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A case-reference study of neuropsychiatric disorders among workers exposed to solvents in the Danish wood and furniture industry.

A case-reference study was conducted to estimate the association between neuropsychiatric diseases leading to early retirement pensioning and exposure to organic solvents in the Danish wood industry. Cases were defined as all members of the Carpenter/Cabinet Makers' Trade Union who were diagnosed with a neuropsychiatric disease and received disability or early old-age pensions during the period January 1, 1971 to December 31, 1975. The case group comprised 171 disability pensioners and 35 early old-age pensioners. A reference group of equal size was selected among union members with other diseases who were pensioned over the same time-period. Controls were matched to cases according to age and type of pension. Among a total of 412 eligible study subjects, 342 (i.e., 287 disability pensioners and 55 early old-age pensioners) could be located in 1978. Of these, 9.8% of the disability pensioners and 12.7% of the early old-age pensioners did not respond to the questionnaire. Information regarding occupational exposure and vocational training was obtained both directly from study subjects and from the files of the trade union. Medical diagnoses were obtained through registry linkage and by manual search of hospital records. Former employees with high levels of exposure to organic solvents were more likely to receive disability pensions for neuropsychiatric reasons compared to more modestly-exposed individuals. Cabinet-makers and especially cabinet-makers with high exposure to lacquers and glues had a higher risk of receiving a disability pension for a neuropsychiatric disease than carpenters. Possible sources of bias are discussed in the article.

Adult↗

Cross-level analysis of the influence of local union structure on women's and men's union commitment.

The authors tested the influence of structural features of local unions (N = 43) on members' union commitment (N = 539) as moderated by members' gender. By using a cross-level analysis, they identified local structure with officers' ratings of innovation, formalization, and centralization. An anticipated interaction between gender and innovation was not found. However, as predicted, women's commitment was positively related to formalization and negatively related to centralization. In contrast, men's commitment was only slightly influenced by local formalization but was positively related to centralization. The need for structural redesign to enhance member's commitment, particularly among women, was discussed.

Female↗

Consultation and capital works: a recipe for implementing change.

When the Royal Children's Hospital launched into a $50 million building/refurbishment program in 1987/88, there was a clear recognition of the need to establish appropriate consultation mechanisms with unions and employees. Little documentation existed on major capital works consultation models. As Monash Medical Centre and Western Hospital were involved in major projects, discussions took place between the three hospitals and the Health Department Victoria, which resulted in a model (based largely on Monash's existing arrangements), capable of being applied across the hospital field. This model was subsequently ratified by the Victorian Trades Hall Council on behalf of the unions, and implemented (with minor differences in each case) at the three hospitals. The purpose of this paper is to document this consultation model. Highlighted is the importance of tight project management, regular communication, and substantial involvement by staff affected in the area(s) under development in 'user groups'. As the model has been agreed by the Trades Hall Council for use in Victorian public hospitals, it is hoped that this paper may provide a useful basis for other hospitals contemplating major capital works.

Decision Making, Organizational↗

Management and employee agreement on reports of organizational policies and practices important in return to work following carpal tunnel surgery.

This study's purpose was to assess the agreement between management and employee ratings of organizational policies and practices (OPP) involved in the return to work process following carpal tunnel surgery. As a part of the prospective community-based Maine Carpal Tunnel II Study, 65 manager and employee pairs completed a questionnaire tapping four OPP dimensions. people oriented culture, safety climate, ergonomic practices, and disability management. It was hypothesized that managers and employees would agree on their assessment of the four OPPs and a composite organizational support index. Agreement was assessed using Lin's concordance correlation coefficient. Employee and manager ratings were similar for the organizational support index (rho(c) = 0.14, p = 0.08), and people oriented culture (rho(c) = 0.25, p = 0.01) but not the other three OPPs. In larger companies (>450 employees), ratings were also similar for safety climate (rho(c) = 0.24, p = 0.09), disability management (rho(c) = 0.22, p = 0.07) and ergonomic practices (rho(c) = 0.35, p = 0.02). In unionized companies there was agreement for safety climate (rho = 0.44, p = 0.02), disability management (rho(c) = 0.41, p = 0.01) and ergonomic practices (rho(c) = 0.40, p = 0.06). These preliminary results suggest employees can report on certain OPPs and that an employee questionnaire can be used to assess organizational support. Given recent evidence that employee ratings of OPPs are predictive of injury/illness incidence, work disability and return-to-work outcomes, further research is needed to confirm these findings.

Carpal Tunnel Syndrome↗

An analysis of case-intensity-adjusted nursing staff patterns in New York State skilled nursing facilities.

In 1979 skilled nursing facility staffing patterns in New York State were examined to test for significant differences in hours per patient day of nursing staff with respect to sponsorship, size, unionization, and region. Facilities that were cited for one or more nursing standard deficiencies were eliminated from consideration to control for quality of care differences. Also, adjustments in reported staffing hours were made to control for case mix differences among the facilities. A hierarchic analysis of covariance model was used to perform the analysis. The results indicated that, ceteris paribus, staffing on a per patient day basis was significantly higher for voluntary and public homes, homes in upstate locations, nonunionized homes, and homes with 99 beds or less.

Clinical Competence↗

Unions and strikes in the National Health Service in Britain.

This article outlines the origins of the main manual and white-collar trade unions in the British Health Service, traces their growth after the establishment of the National Health Service in 1949, and examines the wave of industrial action in British hospitals in the seventies. It is argued that although strike action inside hospitals in the early seventies was a novel tactic adopted as a last resort by manual workers pressing for wage increases, industrial action over a wide range of political and medical issues has now been taken by all types of hospital worker in Britain and plays a central part in the national debate over the future of the National Health Service.

Collective Bargaining↗

Delivery of primary health care--union style. A critical review of the Robert F. Kennedy plan for the United Farm Workers of America.

The primary health-care program developed by the United Farm Workers of America, an example of a consumer-controlled system, provides quality health care at locations and time convenient to patients and employs bilingual clinic personnel from the same worker background to bridge the cultural gap between provider and consumer. By combining health-care delivery with union activities, it has been possible to finance the system through grower contribution by contract and to alter unhealthy working and living conditions on the farms. However, the lack of decision-making power by the health workers has resulted in poor working conditions and a high turnover of personnel. Complete consumer control has built into it the same hazards as complete professional control, and some balance of power is clearly necessary if the needs of both are to be adequately met.

Agriculture↗

Work satisfaction, unionism and militancy amongst nurses.

In recent years there has been a substantial increase in attitudinal and industrial militancy amongst nurses. This paper examines some of the factors associated with this change, in the context of the 50-day strike by Victorian nurses in late 1986. Using data collected from 125 nurses in a large public hospital in Melbourne, it is shown that dissatisfaction with the levels of autonomy, pay and intrinsic work rewards were of greatest concern to nurses at that time, and contributed to their growing unrest and attitudinal militancy. This suggests that measures such as professionalisation and salary restructuring may help to alleviate some of the grievances of nurses, but are unlikely to resolve other important issues that contribute to their discontent.

Attitude of Health Personnel↗

Comparison of SMR, PMR, and PCMR in a cohort of union members potentially exposed to diesel exhaust emissions.

A comparison of cause specific standarised mortality ratios (SMRs) and proportionate mortality ratios (PMRs) or proportionate cancer mortality ratios (PCMRs) was made based on the mortality experience of a cohort of 34 156 members of a heavy equipment operators union. Two types of PMRs or PCMRs were used in the comparison: those based on all deaths and those based on deaths known to the union only. The comparison indicated that, for the entire cohort, both types of PMRs were poor indicators for cancer risk and produced a large number of false positives. On the other hand, PCMRs appeared to be better than PMRs for assessing the direction of site specific cancer risk, but they tended to overstate the magnitude of risk. Analysis by duration of union membership or latency indicated that PMRs or PCMRs based on deaths known to the union tended to overestimate the risk of lung cancer by disproportionately larger amounts in groups with shorter time than in groups with longer time. This differential bias had the net effect of reducing the gradient of any trend or eliminating the trend entirely. In conclusion, PMR or PCMR, based on reasonably sufficient death ascertainment, has a certain usefulness in generating hypotheses, but they are not useful or reliable in measuring the magnitude of risk or in detecting trends in dose response analysis. No conclusion should be drawn from either PMR or PCMR.

Air Pollutants, Occupational↗

Workplace smoking policies: attitudes of union members in a high-risk industry.

We surveyed members of a medium-size national union representing workers in high-risk industries to assess workers' support for union and company programs to help smokers break the habit and policies that restrict smoking. Two surveys were conducted that involved 690 respondents in 1984 and 593 respondents in 1985. Respondents overwhelmingly (82%) favored restrictions on smoking in the workplace but less than half agreed that companies or unions should be concerned about workers smoking off the job. For both smokers and nonsmokers, beliefs that cancer has specific causes and can be prevented strongly predict support for workplace smoking control policies. Exposure to company occupational health training also influenced smokers and nonsmokers to support selected smoking control policies. These and other findings led to the conclusion that: (1) educating workers about cancer may promote support for smoking control policies, and (2) smoking control policies are more acceptable in the context of a strong company health and safety program.

Attitude↗

The mortality experience of early old-age and disability pensioners from unskilled- and semiskilled labour groups in Fredericia.

Survival of early old-age and disability pensioners from unskilled and semiskilled labourers was compared with the employed workers from the same local trade union. All members receiving early old-age or disability pensions during the period October 1, 1969 to September 30, 1973 were assigned to the index group provided they were still alive September 30, 1973. 2 active workers were selected as controls for each pensioner according to the closest age match. The pensioners had about 7 times higher mortality risk than their active fellow workers in the follow-up period from September 30, 1973 to January 1, 1979. It is emphasized that proper comparison is needed if excess mortality associated with early retirement is to be estimated.

Adult↗

Labour relations in health services management.

'Labour relations' or 'industrial relations' refers to employer-employee relations which are both economic as in matters of pay and conditions, and managerial, i.e. the political relationships between management and employees, collectivized through trade unions and professional associations. This paper traces the development of managerial relationships as illustrated by experiences in the British National Health Service particularly over the past 20 years focusing on groups of actors--management (within which may be distinguished government and local managers), health professional workers and other workers--whose interactions need to be studied if managerial relations within health services are to be satisfactorily analysed. We conclude that, although until recently, developments in management have had little impact upon worker behaviour outside unskilled groups, changing economic and other circumstances could create the conditions in which stronger managerial control over professional workers might emerge.

Forecasting↗

Beyond the biomedical and behavioural: towards an integrated approach to HIV prevention in the southern African mining industry.

While migrant labour is believed to play an important role in the dynamics of HIV-transmission in many of the countries of southern Africa, little has been written about the way in which HIV/AIDS has been dealt with in the industrial settings in which many migrant workers are employed. This paper takes the gold mining industry in the countries of the Southern African Development Community (SADC) as a case study. While many mines made substantial efforts to establish HIV-prevention programmes relatively early on in the epidemic, these appear to have had little impact. The paper analyses the response of key players in the mining industry, in the interests of highlighting the limitations of the way in which both managements and trade unions have responded to HIV. It will be argued that the energy that has been devoted either to biomedical or behavioural prevention programmes or to human rights issues has served to obscure the social and developmental dimensions of HIV-transmission. This argument is supported by means of a case study which seeks to highlight the complexity of the dynamics of disease transmission in this context, a complexity which is not reflected in individualistic responses. An account is given of a new intervention which seeks to develop a more integrated approach to HIV management in an industrial setting.

Adult↗

Ethnographic explanations for the clustering of attendance, injury, and health problems in a heavy machinery assembly plant.

We examine the clustering of attendance, illness, and accidental injury problems in a large unionized manufacturing plant using both quantitative and qualitative methods. We find that the distribution of workers into problem groups is related to 1) conflicts over seniority, 2) physical stressors and their influence on perceived desirability of certain kinds of jobs, and 3) organizational conditions and environments congenial to the development of distinct occupational "subcultures." We suggest that the case study approach we apply in this paper is critical to the design of programs of preventive intervention and complements the more commonly applied multiple-site and individually focused, survey approaches.

Absenteeism↗

Scandinavian research on stress in working life.

This paper discusses research strategies and summarizes pertinent knowledge that has influenced Scandinavian legislation and trade union policies in the field of stress at the workplace. Work stress is shown to be problematic in two ways. First, there may be a direct relation between certain objective working conditions, physiological and psychological stress, and ill health. Second, certain stress conditions may create fatigue and/or passivity and thus make it more difficult for individuals to actively involve themselves in changing those working conditions-including physical and chemical risk factors-that may be detrimental to health. This latter aspect is especially relevant for prevention on the systems level, where one has to rely on collective means for changes in technology and the organization of work.

Employment↗

Health selection among members of a Danish Trade Union.

The effect of selection on the mortality of members of the Danish carpenters and cabinet makers trade union is reported. Some 40 000 persons entering or leaving the Union between January 1971 to June 1976 were followed until September 1977, and deaths identified by record linkage with the central person-register. The male leaving cohort had a statistically significant higher age adjusted mortality rate than the male entry cohort with a relative death risk of 1.65. For females the difference was not significant but the relative death risk was estimated to be 1.42. Males leaving to or coming from well paid and socially esteemed jobs had significant lower mortality rates than the remainder. The influence of these results on the choice of study design is discussed.

Adolescent↗

Achievement of the POSITIVE (Participation-Oriented Safety Improvement by Trade Union InitiatiVE) activities in the Philippines.

The POSITIVE (Participation-oriented safety improvement by trade union initiative) programme was introduced into the Philippines in 1995. The monitoring of activities was carried out in 2004 among core trainers who had been trained before. The results of the questionnaire survey showed that the core trainers evaluated their activities satisfactory in general, and particularly the training activities were considered excellent. Also, the union workers who had been trained by the POSITIVE programme implemented improvements at the rate of around 5 examples a year on average. It was of note that the installation ratio (the number of installations/that of plans) was higher in small- and medium-sized enterprises than in larger companies, although the numbers of plans and installations of improvements were greater in large enterprises. Together with the previous findings, the present results suggest that the POSITIVE-style participatory training program is effective and efficient for workers to take actions for the OSH in not only larger enterprises but also small enterprises.

Cooperative Behavior↗

Weight reduction at the work site: a promise partially fulfilled.

Three consecutive studies of weight reduction at the work site were conducted with 172 female union members, who participated in 16-week behavioral group programs. There was no significant difference in weight loss over the three studies, but attrition decreased from 57.5% to 33.8% and weight loss maintenance improved. Groups that met three to four times weekly had less attrition than those which met once a week, but had no more weight loss. These behavioral weight reduction programs were as effective as self-help and commercial groups, and lay leaders produced results equivalent to those produced by professional therapists at one-third the cost.

Appointments and Schedules↗