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Workers' participation and their health and safety protection in China's transitional industrial economy.

Chinese workers have inherited from the Maoist era two institutions through which they may participate in workplace management--the trade union and the Staff and Workers' Representative Congress. This paper analyzes how workers have participated in the protection of their health and safety through these institutions, describing their functions, on paper, as stipulated by laws and regulations, and in practice, in a printing-machinery shareholding company, based on an in-depth case study. The impacts of these two institutions have declined with industrial economic reform, and the power of the enterprise is shifting toward management. China is confronted with serious occupational health and safety problems. It is imperative to strengthen the mechanisms that engage workers in the prevention of these problems.

Accidents, Occupational↗

Respiratory diseases among union carpenters: cohort and case-control analyses.

Lung diseases, defined by ICD-9 diagnoses on medical insurance claims, were studied through the combined use of administrative records, private health insurance, and workers' compensation claims for a cohort of 10,938 active union carpenters between 1989 and 1992. The cohort defined the study base for a nested case-control study, in which cases (n = 220) were initially identified by an ICD-9 code for asthma in private health insurance or workers' compensation files. A questionnaire was used to collect information on respiratory history and potential home and workplace exposures. Questions used by Burney et al. to define a discriminant function predictor (DFP) of a bronchial response to histamine were used to reclassify cases and controls for further exploratory analyses. Bronchitis accounted for over 50% of the lung disease cases among this cohort followed by asthma, chronic obstructive airway disease, and chronic bronchitis. Incidence density rates of asthma, chronic bronchitis, and chronic obstructive airway disease adjusted for age, sex, and time in the union increased with increasing age. Using Surveillance, Epidemiology, and End Results (SEER) Program data to estimate expected lung cancer cases in our cohort, an elevated standardized incidence rate (SIR) was seen among male carpenters between the ages of 45-54. Smoking history was not available for the entire cohort. Using the ICD-9 or Burney case definition of asthma, odds ratios were significantly elevated for exposure to hay, epoxy paints, enzymes, animals, and molds. Additional exposures associated with asthma using Burney's definition, are ones to which a majority of these carpenters were exposed including cement, drywall, and demolition dusts.

Adolescent↗

Organized medicine and Scandinavian professional unionism: hospital policies and exit options in Denmark and Sweden.

Strikes by junior hospital doctors over the issue of on-call remuneration in Denmark and Sweden in 1981 are analyzed to clarify the impact of public-sector cost-control policies on intra- and interprofessional solidarity within the Scandinavian professional peak associations. The junior doctors' grievances could find expression either through increased "voice" within the medical negotiating machinery, or by pursuing the exit option in having the medical associations quit the peak associations. The article explains why the "exit" option was selected in Denmark, while in Sweden the granting of additional voice helped persuade the medical association to withdraw its exit threat and to remain within the peak association. The two cases are interpreted as presaging a divergence in the paths being taken by the various Scandinavian welfare states.

Collective Bargaining↗

Historical employment records as data bases for occupational disease research--a case study.

Historical employment records in the B.C. coastal lumber industry were examined for adequacy for record linkage to the national Mortality Data Base. Employer, union, pension, and health and welfare plan records existed with varying amounts of personal information. The recommended list of identifiers for linkage is extensive. To evaluate the likelihood of successful linkage with the limited identifiers available in the case study, we compared our findings with the INCO-United Steelworkers mortality study carried out by McMaster University. Their evaluation of automated record linkage using limited identifiers compared to intensive direct follow-up of a sample of 1000 indicated a satisfactory rate of follow-up. This suggests that the historical records found in the case study would provide an adequate basis for research using record linkage.

Adult↗

Worker-trainers as evaluators: a case study of a union-based health and safety education program.

The United Automobile Workers uses worker-trainers to deliver health and safety education training to its members. The union has experimented with worker-trainers participating in program evaluation. Worker-trainers participated in the design and conduct of a telephone survey of training impact, and of an on-site survey of trainee perceptions of a large-scale program. Worker evaluators were able to analyze data and give a highly successful presentation of results to trainees at the large-scale program. The incorporation of workers as evaluators is a key step toward the goal of worker empowerment. The involvement of program participants in their program's evaluation can enhance the quality and usefulness of work-site health and safety programs in general.

Inservice Training↗

Work absence after breast cancer diagnosis: a population-based study.

BACKGROUND: Absence from work after breast cancer diagnosis may be part of the burden of disease for women with cancer, but little research has addressed this. We examined work absences of 4 weeks or more among women who had had breast cancer during the 3 years after diagnosis and compared their absences with those of women who had never had cancer. METHODS: Our 2 target study groups were women in Quebec 18-59 years of age who were working when they first received therapy for breast cancer between November 1996 and August 1997 and similarly aged women randomly selected from provincial health care files who had never had cancer and were working at the time of diagnosis in women who had cancer. We interviewed 646 women who had had breast cancer (73% of those eligible) and 890 women in the comparison group (51% of those eligible) by telephone 3 years after first diagnosis. RESULTS: One year after diagnosis, 85% (459/541) of breast cancer survivors who remained free of disease during the 3-year study period were absent from work for 4 weeks or more compared with 18% (156/881) of healthy women (geometric mean total duration 5.6 v. 1.7 months, p < 0.001). By the third year, disease-free women were not absent more than women in the comparison group; however, more women who had experienced any new cancer event continued to be absent from work and to be absent from work for longer periods of time. Receiving adjuvant chemotherapy prolonged absence duration (9.5 v. 5.4 months among women not receiving chemotherapy). Compared with survivors belonging to a union, those who did not belong to a union (multivariate relative risk [RR] 7.54, 95% confidence interval [CI] 3.02-18.83) and those who were self-employed (RR 13.95, 95% CI 5.53-35.21) were more likely to report no work absence. INTERPRETATION: Most of the women with breast cancer took time off work (almost 6 months on average) after receiving the diagnosis. Three years after diagnosis, breast cancer survivors who remained disease-free--a large proportion of women with nonmetastatic breast cancer--were not absent from work more often or for longer periods of time than other working women.

Absenteeism↗

A comparison of service profiles in alternative dental care delivery systems.

The financial crisis within the health care sector has resulted in the search by medical benefit funds of worker organisations for cost-effective alternatives to the private health care sector. This study compares the profile of services rendered to members of a union medical benefit fund by an 'in house' dental clinic and private dental practitioners. A total of 2,858 union clinic claims and 10,811 private practitioner accounts were selected. Each treatment code was categorised into either preventive, restorative, extraction or denture services. For the union clinic and private dental practitioners a total of 3,021 and 15,853 treatment codes respectively were included in the analysis. Significant differences were found in the profile of services rendered by the union clinic and private dental practitioners. The union clinic provided predominantly preventive and denture-related treatment compared with private practitioners who provided mainly preventive and extraction services. Members and their dependants are far more likely to have dentures made through the dental clinic (the odds of having dentures made at the clinic were 4.67 times the odds of having dentures made through private practitioners). On the other hand, members were more likely to receive all the other services (restorative, preventive and extractions) from private practitioners. However, the nature of the study design and the findings do not allow conclusions to be drawn regarding whether these differences were due to demand or supplier influences.

Dental Clinics↗

Integrating a nursing professional practice model and nursing informatics in a collective bargaining environment.

The integration of a professional practice model of nursing and nursing informatics support for that model is congruent with the goals of a professional nursing union. Thus, the collective-bargaining unit can be a powerful ally to nursing management in achieving the integration of a professional practice model of nursing and nursing informatics. This alliance is based on a shared vision of the nature of professional nursing practice and a common concern for the quality of working life and working environment of the professional nurse. This alliance can provide the basis for decision making about the type of nursing information system to be selected or developed for installation in a particular organization. Use of a participatory decision-making process will ensure that all nursing stakeholders are committed to the decision made and prepared to assist with the resolution of implementation issues as they arise. A harmonious alliance of nursing management and the nursing union ensures a partnership that will protect the clinical nursing caregiver and provide a unified voice for nursing within the organization to resist any attempt by other stakeholders to implement an information system that will not meet the needs of nursing. If nursing management and the collective bargaining unit share the concept of a professional model of nursing practice and view nursing informatics as a tool to assist the nursing staff to operationalize the professional model of nursing, then collaboration in resolving issues related to the implementation of nursing information systems will facilitate the process of achieving the integration of a professional practice model of nursing and nursing informatics support for that model.

Collective Bargaining↗

A predictive study of voting behavior in a representation election using union instrumentality and work perceptions.

A literature-based model of the unionization process is presented. The process is defined in terms of instrumentality perceptions, behavioral intent, and actual behavior components. The primary determinant of the process is shown to be the instrumentality perceptions of the potential members. The model is tested via discriminant analysis and step-wise regression in a sample of hospital nurses. The results suggest the overriding importance of instrumentality perceptions in the determination of voting behavior. In excess of 75% of the votes were accurately predicted from knowledge of the respondent's instrumentality perceptions alone. Several avenues for future research were suggested, including an expanded view of personal characteristics and extension of expectancy theory to employee voting behavior.

Analysis of Variance↗

Mortality among Ontario members of the International Union of Bricklayers and Allied Craftworkers.

BACKGROUND: Dust exposed workers may be at increased risk of pneumoconiosis, stomach cancer, lung cancer, and obstructive lung disease. Bricklayers may experience high exposures to silica and inorganic dusts. The aim of this study was to examine the mortality pattern of bricklayers to identify occupational associations with mortality. METHODS: A cohort of 10,953 workers was assembled from records of the International Union of Bricklayers and Allied Craftworkers (IUBAC). Mortality was ascertained by linkage to the Canadian Mortality Registry at Statistics Canada. Standardized Mortality Ratios (SMRs) were computed using Ontario general population mortality rates as the reference. RESULTS: Twenty or more years from first membership, SMRs for lung (158; 130-190) and stomach (235; 140-370) cancers were significantly elevated. There were four deaths from pneumoconiosis, but non-malignant respiratory mortality SMRs were not increased. CONCLUSIONS: Bricklayers and Allied Craftworkers are at risk from diseases associated with heavy exposure to inorganic dust: lung cancer, stomach cancer, and pneumoconiosis. Dust control as well as education and training of these workers to protect themselves against inhalation hazards is necessary.

Adult↗

Implementing shared governance: a false start.

A case study of the implementation of shared governance in a large teaching hospital in Western Canada has been presented. The project was placed in jeopardy due to two major contingencies: turnover in the chief nursing executive position, and a sudden reduction in the operating budget of the nursing division necessitating significant layoffs. Other factors that threatened the survival of shared governance included lack of systematic, long-range planning; the number and diversity of major changes introduced concurrently in the nursing division; and insufficient support systems to sustain organizational change. In particular, some senior and first-line managers could not adapt to or accept the radical philosophical change and so they were unable to empower their staff and to provide the necessary reinforcement needed to ensure the success of shared governance. This combination of these factors contributed to the loss of momentum in the implementation of shared governance. Lowered morale in the wake of layoffs, together with union grievances, and lack of clarity of the role to be played by union representatives in shared governance produced conflict and confrontation within the nursing division and between union and management. Despite the difficulties encountered, there remains optimism and commitment to the challenge of making shared governance succeed. As this article goes to press, remarkable strides have been made in addressing the described issues. A task force composed primarily of staff nurses has developed a "customized" model of governance that meets the needs of the hospital and deals with the identified flaws of the first implementation attempt. The organization is optimistic that by taking time to develop a solid foundation for the proposed change and tending carefully to the details of decision-making processes, an effective structure to support the professional role of the nursing staff will be a reality.

Attitude of Health Personnel↗

Collective bargaining and organized nurses: correlation of support and participation.

The objective of this article was to list identified personal characteristics which are intrinsic to the respondents, irrespective of their profession or employment, and which influence their viewpoints and participation in collective bargaining. Little information is reported in the nursing literature which points out the similarities of nurses to other subsets of society. The belief systems of various sub-group affiliations can have greater influence on one's opinions than one's socialization to professional values or exposure to particular environments. The current investigation was of an explorative nature. Moreover, as with many surveys, the applicability of findings is limited to the respondent population. No significant correlations were identified for nurses who are financially dependent on the income from their position, union membership of a family member, hospital size, shift worked or full-time/part-time employment status. The identified correlates of participation in collective bargaining as seniority in bargaining units and employment, hierarchical employment position and involvement in the organizing campaign were consistent with findings regarding blue collar unionists. Perception and militance correlates of age, seniority in the profession and the bargaining unit, race, religion, sex, employment position, membership in the professional association prior to collective bargaining, involvement in the initial organizing campaign and geographic location are also supportive of previous findings. The major finding of this investigation was that a tendency toward negative perceptions was associated with a proclivity toward militance. This was particularly true for the professional model of collective bargaining.(ABSTRACT TRUNCATED AT 250 WORDS)

Attitude↗

Unionisation in a comparative neural network model: a trade union membership prediction in 12 states.

The sociometric and theoretical models traditionally associated with the determinants of unionisation and based on international comparisons, generally use linear analysis of a restricted number of complex variables. The effectiveness of such models often have an unsatisfactory result. In this study a different theoretical and methodological approach has been used. It is based on a integrated scheme made by transposing the principles of the "Squashing Theory" (Buscema, 1994) into the social field, by the connectionist paradigm, and by the Artificial Neural Networks (ANN). This has permitted the carrying out of a larger data base (49 variables, 12 Nations, 12 Years maximum time interval), the adjusting of a model that has an elevated explanatory capacity (in terms of open variance) an ulterior capacity of generalization (in terms of a one-year span) and of metageneralization (in terms of generalization to nonprocessed nations). What emerges is surely the need for more and greater in-depth study of socializing facts which follow such aspects.

Databases as Topic↗

Mortality among members of a heavy construction equipment operators union with potential exposure to diesel exhaust emissions.

A historical prospective mortality study was conducted on a cohort of 34 156 male members of a heavy construction equipment operators union with potential exposure to diesel exhaust emissions. This cohort comprised all individuals who were members of the International Union of Operating Engineers, Locals 3 and 3A, for at least one year between 1 January 1964 and 31 December 1978. The mortality experience of the entire cohort and several subcohorts was compared with that of United States white men, adjusted for age and calendar time. The comparison statistic was the commonly used standardised mortality ratio (SMR). Historical environmental measurements did not exist, but partial work histories were available for some cohort members through the union dispatch computer tapes. An attempt was made to relate mortality experience to the union members' dispatch histories. Overall mortality for the entire cohort and several subgroups was significantly lower than expected. When cause specific mortality was examined, however, the study provided suggestive evidence for the existence of several potential health problems in this cohort. Mortality from liver cancer for the entire cohort was significantly high. Although mortality from lung cancer for the entire cohort was similar to expected, a positive trend by latency was observed for lung cancer. A significant excess of mortality from lung cancer was found among the retirees and the group for whom no dispatch histories were available. Other dispatch groups showed no evidence of lung cancer excess. In addition, the total cohort experienced significant mortality excess from emphysema and accidental deaths.

Accidents, Occupational↗

Characterization of the airborne concentrations of lead in U.S. industry.

Occupational exposure to lead represents a continuing problem of significant magnitude in the United States. To characterize the problem for surveillance purposes, an analysis of the airborne concentrations of lead identified in OSHA compliance inspections was conducted for the years 1979 to 1985. The five specific objectives of the study were: 1) to examine the distribution of air lead concentration in industrial environments; 2) to determine the secular trends in air lead concentrations for high lead industries; 3) to assess which job titles had excessive airborne lead concentrations; 4) to evaluate whether there was a relationship between lead overexposure and company size, unionization, or type of inspection; and 5) to investigate the prevalence of respirator violations for lead. Fifty-two industries were identified which had more than 1/3 of their inspection medians greater than the permissible exposure limit. These included primary and secondary lead smelting, battery manufacture, pigment manufacture, brass/bronze foundries, as well as 46 other industries. There has been little if any improvement in the prevalence and severity of airborne lead concentrations for the high lead industries, battery manufacture, secondary smelting, pigment manufacture, and brass/bronze foundries. Specific high exposure job titles are identified for certain high lead industries. The job title of painting stands out as an especially problematical job title across a number of industries. The prevalence of respirator violations is approximately 20% of all lead inspections.

Air Pollutants, Occupational↗

Perceived safety climate, job demands, and coworker support among union and nonunion injured construction workers.

PROBLEM: This study evaluated injured construction workers' perceptions of workplace safety climate, psychological job demands, decision latitude, and coworker support, and the relationship of these variables to the injury severity sustained by the workers. METHODS: Injury severity was assessed using the Health Assessment Questionnaire (HAQ), which evaluates functional limitations. Worker perceptions of workplace variables were determined by two instruments: (a) the Safety Climate Measure for Construction Sites and (b) the Job Content Questionnaire (JCQ). RESULTS: The overall model explained 23% of the variance in injury severity, with unique contributions provided by union status, the Safety Climate Score, and Psychological Job Demands. A positive significant correlation was found between injury severity and the Safety Climate Scores (r = .183, P = .003), and between the Safety Climate Scores and union status (r = .225, P < .001). DISCUSSION: There were statistically significant differences between union and nonunion workers' responses regarding perceived safety climate on 5 of the 10 safety climate items. Union workers were more likely than nonunion workers to: (a) perceive their supervisors as caring about their safety; (b) be made aware of dangerous work practices; (c) have received safety instructions when hired; (d) have regular job safety meetings; and (e) perceive that taking risks was not a part of their job. However, with regard to the 49-item JCQ, which includes Coworker Support, the responses between union and nonunion workers were very similar, indicating an overall high degree of job satisfaction. However, workers who experienced their workplace as more safe also perceived the level of management (r = -.55, P < .001) and coworker (r = -.31, P < .001) support as being higher. IMPACT ON INDUSTRY: The findings of this study underscore the critical need for construction managers to alert workers to dangerous work practices and conditions more frequently, and express concern and praise workers for safe work in a manner that is culturally acceptable in this industry. Workplace interventions that decrease the incidence and severity of injuries, but that are flexible enough to meet a variety of potentially competing imperatives, such as production deadlines and client demands, need to be identified.

Accidental Falls↗

Case-control study of lung cancer and truck driving in the Teamsters Union.

We conducted a case-control study of lung cancer deaths in the Teamsters Union to compare the risk of different occupations within the teamsters, after controlling for smoking and other confounders. Occupations with no presumed exposure to diesel fumes were used as the nonexposed group. The study population consisted of 996 cases and 1,085 controls who had died in 1982-83 after applying for pensions. Next of kin provided information on smoking, work history, and other potential confounders. Work history data were also obtained from the Teamsters Union. While no single job category had a significant excess risk compared to the non-exposed group, certain sub-groups were elevated. The odds ratio for those with long-term employment as long-haul truckers after 1959 (an approximate date for the introduction of diesel engines) was 1.55 (95% CI: 0.97, 2.47). Long-term drivers of primarily diesel trucks had an odds ratio of 1.89 (95% CI: 1.04, 3.42). Overall, our results suggest that diesel truck drivers have an excess risk of lung cancer compared to other teamsters in jobs outside the trucking industry. However, our findings were not uniformly consistent and our data have many limitations, the most important of which is the lack of data on exposure to diesel fumes.

Automobile Driving↗

A cohort mortality study of painters and allied tradesmen.

A cohort study was conducted of the membership of a large international union of painters and allied tradesmen. The union membership consisted of both painters and associated trades such as glaziers and tile and carpet layers. The study examined the mortality experience of 57 175 current and former union members in four states (California, Missouri, New York, and Texas) in the United States (US) from 1975 through 1979. No excess mortality was observed for the total union membership when compared to that of all US white males. When the study population was subdivided by the trade affiliation, members of locals comprised primarily of painters exhibited a significant elevation in mortality from all malignant neoplasms, lung cancer, and stomach cancer, compared to all US white males. To reduce the impact of potential nonoccupational differences between the study population and all US white males, the data were also analyzed using the entire cohort as the standardization population. Significant elevations continued to be observed for all malignant neoplasms and lung cancer among the membership of painting locals compared to other locals. In addition there was a statistically significant difference in mortality from leukemia and cancer of the bladder observed between the groups.

Adult↗