length of stay and emergency admissions were more likely to be reported. Falls, struck against, and overexertion injuries had lower reporting rates; whereas, machinery-related, cutting/piercing, and caught in/between injuries had higher reporting rates. CONCLUSIONS: When compared with hospital discharge records, the compensation agency underreported incidents of serious work-related injuries by 10-15% among the sawmill workers.

Adult↗

PubMed2006

The impact of work-related musculoskeletal disorders on workers' caregiving activities.

BACKGROUND: The purpose of the study was to describe and quantify the impact of work-related musculoskeletal disorders on workers' caregiving activities. METHODS: A cross-sectional study was conducted in which a telephone survey was administered to 187 lost-time workers' compensation claimants from Ontario, of whom 49.2% were women. Forty-eight percent of the injured workers were providing unpaid care prior to the injury. RESULTS: Injured workers providing caregiving reported an average reduction in time spent in caregiving activities of 5.5 hr/week, 8 months post-injury. A Sex X Return-to-work status ANCOVA was conducted with difference in caregiving hours as the dependent variable, and with the following covariates: Mean number of caregiving hours, comorbidities, site of injury, and education. Independent of weekly hours of caregiving, decreases in caregiving hours were significantly higher if the worker was a woman or had not returned to work. CONCLUSIONS: Work-related musculoskeletal disorders have a significant impact on workers' time spent in unpaid caregiving activities, an example of the social consequences of occupational injuries. Occupational and caregiving roles are limited by work-related disorders in a parallel fashion.

Activities of Daily Living↗

PubMed1980

Morbidity and mortality in workers occupationally exposed to pesticides.

Utilizing cause-of-death information and responses to questionnaires addressed to survivors, mortalities and health impairments in a cohort of workers occupationally exposed to pesticides were compared to occurrences in workers not pesticide exposed, over the period 1971-1977. Seventy-two percent of 2,620 pesticide-exposed workers, and 75% of 1,049 "controls", recruited in 1971-73, were accounted for either by returned questionnaire or mortality. Disease incidence rates were studied in relation to broadly defined occupational subclasses, and to serum concentrations of organochlorine pesticides (OCl) measured at the time of recruitment. Death by accidental trauma was unusually frequent among pesticide applicators. Mortalities from cancer and arteriosclerosis were not detectably different from those observed in the controls. Among survivors, dermatitis and skin cancer were unusually common in structural pest-control operators. Internal cancer was no more frequent in the intensively pesticide-exposed workers than in the controls, but it appeared to occur at an unusually high rate in workers characterized as "possibly pesticide-exposed". There were apparent associations between high serum pesticide OCl levels measured in 1971-73 and the subsequent appearance of hypertension, arteriosclerotic cardiovascular disease, and possibly diabetes. This could imply a causal role of any of the pesticidal and other environmental stresses to which these workers were exposed. The limitations of this type of followup study are discussed.

Age Factors↗

PubMed2005

Lymphohematopoietic cancers in the United Farm Workers of America (UFW), 1988-2001.

OBJECTIVE: Agricultural risk factors for lymphohematopoietic cancers (LHC) in Hispanic farm workers in California were examined in a nested case-control study embedded in a cohort of 139,000 ever members of a farm worker labor union in California. METHODS: Crop and pesticide exposures were estimated by linking county/month and crop specific job history information from union records with California Department of Pesticide Regulation pesticide use reports during the 20-year period prior to cancer diagnosis. RESULTS: A total of 131 LHC diagnosed in California between 1988 and 2001 were included in the analysis. Analyses were conducted by gender and subtype of non-Hodgkins lymphoma (nodal, extra nodal) and by leukemia histology (lymphocytic, granulocytic). Odds ratios were calculated by stratification and by unconditional logistic regression. Risk for all LHC was elevated in workers cultivating vegetables (OR = 1.67, 95% CI = 1.12-2.48). Risk of leukemia was associated with exposure to the pesticides mancozeb (OR = 2.35, 95% CI = 1.12-4.95) and toxaphene (OR = 2.20, 95% CI = 1.04-4.65) while NHL risk was increased in association with 2,4-D (OR = 3.80, 95% CI=1.85-7.81). Risk of leukemia was particularly elevated among female workers and for granulocytic versus lymphocytic leukemia for several chemicals. No associations were noted for multiple myeloma. CONCLUSIONS: California farm workers employed where mancozeb and toxaphene were used had an increased risk of leukemia compared to farm workers employed elsewhere. Employment in farms using 2,4-D was associated with an increased risk of NHL.

Agricultural Workers' Diseases↗

PubMed1983

Training health workers: what needs to be taught and who should teach it.

The training of many health workers has been inadequate in producing workers who can function effectively in rural health services. This inadequacy is seen in two areas. While health workers are well drilled in technical procedures, operational strategies for applying these procedures in the conditions of rural health services are often lacking; and much of what they are taught is inappropriate in terms of the practicalities of working in rural areas. Two aspects of training are then discussed. What is taught and who teaches it. A distinction is made between teaching routine technical procedures and teaching cognitive strategies for problem-solving. These need to be distinguished and both considered when training health workers. The use of health workers themselves as trainers of other health workers is then considered. They often do not have the confidence necessary to teach in open participatory, discussion-centred ways. These ideas are then briefly considered in the light of a training scheme in Kenya, and how it has been used for training in Primary Eye Care.

Clinical Competence↗

PubMed1994

Qualities of an ideal volunteer community malaria worker: a comparison of the opinions of community residents and national malaria service staff.

Since the late 1950s, most malaria surveillance and treatment in rural areas of Latin America has been carried out by networks of unpaid community malaria workers, known as Volunteer Collaborators, who are selected and supervised by staff of the national malaria services (NMSs) in each country. In spite of the free and readily accessible antimalarial treatment available at these Volunteer Collaborator posts, many residents continue to seek treatment elsewhere and in most cases take doses of antimalarials that are insufficient to cure their infections. To identify ways in which the Volunteer Collaborator Network could be made more attractive to residents and to improve the process of selection of new workers, we asked community residents and Guatemalan NMS workers to rank order, according to their importance, 11 qualities or characteristics of an 'ideal' volunteer malaria worker. Community residents preferred someone who is available to take care of patients at all times of the day, is a responsible person, and has a general knowledge of medicine. No significant differences were noted in the rank orders of male and female residents or literate and illiterate residents. National Malaria Service workers also preferred someone who takes care of patients at all times of the day, even when busy. In addition, they wanted individuals who recognize the importance of their work as a Volunteer Collaborator, but choosing volunteers who had a general knowledge of medicine was not important. By modifying the procedures used to select Volunteer Collaborators so as to identify candidates with the qualities preferred by residents, it should be possible to increase acceptance and improve the performance of these volunteer workers.

Adolescent↗

PubMed2004

Workers' compensation: a historical review and description of a legal and social insurance system.

The workers' compensation system is a no-fault legal and social insurance system established to address compensation issues that involve work-related injuries and illnesses. The system was developed in response to dissatisfaction with common law litigation on the parts of injured workers and employers. The history of the development of workers' compensation is reviewed, and a general description of the system is offered, including discussion of state law and insurance structures, benefits and costs, administrative boards/commissions, and the federal systems for workers' compensation and related programs. The recent history of the workers' compensation system is provided, the recommendations of the National Commission on State Workmen's Compensation Laws in 1972 are reviewed, and the problems and state-initiated changes in worker's compensation that occurred during the 1990s are discussed.

Humans↗

PubMed2004

Workers' compensation reform.

Workers' compensation reform efforts respond to the competing interests of business, labor and insurers. Early reforms expanded programs in response to inadequate benefits and coverage while in the 1980s and 1990s states responded to increasing costs by tightening fee schedules, limiting physician choice, restricting eligibility,lowering benefits, and integrating managed care into workers' compensation. Although managed care has resulted in significant medical savings, the cost of workers' compensation is again rapidly increasing in some states, where workers' compensation legislation is again at the center of debate. Increasing the use of treatment guidelines, placing limitations on use of services, developing more objective criteria for determining level of disability, and streamlining dispute resolutions have been offered as solutions. Controlling costs alone, however, cannot solve other problems of workers' compensation. Future reform efforts will need to focus not only on the costs of the system but also its inclusiveness and support of the workers and their families it was intended to protect.

Cost Control↗

PubMed2006

Factors associated with early opioid prescription among workers with low back injuries.

UNLABELLED: Prescription of opioids for nonmalignant musculoskeletal pain has increased substantially in recent years, but there is little information on the incidence of, or factors associated with, such prescription for work-related back pain. In a prospective cohort study (N = 1,067), we examined associations between worker sociodemographic and other characteristics and opioid prescription within six weeks of the first medical visit for workers' compensation claims for work loss due to back injury. We examined administrative, pharmacy, and worker-reported data. In bivariate logistic regression models, Hispanics were less likely than non-Hispanic whites to receive opioid prescriptions, and very high body mass index, daily tobacco use, greater pain and physical disability, pain radiating below the knee, injury severity categorizations (from medical records) of major sprain and radiculopathy, and worse mental health were associated with opioid prescription. Adjusting for demographics, pain intensity, and physical disability, opiate prescription was significantly associated with daily tobacco use, pain radiating below the knee, and injury severity categories (major sprain and radiculopathy). Knowledge of worker characteristics associated with early opioid prescription may be useful in future studies of the role of early pain treatment in influencing subsequent course of pain and disability among workers with back injuries. PERSPECTIVE: Little is known about patient characteristics that may influence physicians' decisions concerning prescription of opioids for acute back pain. Not surprisingly, workers with more severe back injuries are more likely to be prescribed opioids, but reasons for prescription disparities based on ethnicity and tobacco use warrant further study.

Adult↗

PubMed2026

Assessing perinatal depression identifying abilities among maternal and child health workers in rural China using smartphone-based virtual patients: a multi-center cross-sectional study.

OBJECTIVE: To assess rural maternal and child health (MCH) workers' virtual patients (VPs)-assessed performance in identifying perinatal depression (PND) using smartphone-based VPs, and to identify factors associated with this performance in rural Hunan, China. METHODS: A multicentre cross-sectional study was conducted in Hunan Province, China. A standardized questionnaire collected demographic and work-related characteristics of rural MCH workers. Smartphone-based VPs were used to assess PND identification performance in a simulated clinical scenario. An overall score ≥60 was used as a prespecified operational benchmark across consultation, ancillary assessment, diagnosis, management, and health education domains. Data were analyzed using SPSS 26.0. RESULTS: A total of 375 rural MCH workers participated, yielding an effective response rate of 90.4%. Only 25.9% met the prespecified operational benchmark for VP-assessed PND identification performance. The mean accuracy scores for consultation, ancillary assessment, diagnosis, management, and health education were 94%, 48%, 64%, 58%, and 74%, respectively. Complete consultation accuracy was higher among MCH workers from township health centers than among those from county-level MCH hospitals. MCH workers aged 18-39 years showed higher odds of complete diagnostic accuracy for PND than those aged ≥40 years. CONCLUSIONS: Smartphone-based VP assessment was feasible in rural MCH settings and revealed suboptimal PND identification performance. Mobile VPs may help identify frontline performance gaps and inform targeted training, but further validation against real-world clinical performance, or standardized patient encounters is needed before large-scale implementation. These findings may support targeted capacity-building for rural MCH workers and more equitable perinatal mental health care.

Humans↗

PubMedDate not supplied

Symptomatic cervical disc herniation following a motor vehicle collision: return to work comparative study of workers' compensation versus personal injury insurance status.

BACKGROUND CONTEXT: Patients with approved workers' compensation injuries receive guaranteed compensation for the duration of their injury, whereas patients with personal injury claims are only compensated, if at all, at the time of a successful settlement or trial verdict at a time point distant from their injury. PURPOSE: This study compares the financial impact and loss of work patterns due to a workers' compensation (WC) claim or personal injury in patients with a symptomatic cervical disc herniation resulting from a motor vehicle collision. STUDY DESIGN: A prospective study of patients who were seen by a single spine specialist between 1/2/96 and 9/1/01. PATIENT SAMPLE: A consecutive evaluation of 531 patients who were treated for a cervical pain syndrome caused by a motor vehicle collision. OUTCOME MEASURES: Mechanism of injury and insurance type, ie, workers' compensation or personal injury, was recorded for each patient as well as treatment response and return to work patterns. The data were analyzed using the two-way Z test. METHODS: All patients were managed in a similar manner with noninvasive treatment initially, followed by injections, and finally surgical intervention in those who failed conservative measures. Return to work rates and work disability were determined at either final follow-up or at the last doctor's visit before loss to follow-up. RESULTS: 270 of 531 patients were diagnosed with a symptomatic one or two level disc herniation by a cervical magnetic resonance imaging scan. Fifty-four patients were insured through the workers' compensation board, and 216 reported their crash as a personal injury claim. In the WC group the work disability at 3 months follow-up revealed a cumulative 2,262 total lost days of work (average 37.1 days per person). At the point of maximal medical improvement (MMI) or 2-year follow-up, total days lost from work were 7,107 (average 131.6 days per person.) In the personal injury non-WC group, the 3-month follow-up of lost days of work was 1,093 days (average 5.1 days per person.) At 2 years follow-up, the total lost days of work were 6,206 (average 28.7 days per person.) CONCLUSIONS: Participants compensated through the workers' compensation system demonstrated a significant loss of days of work as compared with injured patients who received compensation by other means. This may be a reflection of the guaranteed method of compensation afforded to WC patients as opposed to patients who receive no form of financial support (i.e., personal injury) during the recuperative process. Further analysis as to injury severity and a stratification of non-workers' compensation reimbursement methods are needed to further improve the validity of this study.

Accidents, Traffic↗

PubMed2002

Treating the injured worker in Brazil. The South American experience.

Despite appropriate laws to protect workers, the health conditions of Brazilian workers reflect the social and economic reality in Brazil. A statistical analysis of health actions in Brazil shows serious distortions caused by the immense discrepancy between the poverty of the Northern and Northeastern states and the richness, although concentrated, of the great Southern and Southeastern cities of the country. Valid quantitative measures of health care problems of workers are confounded by the presence of a large mass of informal workers within the country, which may not be included in standard statistical analysis. Despite the existence of norms and laws related to the health of workers, their application is precarious and selective. The development of educational and preventive actions is already a reality in Brazil with unquestionable statistical repercussions, notwithstanding their doubtful comprehensiveness. The diseased worker or victim of a work-related accident in Brazil has no access to adequate medical assistance, and survival depends on benefits that are often insufficient to enable them to support themselves.

Accidents, Occupational↗

PubMed2003

Posttraumatic stress disorder (PTSD) in the workplace: a descriptive study of workers experiencing PTSD resulting from work injury.

In view of the relatively understudied status of work-related posttraumatic stress disorder (PTSD), this study retrospectively examined 44 workers whose claims were accepted for workers' compensation benefits in the absence of significant coexisting physical injuries. The majority of workers (82%) directly experienced the traumatic event while the rest witnessed the event. Over half (54%) of those directly experiencing the event were involved in armed robberies, whereas 38% were physically or verbally assaulted in nonrobbery situations. Almost half of the workers were assigned a coexisting mood or anxiety diagnosis. Psychoactive medication was prescribed to 66% of workers, and 93% of all workers received some form of psychological/psychiatric treatment. Twenty-three percent of the group received vocational rehabilitation assistance and only 43% returned to their previous job with the accident employer. Findings suggest that work-related PTSD is both complex and disabling and merits further investigation.

Adult↗