PubMed Search: National Health Interview Survey
Crossed with keywords: Job, Work, Employment, Occupation, and Vocation
Conducted on: Tuesday, January 5, 2009
1. Soc Psychiatry Psychiatr Epidemiol. 2009 Dec 24. [Epub ahead of print]
Occupation and mental health in a national UK survey.
Stansfeld SA, Rasul FR, Head J, Singleton N.
Centre for Psychiatry, Queen Mary University of London, Wolfson Institute of
Preventive Medicine, Barts and the London School of Medicine and Dentistry,
London, EC1M 6BQ, UK, s.a.stansfeld@qmul.ac.uk.
OBJECTIVES: To measure the prevalence of common mental disorder (CMD) by
occupation in a representative sample of Great Britain and to identify
occupations with increased and decreased risk of CMD. METHODS: A cross-sectional
interview-based survey was carried out including 5,497 working male and female
respondents, 16-64 years from a stratified random survey of private households in
Britain. Occupations were classified by the Standard Occupational Classification
(SOC) into four groups: major, sub-major, minor and constituent unit groups.
Common Mental Disorder was measured by the Revised Clinical Interview Schedule.
RESULTS: Major SOC groups with higher prevalence of common mental disorder
included clerical and secretarial, sales, and personal and protective services
whereas craft and related, 'other' professional occupations and plant and machine
operatives had lower prevalence compared to 13% overall prevalence in all adults.
In sub-major SOC groups managers and administrators, teaching professionals,
clerical and secretarial, 'other' sales and personal service occupations had
higher prevalence whereas many professional and skilled occupations had lower
prevalence. Specific SOC unit groups with higher prevalence included primary and
secondary teachers, welfare community, youth workers, security staff, waiters,
bar staff, nurse auxiliaries and care assistants. General managers in government
and large organizations (OR = 2.79, 95% CI 1.41-5.54), managers in transport and
storing (OR = 2.44, 95% CI 1.18-5.03), buyers and mobile sales persons (OR =
2.48, 95% CI 1.09-5.60), sales occupations (NES) (OR = 2.78, 95% CI 1.25-6.19)
and clerks (NES) (OR = 2.71, 95% CI 1.59-4.61) had increased risk of common
mental disorder relative to specialist managers adjusting for social and
financial factors and physical ill-health. CONCLUSIONS: Occupations with higher
risk of common mental disorder may be typified by high levels of job demands,
especially emotional demands and lack of job security. The reasons why
occupations have low rates of common mental disorder are varied and may include
high levels of job discretion, good job training and clearly defined job tasks.
PMID: 20033130 [PubMed - as supplied by publisher]
2. Psychol Med. 2009 Nov 11:1-7. [Epub ahead of print]
Job insecurity, socio-economic circumstances and depression.
Meltzer H, Bebbington P, Brugha T, Jenkins R, McManus S, Stansfeld S.
Department of Health Sciences, Medical School, University of Leicester,
Leicester, UK.
BACKGROUND: Economic recessions are characterized by job insecurity and rising
unemployment. The relationship between job insecurity and poor mental health is
known. However, we do not know how this relationship is affected by individual
socio-economic circumstances.MethodA random probability sample comprising 3581
respondents (1746 men and 1835 women) were selected from the third national
survey of psychiatric morbidity in Great Britain. Fieldwork was carried out
throughout 2007. Depression was assessed using the revised Clinical Interview
Schedule and ICD-10 research diagnostic criteria administered by well-trained lay
interviewers. RESULTS: One-fifth of all working men and women aged 16-64 years
felt that their job security was poor. From a multivariate analysis of several
job stressors, there was an increased likelihood of depression among those
agreeing that their job security was poor [odds ratio (OR) 1.58, 95% confidence
intervals (CI) 1.22-2.06, p<0.001]. After controlling for age and sex, job
insecurity (OR 1.86, 95% CI 1.47-2.35, p<0.001) and being in debt (OR 2.17, 95%
CI 1.58-2.98, p<0.001) were independently associated with depression.
CONCLUSIONS: Job insecurity has a strong association with feelings of depression
even after controlling for biographic characteristics (age and sex), economic
factors (personal debt) and work characteristics (type of work and level of
responsibility). Despite the organizational changes needed to cope with a
recession, employers should also take note of the additional distress experienced
by workers at a time of great uncertainty, particularly those in less skilled
jobs and in financial straits.
PMID: 19903366 [PubMed - as supplied by publisher]
3. J Am Med Dir Assoc. 2009 Oct;10(8):559-67. Epub 2009 Sep 3.
Perceived barriers to effective job performance among nursing assistants in
long-term care.
Parmelee PA, Laszlo MC, Taylor JA.
Center for Mental Health and Aging, The University of Alabama, Tuscaloosa, AL
35487, USA. pparmelee@ua.edu
OBJECTIVES: This research explored perceived barriers to job performance among a
national sample of nursing assistants (NAs). Specific objectives were (1) to
clarify which of the problems identified by previous research are most
troublesome for NAs, (2) to develop a reliable quantitative measure of perceived
barriers to job performance, and (3) to test construct validity of the measure
vis-à-vis work-related psychological empowerment and job satisfaction. METHODS:
Nursing assistants attending the 2006 national conference of the National
Association of Health Care Assistants completed a paper-and-pencil survey
including 33 barriers to job performance and standardized measures of empowerment
and job satisfaction. The barriers were also rated by a small sample of NAs at a
single Georgia nursing home. RESULTS: Factor analysis of barriers items yielded a
30-item Nursing Assistants Barriers Scale (NABS) comprising 6 subscales:
Teamwork, Exclusion, Respect, Workload, Work Stress, and New NAs. Lack of
teamwork and exclusion from communication processes were rated as most
problematic by both samples. The 6 NABS subscales were significantly and
independently associated with empowerment and satisfaction; different barriers
predicted the 2 constructs. DISCUSSION: This study is a first step toward
quantitative assessment of NAs' perceptions of barriers to doing their jobs.
Primary limitations are the select sample and use of a job satisfaction measure
that may have artificially inflated correlations with the NABS. Nonetheless,
results confirm the validity of the new scale as an operationalization of the
barriers construct. CONCLUSION: The concept of barriers to job performance is a
unique construct from work empowerment and satisfaction with one's job. Nursing
assistants clearly differentiate various barriers, converging on workload and
lack of teamwork as most problematic. Further work is needed to substantiate
validity and reliability of the NABS, particularly with respect to NAs' actual
job performance, intent to stay on the job versus leave, absenteeism, and
turnover.
PMCID: PMC2774771 [Available on 2010/10/1]
PMID: 19808154 [PubMed - indexed for MEDLINE]
4. Soc Sci Med. 2009 Dec;69(11):1616-24. Epub 2009 Sep 30.
Job authority and health: unraveling the competing suppression and explanatory
influences.
Schieman S, Reid S.
Department of Sociology, University of Toronto, Toronto, ON M5S 2J4, Canada.
scott.schieman@utoronto.ca
Using data from a 2005 national survey of working American adults (N=1800), we
examine the association between job authority and three health outcomes: physical
symptoms, psychological distress, and anger. We also seek to explicate the
intervening conditions that suppress and/or contribute to those associations. We
observe that higher levels of interpersonal conflict in the workplace and
work-to-home interference among those with more job authority suppress the
negative association between authority and each health outcome. By contrast, the
greater earnings and nonroutine work among those with higher job authority
explain their lower levels of physical symptoms, distress, and anger. These
observations elaborate on and refine the "stress of higher status" theoretical
perspective and illuminate the paradox of the overall null association between
job authority and health. Moreover, they draw much-needed attention to the ways
that suppression effects can broaden our understanding of workplace inequality,
stress processes, and multiple health outcomes.
PMID: 19800159 [PubMed - indexed for MEDLINE]
5. J Korean Acad Nurs. 2009 Aug;39(4):549-61.
[Work-related stress and risk factors among Korean employees]
[Article in Korean]
Choi ES, Ha Y.
The Institute of Nursing Science, Kyungpook National University, Daegu, Korea.
PURPOSE: Work-related stress and risk factors among Korean employees were
identified in this study. METHODS: Data were obtained from employees aged 20 to
64 using the Korean Working Conditions Survey 2006 (KWCS). Multiple logistic
regression analysis using SAS version 9.1 was performed to examine risk factors
of work-related stress by gender. RESULTS: The age-adjusted prevalence of
work-related stress among male and female employees was 18.4% and 15.1%
respectively. After adjustments for multiple variables among both male and female
employees, there was a significant relationship between work-related stress and
risk factors including education, company size, work time, ergonomic risks,
biological.chemical risks, and job demands. The significant variables for male
employees were housework load, occupational class, and shift work, and for female
employees, type of employment. CONCLUSION: There is a need to develop and support
intensive stress management programs nationally giving consideration to
work-related stress associated with working time, physical working environment,
and job demands. Based on gender specific approaches, for male employes, stress
management programs should be developed with consideration being given to
occupational class and shift work. For stress management programs for female
employees, consideration needs to be given to permanent employment status,
specifically those in small companies.
PMID: 19726911 [PubMed - indexed for MEDLINE]
6. Scand J Public Health. 2009 Sep;37(7):778-80. Epub 2009 Aug 7.
The impact of job satisfaction on the risk of disability pension. A 15-year
prospective study.
Labriola M, Feveile H, Christensen KB, Bültmann U, Lund T.
Danish National Centre for Social Research, Herluf Trolles Gade 11, DK-2100
Copenhagen, Denmark. mee@sfi.dk
OBJECTIVES: To identify the impact of job satisfaction on the risk of disability
pension. METHODS: A total of 8,338 employees were sampled from the total working
population in Denmark. They were interviewed regarding age, gender, job
satisfaction and health behaviour. Interview data were merged with national
register data on granted disability pension for up to 15 years after baseline
data collection. RESULTS: The study found a statistically significant association
between low job satisfaction and disability pension for women when adjusted for
age, smoking status and BMI. CONCLUSIONS: Based on the results, investing in
giving workers a satisfying work environment could be a low-cost way of improving
employee health and prolonging labour market participation.
PMID: 19666670 [PubMed - indexed for MEDLINE]
7. J Occup Environ Hyg. 2009 Oct;6(10):D55-62.
Using ergonomics to enhance safe production at a surface coal mine--a case study
with powder crews.
Torma-Krajewski J, Wiehagen W, Etcheverry A, Turin F, Unger R.
Pittsburgh Research Laboratory, National Institute of Occupational Safety and
Health, Arvada, Colorado, USA.
Job tasks that involve exposure to work-related musculoskeletal disorder (WMSD)
risk factors may impact both the risk of injury and production downtime. Common
WMSD risks factors associated with mining tasks include forceful exertions,
awkward postures, repetitive motion, jolting and jarring, forceful gripping,
contact stress, and whole body and segmental vibration. Mining environments that
expose workers to temperature/humidity extremes, windy conditions, and slippery
and uneven walking surfaces also contribute to injury risk. National Institute
for Occupational Safety and Health (NIOSH) researchers worked with powder crew
members from the Bridger Coal Company to identify and rank routine work tasks
based on perceived exposure to WMSD risk factors. This article presents the
process followed to identify tasks that workers believed involved the greatest
exposure to risk factors and discusses risk reduction strategies. Specifically,
the proposed prill truck design changes addressed cab ingress/egress, loading
blast holes, and access to the upper deck of the prill truck.
PMID: 19626526 [PubMed - indexed for MEDLINE]
8. Gerontologist. 2009 Oct;49(5):596-610. Epub 2009 Jun 9.
Intrinsic job satisfaction, overall satisfaction, and intention to leave the job
among nursing assistants in nursing homes.
Decker FH, Harris-Kojetin LD, Bercovitz A.
Long-Term Care Statistics Branch, Division of Health Care Statistics, National
Center for Health Statistics, 3311 Toledo Road, Hyattsville, MD 20782, USA.
fdecker@cdc.gov
PURPOSE: We examined predictors of intrinsic job satisfaction, overall
satisfaction, and intention to leave the job among nursing assistants (NAs).
DESIGN AND METHODS: The study focused on NAs who worked 30 or more hours per week
in a nursing home. Data on 2,146 NAs meeting this criterion came from the 2004
National Nursing Assistant Survey, the first telephone interview survey of NAs
nationwide. Regression equations were calculated in which intrinsic satisfaction,
overall satisfaction, and intention to leave were dependent variables. NA
attributes (e.g., job tenure and education) and extrinsic job factors (e.g.,
assessment of supervisor behavior, pay satisfaction, and benefits) were exogenous
variables. RESULTS: A positive assessment of the supervisor's behavior had the
strongest association with intrinsic satisfaction. Pay satisfaction had the
second strongest association with intrinsic satisfaction. Predictors with the
strongest associations with intention to leave were overall and intrinsic
satisfaction. Assessment of the supervisor was not associated directly with
intention to leave. Assessments of the supervisor and pay may affect overall
satisfaction and intention to leave in part through their direct effects on
intrinsic satisfaction. Some facility and NA attributes were related to intrinsic
satisfaction but not to overall satisfaction, suggesting that intrinsic
satisfaction may be an intervening variable in the impact of these attributes on
overall satisfaction. IMPLICATIONS: Intrinsic satisfaction and extrinsic job
factors amenable to change appear central to NAs' overall satisfaction and
intention to leave. A facility may be able to improve extrinsic job factors that
improve NAs' job-related affects, including intrinsic satisfaction.
PMID: 19515636 [PubMed - indexed for MEDLINE]
9. J Burn Care Res. 2009 Jul-Aug;30(4):661-7.
Factors related to return to work and job modification after a hand burn.
Hwang YF, Chen-Sea MJ, Chen CL.
Institute of Allied Health Sciences, Department of Occupational Therapy, College
of Medicine, National Cheng Kung University Hospital, National Cheng Kung
University, Tainan, Taiwan.
Occupational therapy aims to help patients resume their occupations. Therefore,
we must know their work status after our intervention. We collected demographic
and burn-related data from patient charts and analyzed it to determine the work
status of former patients with burned hands and what influenced their returning
to work. From 284 former patients with burns, we screened 159 with burned hands,
108 of whom were interviewed through the telephone about their work status. We
used logistic regression analysis to analyze factors for having work, returning
to work, the length of time required to return to work, and job modifications. We
found that 1) having preburn employment increased the likelihood of having
postburn employment; 2) being the primary wage earner in a family increased the
likelihood of having work and of a return to work postburn; 3) a longer stay in
the hospital, and burn injuries on both hands and trunk increased the time
required to return to work; and 4) being older and having a smaller percentage of
total body burn area decreased the likelihood of returning to a job modified
because of a burn injury. Returning to work was affected not only by burn-related
factors but also by general demographic and employment factors. We urge
occupational therapy departments to include a return-to-work program in their
routine services to improve the chances of patients with hand burns to return to
work. We strongly recommend that a multicenter prospective study of hand-burn
injuries should be performed.
PMID: 19506508 [PubMed - indexed for MEDLINE]
10. Psychiatr Serv. 2009 May;60(5):655-62.
Employment among persons with past and current mood and anxiety disorders in the
Israel National Health Survey.
Levinson D, Lerner Y.
Ministry of Health, 2 Ben Tabai St., Jerusalem, Israel.
daphna.levinson@moh.health.gov.il
OBJECTIVE: The study examined associations between having a past or current mood
or anxiety disorder and being employed in the past month and salary level.
METHODS: The Israel National Health Survey used data from the National Population
Register to compile a representative sample of noninstitutionalized residents
aged 21 and older. Data for this study were from 4,859 persons interviewed in
their homes between May 2003 and April 2004. Lifetime, past-year, and past-month
DSM-IV mood and anxiety disorders were assessed with a revised version of the
Composite International Diagnostic Interview. Respondents self-reported
employment and salary information. Logistic regression was used to estimate
associations. RESULTS: The employment rate was lowest-35%-among respondents with
a past-month mood or anxiety disorder, compared with rates of 52% among those
with a past-year disorder, 60% among those with a lifetime disorder who did not
have a disorder in the past year, and 58% among those with no disorder. No
significant differences in rates of employment were found between those who had
never had a disorder and those who had a lifetime or past-year disorder. Age at
onset of the disorder was related to earning above the average salary for the
population of Israel: those with onset before age 25 had lower odds of being in
the above-average group. CONCLUSIONS: The results indicate that employment was
affected only during the acute phase of a disorder and that early onset had
lasting effects in terms of job level and salary.
PMID: 19411354 [PubMed - indexed for MEDLINE]
11. Gerontologist. 2009 Apr;49(2):185-97. Epub 2009 Apr 1.
The National Nursing Assistant Survey: improving the evidence base for policy
initiatives to strengthen the certified nursing assistant workforce.
Squillace MR, Remsburg RE, Harris-Kojetin LD, Bercovitz A, Rosenoff E, Han B.
Disability, Aging and Long-Term Care Policy, Office of the Secretary/Assistant
Secretary for Planning and Evaluation, US Department of Health and Human
Services, Washington, DC 20201, USA. marie.squillace@hhs.gov
PURPOSE: This study introduces the first National Nursing Assistant Survey
(NNAS), a major advance in the data available about certified nursing assistants
(CNAs) and a rich resource for evidence-based policy, practice, and applied
research initiatives. We highlight potential uses of this new survey using select
population estimates as examples of how the NNAS can be used to inform new policy
directions. DESIGN AND METHODS: The NNAS is a nationally representative survey of
3,017 CNAs working in nursing homes, who were interviewed by phone in 2004-2005.
Key survey components are recruitment; education; training and licensure; job
history; family life; management and supervision; client relations;
organizational commitment and job satisfaction; workplace environment;
work-related injuries; and demographics. RESULTS: One in three CNAs received some
kind of means-tested public assistance. More than half of CNAs incurred at least
1 work-related injury within the past year and almost one quarter were unable to
work for at least 1 day due to the injury. Forty-two percent of uninsured CNAs
cite not participating in their employer-sponsored insurance plan because they
could not afford the plan. Years of experience do not translate into higher
wages; CNAs with 10 or more years of experience averaged just $2/hr more than
aides who started working in the field less than 1 year ago. IMPLICATIONS: This
survey can be used to understand CNA workforce issues and challenges and to plan
for sustainable solutions to stabilize this workforce. The NNAS can be linked to
other existing data sets to examine more comprehensive and complex relationships
among CNA, facility, resident, and community characteristics, thereby expanding
its usefulness.
PMID: 19363014 [PubMed - indexed for MEDLINE]
12. J Ment Health Policy Econ. 2009 Mar;12(1):3-17.
Psychiatric disorders and the labor market: an analysis by disorder profiles.
Cowell AJ, Luo Z, Masuda YJ.
RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709, USA.
cowell@rti.org
BACKGROUND: A key societal cost of mental illness is its impact on the labor
market. In examining the relationship between psychiatric disorders and the labor
market, the literature to date either examines psychiatric disorders in broad
classes or focuses on the impact of specific conditions. AIMS OF THE STUDY: The
aim is to examine the relationships among meaningful profiles of concurrent past
year disorders and labor market outcomes by gender. METHODS: Data are from the
National Epidemiologic Survey on Alcohol and Related Conditions for 2001/2002
(NESARC), a representative sample of the noninstitutionalized population aged 18
or older residing in the United States. The analysis sample contains 18,429 women
and 16,426 men (unweighted). We examined the relationship between profiles of
psychiatric disorders and three labor market outcomes: labor force participation;
employment, conditional on labor force participation; and working full-time
conditional on being employed. Because no attempt was made to control for
potential endogeneity between the labor market outcomes and the psychiatric
profiles, we are unable to establish the causal direction of the associations
estimated. RESULTS: First, anxiety disorders among women appear to be associated
with labor market outcomes (e.g., anxiety profile in employment outcome: OR=0.76,
p<.05). Second, for employment among women large effects were seen for mood
disorder and mood and anxiety; in contrast for men, these disorder profiles had
significant associations with working full-time rather than employment. Third,
for women, of the three labor market outcomes, employment status is particularly
sensitive to the profiles of disorders. For men, no such pattern was found for
any single labor market outcome. DISCUSSION: Concurrent psychiatric disorder
profiles affect men and women differently in the labor market. The greatest
differences are in (i) the relationship between labor market outcomes and
profiles exhibiting anxiety disorders, and (ii) which labor market outcomes are
influenced. The main methodological limitation is that the approach does not
attempt to assert a direction of causation between mental health conditions and
the labor market outcomes. Unobserved heterogeneity and endogeneity are both
possible and likely to some degree. Other limitations pertain to the data, which
are cross-sectional and exclude some relatively rare disorders (e.g.,
schizophrenia). IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The results may
have significant implications for access to appropriate treatment, which may vary
greatly by psychiatric disorder profile and by gender. IMPLICATIONS FOR HEALTH
POLICIES: In the United States, private third-party coverage for treatment is
obtained either directly through working full-time at a medium to large firm or
through a spouse being employed. The findings thus suggest that mental health
policy may need to account for labor market policy. IMPLICATIONS FOR FURTHER
RESEARCH: Additional research is needed to disentangle the findings presented.
For example, it is important to separate the influence of substance use disorders
from mood disorder and uncover the pathways by which the different conditions in
substance use disorders may influence the job market.
PMID: 19346562 [PubMed - indexed for MEDLINE]
13. Prim Dent Care. 2009 Jan;16(1):29-37.
A question of value: a qualitative study of vocational dental practitioners'
views on oral healthcare systems and their future careers.
Gallagher JE, Clarke W, Eaton KA, Wilson NH.
Head of Oral Health Services Research & Dental Public Health, King's College
London Dental Institute at Guy's, King's College and St Thomas' Hospitals,
London, UK. jenny.gallagher@kcl.ac.uk
BACKGROUND: New dental graduates in England and Wales spend one year as
vocational dental practitioners (VDPs) preparing for independent clinical
practice. In recent years, they have entered a state-funded healthcare system
undergoing the greatest period of change since the inception of the National
Health Service (NHS) and a profession in which there has been a significant shift
of care to the private sector. Against this background, the objectives of this
study were to investigate VDPs' vision of their future professional career and
the influences that will impact on their choice of state-funded (NHS) and/or
private dentistry, and to identify what factors may attract graduates to work for
the NHS. METHODS: In 2004/2005, purposive sampling of a range of VDP training
schemes across England and Wales was used to select the VDPs from ten schemes to
take part in focus groups. To standardise data collection, a topic guide was
used. Respondents' views were recorded on tape and field notes. The data were
transcribed and analysed using framework methodology. RESULTS: Ninety-nine VDPs
from all parts of England and Wales participated in ten focus groups. They
identified three main categories of future practice: private, state-funded (NHS),
and mixed. Private practice was perceived as providing 'professional
independence', 'financial reward', 'time with patients' and 'clinical freedom'.
NHS practice was associated with 'providing access to specialist training' and
'gaining clinical experience', often as preparation for private practice.
Providing NHS care was attractive for VDPs who valued the ethos of public
service. The VDPs considered that NHS practice could be made more attractive to
young dentists by a range of factors, involving the funding, culture and
philosophy of the system and the degree of fit with their personal and
professional vision. They reported that they would welcome 'incentives to work in
areas of high need', 'assistance with debt' and a 'culture of valuing NHS
dentists'. CONCLUSIONS: The findings suggest that the commitment to healthcare
systems of the VDPs who took part in this study was associated with being true to
their values and being valued within the system. They perceived a tension between
state-funded and private practice, considering the latter more likely to meet
personal and professional expectations. However, they remained open to working in
an enhanced and supportive state-funded system, should it correspond with their
values, and demonstrate that they were valued healthcare professionals.
PMID: 19126350 [PubMed - indexed for MEDLINE]
14. Psychiatr Serv. 2009 Jan;60(1):56-60.
Mental health and substance use problems of parents involved with child welfare:
are services offered and provided?
Staudt M, Cherry D.
College of Social Work, University of Tennessee, 202 Henson Hall, Knoxville, TN
37996, USA. mstaudt@utk.edu
OBJECTIVES: This study examined service delivery to parental caregivers with
mental health problems, substance use problems, or both. The study sought to
determine whether, once need is identified, suitable services are offered and
then provided. METHODS: The study was a secondary analysis of the 1994 National
Study of Protective, Preventive, and Reunification Services Delivered to Children
and Their Families. The national study interviewed child welfare caseworkers
about the problems of and services provided to 2,109 families. RESULTS: Of
parents with mental problems, 77.9% were offered services and 84.0% of those were
provided services. Of parents with substance use problems, 65.7% were offered
treatment and 67.5% of those were provided it. Other problems included lack of
parenting skills, lack of education and job skills, parent-child conflict, and
lack of income. Significant associations were found between caseworkers'
identifying problems and offering relevant services. Caregivers with substance
use problems were less likely to be offered substance treatment services than
caregivers with both mental health and substance use problems. CONCLUSIONS: The
child welfare system may facilitate service use for caregivers. More research is
needed to understand the process of service delivery to caregivers, including why
services are not offered to some caregivers and why some services are not
provided after being offered. Future research should examine why caregivers with
substance use problems are vulnerable to not receiving treatment and whether and
how service use varies for other problems not examined in this study.
PMID: 19114571 [PubMed - indexed for MEDLINE]
15. J Occup Environ Med. 2008 Dec;50(12):1401-13.
Examining associations between job characteristics and health: linking data from
the Occupational Information Network (O*NET) to two U.S. national health surveys.
Alterman T, Grosch J, Chen X, Chrislip D, Petersen M, Krieg E Jr, Chung H,
Muntaner C.
Division of Surveillance, Hazard Evaluations and Field Studies, National
Institute for Occupational Safety and Health, Cincinnati, Ohio 45213, USA.
talterman@cdc.gov
OBJECTIVE: To determine whether the Occupational Information Network (O*NET)
database can be used to identify job dimensions to serve as proxy measures for
psychosocial factors and select environmental factors, and to determine whether
these factors could be linked to national health surveys to examine associations
with health risk behaviors and outcomes. METHODS: Job characteristics were
obtained from O*NET 98. Health outcomes were obtained from two national surveys.
Data were linked using Bureau of Census codes. Multiple logistic regression was
used to examine associations between O*NET factors and cardiovascular disease,
depression, and health risk factors. RESULTS: Seven of nine work organization or
psychosocial factors were significantly associated with health risk behaviors in
both the National Health and Nutrition Examination Survey III and National Health
Interview Survey. CONCLUSIONS: This study demonstrates a method for linking
independently obtained health and job characteristic data based on occupational
code.
PMID: 19092496 [PubMed - indexed for MEDLINE]
16. J Nurs Manag. 2008 Oct;16(7):804-12.
The matron's role in acute National Health Service trusts.
Gould D.
City Community and Health Sciences incorporating St Bartholomew School of Nursing
and Midwifery, City University, London, UK. d.gould@city.ac.uk
AIM: The aim of this study was to describe how matrons in an acute National
Health Service trust perceive and undertake their role since its reconfiguration
in 2005 and to investigate their needs for continuing professional development.
BACKGROUND: Matrons returned to acute National Health Service trusts in 2002 to
provide a senior, authoritative nursing presence throughout clinical areas. Their
function is to promote high standards of clinical care and leadership; ensure
that administrative and support services are in place to deliver high standards
of care; and provide a visible, accessible and authoritative presence in ward
settings. METHODS: Data were obtained by interview. A qualitative approach using
a semi-structured interview schedule was used to obtain data from 22 matrons and
the data were subjected to thematic analysis. RESULTS: There were differences in
the way that matrons performed their role. They promoted clinical leadership
effectively and maintained a high clinical profile. Attempts to promote high
standards of cleanliness and infection control were less effective because of the
shortcomings of the domestic service. CONCLUSION: Overall the matron role is
proving effective. However, matrons' ability to promote adequate levels of
environmental cleanliness and control infection is a cause for concern.
IMPLICATIONS FOR NURSING MANAGERS: The study findings suggest that where an
existing service is performing poorly, expecting another occupational group to
oversee it will not contribute to improvement unless resources can be improved.
WHAT THIS PAPER ADDS TO CURRENT KNOWLEDGE: This study has provided an in-depth
evaluation of the matron role at a local level. It is to date the most
comprehensive study of its kind.
PMID: 19017242 [PubMed - indexed for MEDLINE]
17. Cien Saude Colet. 2008 Jan-Feb;13(1):51-60.
[The identity of the community healthcare agent: a phenomenological approach]
[Article in Portuguese]
Bachilli RG, Scavassa AJ, Spiri WC.
Secretaria Municipal de Saúde de Cerquilho, Cerquilho, SP, 18520-000.
rosabachi@hotmail.com
The structure of Brazil's National Health System (SUS) is being firmed up through
programs adding a new element to its multi-professional healthcare teams:
Community Healthcare Agents. This study examines psycho-social factors that are
significant for the construction of this identity, from the standpoint of these
Community Healthcare Agents, using the hermeneutic phenomenology of Paul Ricoeur
as its reference methodology. The subjects of this survey were seven Community
Healthcare Agents who were asked during interviews (with informed consent and
after approval by the Research Ethics Committee) to: 'Tell me about your
experience as Community Healthcare Agent'. The analysis of their replies
indicated the following topics: previous experience; capacity-building for the
job; bonding; building up expertise; gratifying experience; feelings of
power(lessness); communications; daily work routines, personal growth; criticisms
of the institution; user-agent experiences; and insertion into the social
reality. The overall analysis disclosed the phenomenon through the convergence
and divergence of the grouping of these topics, viewed from the standpoint of
these Community Healthcare Agents and the psycho-social aspects constructing
their identity.
PMID: 18813520 [PubMed - indexed for MEDLINE]
18. Health Promot Int. 2008 Dec;23(4):302-10. Epub 2008 Sep 18.
Employees' job satisfaction after the introduction of a total smoke-ban in bars
and restaurants in Norway.
Hetland J, Hetland H, Mykletun RJ, Aarĝ LE, Matthiesen SB.
Faculty of Psychology, University of Bergen, Norway. joern.hetland@psych.uib.no
The aim of the study was to investigate possible effects of a total smoke-ban in
Norwegian bars and restaurants (introduced on June 1st 2004) on employees' job
satisfaction. A national representative sample was randomly selected from the
public registry of all companies in the hospitality business. A baseline survey
was conducted in May 2004, follow-up measurements were performed in
September/October 2004 and May 2005. Altogether, 1525 employees agreed to
participate in the baseline survey. Among respondents at baseline, 894 (59.4%)
remained in the sample at the first follow-up and 758 (49.7%) at the second
follow-up. Analysis of variance for repeated measures revealed a significant
three-way interaction between personal smoking behaviour, attitudes towards the
ban before it was enacted and time from baseline to the second follow-up. A small
decline in job satisfaction was found between baseline and the first follow-up
among employees who were daily smokers and had a negative attitude towards the
ban. There was, however, an increase in job satisfaction between the first and
second follow-up among the others (non-smokers and smokers with a positive
attitude towards the ban). While job satisfaction was higher among smokers with
negative attitudes towards the ban than among other employees before the ban
entered into force, the opposite was the case one year later. The work
environments in bars and restaurants seem to have changed towards being more
satisfactory for non-smokers and smokers with positive attitudes towards the ban
before it was enacted. In contrast, a small but persisting worsening of job
satisfaction was found among employees that were daily smokers and had a negative
attitude towards the ban.
PMID: 18805780 [PubMed - indexed for MEDLINE]
19. J Health Soc Behav. 2008 Sep;49(3):286-300.
Relational demography in the workplace and health: an analysis of gender and the
subordinate-superordinate role-set.
Schieman S, McMullen T.
Department of Sociology, University of Toronto, Toronto, ON, Canada.
scott.schieman@utoronto.ca
Using data from a 2005 national survey of working adults in the United States, we
examine the effects of the gender composition of the superordinate-subordinate
role-set on mental and physical health measures. Subordinates' and
superordinates' genders are important determinants. Men who work in gender-mixed
superordinate contexts (i.e., with one male and one female superior) report lower
levels of distress and physical symptoms than men who work with one male
superior. Women who work with one male superior report less distress and fewer
physical symptoms compared to women who work with one female superior or in
gender-mixed superordinate contexts. With a few exceptions, these observations
generally hold net of occupation, job sector, and an array of work-related
conditions. We discuss the implications of these findings in light of predictions
derived from the similarity-attraction and role congruity theories. We also
outline ways that theoretical development in relational demography can be refined
by a more specific focus on the demographic characteristics--especially
gender--of the superordinate-subordinate role-set.
PMID: 18771064 [PubMed - indexed for MEDLINE]
20. Work. 2008;30(4):473-82.
Workplace health interventions in small enterprises: a Swedish longitudinal
study.
Vinberg S.
National Institute for Working Life, SE-831 40 Ostersund, Sweden.
stig.vinberg@niwl.se
This article has a two-fold approach. First, it investigates relationships
between work organizational factors, and health and performance outcomes. Second,
it compares two change strategy approaches in workplace health interventions by
studying changes of these factors and outcomes. The sample consisted of ten
Swedish small enterprises including 102 individuals, who answered a before and
after questionnaire about organizational factors and outcomes. The leaders were
interviewed and answered a questionnaire about performed workplace health
interventions. Statistical methods used were reliability tests, correlation
analyses and t-tests. Results indicate rather strong links between indicators of
respectful leadership, creative work and team spirit, and the outcome indicators
self-assessed health and judged workplace adaptability in association with
customer satisfaction. The results concerning changes of determinants and
outcomes (after workplace health interventions) showed significant differences
between enterprises using a broad change strategy and those using an
expert/problem-based strategy with the former having more favourable results. The
leader interview results also point at obstacles concerning workplace change
processes as lack of resources, insufficient competence and influence of external
factors. The study results suggest that work organizational factors and
integrated models for workplace health intervention are of importance for health
and performance outcomes in small enterprises.
PMID: 18725710 [PubMed - indexed for MEDLINE]
21. J Environ Health. 2008 Jul-Aug;71(1):16-20, 40-1.
The View-Master Health Study Focus Groups.
Krall K, Douglas J, Perrin NA, Austin D, Lambert WE, Heumann M.
Willamette Family Medical Center, Portland, OR 97219, USA.
Krallfamily@comcast.net
Comment in:
J Environ Health. 2009 Apr;71(8):29.
Trichloroethylene (TCE), a common groundwater contaminant, was found at high
levels at an Oregon work site in 1998. According to a recent report released by
the National Research Council, "the evidence on carcinogenic risk and other
health hazards from exposure to trichloroethylene has strengthened since 2001." A
convenience sample of 13 former workers from the Oregon work site was recruited
for a series of focus groups. Information obtained on plant processes, safety
procedures, attitudes regarding medical record access, and opinions about proxy
accuracy was subjected to qualitative content analysis. Workers recalled few
safety policies and no training or support for control of safety. Most thought
co-workers and family members would be the best source of proxy exposure
information and favored granting access to medical records. Job-role mobility
confirmed the importance of using a job or task exposure matrix. Information
obtained will be used in development of an exposure assessment interview tool.
PMID: 18724499 [PubMed - indexed for MEDLINE]
22. J Health Serv Res Policy. 2008 Jul;13(3):133-9.
Effects of payment for performance in primary care: qualitative interview study.
Maisey S, Steel N, Marsh R, Gillam S, Fleetcroft R, Howe A.
School of Medicine, Health Policy and Practice, University of East Anglia,
Norwich, UK. s.maisey@uea.ac.uk
OBJECTIVES: To understand the effects of a large scale 'payment for performance'
scheme (the Quality and Outcomes Framework [QOF]) on professional roles and the
delivery of primary care in the English National Health Service. METHODS:
Qualitative semi-structured interview study. Twenty-four clinicians were
interviewed during 2006: one general practitioner and one practice nurse in 12
general practices in eastern England with a broad range of sociodemographic and
organizational characteristics. RESULTS: Participants reported substantial
improvements in teamwork and in the organization, consistency and recording of
care for conditions incentivized in the scheme, but not for non-incentivized
conditions. The need to carry out and record specific clinical activities was
felt to have changed the emphasis from 'patient led' consultations and listening
to patients' concerns. Loss of continuity of care and of patient choice were
described. Nurses experienced increased workload but enjoyed more autonomy and
job satisfaction. Doctors acknowledged improved disease management and teamwork
but expressed unease about 'box-ticking' and increased demands of team
supervision, despite better terms and conditions. Doctors were less motivated to
achieve performance indicators where they disputed the evidence on which they
were based. Participants expressed little engagement with results of patient
surveys or patient involvement initiatives. Some participants described data
manipulation to maximize practice income. Many felt overwhelmed by the flow of
policy initiatives. CONCLUSIONS: Payment for performance is driving major changes
in the roles and organization of English primary health care teams.
Non-incentivized activities and patients' concerns may receive less clinical
attention. Practitioners would benefit from improved dissemination of the
evidence justifying the inclusion of new performance indicators in the QOF.
PMID: 18573761 [PubMed - indexed for MEDLINE]
23. Emerg Infect Dis. 2008 May;14(5):778-86.
Public response to community mitigation measures for pandemic influenza.
Blendon RJ, Koonin LM, Benson JM, Cetron MS, Pollard WE, Mitchell EW, Weldon KJ,
Herrmann MJ.
Department of Health Policy and Management, Harvard School of Public Health, 677
Huntington Ave, Boston, MA 02115, USA. rblendon@hsph.harvard.edu
Comment in:
Emerg Infect Dis. 2008 Sep;14(9):1501-2; author reply 1502.
We report the results of a national survey conducted to help public health
officials understand the public's response to community mitigation interventions
for a severe outbreak of pandemic influenza. Survey results suggest that if
community mitigation measures are instituted, most respondents would comply with
recommendations but would be challenged to do so if their income or job were
severely compromised. The results also indicate that community mitigation
measures could cause problems for persons with lower incomes and for racial and
ethnic minorities. Twenty-four percent of respondents said that they would not
have anyone available to take care of them if they became sick with pandemic
influenza. Given these results, planning and public engagement will be needed to
encourage the public to be prepared.
PMCID: PMC2600239
PMID: 18439361 [PubMed - indexed for MEDLINE]
24. Eur J Dent Educ. 2008 May;12(2):89-98.
Understanding the motivation: a qualitative study of dental students' choice of
professional career.
Gallagher J, Clarke W, Wilson N.
Oral Health Services Research & Dental Public Health, King's College London
Dental Institute, London, UK. jenny.gallagher@kcl.ac.uk
BACKGROUND: Given the changing nature of the dental workforce, and the need to
retain the services of future members, it is important to understand why current
dental students perceive that they were motivated to study dentistry. Qualitative
research provides the opportunity to explore the underlying issues in addition to
informing subsequent quantitative research. The objectives of this research were
to investigate final-year dental students' motivation for studying dentistry and
how they perceive this has been modified during their undergraduate degree
programme. METHODS: Purposive sampling of a representative group of 35 final-year
dental students at King's College London Dental Institute to participate in
audio-taped focus groups. Qualitative data were analysed using Framework
Methodology. RESULTS: The findings suggest a strong emphasis on having a career,
providing 'professional status', 'financial benefits', 'job security, flexibility
and independence' and 'good quality of life'. Students reported being attracted
by features of the job, supported to a greater or lesser extent by personal
experience, family and friends. It appears however that students' initial
motivation is being tempered by their experiences during their undergraduate
degree programme, in particular, the 'responsibilities of an intensive
professional education', their 'mounting student debt' and the perception of
'feeling undervalued'. This perception related to dentistry in general and
National Health Service dentistry in particular, being undervalued, by
government, patients, the public and members of the dental profession.
CONCLUSIONS: Students' vision of a 'contained professional career' within health
care, providing status and financial benefits, appears to have influenced their
choice of dentistry. Pressures relating to student life and policy changes are
perceived as impacting on key components of professional life, particularly
status in the social and economic order. The implications for educators,
professional leaders and policy makers are explored.
PMID: 18412737 [PubMed - indexed for MEDLINE]
25. BMC Public Health. 2008 Mar 25;8:95.
Validity of parental work information on the birth certificate.
Brender JD, Suarez L, Langlois PH.
Department of Epidemiology and Biostatistics, Texas A&M Health Science Center
School of Rural Public Health, 201 SRPH Administration Building, College Station,
Texas, 77843-1266, USA. jdbrender@srph.tamhsc.edu
BACKGROUND: In the most recent revision (2003) of the U.S. standard certificate
of live births, the National Center for Health Statistics recommended that all
states collect maternal and paternal usual occupation. Because such information
might be useful in the surveillance of job-related risk areas, we assessed the
quality of parental work information on the U.S. birth certificate. METHODS:
Occupational histories obtained from maternal interviews with Texas (USA)
participants in the National Birth Defects Prevention Study were linked to and
compared with parental work information on birth certificates. With occupational
information from interviews serving as the gold standard, we assessed the quality
of occupational information on the birth certificate with measures of
sensitivity, specificity, and the kappa statistic. RESULTS: Of the 649 births
available for study, parental occupation agreed between the birth certificate and
interview for 77% of mothers and 63% of fathers with similar agreement by
case-control status. Among occupations and industries with 10 or more workers by
interview, sensitivity of the birth certificate information ranged from 35% to
100% for occupational groups and 55% to 100% for industrial sectors.
Specificities of occupations/industries studied ranged from 93 to 100%. Kappa
statistics for maternal occupations (0.76 to 0.90) and industries (0.59 to 0.94)
were higher than those for paternal occupations (0.48 to 0.92) and industries
(0.47 to 0.89). Mothers were frequently misclassified as homemakers or otherwise
unemployed while the paternal information was often missing altogether on the
birth certificate. Women who worked as health diagnosing and treating
practitioners were the least likely (0%) and women in food preparation or serving
occupations were the most likely (65%) to be misclassified as not employed on the
birth certificate. Among fathers, the proportion of missing occupations was the
lowest for occupations in business or financial operations (0%) and highest for
occupations in food preparation and serving (30%). CONCLUSION: Sensitivity of
occupation/industry information on birth certificates varies although the
specificity of such information may exceed 95%. Quality of this information also
varies by maternal and paternal occupation with misclassification as homemaker a
limiting factor among maternal and missing information a limiting factor among
paternal work information.
PMCID: PMC2324093
PMID: 18366739 [PubMed - indexed for MEDLINE]
26. Contact Dermatitis. 2008 Apr;58(4):210-6.
Clinical characteristics and consequences of hand eczema - an 8-year follow-up
study of a population-based twin cohort.
Lerbaek A, Kyvik KO, Ravn H, Menné T, Agner T.
National Allergy Research Centre, Gentofte Hospital, University of Copenhagen,
Copenhagen, Denmark. anne.lerbaek@dadlnet.dk
BACKGROUND: Few population-based clinical follow-up studies on hand eczema are
reported. Objectives: The aim of this study was to characterize clinical symptoms
and to examine occupational and medical consequences as well as persistence of
hand eczema in a population-based twin cohort. PATIENTS/METHODS: A total of 274
individuals with and without hand eczema were examined, patch tested, and
interviewed in 1997-1998 and 2005-2006. Data on 188 individuals with hand eczema
in 2005-2006 were analysed. RESULTS: Erythema and scaling were the most frequent
symptoms, and fingers and palms were most often affected. Mean hand eczema
severity index score in individuals with clinical symptoms was 12.0. Sick leave
was reported by 12.4%; job change by 8.5%. Being in the lowest socio-economic
group and atopic dermatitis were risk factors for sick leave [odds ratio (OR) =
5.6; 95% confidence interval (95% CI) 1.5-22.9 and OR = 2.9; 95% CI 1.0-8.1]. The
majority (63.4%) had seen a doctor at least once, and atopic dermatitis was a
risk factor for more than 1 visit (OR = 3.0; 95% CI 1.4-6.4). Duration of >10
years was a risk factor for persistence of symptoms, which was reported by 67.7%.
CONCLUSIONS: The clinical picture and consequences of hand eczema vary; however,
the majority experience chronic symptoms.
PMID: 18353028 [PubMed - indexed for MEDLINE]
27. J Adv Nurs. 2008 Mar;61(6):631-40.
Real nursing? The development of telenursing.
Snooks HA, Williams AM, Griffiths LJ, Peconi J, Rance J, Snelgrove S, Sarangi S,
Wainwright P, Cheung WY.
Centre for Health Information, Research and Evaluation, Swansea University, UK.
h.a.snooks@swan.ac.uk
Erratum in:
J Adv Nurs. 2008 Jun;62(6):725. Snelgrove, Sharon [corrected to Snelgrove,
Sherrill].
AIM: This paper is a report of a study to understand the impact of telenursing
from the perspective of nurses involved in its provision, and in more traditional
roles. BACKGROUND: Nurse-led telephone helplines have recently been introduced
across the United Kingdom, a major step in the development of nursing practice.
METHOD: A structured questionnaire was sent to all nurses working in the NHS
Direct (National Health Service Direct) Wales telephone service (n = 111).
Ninety-two completed questionnaires were returned (response rate 83 per cent).
Two focus groups were conducted: one with telephone service nurses (n = 8) and
one with other nurses (n = 5). The data were collected in 2002. FINDINGS:
Respondents represented a highly educated workforce from a range of healthcare
specialties. They reported that they joined the telephone service for improved
salary and flexible working. Two-thirds reported improved job satisfaction. All
focus group participants reported that the development of nursing skills was
affected by the use of decision support software and the remote nature of the
consultation. Participants reported opportunities for skill development, although
the role could be stressful. All agreed that the service was popular with
callers, but the nurses from outside raised concerns about whether telenursing
was 'real' nursing and about the evidence base for the service and access by
disadvantaged groups. CONCLUSION: Differences between the groups reflect policy
tensions between the need to develop new nursing skills, including the use of
technology, to improve efficiency and recognition of the worth of hands-on
nursing. These tensions must be addressed for the telephone service to function
as part of an integrated healthcare system.
PMID: 18302604 [PubMed - indexed for MEDLINE]
28. Sociol Health Illn. 2008 Mar;30(2):289-308.
Professional legitimacy claims in the multidisciplinary workplace: the case of
heart failure care.
Sanders T, Harrison S.
Division of Primary Care, University of Manchester, UK.
tom.sanders@manchester.ac.uk
The pattern of occupations engaged in the care of patients has grown steadily
more complex, and is characterised by the creation of new occupations, additional
specialisation within existing occupations, and extensions to existing
occupational roles. This paper presents empirical data from a study of
professionals working with heart failure patients in the English National Health
Service, focusing on the discourses employed by nurses and by three different
specialties within medicine to legitimise their occupational boundaries. We
identify four themes that characterise such discourses, specialised expertise,
competence, organisational efficiency and patient-centredness, though these are
deployed to different degrees by the different professions. The findings point to
a theory of 'occupational legitimation talk' in which newer occupations utilise a
wider set of legitimacy claims as a means of strengthening their role and
credibility within an increasingly complex and fluid healthcare environment.
PMID: 18290937 [PubMed - indexed for MEDLINE]
29. Am J Clin Dermatol. 2008;9(2):111-7.
Quality of life and treatment satisfaction among patients with psoriasis and
psoriatic arthritis and patients with psoriasis only : results of the 2005 Spring
US National Psoriasis Foundation Survey.
Ciocon DH, Horn EJ, Kimball AB.
Department of Dermatology, Albert Einstein College of Medicine, Bronx, New York,
USA.
INTRODUCTION: Five to forty percent of patients with cutaneous psoriasis develop
an inflammatory, oligoarticular spondyloarthropathy known as psoriatic arthritis.
OBJECTIVE: To compare health-related quality of life (QOL) between cutaneous
psoriatic patients with and without psoriatic arthritis. METHOD: Secondary
cross-sectional analysis of data obtained from the 2005 Spring US National
Psoriasis Foundation Quality of Life Telephone/Internet Survey. 426 patients with
psoriasis and/or psoriatic arthritis were included in the 2005 survey. Among
these respondents, the self-reported disease histories of 140 patients with
cutaneous psoriasis and psoriatic arthritis were compared with those of 278
patients with cutaneous psoriasis only. Both groups were compared with respect to
demographics, skin disease severity, treatment history and satisfaction, and QOL
using previously validated assessment scales. RESULTS: Compared with those with
skin psoriasis only, respondents with cutaneous psoriasis and psoriatic arthritis
were slightly older, more likely to be female and members of the National
Psoriasis Foundation, and more likely to report a younger age of disease onset.
They were also more likely to be unemployed, to report their job was affected by
their condition, and to report a higher mean estimate of lost annual wages. On
both univariate and multivariate analysis, however, no significant differences
between groups were detected in skin disease severity, overall QOL, and
satisfaction with current treatment options. At the same time, individuals with
skin psoriasis and psoriatic arthritis were more likely to be taking systemic
agents. They also reported higher mean scores for pain, while those with
cutaneous psoriasis reported higher mean scores for self-consciousness only.
CONCLUSION: In contrast to previous reports that did not control for skin disease
severity, this study demonstrates that patients with cutaneous psoriasis and
psoriatic arthritis do not report significantly worse health-related QOL compared
with patients with cutaneous psoriasis only. Nor do they report significantly
greater dissatisfaction with current treatment options. These findings may
reflect the intrinsic inadequacy of the QOL instruments used in this study for
capturing the additional burden of joint disease. Alternatively, these findings
may reflect the existence of a threshold of joint disease in patients with skin
psoriasis and psoriatic arthritis below which joint symptoms are perceived as
negligible relative to cutaneous disease.
PMID: 18284265 [PubMed - indexed for MEDLINE]
30. J Gerontol B Psychol Sci Soc Sci. 2007 Nov;62(6):S399-403.
Employment and occupation effects on depressive symptoms in older Americans: does
working past age 65 protect against depression?
Christ SL, Lee DJ, Fleming LE, LeBlanc WG, Arheart KL, Chung-Bridges K, Caban AJ,
McCollister KE.
Department of Sociology and Odum Institute for Research in Social Science,
University of North Carolina at Chapel Hill, 06 Manning Hall, CB #3355, Chapel
Hill, NC 27599-3355, USA. slchrist@email.unc.edu
OBJECTIVES: This article examines the effects of work status, occupational
sector, and occupation type on depressive symptoms in older Americans. We
partially controlled for the healthy worker selection effect by including
disability as a predictor of both work status and depressive symptoms. METHODS:
We analyzed a nationally representative sample of 23,247 respondents aged 65 to
88 from the National Health Interview Survey pooled over 1997 to 2000. We used
structural equation models with latent variables to assess relationships between
work/occupation and depressive symptoms. RESULTS: Older Americans who work had
lower levels of depressive symptoms as compared to older nonworkers. Membership
in several worker groups, generally higher status occupations, protected against
depressive symptoms. After controlling for disability, the difference in level of
depressive symptoms for workers versus nonworkers did not persist. However,
workers in specific occupational sectors and types reported different levels of
depressive symptoms even when we controlled for disability. DISCUSSION: The
mental health benefit of working, among persons aged 65 and older, may be due to
the healthy worker effect. However, the particular job sector in which older
workers are employed matters. Socioeconomic status and financial versus personal
motivations for working are potentially important explanations for differences.
PMID: 18079428 [PubMed - indexed for MEDLINE]
31. J Epidemiol Community Health. 2008 Jan;62(1):42-7.
The relationship between work stress and mental disorders in men and women:
findings from a population-based study.
Wang JL, Lesage A, Schmitz N, Drapeau A.
Department of Psychiatry and of Community Health Sciences, Faculty of Medicine,
University of Calgary, Calgary, Alberta, Canada. jlwang@ucalgary.ca
OBJECTIVES: [corrected] This analysis estimated the gender-specific associations
between work stress, major depression, anxiety disorders and any mental disorder,
adjusting for the effects of demographic, socioeconomic, psychological and
clinical variables. METHODS: Data from the Canadian national mental health survey
were used to examine the gender-specific relationships between work stress
dimensions and mental disorders in the working population (n = 24,277). Mental
disorders were assessed using a modified version of the World Mental Health -
Composite International Diagnostic Interview. RESULTS: In multivariate analysis,
male workers who reported high demand and low control in the workplace were more
likely to have had major depression (OR 1.74, 95% CI 1.12 to 2.69) and any
depressive or anxiety disorders (OR 1.47, 95% CI 1.05 to 2.04) in the past 12
months. In women, high demand and low control was only associated with having any
depressive or anxiety disorder (OR 1.39, 95% CI 1.05 to 1.84). Job insecurity was
positively associated with major depression in men but not in women. Imbalance
between work and family life was the strongest factor associated with having
mental disorders, regardless of gender. CONCLUSIONS: Policies improving the work
environment may have positive effects on workers' mental health status. Imbalance
between work and family life may be a stronger risk factor than work stress for
mental disorders. Longitudinal studies incorporating important workplace health
research models are needed to delineate causal relationships between work
characteristics and mental disorders.
PMID: 18079332 [PubMed - indexed for MEDLINE]
32. Clin Rehabil. 2008 Jan;22(1):60-70. Epub 2007 Nov 29.
Screening for depression after stroke: an exploration of professionals'
compliance with guidelines.
Hart S, Morris R.
Bristol Clinical Psychology Training Programme, Bristol, UK.
OBJECTIVE: National guidelines recommend screening for poststroke depression, but
compliance is low. This research studied staff compliance in stroke units using
the theory of planned behaviour to investigate influences upon screening. DESIGN:
The study used a questionnaire based on a semi-structured interview and measuring
the theory of planned behaviour components. SETTING: Sixteen stroke units
throughout the UK were included. SUBJECTS: Seventy-five health care professionals
in stroke services participated. MAIN MEASURES: A postal questionnaire with
7-point rating scales and open-ended questions was used. RESULTS: Response rates
were low, but the 75 returns demonstrated poor compliance for screening, despite
positive attitudes towards it. Five variables, including three of the theory of
planned behaviour components, predicted intention to screen: perceived control
over screening, perceived expectations of others (direct and indirect normative
beliefs), awareness of guidelines and screening being part of routine assessment.
Perceived expectations of others, perceived control and awareness of guidelines
also differentiated those intending to screen from 'non-intenders'. Being
knowledgeable about screening, having screening in the job role and belief in its
clinical value were additional facilitating factors, while time pressure and
concerns about screening tests were barriers. Profession and psychology input
were not associated with screening. CONCLUSIONS: The theory of planned behaviour
provides a framework for understanding screening intentions. Both individual and
organizational factors were associated with screening. Compliance may be enhanced
by: training to increase knowledge and skills, providing evidence of the utility,
increasing awareness of guidelines, support from colleagues and integrating mood
assessment into job roles and routine assessment.
PMID: 18048484 [PubMed - indexed for MEDLINE]
33. Inquiry. 2007 Fall;44(3):257-79.
Why do Hispanics have so little employer-sponsored health insurance?
Reschovsky JD, Hadley J, Nichols L.
Center for Studying Health System Change, Washington, DC 20024, USA.
jreschovsky@hschange.org
This paper investigates low rates of employer health insurance coverage among
Hispanics using national data from the Community Tracking Study Household Survey.
Interview language served as a proxy for the degree of assimilation. Findings
indicate that English-speaking Hispanics are more similar to whites in their
labor market experiences and coverage than they are to Spanish-speaking
Hispanics. Spanish-speakers' very low human capital (including their inability to
speak English) results in much less access to job-based insurance. Though less
important, Spanish-speaking Hispanics' demand for employer-sponsored insurance
appears lower than that of English-speaking Hispanics or whites. Results suggest
that language and job training may be the most effective way to bolster
Hispanics' insurance coverage.
PMID: 18038864 [PubMed - indexed for MEDLINE]
34. Am J Ind Med. 2008 Jan;51(1):37-46.
Analysis of the Third National Health and Nutrition Examination Survey (NHANES
III) using expert ratings of job categories.
D'Souza JC, Werner RA, Keyserling WM, Gillespie B, Rabourn R, Ulin S, Franzblau
A.
Department of Environmental Health Sciences, The University of Michigan School of
Public Health, Ann Arbor, Michigan, USA.
BACKGROUND: Few epidemiologic studies have addressed the exposure-response
relationships between work activities and symptomatic knee osteoarthritis (OA).
This analysis used data from a national survey and ergonomists' ratings to
address this issue. METHODS: Interview and knee X-ray data were obtained from the
Third National Health and Nutrition Examination Survey. Occupational ratings were
obtained using ergonomists. A weighted logistic regression was used. RESULTS:
Among men, a significant exposure-response relationship was found between
symptomatic knee OA and kneeling. In both genders, there was a significant trend
in heavy lifting and severe symptomatic knee OA. Approximately 20.7% of knee OA
can be attributed to kneeling >14% of the workday among men. CONCLUSIONS: The
significant exposure-response relationships suggest that modest reductions in
certain occupational activities can reduce the burden of knee OA. The study was
limited by unvalidated expert ratings. Research is needed to identify hazardous
characteristics of work activities and to clarify exposure-response
relationships. 2007 Wiley-Liss, Inc
PMID: 18033730 [PubMed - indexed for MEDLINE]
35. J Safety Res. 2007;38(5):597-608. Epub 2007 Oct 12.
Reducing non-contact electric arc injuries: an investigation of behavioral and
organizational issues.
Kowalski-Trakofler K, Barrett E.
kkowalski@cdc.gov
PROBLEM: It is estimated that 5 to 10 arc flash explosions occur in electric
equipment every day in the United States. In the mining industry the largest
single injury category of electrical injuries are caused by non-contact
electrical arcs. METHOD: This investigation progressed in two phases: (a) 836
Mine Safety and Health Administration (MSHA) reports of electric arcing incidents
that occurred over a period of 11 years were reviewed, and (b) personal
interviews were conducted with 32 individuals. A theoretical Safe Job Performance
Model guided the study. RESULTS: Behavioral dimensions were identified and
included the effect of worker experience, judgment and decision-making ability,
behavioral and organizational controls, and safety culture. SUMMARY: The National
Institute for Occupational Safety and Health (NIOSH) conducted an investigation
of behavioral components associated with arc flash incidents and developed
recommendations for interventions based on findings. IMPACT ON INDUSTRY: This
study fills a vacuum in electrical training with a focus on the organizational
and behavioral aspects of arc flash incidents. The research is cross-cutting in
its scope, in that the results apply not only to mining and construction, but
many other industries employing electricians. Although the majority of mine
electrical injuries are the results of burns from electrical arcs, few miners are
aware that such a hazard exists. A safety training program, which includes a
video and an instructor's discussion guide, was developed for electricians based
on this study's findings. "Arc Flash Awareness" was released in 2007 (DHHS NIOSH
Publication No.2007-116D) and is available through 1-800 CDC INFO. Phone: 1-800
232-4636 or email cdcinfo@cdc.gov. It is also available from MSHA at
MSHADistribution@dol.gov or 304-256-3257 (DVD-576). Private industry is producing
Portuguese and Spanish language translations.
PMID: 18023645 [PubMed - indexed for MEDLINE]
36. Am J Infect Control. 2007 Oct;35(8):516-20.
How much would you be willing to pay for preventing a new dangerous infectious
disease: a willingness-to-pay study in medical personnel working in the emergency
department.
Yen ZS, Chang CJ, Chen SY, Lee CC, Hsu CY, Chen SC, Chen WJ.
Department of Emergency Medicine, National Taiwan University Hospital and
National Taiwan University College of Medicine, Taipei, Taiwan.
BACKGROUND: The risk of developing nosocomial infectious diseases among medical
personnel in the emergency department (ED) can result in tremendous psychologic
stress. The objective of this study was to estimate the median amount of money ED
personnel would be willing to pay for preventing nosocomial severe acute
respiratory syndrome (SARS). METHODS: A contingent valuation approach with
close-ended format was used. During the study period from June 15, 2003 through
June 30, 2003, a convenience sample of all medical personnel working in the ED of
National Taiwan University Hospital was carried out. Participants were
interviewed by a standard questionnaire and were asked to choose whether or not
they would pay at a specified price to purchase a hypothetical SARS vaccine. A
logistic regression model was created to evaluate the relationship between
willingness-to-pay and the log of the price offered in the bid questions. The
median and mean amounts of willingness-to-pay were calculated. RESULTS: A total
of 115 subjects were interviewed and most were nurses (68.7%). The median and
mean amount subjects reported being willing to pay for a SARS vaccine was US
$1762 and US $720, respectively. Subject responses were significantly related to
the price of vaccination and their type of job. CONCLUSIONS: Medical personnel in
the ED reported that they would be willing to pay substantial monetary amounts
for preventing nosocomial SARS.
PMID: 17936142 [PubMed - indexed for MEDLINE]
37. Br Dent J. 2007 Oct 13;203(7):413-7.
Supporting return to dentistry: a national evaluation of the Retaining and
Returning Advisory Service.
Firmstone VR, Bullock AD, Bedward J, Frame JW.
Centre for Research in Medical and Dental Education, School of Education,
University of Birmingham, Birmingham B15 2TT. v.r.firmstone@bham.ac.uk
INTRODUCTION: Workforce concerns in National Health Service (NHS) dentistry have
led to Government initiatives to strengthen recruitment and retention. This study
(commissioned by the Department of Health, England) explored the role, uptake and
user reaction to the new Retaining and Returning Advisory Service in dentistry
operating in all 12 postgraduate deaneries in 2002. METHOD: The primary focus of
the evaluation study was the first year of the Retaining and Returning Advisory
Service. All 12 Retaining and Returning Advisers (RRAs) were interviewed twice;
all completed a record form for each one-to-one contact with users of the service
(n = 217); and users' views were elicited through questionnaires (n = 82) and
case study interviews (n = 10). RESULTS: RRAs' key activities in the first 12
months were to raise awareness of their role and provide one-to-one support for
users (n = 217). Some also organised courses for dentists out of practice. Most
one-to-one contacts were with female dentists on career breaks and registered on
the Keeping in Touch Scheme (KITS). Support included: (i) planning continuing
education; (ii) advice on job applications and requirements; and (iii) general
careers guidance. Users' feedback was positive: confidence was increased and they
valued targeted, hands-on courses. Postgraduate Dental Deans have integrated RRAs
into their wider activities. CONCLUSION: The Retaining and Returning Advisory
Service provided support to potentially vulnerable groups of dentists. The joint
launch of the Retaining and Returning Advisory Service, the revised Keeping in
Touch Scheme, and expanded availability of update courses created a comprehensive
package of support.
PMID: 17934432 [PubMed - indexed for MEDLINE]
38. Am J Public Health. 2007 Nov;97(11):2088-93. Epub 2007 Sep 27.
Major depressive episodes and work stress: results from a national population
survey.
Blackmore ER, Stansfeld SA, Weller I, Munce S, Zagorski BM, Stewart DE.
University of Rochester Medical Center, Rochester, New York 14462-8409, USA.
emma_robertsonblackmore@urmc.rochester.edu
OBJECTIVES: We determined the proportion of workers meeting criteria for major
depressive episodes in the past year and examined the association between
psychosocial work-stress variables and these episodes. METHODS: Data were derived
from the Canadian Community Health Survey 1.2, a population-based survey of 24324
employed, community-dwelling individuals conducted in 2002. We assessed
depressive episodes using the Composite International Diagnostic Interview.
RESULTS: Of the original sample, 4.6% (weighted n=745948) met criteria for major
depressive episodes. High job strain was significantly associated with depression
among men (odds ratio [OR]=2.38; 95% confidence interval [CI]=1.29, 4.37), and
lack of social support at work was significantly associated with depression in
both genders (men, OR=2.70; 95% CI=1.55, 4.71; women, OR=2.37; 95% CI=1.71,
3.29). Women with low levels of decision authority were more likely to have
depression (OR=1.59; 95% CI=1.06, 2.39) than were women with high levels of
authority. CONCLUSIONS: A significant proportion of the workforce experienced
major depressive episodes in the year preceding our study. Gender differences
appear to affect work-stress factors that increase risk for depression.
Prevention strategies need to be developed with employers and employee
organizations to address work organization and to increase social support.
PMCID: PMC2040353
PMID: 17901431 [PubMed - indexed for MEDLINE]
39. Int J Law Psychiatry. 2007 Jul-Oct;30(4-5):369-84. Epub 2007 Jul 30.
Combining work and family in the Netherlands: blessing or burden for one's mental
health?
Oomens S, Geurts S, Scheepers P.
TNO Quality of Life Labour, Hoofddorp, The Netherlands. shirley.oomens@tno.nl
In this article we study which characteristics of combining work and family put
people at risk for mental illness. Two alternative perspectives on the impact of
multiple social roles on mental health are tested: the role accumulation
perspective and the role strain perspective. Both perspectives are studied with
data from a cross-sectional national survey held among a large, representative
sample of Dutch people (N=1008). Multivariate analyses provided support for both
perspectives. Having more social roles was related to better mental health. We
also found a positive mental health effect of having a full-time job in
combination with having children. However, having a partner who contributes less
to household duties or having a job with low decision latitude or lower skill
discretion was related to mental illness. So, certain aspects of social roles may
also threaten people's mental health. Overall, our findings do not support the
idea that combining work and family is necessarily a burden and harmful for
people's mental health. Whether multiple social roles are a blessing or burden
for people's mental health seems to depend on the characteristics of the social
roles.
PMID: 17673292 [PubMed - indexed for MEDLINE]
40. Rev Epidemiol Sante Publique. 2007 Aug;55(4):253-63.
[Situations regarding the labour market for people suffering from chronic
diseases]
[Article in French]
Saliba B, Paraponaris A, Ventelou B.
Institut national de la santé et de la recherche médicale, UMR 379, Marseille,
France.
BACKGROUND: This paper is aimed at investigating the extents to which illness
modifies labour supply and employment conditions of people with chronic diseases
(defined as severe diseases giving rise to 100% coverage of health expenditures
by the Sickness Fund). METHODS: It is based on the data of 35073 individuals
interviewed in the 2002-2003 French Decennial Health Survey, reporting their
health, health care consumption and socioeconomic characteristics, and collected
by the French National Institute of Statistics and Economic Studies. Models have
been estimated with logistic strategies. RESULTS: Participation in labour market
appears, all other things being equal, to be less important for people with
chronic diseases. Chronic diseases are more deleterious for blue collar than for
white collars workers. The probability to have a part-time job is raised by 60%
for people with chronic diseases (100% for men, 50% for women). Suffering from
chronic diseases raises the probability to have a desired part-time job rather
than a full-time job by 80% (170% for men, 60% for women) and the probability to
have an undesired part-time job rather than a full-time job by 50% (30% for men,
50% for women). For the elderly (50-65 years), chronic diseases multiply by three
the probability to be out-of-work (and not retired), by two the probability to be
retired and by 1.5 the probability to be unemployed compared to being employed.
CONCLUSION: The consequences of chronic diseases on the workplace are not
negligible, creating new social inequalities that the French social protection
system does not seem to be able to completely cover.
PMID: 17604585 [PubMed - indexed for MEDLINE]
41. J Clin Nurs. 2007 Jul;16(7):1323-32.
Consensus and diversity: an action research study designed to analyse the roles
of a group of mental health consultant nurses.
Jinks AM, Chalder G.
Liverpool John Moores University, Liverpool, UK. a.m.jinks@livjm.ac.uk
AIM: The purpose of this action research study was to enable a group of mental
health consultant nurses in the UK to map the scope and dimensions of their
roles. This initial benchmarking exercise is a precursor to the development of
plans for role improvement and evaluation. BACKGROUND: There is a growing body of
literature that addresses advanced nursing practice roles. There is, however, no
international agreement on what constitutes an advanced practice role. A few
countries have addressed the statutory requirements governing such roles.
Consultant nurses' roles in the UK are relatively new innovations that aim to
enhance care. However, only a few investigations have evaluated the dimensions
and impact of these roles. METHODS: The study was framed by use of action
research as a form of self-reflective enquiry. Initial data were generated
through use of four focus group discussions, which were held with a group of
consultant nurses employed predominately at a mental health National Health
Service Trust. Five structured confirmatory questionnaires developed from the
focus group data were also administered. FINDINGS: Analysis of the focus group
data gave five themes, 71 categories and 271 items that were used to inform
development of the questionnaires. Responses to the questionnaire showed that 61%
(n = 166) of the items had non-consensus responses. It was found there was most
consensus relating to leadership theme with 63% (n = 19) items having consensus
responses. Least agreement was found in the education theme where there was <15%
(n = 5) agreement to individual items. CONCLUSIONS: The study demonstrated
complexity and variety in how the consultant nurses' roles in the UK are being
developed. RELEVANCE TO CLINICAL PRACTICE: The potential for consultant nurse
roles to enhance patient care is tremendous. This study provides initial
indicators, which the practitioners involved, can use to plot future developments
and changes to their roles.
PMID: 17584351 [PubMed - indexed for MEDLINE]
42. New Solut. 2007;17(1-2):111-21.
Questions related to a research intervention carried out with female and male
public school workers.
Brito J, Neves MY, Athayde M.
National School of Public Health, Rua Leopolda Bulhġes 1480 Manguinhos, 21041-210
Rio de Janeiro RJ, Brazil. jussarabr@uol.com.br
This article presents a health intervention-research project done with workers in
Brazilian public schools. Health, as we understand it, is linked both to the way
in which we live and to our capacity to change that way of life. We emphasize the
critical importance of initiating dialogue between research professionals and
workers (co-investigators) in order to understand and transform work situations.
We highlight the effects of debates about gender relations that led to work
transformations. Such debates made it easier for workers and researchers to
understand that men and women experience job requirements differently. We found
that some staff favored reproduction of a sexually differentiated school system.
These debates also allowed male and female workers to make their family members
aware of difficulties in their work, unknown to society in general. We considered
how to expand this research process, including examples of how the work was
transformed.
PMID: 17434863 [PubMed - indexed for MEDLINE]
43. New Solut. 2007;17(1-2):83-95.
Restructuring of the Québec health network and its effects on the profession of
home health aides and their occupational health and safety.
Cloutier E, Ledoux E, Bourdouxhe M, David H, Gagnon I, Ouellet F.
Institut de recherche, Robert Sauvé en santé et en sécurité du travail, 505
boulevard de Maisonneuve ouest Montréal (Québec) Canada H3A 3C2.
ESTCLD@irsst.qc.ca
The Québec health sector is facing profound macroeconomic and
macro-organizational changes. This article addresses the impact of these changes
on the work of home health aides (HHAs) and their occupational health and safety
(OHS). The study was carried out in the home care services of four local
community service centers (CLSCs) with different organizational characteristics.
It is based on an analysis by triangulation of 66 individual and group
interviews, 11 work days, and 35 multidisciplinary or professional meetings
observed, as well as administrative documents. HHAs are experiencing an erosion
of their job because the relational and emotional components of their work are
disappearing. This results in an increase in musculoskeletal and psychological
health problems. This study also shows that managers' decisions can reduce or
increase the HHAs' work constraints. Stability in the clientele served and the
possibility of organizing their routes are good examples of positive impacts.
PMID: 17434861 [PubMed - indexed for MEDLINE]
44. Vital Health Stat 1. 2007 Mar;(44):1-54.
An introduction to the National Nursing Assistant Survey.
Squillace MR, Remsburg RE, Bercovitz A, Rosenoff E, Branden L.
U.S. Department of Health and Human Services, Office of the Assistant Secretary
for Planning and Evaluation, USA.
OBJECTIVES: This report provides an introduction and overview of the National
Nursing Assistant Survey (NNAS),the first national probability survey of nursing
assistants working in nursing homes. The NNAS was designed to provide national
estimates and to allow for separate estimates to be calculated for nursing
assistants by geographic location of the agency and for workers by tenure at the
sampled facility. This report includes a description of relevant research that
led to federal interest in sponsoring the NNAS, types of data collected,
methodology, linkage between the NNAS and the 2004 National Nursing Home Survey
(NNHS), advantages of combining establishment and worker surveys, and potential
uses of the data. METHODS: The NNAS was conducted as a supplement to the 2004
National Nursing Home Survey. The design was a stratified, multistage probability
survey. Nursing facilities were sampled and then nursing assistants were sampled
within the facilities. Telephone interviews were conducted with nursing
assistants using Computer-Assisted Telephone Interviews (CATI). The survey
instrument consisted of sections on recruitment, training and licensure, job
history, family life, management and supervision, client relations,
organizational commitment and job satisfaction, workplace environment,
work-related injuries, and demographics. RESULTS AND CONCLUSIONS: A total of
3,017 interviews were completed from September 2004 to February 2005. The overall
response rate was 53.4 percent. A public-use data file has been released that
contains the interview responses and sampling weights. The file also includes
ownership, bed size, and geographic location of the facility where the nursing
assistant was sampled. Estimates based on the sampling weights can be used to
produce national estimates.
PMID: 17402361 [PubMed - indexed for MEDLINE]
45. Fam Pract. 2007 Apr;24(2):138-44. Epub 2007 Jan 29.
Primary care practice a la carte among GPs: using organizational diversity to
increase job satisfaction.
Geneau R, Lehoux P, Pineault R, Lamarche PA.
Department of Family Medicine, University of Ottawa, 43 Bruyere Street, Ottawa,
Ontario K1N 5C7, Canada. rgeneauj@scohs.on.ca
BACKGROUND: Primary care revival in Canada and elsewhere is viewed by many as
conditional to the introduction of new organizational models. Endorsement by GPs
is a key factor in the success of these models, and increasing GPs' job
satisfaction is often one of the desired outcomes of the reforms currently
underway. OBJECTIVES: The phenomenon of work satisfaction from the GP's
perspective is not yet fully understood. The objectives of this study were to
elicit its different facets and to understand better how organizational factors
affect it. METHODS: This is a case study carried out in the province of Quebec
(Canada). We conducted semi-structured interviews with 28 GPs working in private
clinics and community health centres (Centre local de services communautaires).
RESULTS: The main themes uncovered are related to the relationship between time
management and quality of care, variation in work, autonomy in day-to-day
practice, team 'orientedness' and social rewards. We also found that some GPs
prefer to combine work in different organizations and models in order to increase
their job satisfaction and to better cope with an increasingly complex task
environment. CONCLUSION: Our study provides a comprehensive view of the various
dimensions that GPs consider important in their professional life. Our findings
suggest that, for many GPs, the perfect practice is tailor made and implies a
combination of organizational models in order to fulfil their multiple
professional goals. This has important implications for decision makers who are
promoting new primary care models.
PMID: 17264070 [PubMed - indexed for MEDLINE]
46. Rehabil Nurs. 2007 Jan-Feb;32(1):9-14.
Relationship of RN role responsibilities to job satisfaction.
Nathenson P, Schafer L, Anderson J.
Madonna Rehabilitation Hospital, Lincoln, NE, USA. pnathenson@madonna.org
This study tested a delivery of care model that maximizes the role of the
registered nurse in rehabilitation by providing care based on the scope of
practice exclusive to the registered nurse and supplementing that practice with
licensed and non-licensed support personnel. The model of care was developed as a
response to the nursing shortage. The model attempts to best utilize the limited
resource of registered nurse staffing. The nursing shortage is a national and
global public health problem that is expected to intensify as the nursing
population ages. The hypothesis was that when the rehabilitation registered nurse
is allowed to function in areas for which they are exclusively trained, job
satisfaction will significantly improve as long as there is sufficient support
staff to provide for non-essential functions. The conceptual model for the study
is based on Donabedian's model which demonstrates the relationship between
satisfaction and patient outcomes. Results indicated that after an initial stage
of discomfort resulting from a change in role expectations nurse satisfaction
improved when registered nurses functioned within their exclusive scope of
practice.
PMID: 17225369 [PubMed - indexed for MEDLINE]
47. Ann Intern Med. 2007 Jan 2;146(1):45-51.
Impact of race on the professional lives of physicians of African descent.
Nunez-Smith M, Curry LA, Bigby J, Berg D, Krumholz HM, Bradley EH.
Yale University School of Medicine and Yale University School of Epidemiology and
Public Health, New Haven, Connecticut 06520, USA. marcella.nunez-smith@yale.edu
Comment in:
Ann Intern Med. 2007 Jan 2;146(1):68-9.
Ann Intern Med. 2007 Aug 21;147(4):282-3.
BACKGROUND: Increasing the racial and ethnic diversity of the physician workforce
is a national priority. However, insight into the professional experiences of
minority physicians is limited. This knowledge is fundamental to developing
effective strategies to recruit, retain, and support a diverse physician
workforce. OBJECTIVE: To characterize how physicians of African descent
experience race in the workplace. DESIGN: Qualitative study based on in-person
and in-depth racially concordant interviews using a standard discussion guide.
SETTING: The 6 New England states in the United States. PARTICIPANTS: 25
practicing physicians of African descent representing a diverse range of primary
practice settings, specialties, and ages. MEASUREMENTS: Professional experiences
of physicians of African descent. RESULTS: 1) Awareness of race permeates the
experience of physicians of African descent in the health care workplace; 2)
race-related experiences shape interpersonal interactions and define the
institutional climate; 3) responses to perceived racism at work vary along a
spectrum from minimization to confrontation; 4) the health care workplace is
often silent on issues of race; and 5) collective race-related experiences can
result in "racial fatigue," with personal and professional consequences for
physicians. LIMITATIONS: The study was restricted to New England and may not
reflect the experiences of physicians in other geographic regions. The findings
are meant to be hypothesis-generating and require additional follow-up studies.
CONCLUSIONS: The issue of race remains a pervasive influence in the work lives of
physicians of African descent. Without sufficient attention to the specific ways
in which race shapes physicians' work experiences, health care organizations are
unlikely to create environments that successfully foster and sustain a diverse
physician workforce.
PMID: 17200221 [PubMed - indexed for MEDLINE]
48. Soc Sci Med. 2007 Mar;64(6):1178-91. Epub 2006 Dec 12.
Workplace harassment patterning, gender, and utilization of professional
services: findings from a US national study.
Shannon CA, Rospenda KM, Richman JA.
University of Illinois at Chicago, Chicago, IL, USA. cshannon@psych.uic.edu
This study constitutes the first national longitudinal survey to address the
relationship between workplace harassment and service utilization. We examine how
patterns of sexual harassment and generalized workplace harassment are linked to
utilization of mental health, health, legal, spiritual, and work-related
services, and whether and how gender influences these relationships. Data derive
from a random digit dial telephone survey with a continental US sample of
employed adults. Eligibility criteria were being 18 years of age or over, and
being employed at least 20 h per week at some time in the 12 months prior to the
wave 1 survey. Out of 4116 households with eligible individuals, 2151 agreed to
participate at wave 1. At wave 2, 1418 participated, thus, the overall response
rate was 34.5%. We show that the patterning of workplace harassment over two time
points (chronic, remission, onset, never harassed) is associated with the use of
different types of services. Gender partially moderated the relationship between
workplace harassment and services.
PMCID: PMC1865113
PMID: 17166642 [PubMed - indexed for MEDLINE]
49. Sociol Health Illn. 2006 Nov;28(7):927-50.
Shifting discourses of professionalism: a case study of general practitioners in
the United Kingdom.
Jones L, Green J.
National Collaborating Centre for Women and Children's Health, Royal College of
Obstetrics and Gynaecology, London.
This paper addresses shifting constructions of professional identity in the
context of debates about reflexive modernisation and the changing role of
professionals in the provision of primary healthcare. Data are drawn from
interviews with 20 early-career general practitioners (GPs), who accounted for
their orientations towards work in rather different ways from those typically
reported in much primary care research. In particular, they reported high job
satisfaction and success in achieving what they called 'nice work'. We argue that
these GPs typify a shift in discourses of professionalism, characterised by
respondents as the 'new general practice', which explicitly rejects many values
attributed to 'traditional' general practice. Within the 'new general practice',
professionalism has been de-coupled from some of the paradigmatic traits of
traditional rhetorical accounts (such as vocation), and has significantly
reframed others. Despite policy concerns that a retreat from 'vocational'
professionalism will lead to reductions in service quality, we argue that this is
not inevitable. The 'new general practice' resonates with the social values of
reflexive modernisation, and has the potential to enable new, less paternalistic,
forms of relationships with clients, although it remains to be seen whether this
potential is realised in healthcare delivery.
PMID: 17163860 [PubMed - indexed for MEDLINE]
50. Int J Tuberc Lung Dis. 2006 Nov;10(11):1279-85.
Human immunodeficiency virus, smoking and self-rated health in Harare, Zimbabwe.
Munyati SS, Redzo N, Dauya E, Matambo R, Makamure B, Bandason T, Butterworth AE,
Gwanzura L, Rusakaniko S, Mason PR, Corbett EL.
National Institute of Health Research (former Blair Research Institute), Harare,
Zimbabwe. smunyati@mrczimshared.co.zw
SETTING: Twenty-two urban factories in Harare. OBJECTIVE: To determine the
relationship between the human immunodeficiency virus (HIV), smoking and
self-rated health in a high HIV prevalence urban workforce. DESIGN:
Cross-sectional survey. RESULTS: Of 7482 employees, 6111 (82%) consented to
interview and anonymous HIV serology; 88% were male; median age was 34 years. HIV
prevalence was 19%. Current (median 6 cigarettes per day) and former smoking were
reported by 17% and 7%, respectively. Smoking (current or former) was more common
among HIV-positive (27%) than -negative participants (17%; P < 0.001). Factors
significantly associated with being a smoker on multivariate analysis were being
HIV-infected (OR 1.5, 95% CI 1.4-1.7), older age (P < 0.001), non-Christian (OR
1.6, 95% CI 1.2-2.2) and manual job (OR 1.4, 95% CI 1.2-1.6). Women (OR 0.05, 95%
CI 0.03-0.11) and the better educated (OR 0.7, 95% CI 0.5-0.9) were significantly
less likely to smoke. HIV-positive smokers had the highest risk of reporting poor
health (adjusted OR compared to HIV-negative non-smokers 3.4, 95% CI 2.3-5.0).
CONCLUSIONS: Smoking was significantly more common among HIV-positive than
-negative employees in this predominantly male workforce. There was evidence of a
combined effect on self-rated poor health, a variable shown to be a strong
independent predictor of mortality in industrialised countries. Interventions to
encourage smoking cessation may be an important component of HIV care in Southern
Africa.
PMID: 17131789 [PubMed - indexed for MEDLINE]
51. Health Rep. 2006 Oct;17(4):11-29.
Stress and depression in the employed population.
Shields M.
Health Statistics Division, Statistics Canada, Ottawa, Ontario, K1A 0T6.
Margot.Shields@statcan.ca
OBJECTIVES: This article describes stress levels among the employed population
aged 18 to 75 and examines associations between stress and depression. DATA
SOURCES: Data are from the 2002 Canadian Community Health Survey: Mental Health
and Well-being and the longitudinal component of the 1994/95 through 2002/03
National Population Health Survey. ANALYTICAL TECHNIQUES: Stress levels were
calculated by sex, age and employment characteristics. Multivariate analyses were
used to examine associations between stress and depression in 2002, and between
stress and incident depression over a two-year period, while controlling for age,
employment characteristics, and factors originating outside the workplace. MAIN
RESULTS: In 2002, women reported higher levels of job strain and general
day-to-day stress. When the various sources of stress were considered
simultaneously, along with other possible confounders, for both sexes, high
levels of general day-to-day stress and low levels of co-worker support were
associated with higher odds of depression, as was high job strain for men. Over a
two-year period, men with high strain jobs and women with high personal stress
and low co-worker support had elevated odds of incident depression.
PMID: 17111591 [PubMed - indexed for MEDLINE]
52. Health Informatics J. 2006 Dec;12(4):293-303.
Neglected user perspectives in the design of an online hospital bed-state system:
implications for the National Programme for IT in the NHS.
Harrop N, Wood-Harper T, Gillies A.
Victoria Hospital, Blackpool FY38NR, UK.
Technical aspects of the National Programme for IT in the National Health Service
have run ahead of genuine engagement with front-line users. We have explored with
front-line NHS staff the factors which limit their contribution to management
information from operational systems. Staff place psychological distance between
'the real job' and the reporting of information. Even where accurate reporting is
heavily incentivized, and operational control is shared between staff and shift
leader, the reporting of information to the computer represents a division
between caregiving and computer input, and between information openly declared
and that waiting to be disclosed. The Programme needs to reconsider how
clinicians are to be engaged. Equally, information systems designers, if they
expect to obtain management information and want to understand the limitations of
that process, need to be socialized into the fields where systems are to be
deployed.
PMID: 17093000 [PubMed - indexed for MEDLINE]
53. J Occup Health. 2006 Sep;48(5):332-8.
The association of job strain with coronary heart disease and metabolic syndrome
in municipal workers in Turkey.
Demiral Y, Soysal A, Can Bilgin A, Kiliç B, Unal B, Uçku R, Theorell T.
Department of Public Health, Dokuz Eylül University School of Medicine,
Inciralti, Izmir, Turkey. yucel.demiral@deu.edu.tr
Erratum in:
J Occup Health. 2006 Nov;48(6):2p following xii.
To explore the association of job strain with CHD and metabolic syndrome in
municipal workers. A cross-sectional study was completed of 450 male workers.
Coronary heart disease was defined as: physician diagnosed ischemic heart
disease; and/or, ischemic findings in the ECG. Metabolic syndrome was defined
according to the criterion set by the National Cholesterol Education Panel. The
demand-control model was used to assess job strain. Self administered
questionnaires were completed after a face to face interview. Logistic regression
models were constructed to assess the association of job strain with CHD and
metabolic syndrome. The prevalence of metabolic syndrome and CHD were 17.8% and
8.0% respectively. Both CHD and metabolic syndrome were found to be significantly
higher in higher income groups. Job demand and job control were not found to be
associated with either CHD or metabolic syndrome. Metabolic syndrome was
significantly more prevalent among the high job strain workers, but the
significance was lost when controlled for age. The findings suggest that there is
no significant association between job strain and metabolic syndrome and CHD in
this sample of Turkish workers. Job strain may possibly be perceived differently
in different cultures and occupations. Future studies may benefit from using a
combination of different stress models and more diverse study populations.
PMID: 17053299 [PubMed - indexed for MEDLINE]
54. J Healthc Manag. 2006 Sep-Oct;51(5):295-306; discussion 306-7.
Task overlap among primary care team members: an opportunity for system redesign?
Best RG, Hysong SJ, Pugh JA, Ghosh S, Moore FI.
Veterans Evidence-Based Research Dissemination and Implementation Center, San
Antonio, Texas, USA. rbest@satx.rr.com
This article presents the results of research on a systematic approach to the
assignment of primary care work in the Veterans Health Administration. Based on a
functional job analysis protocol, the study identified overlap in the performance
of primary care tasks among multiple occupational groups as prima facie evidence
of opportunities to reallocate work responsibilities. Results show that
registered nurses, physicians, advanced practitioners, and licensed vocational
nurses reported performing 60 percent to 97 percent of the same tasks, while
clerks and health technicians appeared to be underutilized. The frequency and
duration with which occupational groups performed each task were also examined,
providing additional evidence to be used in improving clinic efficiency. The
management of healthcare personnel can be improved through systematic analysis of
the work, the worker, and the work organization and through more informed
decisions about the appropriateness of task assignment (or reassignment). This
article presents an evidence-based approach to personnel management with
important implications for clinic efficiency. The approach can be used to guide
strategic planning and staffing decisions by identifying not only who currently
does the work but, more importantly, who should be doing the work given the full
array of data.
PMID: 17039689 [PubMed - indexed for MEDLINE]
55. Inj Prev. 2006 Aug;12(4):236-41.
Blurring the distinctions between on and off the job injuries: similarities and
differences in circumstances.
Smith GS, Sorock GS, Wellman HM, Courtney TK, Pransky GS.
Liberty Mutual Research Institute for Safety, Hopkinton, MA 01748, USA.
Gordon.Smith@LibertyMutual.com
OBJECTIVES: To compare the causes of non-fatal work and non-work injuries and the
places or environments where they occur. It has been suggested that many injuries
may have similar etiologies on and off the job and thus involve some common
prevention strategies. However lack of comparable data on work relatedness has
prevented testing this proposition. METHODS: The National Health Interview Survey
(NHIS) now collects information on the cause, location, and work relatedness of
all medically attended injuries. National US estimates of non-fatal work and
non-work injuries were compared by cause and place/location for working age
adults (18-64 years). RESULTS: Overall 28.6% of injuries to working age adults
were work related (37.5% among employed people). The causes and locations of many
work and non-work injuries were similar. Falls, overexertion, and struck/caught
by were leading causes for work and non-work injuries. Motor vehicle injuries
were less likely to be work related (3.4% at work v 19.5% non-work) and
overexertion injuries more likely to be work related (27.1% v 13.8%). Assaults
were less than 1% of work injuries and 1.8% of non-work injuries. Both work and
non-work injuries occurred in every location examined-including the home where
3.5% of injuries were work related. CONCLUSIONS: Work and non-work injuries share
many similarities suggesting opportunities to broaden injury prevention programs
commonly restricted to one setting or the other. Comprehensive efforts to prevent
both non-work and work injuries may result in considerable cost savings not only
to society but also directly to employers, who incur much of the associated
costs.
PMCID: PMC2586787
PMID: 16887945 [PubMed - indexed for MEDLINE]
56. Mymensingh Med J. 2006 Jul;15(2):159-62.
Prevalence of soil transmitted helminthes infections among Bangladeshi males
seeking job abroad.
Khatun M, Naher A.
Department of Microbiology & Mycology, NIPSOM, Mohakhali, Dhaka-1212.
This cross-sectional study was undertaken to identify the prevalence of soil
transmitted helminthes infections and its relation to socio-demographic
characteristics among Bangladeshi males seeking job abroad. The stool sample of
each respondent coming for medical check up was collected by code number and
examined under microscope to see the presence helminthic ova or larvae. Among
8140 respondents, 68.05% were from rural and 31.95% from urban area. As a whole,
helminthic infection was found in 20.22% respondents. Off which rural and urban
distribution were 27.58% and 5.22% respectively (p<0.001). Pattern of helminthes
as per rural and urban basis were as follows: Ascaris lumbricoides in 12.45% &
2.61%, Trichuris trichurias in 2.61% & 2.50% samples respectively. As per age
distribution was concerned, number of positive cases among rural population in
all age groups was statistically higher (p<0.001) than that of urban population.
Similarly, rate of combined infections among the rural population was also
statistically higher (p<0.001). Higher positivity of helminthes was obtained in
low-level educated respondents and in the farmers group. Since the study
reflected a high proportion of helminthes infections in rural people, so it was
recommended to launch regular deworming programme in rural community at national
level. Health education activities on proper sanitary practice, safe disposal of
excreta and taking safe food-drinks should be meaningful to eradicating
helminthes infections. Further study is needed for monitoring the active status
in the community.
PMID: 16878097 [PubMed - indexed for MEDLINE]
57. BMC Public Health. 2006 Jul 21;6:192.
Political dynamics promoting the incremental regulation of secondhand smoke: a
case study of New South Wales, Australia.
Bryan-Jones K, Chapman S.
School of Public Health, University of Sydney, New South Wales 2006, Australia.
kbj@stanfordalumni.org
BACKGROUND: The history of governmental responses to the accumulation of
scientific evidence about the harms of secondhand smoke (SHS) presents an
intriguing case study of incremental public health policy development. Australia
has long been considered a world-leader in progressive tobacco control policies,
but in the last decade has fallen behind other jurisdictions in introducing SHS
legislation that protects all workers. Bars, clubs and pubs remain the only
public indoor spaces where smoking is legally permitted, despite SHS exposure in
the hospitality industry being higher and affecting more people than in any other
setting after domestic exposure. This paper examines the political dynamics that
have shaped this incremental approach to SHS. METHODS: In-depth interviews with
21 key stakeholders in the state of New South Wales (NSW), including politicians,
their advisors, health officials and tobacco control advocates, were conducted
and subjected to thematic content analysis. Interviewees' comments provided
insights into the dynamics surrounding the debates and outcomes of SHS
legislative attempts and the current political environment, and about how to
progress SHS legislation. RESULTS: SHS restrictions have been delayed by several
broad factors: the influence of industry groups successfully opposing regulation;
issue wear-out; and political perceptions that there is not a salient
constituency demanding that smoking be banned in bars and clubs. Interviewees
also provided suggestions of strategies that advocates might utilise to best
overcome the current political inertia of incremental compromises and achieve
timely comprehensive smoking bans. CONCLUSION: Advocates concerned to shorten the
duration of incremental endgames must continue to insist that governments address
SHS fundamentally as a health issue rather than making political concessions to
industry groups, and should broaden and amplify community voices calling on
governments to finish the job. Publicity to the growing number of state and
national governments that have successfully implemented total bans over the past
decade is likely to make incrementalism an increasingly unattractive political
option.
PMCID: PMC1560380
PMID: 16859560 [PubMed - indexed for MEDLINE]
58. Can J Public Health. 2006 May-Jun;97(3):225-9.
Changes in job stressors in the Canadian working population.
Shannon HS, Ibrahim SA, Robson LS, Zarinpoush F.
Institute for Work & Health, Toronto, ON.
OBJECTIVES: To determine the changes in levels of work stressors in a nationally
representative sample of Canadian workers from 1994/95 to 2000/01. METHODS: We
compared responses for an abbreviated version of the Job Content Questionnaire in
two waves of the National Population Health Survey (NPHS). Other items and scales
related to work and health were also analyzed. Data were transformed to range
from 0 to 10. Comparisons of the 2000/01 data were also made with the Canadian
Community Health Survey (CCHS) conducted in 2000. RESULTS: There were only very
small absolute differences between NPHS 2000/01 data and CCHS 2000 data. The NPHS
comparison from 1994/95 to 2000/01 showed an increase in job security (change in
means = 0.49, 95% CI 0.39 to 0.58) and a decrease in job physical demands (change
in means = 0.45, 95% CI 0.35 to 0.54). Other changes in work characteristics were
small in absolute value. The combined "overall work stressors" index dropped by
0.12 (95% CI 0.08 to 0.15). CONCLUSIONS: Levels of work stressors did not
increase over the period. Some subscales showed an improvement.
PMID: 16827413 [PubMed - indexed for MEDLINE]
59. J Occup Health. 2006 May;48(3):210-5.
Plasma catecholamine levels and neurobehavioral problems in Indian firefighters.
Ray MR, Basu C, Roychoudhury S, Banik S, Lahiri T.
Experimental Hematology Unit, Chittaranjan National Cancer Institute, Kolkata,
India. manasrray@rediffmail.com
Firefighting is a stressful and hazardous job. Persons engaged in firefighting
are highly exposed to work-related stress as well as to smoke containing a host
of chemicals potentially harmful to human health. In order to elucidate whether
firefighting affects neuroendocrine and behavioral responses of firefighters,
plasma catecholamine (CA) levels and the prevalence of neurobehavioral symptoms
in 62 firefighters (all males, mean age 43 yr) and 52 control subjects matched
for age and sex were examined in this study. Self-reported neurobehavioral
symptoms data were obtained from a questionnaire survey and personal interview.
Concentrations of epinephrine (E), norepinephrine (NE) and dopamine (DA) in
plasma were measured by high-performance liquid chromatography with
electrochemical detection. Compared with matched controls, the firefighters
showed higher prevalence (p<0.05) of neurobehavioral symptoms such as burning
sensation in the extremities, tingling and numbness, transient loss of memory,
and depression, but no significant difference was recorded in the prevalences of
anxiety, vertigo and dizziness. The firefighters demonstrated a more than
two-fold (p<0.05) rise in plasma levels of E and NE, but the plasma DA level was
relatively unchanged. Controlling age and smoking as possible confounders,
firefighting was found to be associated with raised E (OR=2.15; 95% CI,
0.98-4.52), and NE levels (OR=2.24 95% CI, 1.22-3.61). In conclusion, the job of
firefighting appears to be associated with stimulation of sympathetic activity
and a rise in the prevalence of neurobehavioral symptoms.
PMID: 16788283 [PubMed - indexed for MEDLINE]
60. Am J Ind Med. 2006 Aug;49(8):658-69.
Impact of psychosocial job stress on non-fatal occupational injuries in small and
medium-sized manufacturing enterprises.
Nakata A, Ikeda T, Takahashi M, Haratani T, Hojou M, Fujioka Y, Swanson NG, Araki
S.
National Institute of Industrial Health, Kawasaki, Japan. nakataa-tky@umin.ac.jp
BACKGROUND: Workers involved in manufacturing are known to comprise a high-risk
population for occupational injury, and this risk is greater in small and
medium-sized enterprises (SMEs). The purpose of this study was to examine the
association between psychosocial job stress and occupational injuries among
workers in SMEs. METHODS: One thousand forty-nine men and 721 women from 244 SMEs
participated in this study. Perceived job stress was evaluated with the Japanese
version of the generic job stress questionnaire, which covered 14 job stress
variables. Occupational injury was assessed by self-report during the last 1-year
period. RESULTS: Workers with high quantitative workload (odds ratio [OR] = 1.55
for men, 1.62 for women), high cognitive demands (OR = 1.70 for men, 1.53 for
women), and low job satisfaction (OR = 1.33 for men, 1.93 for women) had a
significantly increased risk of occupational injury in the multivariate model.
High variance in workload (OR = 1.70) and high job future ambiguity (OR = 1.35)
in men, and low job control (OR = 2.04) and high intragroup conflict (OR = 1.66)
in women were significantly associated with occupational injury. In
manufacturing/production workers, high quantitative workload (OR = 1.91), high
variance in workload (OR = 2.02), and high depressive symptoms (OR = 1.55) were
significantly associated with injury in men, while low social support from
colleagues (OR = 2.36) or family (OR = 2.51) was related to injury in women.
CONCLUSIONS: These data point to an independent relationship between psychosocial
job stress and self-reported occupational injury in SMEs. Copyright 2006
Wiley-Liss, Inc
PMID: 16758484 [PubMed - indexed for MEDLINE]
61. J Nurs Manag. 2006 Apr;14(3):213-21.
Commitment to nursing: results of a qualitative interview study.
Gould D, Fontenla M.
Applied Health, School of Nursing, London, UK. dinahgould@aol.com
AIM: The aims of the study were to explore opportunities to undergo continuing
professional education, family friendly policy and holding an innovative or
traditional post on nurses' job satisfaction and professional and organizational
commitment. BACKGROUND: Qualified nurses have become a scare resource in the
National Health Service. Managers need to be aware of the work-related factors
most likely to secure nurses' professional and organizational commitment which
will contribute to the retention. Commitment is thought to be increased if
opportunities for continuing professional education are good. Family friendly
policy is also important. Less is known about the relationship between type of
nursing work and commitment. METHODS: An in-depth, exploratory approach to data
collection were taken, employing an interview guide with open-ended questions.
Data were collected with 27 nurses in clinical grades in two contrasting trusts.
RESULTS: Family friendly policies emerged as most important in securing nursing
commitment. Those in innovative posts whose work entailed social hours and
greater professional autonomy also displayed greater levels of job satisfaction.
Opportunities for continuing professional education had less influence on
professional and organizational commitment. CONCLUSION: Providing flexible or
social working hours appears to be more influential than providing opportunities
for continuing professional education in securing nursing commitment in this
exploratory study.
PMID: 16600010 [PubMed - indexed for MEDLINE]
62. J Interprof Care. 2006 Jan;20(1):60-74.
Interprofessional collaboration with service users in the development of cancer
services: the Cancer Partnership Project.
Sitzia J, Cotterell P, Richardson A.
Worthing and Southlands Hospitals NHS Trust, Worthing, UK.
Patient and Public Involvement (PPI) is a cornerstone of UK National Health
Service (NHS) policy. The Cancer Partnership Project (CPP) is the leading
national PPI initiative in cancer care. The CPP espouses a "partnership" model,
with a "Partnership Group" - collaborative service improvement groups formed of
NHS staff and service users - in each of 34 cancer networks in England. These
groups aim to enable service users to influence local cancer service development
and thereby improve the effectiveness of services. We interviewed 59 cancer
service users and NHS staff in a reflective evaluation of CPP. Groups were active
and visible in 30 networks, their main activities being: providing an accessible
source of consumer opinion; prolific networking and representation; patient
information and communication projects; and lobbying for service improvements.
The groups exhibited some significant tensions. The motivations of professional
staff varied markedly, and "obligatory" involvement as part of a person's job was
counter-productive when not coupled with a "personal" belief in the value of PPI.
Other controversial areas were the disclosure by patients' of personal health and
treatment experiences, and emotional attachment to the group. It was concluded
that partnership groups represent a useful PPI model, but more attention
generally should be paid to the complexities of PPI and timescales required for
meaningful cultural change.
PMID: 16581640 [PubMed - indexed for MEDLINE]
63. Soc Sci Med. 2006 Aug;63(3):566-74. Epub 2006 Mar 31.
The relationship between nonstandard working and mental health in a
representative sample of the South Korean population.
Kim IH, Muntaner C, Khang YH, Paek D, Cho SI.
School of Public Health and Institute of Health and Environment, Seoul National
University, Republic of Korea. kihsdh2003@yahoo.com
In light of escalating job insecurity due to increasing numbers of nonstandard
workers, this study examined the association between nonstandard employment and
mental health among South Korean workers. We analyzed a representative weighted
sample of 2086 men and 1194 women aged 20-64 years, using data from the 1998
Korean National Health and Nutrition Examination Survey. Nonstandard employment
included part-time work, temporary work, and daily work. Mental health was
measured with indicators of self-reported depression and suicidal ideation. Based
on age-adjusted prevalence of mental health, nonstandard employees were more
likely to be mentally ill compared to standard employees. Furthermore,
nonstandard work status was associated with poor mental health after adjusting
for socioeconomic position (education, occupational class, and income) and health
behaviors (smoking, alcohol consumption, and exercise). However, the pattern of
the relationship between nonstandard work and mental health differed by gender.
Female gender was significantly associated with poor mental health. Although
males tended to report more suicidal ideation, this difference was not
statistically significant. Considering the increasing prevalence of nonstandard
working conditions in South Korea, the results call for more longitudinal
research on the mental health effects of nonstandard work.
PMID: 16580108 [PubMed - indexed for MEDLINE]
64. Health Policy. 2007 Jan;80(1):32-42. Epub 2006 Mar 29.
Community health worker training and certification programs in the United States:
findings from a national survey.
Kash BA, May ML, Tai-Seale M.
School of Rural Public Health, Texas A&M University Health Science Center, TAMU
1266, College Station, TX 77843, USA. bakash@srph.tamhsc.edu
OBJECTIVE: To analyze trends and various approaches to professional development
in selected community health worker (CHW) training and certification programs in
the United States. We examined the expected outcomes and goals of different
training and certification programs related to individual CHWs as well as the
community they serve. METHOD: A national survey of CHW training and certification
programs. Data collection was performed through personal interviews, phone
interviews and focus groups. Data sources included public health officials,
healthcare associations, CHW networks, community colleges, and service providers.
Initial screening interviews resulted in in-depth interviews with participants in
19 states. We applied human capital theory concepts to the analysis of the rich
qualitative data collected in each state. RESULTS: CHW programs in the U.S. seem
to have been initiated mainly due to lack of access to healthcare services in
culturally, economically, and geographically isolated communities. Three trends
in CHW workforce development were identified from the results of the national
survey: (1) schooling at the community college level - provides career
advancement opportunities; (2) on-the-job training - improves standards of care,
CHW income, and retention; and (3) certification at the state level - recognizes
the work of CHWs, and facilitates Medicaid reimbursement for CHW services.
CONCLUSION: Study findings present opportunities for CHW knowledge and skill
improvement approaches that can be targeted at specific individual career,
service agency, or community level goals. Trained and/or certified community
health workers are a potential new and skilled healthcare workforce that could
help improve healthcare access and utilization among underserved populations in
the United States.
PMID: 16569457 [PubMed - indexed for MEDLINE]
65. J Athl Train. 1999 Oct;34(4):368-374.
Job Search and Employment-Related Issues in Athletic Training Education Programs.
Stilger VG, Meador R, Tsuchiya M.
West Virginia University, Morgantown, WV.
OBJECTIVE: To investigate the amount of classroom instruction appropriated for
employment-related issues and how career service centers were used by students in
National Athletic Trainers' Association (NATA)-approved/Commission on
Accreditation of Allied Health Education Programs (CAAHEP)-accredited
undergraduate athletic training curriculums. DESIGN AND SETTING: We developed a
job placement survey and mailed it to subjects. The study was conducted through
the School of Physical Education at West Virginia University. SUBJECTS: The
subjects were all undergraduate athletic training curriculum directors employed
in an NATA-approved or CAAHEP-accredited program. MEASUREMENTS: We developed a
survey instrument based on our experiences with instructional and educational
issues in athletic training. The survey instrument consisted of items that
investigated the amount of classroom time and education devoted to different
aspects of preparing athletic training students for the job market. RESULTS: A
total of 74 surveys were returned, for an 88% return rate. Eighty-six percent of
the curriculum directors spent an average of 116 minutes (mean = 116 +/- 142.09;
range, 5 to 780) instructing students about employment issues. Curriculum
directors spent 63 minutes (mean = 63 +/- 47.86; range, 10 to 270) instructing
students on how to develop a résumé. Most curriculum directors (74%) spent time
with students discussing how to prepare for an interview (mean = 51 +/- 47.07
minutes; range, 1 to 270). Nearly all curriculum directors (97%) responded that
students learned about recognizing allied health postgraduate career options
other than athletic training. College or university career service centers were
available to 96% of students, but only 53% sought instructional assistance from
them. Curriculum directors spent an average of 38 +/- 49.31 minutes (range, 15 to
120) discussing programs available at career service centers. CONCLUSIONS:
Athletic training curriculum directors were providing basic employment
preparation skills to students. However, a wide variance existed for time
allotted to employment- related issues. Additional research is needed to compare
employment instructional methods with program success rates for job placement
within athletic training.
PMCID: PMC1323349
PMID: 16558591 [PubMed - as supplied by publisher]
66. Psychiatr Serv. 2006 Mar;57(3):388-92.
Perceived and measured stigma among workers with serious mental illness.
Baldwin ML, Marcus SC.
Arizona State University School of Health Management and Policy, P.O. Box 874506,
Tempe, Arizona 85287-4506, USA. marjorie.baldwin@asu.edu
OBJECTIVE: This research analyzed the extent to which self-reports of job-related
discrimination by persons with serious mental illness are associated with
econometric measures of discrimination. METHODS: Data were from the 1994-1995
National Health Interview Survey-Disability Supplement. Data for workers with
mood, psychotic, or anxiety disorders (N=1,139) were compared with data for those
without such disorders (N=66,341). The main outcome measures were self-reports of
wages and stigmatizing experiences in the workplace. RESULTS: After the analyses
controlled for functional limitations and job characteristics, no significant
difference in mean wages was found between workers with serious mental illness
who did not report experiencing stigma and those with no mental illness. In
contrast, for all types of mental disorders examined, mean wages for workers with
serious mental illness who reported experiencing stigma were significantly lower
than mean wages for those with no mental illness. CONCLUSIONS: Workers'
self-reports of stigmatizing experiences in the labor market appear to be
consistent with econometric measures of the effect of stigma on wages, suggesting
that workers know when they are being discriminated against.
PMID: 16524998 [PubMed - indexed for MEDLINE]
67. Aust J Rural Health. 2006 Apr;14(2):62-5.
Exploration of self-identified education needs of alcohol and other drug workers.
Grootjans J, Hunt H, Cresswell S, Robinson T.
Faculty Health Sciences, School of Nursing and Health Science, Charles Sturt
University, Dubbo, New South Wales, Australia. jgrootjans@csu.edu.au
OBJECTIVE: It is well established that people who work with clients who are
dependent on substances need to be well equipped to deal with challenging and
complex situations. Our research explores the experience of alcohol and other
drug workers (AODW) in order to identify how successful Australia's teaching
institutions are at preparing AODWs to meet this challenge. DESIGN: Interviews
were conducted to ascertain the perceived gaps in existing training programs and
the perceived training needs of AODW. Using a qualitative research approach
in-depth interviews were conducted with more than 20 counsellors working in six
AODW rehabilitation centres in regional New South Wales. RESULTS: There was a
perception among all workers that their training had been inadequate and that the
preparation for employment in AODW settings had not meet the felt needs of
grass-roots workers leaving them to learn through experience. CONCLUSION:
Considering the recommendations of both national and state policies on AODWs in
Australia there is an urgent need to develop courses relevant to the needs of
workers as suggested by respondents to this research.
PMID: 16512791 [PubMed - indexed for MEDLINE]
68. Int J Nurs Stud. 2007 Jan;44(1):93-104. Epub 2006 Jan 18.
Retention and attrition of certified care assistants in the long-term care
industry from the Taipei area: an interview survey.
Hsieh PC, Su HF.
Department of Health Care Management, National Taipei College of Nursing, Taiwan,
ROC. hpc@ntcn.edu.tw
BACKGROUND/OBJECTIVES: The question, "do certified care assistants (CCAs), after
finishing their training, devote themselves to the long-term care industry in
accordance with the original expectations?", is still unknown. Few studies have
focused on CCAs who have left the long-term care industry. The purposes of this
study were to identify the employment status of CCAs over the January 2000-July
2002 time period who had undergone a training program sometime in 1999 and to
explore the factors affecting whether the CCAs stay or leave the long-term care
industry in the Taipei area. Understanding retention and attrition of CCAs is
important for developing the strategies of managing manpower in this industry.
DESIGN/SETTING/PARTICIPANTS: A descriptive survey design was conducted to
telephone interview 826 CCAs who had trained during the 1999 certification
training program in Taipei area. Three hundred and thirteen participants (an
interview-completed rate of 38%) provided usable data. METHODS: A structured
interview schedule was developed by authors for interview. Descriptive statistics
and chi(2) test were adopted to report the subjects' characteristics and factors
that influenced his/her intention to stay or leave this industry. RESULTS: One
hundred and sixty-eight respondents (53.7%) had still stayed in this industry,
while 145 respondents (46.3%) had left already. Major reasons for staying were
personal interest in caring elderly, good financial benefits from the facility,
and supportive leadership. In contrast, low wages, heavy workloads, long working
hours, a high level of stress, and poor financial benefits were factors
contributing to careers leaving this industry. CONCLUSIONS: Many factors affected
whether CCAs stayed or left, including personal factors, work-related factors,
the welfare system, the managerial system, the leadership style and the work
environment. However, the sequence of these factors and their importance were
different between two groups. This study has significant implications for
managing the manpower of the long-term care industry.
PMID: 16413554 [PubMed - indexed for MEDLINE]
69. Ear Hear. 2005 Dec;26(6):529-45.
Working in noise with a hearing loss: perceptions from workers, supervisors, and
hearing conservation program managers.
Morata TC, Themann CL, Randolph RF, Verbsky BL, Byrne DC, Reeves ER.
National Institute for Occupational Safety and Health, Cincinnati, Ohio, USA.
tmorata@cdc.gov
OBJECTIVE: Workers with hearing loss face special problems, especially when
working in noise. However, conventional hearing conservation practices do not
distinguish between workers with normal hearing versus impaired hearing. This
study collected information from workers with self-reported noise exposure and
hearing loss, supervisors of such workers, and hearing conservation program
managers through focus groups and in-depth interviews to evaluate their
perspectives on the impact of hearing loss on safety and job performance, the use
of hearing protection, and information needed to appropriately manage
hearing-impaired workers who work in noisy environments. RESULTS: Concerns about
working in noise with a hearing loss could be grouped into the following 10
categories: impact on job performance, impact on job safety, impaired ability to
hear warning signals, impaired ability to monitor equipment, interference with
communication, stress and/or fatigue, impaired communication caused by hearing
protector use, reduced ability to monitor the environment as the result of
hearing protector use, concerns about future quality of life, and concerns about
future employability. Mostly, there was an agreement between the perceptions of
workers, supervisors, and hearing conservation program managers regarding
difficulties associated with hearing loss and consequent needs. These findings
suggest that noise-exposed workers with hearing loss face many of the same
problems reported in the literature by noise-exposed workers with normal hearing,
with additional concerns primarily about job safety as the result of a reduced
ability to hear environmental sounds, warning signals, and so forth. CONCLUSIONS:
The study outlines potential challenges regarding job safety and hearing
conservation practices for noise-exposed, hearing-impaired workers. Awareness of
these issues is a necessary first step toward providing appropriate protective
measures for noise-exposed, hearing-impaired workers.
PMID: 16377991 [PubMed - indexed for MEDLINE]
70. Med J Aust. 2005 Dec 5-19;183(11-12):606-11.
Contemporary (post-Wills) survey of the views of Australian medical researchers:
importance of funding, infrastructure and motivators for a research career.
Shewan LG, Glatz JA, Bennett CC, Coats AJ.
Faculty of Medicine, University of Sydney, Sydney, NSW 2006, Australia.
Comment in:
Med J Aust. 2005 Dec 5-19;183(11-12):604-5.
OBJECTIVES: To investigate the perceptions of Australian health and medical
researchers 4 years after the Wills Report recommended and led to a substantial
increase in health and medical research funding in Australia. DESIGN, SETTING AND
PARTICIPANTS: A telephone poll of 501 active health and medical researchers,
conducted between 28 April and 5 May, 2003. MAIN OUTCOME MEASURES: Researchers'
views on the adequacy of funding, infrastructure and support, salary, community
recognition, the excitement of discovery and research outcomes such as
publication and patenting in research. RESULTS: Research funding was the most
important concern: 91% of researchers (455/498) viewed funding as "very" or
"extremely" important to their role, but only 10% (52/500) were "very" or
"extremely" satisfied with the level of funding. Research infrastructure and
support were seen as "very" or "extremely" important by 90% of researchers
(449/501), while only 21% (104/501) were "very" or "extremely" satisfied.
Researchers in medical research institutes were significantly more likely to be
satisfied (27% [56/205] "very" or "extremely" satisfied) with the level of
infrastructure and support than those working in universities (15% [41/268]
"very" or "extremely" satisfied; P = 0.001). Among the factors that motivate
researchers, the excitement of discovery stood out in terms of both high
importance and satisfaction. Publications were viewed as more important research
outcomes than patenting or commercial ventures. CONCLUSIONS: Funding and
infrastructure support remain overwhelmingly researchers' greatest concerns.
University-based researchers were less satisfied with infrastructure and support
than those in independent medical research institutes.
PMID: 16336146 [PubMed - indexed for MEDLINE]
71. Health Qual Life Outcomes. 2005 Nov 8;3:68.
Evaluating change in health-related quality of life in adult rhinitis:
responsiveness of the Rhinosinusitis Disability Index.
Chen H, Katz PP, Shiboski S, Blanc PD.
Department of Medicine, University of California, San Francisco, CA, USA.
hubert.chen@ucsf.edu
BACKGROUND: The Rhinosinusitis Disability Index (RSDI) is a validated measure of
health-related quality of life (HRQL) in rhinitis. Responsiveness of the RSDI to
changes in health status over time has not been described. METHODS: We studied
adults with a self-reported physician diagnosis of rhinitis identified through a
national telephone survey. HRQL was assessed at baseline and at 24 months using
the RSDI. Symptom severity, physical health status (SF-12 PCS), psychological
mood (CES-D), and perceived control of symptoms were also assessed at the time of
each interview. In addition, we ascertained specific health outcomes attributed
to rhinitis, including days of restricted activity, job effectiveness, number of
physician visits, and medication costs. RESULTS: Of 109 subjects interviewed at
baseline, 69 (63%) were re-interviewed 24 months later. RSDI scores improved by =
0.5 standardized response mean in 13 (19%) subjects and worsened in 17 (25%).
Change in the RSDI over time correlated with changes in symptom severity (r =
0.38, p = 0.001), physical health (r = -0.39, p = 0.001), mood (r = 0.37, p =
0.002) and perceived control of symptoms (r = -0.37, p = 0.01). In multivariate
analyses adjusted for baseline health status, improvement in RSDI was associated
with less restricted activity (p = 0.01), increased job effectiveness (p = 0.03),
and decreased medication costs (p = 0.05), but was not associated with change in
the number of physician visits from baseline (p = 0.45). CONCLUSION: The RSDI is
responsive to changes in health status and predicts rhinitis-specific health
outcomes.
PMCID: PMC1308842
PMID: 16277662 [PubMed - indexed for MEDLINE]
72. Health Rep. 2005 Jun;16(4):11-22.
Weekly work hours and health-related behaviours in full-time students.
Carrière G.
Health Statistics Division, Statistics Canada. Gisele.Carriere@statcan.ca
OBJECTIVES: This article examines associations between the number of hours of
paid work and smoking, alcohol use, episodic heavy drinking and leisure-time
physical activity among full-time students aged 15 to 17. DATA SOURCES: Analyses
are based on data from the 2003 Canadian Community Health Survey and the 1994/95
to 2002/03 National Population Health Survey. ANALYTICAL TECHNIQUES: Selected
characteristics and health-related behaviours of working and non-working students
were compared. Logistic regression was used to examine relationships between
average weekly hours at the main job and health-related behaviours, as well as
maintenance of and changes in these behaviours, while controlling for possible
confounders. MAIN RESULTS: Students who worked even a modest number of hours per
week had higher odds of drinking alcohol regularly, and occasionally heavily,
compared with those who had not worked. Students working any number of hours had
higher odds of becoming regular drinkers within two years of their baseline
interview. Longer working hours were associated with higher odds of smoking.
Employed students had higher odds of being physically active in their leisure
time. The influences of age, household income and urban/rural residence were
taken into account.
PMID: 16190321 [PubMed - indexed for MEDLINE]
73. Int J Obes (Lond). 2006 Feb;30(2):359-63.
Betel nut chewing and other risk factors associated with obesity among Taiwanese
male adults.
Chang WC, Hsiao CF, Chang HY, Lan TY, Hsiung CA, Shih YT, Tai TY.
Division of Gerontology Research, National Health Research Institutes, Taipei
City, Taiwan.
OBJECTIVE: The research aimed at examining betel nut chewing and other risk
factors associated with obesity among Taiwanese male adults. DESIGN: The research
analyzed the data obtained by the 2001 National Health Interview Survey in Taiwan
that covered all the administrative divisions in Taiwan. Multistage stratified
systematic sampling design was adopted for survey. All members of a sampled
household received the interview. SUBJECTS: The research analyzed questionnaires
answered by nonaboriginal male respondents aged between 20 and 59 years old, and
the total number of samples analyzed read 6126. Since very few female subjects
chewed betel nut, they were excluded from the analysis. MEASUREMENTS: Criteria of
obesity was defined as body mass index > or = 27 kg/m2. The variables
incorporated for analysis included the respondents' status of betel nut chewing,
age, educational background, presence of hypertension and diabetes mellitus,
drinking and smoking status, exercise status, and demand for physical strength at
job. Generalized estimating equations model was employed to estimate the odd
ratios (with 95% CI) of obesity of each independent variable. RESULTS:
Approximately 16.2% of respondents were obese. The distribution of betel nut
chewing was current chewers 15.9%, ex-chewers 4.3%, and nonchewers 79.8%. After
controlling above-mentioned independent variables, hypertension, diabetes
mellitus, betel nut chewing, never exercising, and sedentary jobs were closely
associated with obesity. CONCLUSION: The research found that betel nut chewing
closely associated with obesity. The increased appetite of betel nut chewers is
speculated as the underlying cause. The prospective study is needed to clarify
this issue. In addition to increasing the risk of developing oral cancer, betel
nut chewing seemed to be related with another health hazard: obesity.
PMID: 16116491 [PubMed - indexed for MEDLINE]
74. Alcohol Alcohol. 2005 Sep-Oct;40(5):453-60. Epub 2005 Jun 21.
The association between stress and drinking: modifying effects of gender and
vulnerability.
Dawson DA, Grant BF, Ruan WJ.
NIAAA/LEB Room 3083, 5635 Fishers Lane MSC 9304, Bethesda, MD 20892-9304, USA.
ddawson@mail.nih.gov
AIMS: To assess the relationship between number and type of past-year stressful
experiences and alcohol consumption, with a focus on how gender, poverty, and
psychological vulnerability moderate this association. METHODS: Data from 26 946
US past-year drinkers 18 years of age and over, interviewed in the 2001-2002
National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), were
used to construct multivariate linear regression models predicting six measures
of drinking pattern and volume. RESULTS: There was a consistent positive
relationship between number of past-year stressors experienced and all measures
of heavy drinking. Frequency of heavy (5+ drinks for men; 4+ drinks for women)
drinking increased by 24% with each additional stressor reported by men and by
13% with each additional stressor reported by women. In contrast, the frequency
of moderate drinking (<5 drinks for men; <4 drinks for women) decreased as stress
levels increased. Job-related and legal sources of stress were more strongly
associated with alcohol consumption than were social and health-related stress.
Men showed a stronger association than women between the number of stressors and
the most consumption measures; they also responded more strongly to the presence
of any legal and job-related stress. Having an income below the poverty level
intensified the effects of job-related stress, but having a mood or anxiety
disorder did not affect any of the associations between stress and consumption.
CONCLUSIONS: Stress does not so much lead individuals to drink more often as to
substitute larger quantities of alcohol on the days when they do drink. Treatment
and brief interventions aimed at problem drinkers might benefit from addressing
the issue of tension alleviation and the development of alternative coping
mechanisms.
PMID: 15972275 [PubMed - indexed for MEDLINE]
75. Midwifery. 2005 Sep;21(3):253-66.
Emotion work and boundary maintenance in hospital-based midwifery.
Hunter B.
University of Wales Swansea, School of Health Sciences, Vivian Tower, Swansea SA2
8PP, UK. B.J.Hunter@swan.ac.uk
OBJECTIVE: To identify and explore the emotion work of hospital-based midwives.
DESIGN: An ethnographic approach using focus groups, observations and interviews.
SETTING: South Wales, UK. PARTICIPANTS: Phase one of the study: self-selected
convenience sample of 27 student midwives in first and final years of 3-year
(direct entry) and 18-month (post-nursing) programmes. Phase two: opportunistic
sample of seven qualified hospital-based midwives. Phase three: Purposive sample
of 10 hospital-based midwives working within one National Health Service Trust.
Sample representative of a range of clinical locations, length of clinical
experience and clinical grades. FINDINGS: The emotion work of midwives was
strongly influenced by the context of practice. For hospital-based midwives,
relationships with midwifery colleagues were of key importance, providing the
main source of feedback on individual practice. Negotiating these relationships
was a major source of emotion work. Although collegial relationships could
provide support and affirmation, they were also a frequent source of conflict,
particularly between junior and senior midwives. This discord was underpinned by
conflicting ideologies of midwifery practice. KEY CONCLUSIONS: The theoretical
framework of boundary maintenance was used to interpret the findings. Senior and
junior midwives frequently held contradictory models of practice, resulting in
competing claims for occupational jurisdiction. Midwives made use of a variety of
devices in order to establish and maintain intra-occupational boundaries. Senior
midwives attempted to maintain their position through unwritten rules and
sanctions, supported by their claim to greater clinical expertise and experience.
Junior midwives rarely challenged this authority; their responses were often
subversive and designed to create an appearance of compliance. IMPLICATIONS FOR
PRACTICE: These findings contribute to our understanding of inter-collegial
conflict in UK midwifery, providing insights into workplace harassment and low
staff morale, which are likely to exacerbate workforce attrition. The
underpinning ideological dissonance experienced by midwives must be acknowledged
and tackled for these issues to be effectively addressed.
PMID: 15967549 [PubMed - indexed for MEDLINE]
76. J Occup Environ Med. 2005 Jun;47(6):623-32.
Work environment and occupational health of dental hygienists: a qualitative
assessment.
Crawford L, Gutierrez G, Harber P.
Division of Occupational and Environmental Medicine, Department of Family
Medicine, David Geffen School of Medicine at UCLA, University of California at
Los Angeles, Los Angeles, California 90024, USA. loricrawford@mednet.ucla.edu
OBJECTIVE: We sought to characterize the work environment and identify factors
that influence the occupational health of dental hygienists. METHODS: We
conducted a qualitative analysis of dental hygiene work based on five national
focus groups. RESULTS: We found that musculoskeletal symptoms are common,
particularly after 10 years; common ergonomic problems included instruments and
chairs. Important non-physical workplace problems include role ambiguity (eg,
employee vs. independent practitioner), inadequate recognition, role identity
(eg, distinction from dental assistants), role conflict (eg, with dentists and
spousal office managers), and social isolation. CONCLUSIONS: Work organizational
factors (eg, frequent part-time work, inadequate breaks, perception as a "second
team" distinct from the dentist and dental-assistant team) impede the remediation
of ergonomics and other problems. Job flexibility encourages hygienists to change
work hours or location rather than deal with work conditions. Occupational health
interventions should address social environment and work organization.
PMID: 15951722 [PubMed - indexed for MEDLINE]
77. J Ayub Med Coll Abbottabad. 2005 Jan-Mar;17(1):48-53.
Recommendations to strengthen the role of lady health workers in the national
program for family planning and primary health care in Pakistan: the health
workers perspective.
Afsar HA, Younus M.
Department of Community Health Sciences, The Aga Khan University, Karachi
BACKGROUND: This study was planned to assess the strengths and weakness of the
National Program for Family Planning and Primary from the Lady Health Workers
(LHIW) perspective. We conducted this study in order to develop recommendations
for strengthening LHWs' role in Primary Health Care (PHC) in Pakistan in
consultation with the health workers. METHODS: A qualitative study, based on key
informant interviews, was carried out in Karachi, Pakistan. A total of 20 workers
were interviewed. Analysis was carried out by grouping similar responses in a
matrix and then analysis with reference to context. RESULTS: Motivations for
joining program included financial benefits, convenient timings and an
opportunity to serve humanity. Training was deemed satisfactory but clinical
training was resented because of doctors' attitudes. Further training needs
identified included basic information about common ailments, reproductive issues
and basic clinical skills. Major strengths of the program mentioned included
provision of services at grass root level, reinforcement of health messages and
the community acceptability of workers. Weaknesses mentioned included the
contractual nature of job, low salaries, irregularity of payment, no career
development and poor logistical support. CONCLUSION: Giving LHWs permanent
government employee status and a raise in salary may strengthen the workers
functions. Eligible LHWs should be given incentives (skills, career development,
financial). The community must be educated about assigned role and
responsibilities of LHWs and patient referral system by the LHW needs to be
strengthened. The valuable role of LHWs in PHC in Pakistan must be acknowledged
and further improvements pursued.
PMID: 15929528 [PubMed - indexed for MEDLINE]
78. J Pediatr Surg. 2005 Jan;40(1):69-73; discussion 73-4.
Cost considerations and applicant characteristics for the Pediatric Surgery
Match.
Little DC, Yoder SM, Grikscheit TC, Jackson CC, Fuchs JR, McCrudden KW, Holcomb
GW 3rd.
Department of General Surgery, Texas A&M University Health Science System,
Temple, TX 76508, USA. dlittle@cmh.edu
BACKGROUND/PURPOSE: Formal training in pediatric surgery is highly competitive.
The limited number of accredited positions has historically favored applicants
with basic science experience, numerous publications, national presentations, and
exposure to well-known pediatric surgeons. This review analyzes characteristics
of successful applicants and cost associated with the Match. METHODS: A survey
was e-mailed to 45 applicants after the 2003 Match. Geographic provenance,
demographics, qualifications, costs, and valued program characteristics were
assessed. Statistics were formulated by chi2 and Student's t test. RESULTS:
Thirty-six applicants (80%) responded. Successful characteristics for matched vs
unmatched included number of publications, 11.2 vs 5.7 (P < .01); first-author
designation, 6.4 vs 3.1 (P = .02); basic science papers, 5.7 vs 1.7 (P < .01);
national presentations, 5.8 vs 2.4 (P = .02); and presentations at pediatric
surgical meetings, 2.0 vs 0.6 (P = .04). Ninety percent of matched applicants
took time off to perform basic science research (P < .01). Average candidate
expense was $6974, which represented 14% of pretax salary. Forty-one percent of
applicants noted that cost limited the number of interviews taken. Fifty percent
preferred a regional interview process to limit expense. Candidates ranked case
diversity, volume, and mentor's advice as the most valued program
characteristics. Successful applicants matched at their fifth rank on average.
Eighty-six percent of unsuccessful applicants will reapply. CONCLUSIONS: Results
of this study are important to those interested in the future of pediatric
surgery. Successful applicants were shown to have several national presentations
and multiple scientific publications, especially in basic sciences. Applicant
costs are high, totaling more than $236,000 for survey respondents.
PMID: 15868561 [PubMed - indexed for MEDLINE]
79. Am J Ind Med. 2005 May;47(5):443-50.
Comparison of asbestos exposure assessments by next-of-kin respondents, by an
occupational hygienist, and by a job-exposure matrix from the National
Occupational Hazard Survey.
Nam JM, Rice C, Gail MH.
Biostatistics Branch, Division of Cancer Epidemiology and Genetics, National
Cancer Institute, National Institutes of Health, Department of Health & Human
Services, Bethesda, Maryland, USA. namj@mail.nih.gov
BACKGROUND: Assessments of occupational exposures in case-control studies of
rapidly fatal illnesses often rely on data from next-of-kin respondents, which
may be inaccurate. METHODS: Three methods for assessing exposure to asbestos from
case-control data on mesothelioma, including next-of-kin assessment, expert
assessment, and use of a generic job-exposure matrix (JEM). Interview data
[Spirtas et al. (1994): Occup Environ Med 51:804-811] were reviewed to determine
exposure status by an occupational hygienist (C.R.) who was unaware of disease
status. Exposure odds ratios were calculated using standard methods, and measures
of agreement included the kappa statistic and conditional and marginal odds
ratios. RESULTS: Expert assessment detected higher proportions of exposed
subjects than the next-of-kin respondents or JEM methods. The disease-exposure
odds ratios were highest for respondents, perhaps because of recall bias, and
lowest for the JEM method. The agreement was highest between the respondent and
expert assessments. A combination of respondent's assessment and JEM assessment
led to the best prediction of the expert's assessment. Results for spouse
respondents were similar to those for other "next-of-kin" respondents.
CONCLUSIONS: Expert assessments were the most plausible, but the data indicate
that disease associations could also be detected with the other exposure
assessment methods. Using some combination of the proxy respondent's assessment
and the JEM assessment, one can predict the expert's assessment. A strategy that
relied on the respondent's assessment when it was positive and otherwise obtained
an expert assessment could reduce costs with little error, compared to expert
assessment on all subjects. Published 2005 Wiley-Liss, Inc.
PMID: 15828074 [PubMed - indexed for MEDLINE]
80. Scand J Public Health. 2005;33(2):107-13.
Assistant nurses in the Swedish healthcare sector during the 1990s: a hard-hit
occupational group with a tough job.
Hertting A, Nilsson K, Theorell T, Larsson US.
National Institute for Psychosocial Medicine (IPM), Stockholm/Department of
Public Health Sciences, Division of Psychosocial Factors and Health, Karolinska
Institutet, Stockholm, Sweden. anna.hertting@ipm.ki.se
AIMS: The aim of the study was to explore hospital-based assistant nurses'
experiences of psychosocial "stressors", following a period of substantial
layoffs (43%) and ongoing healthcare reorganizations. METHODS: An interview study
was carried out with 11 assistant nurses working in the same hospital. The
interviews took place in 1997, in connection with the last round of redundancies,
and were followed up in 1998 and then in 2001. Interviews were audiotaped and
transcribed; the content was then analysed. RESULTS: Two main themes were
identified from the women's perceived stressors: (a) a hard-hit occupational
group experiencing "energy-consuming adjustments", and a "weak position" at the
continuing workplace. Job insecurity meant fear of losing valued work tasks in
nursing care (de-skilling). The common feature was the duality in the women's
descriptions of feeling qualified in nursing care but being treated like a maid,
or having intimate practical knowledge but no formal competence; (b) a tougher
but underpaid job including "heavy workload" concurrent with "organizational
shortcomings", and "frozen salary trends" with a simultaneous feeling of lacking
the power to improve their situation. CONCLUSIONS: Our results underscore the
importance of the employer's attention to the remaining workers in connection
with downsizing, particularly when the reduction of the workforce has been as
dramatic as in this case. It is also important to understand the ongoing dilemma
(strain) for the assistant nurses, who are faced with increasing demands for
further formal qualifications in hospital care, while maintaining a strong
occupational desire to keep their highly valued job working close to the patient.
PMID: 15823971 [PubMed - indexed for MEDLINE]
81. Health Info Libr J. 2005 Mar;22(1):35-43.
The information needs of perioperative staff: a preparatory study for a proposed
specialist library for theatres (NeLH).
Nicholas D, Williams P, Smith A, Longbottom P.
University College London, UK.
AIMS/OBJECTIVES: To undertake an information-needs analysis of operating theatre
staff in order to inform the development of a specialist library of the National
Electronic Library of Health (NeLH). SETTING: Three hospitals in an NHS Trust in
a rural county in the north of England. METHODS: In-depth interviews, during
which staff were questioned in regard to their job roles and information needs,
information-seeking behaviour, access to computers, use and perceptions of the
NeLH, and what they would like from a specialist library. RESULTS: Information
needs were found to concern direct care, professional and academic development,
medical devices knowledge and administration. Currency and speed of delivery were
the key information requirements. Poor communication appeared to be a major
problem for many staff and inhibited efficient information exchange. When using
the Web, both clinical and non-clinical staff searched in a similar fashion to
health consumers generally, despite their need for highly specialist information.
Most respondents reacted warmly to the idea of the proposed National Electronic
Library for Theatre Staff (NeLTS) and made several practical suggestions for
suitable material. However, access was problematic for nurses and might prove to
be an obstacle to take-up of the Specialist Library. CONCLUSIONS: Communication
difficulties, the fragmentation of data in the field and the consequent
difficulties of finding information point to the need for an NeLTS. However, for
this library to embrace and succeed with all the various groups that constitute
the operating theatre staff, issues of access and digital literacy need to be
addressed.
PMID: 15810930 [PubMed - indexed for MEDLINE]
82. J Nurs Adm. 2005 Mar;35(3):110-20.
Group cohesion and nurse satisfaction: examination of a team-building approach.
DiMeglio K, Padula C, Piatek C, Korber S, Barrett A, Ducharme M, Lucas S,
Piermont N, Joyal E, DeNicola V, Corry K.
The Miriam Hospital, 164 Summit Avenue, Providence, RI 02906, USA.
OBJECTIVES: The purpose of this study was to determine the impact of a
team-building intervention on group cohesion, nurse satisfaction, and turnover
rates. BACKGROUND: Creating an environment that supports and retains nurses
represents a formidable challenge for nursing leaders. Research related to
strategies that positively impact the culture in which nurses practice, thus
potentially improving nurse satisfaction and reducing turnover, is critically
needed. METHODS: Registered nurses (RNs) employed on inpatient units in a
247-bed, private acute care Magnet teaching hospital participated in this quasi
experimental preintervention and postintervention design. The RN-RN interaction
subscale from the National Database of Nursing Quality Indicators Adapted Index
of Work Satisfaction, the National Database of Nursing Quality Indicators Adapted
Index of Job Enjoyment, the Group Cohesion Scale, and a facilitator-developed
measure were completed preimplementation and postimplementation of unit-tailored
intervention strategies, which took place over a 12-month period. Turnover rates
were collected 6 month preintervention and postintervention. RESULTS: Improvement
in group cohesion, RN-RN interaction, job enjoyment, and turnover was
demonstrated. CONCLUSION: Targeted, unit-based strategies can be an effective
means of reducing turnover rates and improving group cohesion and nurse
satisfaction.
PMID: 15761307 [PubMed - indexed for MEDLINE]
83. Am J Public Health. 2005 Mar;95(3):496-501.
Racial/ethnic discrimination and common mental disorders among workers: findings
from the EMPIRIC Study of Ethnic Minority Groups in the United Kingdom.
Bhui K, Stansfeld S, McKenzie K, Karlsen S, Nazroo J, Weich S.
Centre for Psychiatry, Barts, and London School of Medicine, Queen Mary, London
E1 4NS, United Kingdom. k.s.bhui@qmul.ac.uk
OBJECTIVES: We measured perceived discrimination and its association with common
mental disorders among workers in the United Kingdom. METHODS: We conducted a
secondary analysis of a national sample of 6 ethnic groups (n=2054).
Discrimination was measured as reports of insults; unfair treatment at work; or
job denial stemming from race, religion, or language. The outcome assessed was
presence of common mental disorders. RESULTS: The risk of mental disorders was
highest among ethnic minority individuals reporting unfair treatment (odds ratio
[OR]=2.0; 95% confidence interval [CI]=1.2, 3.2) and racial insults (OR=2.3; 95%
CI=1.4, 3.6). The overall greatest risks were observed among Black Caribbeans
exposed to unfair treatment at work (OR=2.9; 95% CI=1.2, 7.3) and Indian (OR=3.1;
95% CI=1.4, 7.2), Bangladeshi (OR=32.9; 95% CI=2.5, 436.0), and Irish (OR=2.9;
95% CI=1.1, 7.6) individuals reporting insults. CONCLUSIONS: Racial/ethnic
discrimination shows strong associations with common mental disorders.
PMCID: PMC1449208
PMID: 15727983 [PubMed - indexed for MEDLINE]
84. Health Soc Care Community. 2005 Mar;13(2):155-63.
Multi-agency working in services for disabled children: what impact does it have
on professionals?
Abbott D, Townsley R, Watson D.
Norah Fry Research Centre, University of Bristol, UK. d.abbott@bristol.ac.uk
Whilst agencies in many sectors have been encouraged to work together to better
meet the needs of service users, multi-agency working is now a central feature of
government policy. In relation to children's services, the National Service
Framework, the English green paper, 'Every Child Matters' (DfES, 2003) and the
Children Bill (DfES 2004) give a high priority to an integrated approach to
service provision. This paper focuses on multi-agency working for disabled
children with complex health-care needs, a group of children who, perhaps even
more than most, require the many professionals who support them and their
families, to work more closely together. Drawing on the findings from a 3-year
qualitative research study, this paper examines the impact of working in a
multi-agency service on professionals. Interviews with 115 professionals
concluded that staff were overwhelmingly positive about working as part of a
multi-agency service. They reported improvements to their working lives in areas
such as professional development, communication, collaboration with colleagues,
and relationships with families with disabled children. However, whilst
professionals felt that they were able to offer families a more efficient
service, there was concern that the overall impact of multi-agency working on
disabled children and their families would be limited.
PMID: 15717917 [PubMed - indexed for MEDLINE]
85. Health Soc Care Community. 2005 Mar;13(2):145-54.
The impact of 'statutory duties' on mental health social workers in the UK.
Evans S, Huxley P, Webber M, Katona C, Gately C, Mears A, Medina J, Pajak S,
Kendall T.
lnstitute of Psychiatry and Social Care Workforce Research Unit, King's College,
London, UK. s.evans@iop.kcl.ac.uk
In the UK, applications for involuntary admission to psychiatric units are made
mainly by specially trained approved social workers (ASWs). Proposed changes in
the legislation will permit other professionals to undertake these statutory
duties. This study aimed to examine how ASW status impacts upon work pattern and
workload stresses by comparing ASWs with other mental health social workers who
did not carry statutory responsibilities. A multimethod design was adopted that
included a cross-sectional national survey of mental health social workers
(n=237, including 162 ASWs), and a telephone survey of mental health service
managers (n=60). Data were collected using a semistructured questionnaire and
diary, the content of which was derived from focus-group work and standard
measures. Features of job content, working patterns and conditions were described
and their association with stress, burnout and job satisfaction examined. ASWs
were older and had been qualified longer than non-ASWs. The working patterns and
conditions of the two groups did not differ, although ASWs did more hours on
duty. ASWs received less support at work, particularly from supervisors and their
role afforded less decision latitude than that of non-ASWs. ASW status was
related to an elevated GHQ score, particularly among males. Emotional exhaustion
was very high (over two-thirds in both groups) but ASWs and non-ASWs did not
differ in this or any other feature of burnout, only 8% of the sample were
actually 'burnt-out', being more common among ASWs. ASWs were more dissatisfied
and were more likely than non-ASWs to want to leave their job. Given that ASW
status increased stress and job dissatisfaction, especially for men, and was
related to a desire to leave one's current job, it seems likely that extending
statutory duties to other professionals will increase levels of stress, burnout
and dissatisfaction in these groups also. In turn, this might have consequences
for staff recruitment and retention.
PMID: 15717916 [PubMed - indexed for MEDLINE]
86. J Occup Environ Med. 2005 Jan;47(1):79-90.
Longest held job in U.S. occupational groups: the National Health Interview
Survey.
Gómez-Marín O, Fleming LE, Caban A, Leblanc WG, Lee DJ, Pitman T.
Departments of Epidemiology & Public Health, University of Miami School of
Medicine, Miami, Florida 33101, USA. ogomez@med.miami.edu
OBJECTIVE: We sought to assess the validity of using current or most recent
occupation as surrogate for longest-held job (and its exposures). METHODS: The
National Health Interview Survey (NHIS) is an annual, probability,
cross-sectional U.S. population survey. The 1986 and 1988 NHIS occupational
supplements provided information for more than 49,000 workers. Using Cohen's
Kappa, concordance was assessed by occupational group and several subgroups.
RESULTS: Statistically significant results were observed for all occupational
groups. More than 70% of 13 broad occupations had a Kappa of 50.0 or greater,
with variable concordance by subpopulation. Among 206 occupational groups, there
was more variability: Kappa ranged from 92.7 (dentists) to 9.2 (farm managers).
CONCLUSIONS: Moderate-to-high levels of agreement was observed in this large,
representative sample of US workers. Therefore, current occupation can be used as
a surrogate for longest-held job for many occupational subgroups.
PMID: 15643162 [PubMed - indexed for MEDLINE]
87. J Agric Saf Health. 2004 Nov;10(4):275-85.
Acute and chronic disability among U.S. farmers and pesticide applicators: the
National Health Interview Survey (NHIS).
Gómez-Marín O, Fleming LE, Lee DJ, LeBlanc W, Zheng D, Ma F, Jané D, Pitman T,
Caban A Jr.
Department of Epidemiology and Public Health, University of Miami School of
Medicine, 1801 NW 9th Avenue, Suite 200L, Highland Professional Building, Miami,
FL 33136, USA. ogomez@med.miami.edu
The National Health Interview Survey (NHIS) is a multipurpose household survey of
the U.S. civilian non-institutionalized population conducted annually since 1957.
From 1986 to 1994, over 450,000 U.S. workers, age 18 years and older,
participated in a probability sampling of the entire non-institutionalized U.S.
population; variables collected included a range of measures of acute and chronic
disability. The objective of the present study was to assess predictors of health
status, and acute and chronic disability for farmers and pesticide applicators
(pesticide-exposed workers) compared to all other U.S. workers using the
1986-1994 NHIS. After adjustment for sample weights and design effects using
SUDAAN, several measures of acute and chronic disability and health status were
modeled with multiple logistic regression. Farmers (n = 9576) were significantly
older compared to all other U.S. workers (n = 453,219) and pesticide applicators
(n = 180). Farmers and pesticide applicators had a higher proportion of males,
whites, and Hispanics and were less educated. After adjusting for age, gender,
race-ethnicity, and education, compared to all other workers, farmers were
significantly less likely to report acute and chronic disability and health
conditions, while pesticide applicators were more likely to report chronic
disability, health conditions, and poor health. Given the cross-sectional nature
of the data and the significant job demands of farming, both leading to a
relative healthy worker effect, the present results indicate that at any point in
time, farmers report less acute and chronic disability, compared to other U.S.
workers, whereas pesticide applicators report similar or poorer health.
PMID: 15603226 [PubMed - indexed for MEDLINE]
88. Eur J Epidemiol. 2004;19(8):777-84.
Social class, race/ethnicity and all-cause mortality in the US: longitudinal
results from the 1986-1994 National Health Interview Survey.
Muntaner C, Hadden WC, Kravets N.
Department of Family and Community Health, University of Maryland-Baltimore,
21201-1579, USA. muntaner@son.umaryland.edu
BACKGROUND: Occupational social class has become a leading indicator of social
inequalities in health. In the US, economic sectors are distinct with respect to
wages, benefits, job security, promotion ladders and working conditions. The
growing economic sector of self-employed workers is characterized by lower wages
and benefits, and greater job insecurity. Little attention has been given to the
association between economic sector measures of social class and all-cause
mortality, and there have been no studies of mortality among the self-employed.
METHODS: To determine risk of death associated with economic sector social class,
this study entails a longitudinal analysis of the National Health Interview
Survey (NHIS), an annual household survey representative of the US population for
the period 1986-1994 (n = 377,129). The sample includes 201,566 men and 175,563
women, aged 24-65 years of age, in the civilian labor force. RESULTS: Non-
professionals are at higher risk of death than professionals across all sectors
and self-employed professionals are at higher risk of death than professionals
employed in government and production. Additional social class differences are
accounted for by age, race, gender and marital status. Results are also partially
explained by income. After controlling for income, Black professionals did not
show a lower risk of death than Black non-professionals and self-employed
Hispanic professionals had a higher risk of death than Hispanic professionals
employed in the private sector. CONCLUSIONS: Given the growth of self-employment
in the US, the noted increased risk of death among self-employed professionals
merits further investigation and monitoring.
PMID: 15469035 [PubMed - indexed for MEDLINE]
89. BMC Public Health. 2004 Sep 30;4:41.
The impact of employee level and work stress on mental health and GP service use:
an analysis of a sample of Australian government employees.
Parslow RA, Jorm AF, Christensen H, Broom DH, Strazdins L, D' Souza RM.
Centre for Mental Health Research, Australian National University ACTON ACT 0200
Australia. ruth.parslow@anu.edu.au
BACKGROUND: This study sought to identify the extent to which employee level and
work stressors were associated with mental health problems experienced by
Australian government employees, and with their use of primary care services.
METHODS: 806 government employees aged between 40 and 44 years were surveyed as
part of an epidemiological study conducted in Australia. Data collected from
participants included sociodemographic attributes, physical health, psychological
measures and work stressors relating to job control, job demands, job security
and skills discretion at work. For 88% of these participants, information on
visits made to general practitioners (GPs) for the six months before and after
their survey interview was obtained from health insurance records. RESULTS: When
work stress and personal factors were taken into account, men at more junior
levels reported better mental health, more positive affect and used fewer GP
services. Women at middle-management levels obtained less GP care than their more
senior counterparts. Both men and women who reported higher levels of work stress
were found to have poorer mental health and well-being. The impact of such
stressors on GP service use, however, differed for men and women. CONCLUSION:
Measures of work stress and not employee level affect the mental health and
well-being of government employees. For governments with responsibility for
funding health care services, reducing work stress experienced by their own
employees offers potential benefits by improving the health of their workforce
and reducing outlays for such services.
PMCID: PMC526193
PMID: 15456518 [PubMed - indexed for MEDLINE]
90. Nurs Times. 2004 Aug 10-16;100(32):40-3.
Exploring the role of community mental health team managers.
McGuinness M.
AIM: To explore the perceptions that managers of community mental health teams
have of their role, along with their responsibilities and frustrations. SAMPLE:
Managers of community mental health teams. METHOD: The method consisted of using
focus groups and a survey questionnaire of CMHT managers in seven mental health
trusts. RESULTS: The study found that the job of the CMHT manager is challenging
and demanding, working with adults with severe mental health problems, managing
community multidisciplinary teams and meeting the standards of service delivery
set out in the National Service Framework for Mental Health (Department of
Health, 1999). The data also showed that CMHT managers had a strong commitment
to, and positive working relationships with, CMHT staff. CONCLUSION: There were
significant findings about the pressures that undermined the ability of the CMHT
managers to carry out the role effectively. The most notable of these being
insufficient resources and poor relationships with line managers, who do not seem
to understand the role and its pressures. The study also found that the role of
CMHT managers was reasonably well reflected in their job descriptions, but there
were some disparities that may require a review of job descriptions.
PMID: 15373160 [PubMed - indexed for MEDLINE]
91. Health Policy. 2004 Sep;69(3):329-37.
China's evolving health care market: how doctors feel and what they think.
Lim MK, Yang H, Zhang T, Zhou Z, Feng W, Chen Y.
Department of Community, Occupational & Family Medicine, Faculty of Medicine MD3,
National University of Singapore, 16 Medical Drive, Singapore 117597, Singapore.
coflimmk@nus.edu.sg
This paper reports on a questionnaire survey and 12 focus groups conducted among
doctors in three provinces of China, namely Guangdong, Shanxi, and Sichuan. The
survey (N = 720) and focus group participants were drawn from both rural and
urban areas, as well as public and private sectors, in equal numbers The aim was
to gauge how Chinese doctors feel about themselves and what they think of the
Chinese health care system. We found low satisfaction levels with own income
(8%), job (27%), skill (30%), and other important aspects of their professional
life. The health care system received only 32% approval rating. Quality of care
and patient safety issues were major concerns, especially in the growing but
poorly regulated private sector. The public sector came under criticism for its
high fees and bad service quality. The feedback point to the need for an
appropriate regulatory framework to guide the development of China's evolving
health care market. A revitalized medical profession that is fully engaged in the
reform process could also significantly impact the success of ongoing health care
reform efforts.
PMID: 15276312 [PubMed - indexed for MEDLINE]
92. Epidemiology. 2004 Jul;15(4):433-41.
Comparing questionnaire-based methods to assess occupational silica exposure.
Parks CG, Cooper GS, Nylander-French LA, Hoppin JA, Sanderson WT, Dement JM.
Epidemiology Branch, National Institute of Environmental Health Sciences,
Research Triangle Park, North Carolina, USA. Cqp8@cdc.gov
BACKGROUND: Epidemiologic assessment of occupational exposure to silica is
typically limited to long-term work in the dusty trades, primarily in jobs held
by men. We compared alternative questionnaire-based methods to assess silica
exposure in a recent case-control study of 265 patients with systemic lupus
erythematosus (mostly women) and 355 controls randomly selected from state
driver's license registries and frequency-matched by age and sex. METHODS:
In-person interviews included a job history (all jobs held at least 12 months)
and checklist of silica-related jobs and tasks (work of at least 2 weeks). Three
industrial hygienists reviewed job descriptions without knowing case-control
status. Potential high- or moderate-intensity exposures were confirmed or revised
based on follow-up telephone interviews. RESULTS: In the full assessment
including all work of at least 2 weeks, 9% of cases and 4% of controls were
classified as medium or high silica exposure (odds ratio of disease = 2.9; 95%
confidence interval = 1.3-6.4). In contrast, only 4% of cases and 9% of controls
were identified by the standardized code groups index as having worked in
silica-related industries or occupations for at least 12 months, providing a much
lower risk estimate for disease (0.4; 0.2-0.9). CONCLUSIONS: Specific task-based
questions must be included to assess the full potential of occupational silica
exposure. These findings highlight the limitations of using standardized code
groups to define exposure or to select jobs for industrial hygienist review.
Copyright 2004 Lippincott Williams and Wilkins
PMID: 15232404 [PubMed - indexed for MEDLINE]
93. J Agric Saf Health. 2004 Jan;10(1):17-25.
Operational characteristics of tractors driven by children on farms in the United
States and Canada.
Marlenga B, Pickett W, Berg RL, Murphy D.
National Children's Center for Rural and Agricultural Health and Safety,
Marshfield Clinic Research Foundation, 1000 North Oak Avenue, Marshfield, WI
54449, USA. marlenga.barbara@mcrf.mfldclin.edu
Farm tractors are an important source of traumatic injury for children on farms.
There is, however, no documentation about the age and size of tractors that
children are operating and little information about the frequency with which
rollover protective structures (ROPS) are used. This study described tractors
that children on farms in the U.S. and Canada were operating by age, horsepower,
and the presence of ROPS, according to the age and gender of the farm children
involved. As a sub-analysis of data compiled during a randomized controlled
trial, a descriptive analysis was completed on work exposure data collected by
telephone interview. Of the 1,113 children involved in the trial, 522 (47%) were
reported to perform at least one job that involved the operation of a farm
tractor, and 408 (36.7%) were operating tractors of at least 20 horsepower. The
majority of these children were male. There was a wide range of ages and sizes of
tractors operated. However, the majority of tractors were between 20 and 70
horsepower and manufactured after 1970. Nearly one-half of the tractors were
equipped with ROPS, and these tended to be newer and larger tractors. This
analysis provides new data about the broad range of tractors driven by farm
children in the U.S. and Canada. The findings point to a need to re-examine the
reliance on a single voluntary standard to mitigate the hazard of tractor
rollovers and the need for an enhanced safety policy requiring all tractors
operated by children be equipped with ROPS.
PMID: 15017802 [PubMed - indexed for MEDLINE]
94. Occup Environ Med. 2004 Feb;61(2):163-6.
Integrating qualitative methods into occupational health research: a study of
women flight attendants.
Ballard TJ, Corradi L, Lauria L, Mazzanti C, Scaravelli G, Sgorbissa F, Romito P,
Verdecchia A.
Italian National Institute of Health, Rome, Italy.
AIMS: To identify possible work related sources of psychosocial stress in order
to develop pertinent questionnaire items for a cross-sectional health survey of
3000 Italian women flight attendants, and to solicit suggestions on improving
survey participation. METHODS: Qualitative study in which 26 current and former
women flight attendants participated: three focus groups of 6-7 participants each
and six in-depth individual interviews. The session themes included positive and
negative aspects of the job; relationships with colleagues, superiors, and
passengers; perception of occupational risk for serious diseases; compatibility
of work and family; and experiences of work related sources of stress and their
effect on health. A transcript based analysis of the focus groups and interviews
was used to identify emerging themes related to risk factors for mental health
problems. RESULTS: The participants indicated that mental health was a major
concern. Several work related risk factors possibly related to adverse outcomes,
such as depression and anxiety, were highlighted. These included isolation and
solitude, fears of being inadequate partners and mothers due to job demands,
passenger relationships, and lack of protection by employers with respect to
workplace exposures and violent passengers. The information gained was used to
develop a mental health module for inclusion in the health survey questionnaire
which included questions on history of severe depression or anxiety, suicidal
ideation or attempt, substance abuse, workplace sexual harassment, social
support, leisure time activities, relationship with a partner, and role as
mother. CONCLUSIONS: Employing qualitative methods to identify work related
sources of psychosocial stress enabled development of pertinent questionnaire
items for a cross-sectional epidemiological study of women flight attendants.
Follow up qualitative research may be necessary in order to put the
cross-sectional study findings into context and to explore actions or strategies
for preventing work related health problems evidenced from the survey.
PMCID: PMC1740718
PMID: 14739383 [PubMed - indexed for MEDLINE]
95. Pain. 2003 Dec;106(3):221-8.
Epidemiology of chronic non-malignant pain in Denmark.
Eriksen J, Jensen MK, Sjĝgren P, Ekholm O, Rasmussen NK.
Multidisciplinary Pain Centre, H:S Rigshospitalet, Copenhagen, Denmark.
jeriksen@rh.dk
Comment in:
Pain. 2003 Dec;106(3):213-4.
A series of health surveys are conducted every sixth to seventh year in Denmark.
In the most recent survey of 2000, a national random sample (>16 years) was drawn
from the Danish Central Personal Register. Out of the original sample 12,333
(74%) were interviewed and of these 10,066 returned a completed questionnaire
(SF-36). The present study includes only those who both took part in the
interview and the postal questionnaire. Cancer patients were excluded. Persons
suffering from chronic pain (PG) were identified through the question 'Do you
have chronic/long lasting pain lasting 6 months or more'? An overall chronic pain
prevalence of 19% was found -16% for men and 21% for women. Prevalence of chronic
pain increased with increasing age. Persons >/=67 years had 3.9 higher odds of
suffering from chronic pain than persons in the age group 16-24 years. Compared
with married persons, divorced or separated persons had 1.5 higher odds of
chronic pain. Odds for chronic pain were 1.9 higher among those with an education
of less than 10 years compared with individuals with an education of 13 years or
more. During a 14-day period reporters of chronic pain had an average of 0.8 days
(range 0-10) lost due to illness compared with an average of 0.4 days (range
0-10) for the control group (CG) (Odds Ratio (OR)) 2.0). Persons with a job which
required high physical strain were more likely to report chronic pain compared
with those with a sedentary job (OR 2.2). The odds of quitting one's job because
of ill health were seven times higher among people belonging to the PG. A strong
association between chronic pain and poor self-rated health was also
demonstrated. The PG had twice as many contacts with various health professionals
compared with the CG, and the health care system was, on average, utilised 25%
more (overall contacts) by the PG than by the general population. Among the
persons in the PG, 33% were not satisfied with the examinations carried out in
connection with their pain condition and 40% were not satisfied with the
treatment offered. Nearly 130,000 adults, corresponding to 3% of the Danish
population, use opioids on a regular basis. Opioids are used by 12% of the PG.
PMID: 14659505 [PubMed - indexed for MEDLINE]
96. Mutagenesis. 2003 Nov;18(6):533-7.
Associations between oxidative stress levels and total duration of engagement in
jobs with exposure to fly ash among workers at municipal solid waste
incinerators.
Yoshida R, Ogawa Y, Mori I, Nakata A, Wang R, Ueno S, Shioji I, Hisanaga N.
National Institute of Industrial Health, 6-21-1 Nagao, Kawasaki, Kanagawa
214-8585, Japan.
The fly ash from municipal solid waste incinerators (MSWIs) is known to contain
heavy metals, polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated
dibenzofurans (PCDFs), polyaromatic hydrocarbons (PAHs), and other organic
materials. Heavy metals, PCDDs, PCDFs and PAHs reportedly cause oxidative stress
in vitro and in vivo. In this study, we have measured the blood and urinary
levels of several oxidative stress markers in MSWI workers and discuss herein
whether the duration of engagement in jobs with exposure to MSWI fly ash is
associated with these levels. The subjects were 81 male workers (mean age 42.7
years) from four MSWIs in the same city. Job history was determined from each
subject and jobs were categorized according to the possibility of exposure to fly
ash. The subjects were classified into four groups: long duration of engagement
in jobs with exposure to fly ash, short duration of engagement in jobs with
exposure to fly ash, engagement in jobs with limited exposure to fly ash and
control. Blood and urine specimens were obtained from the subjects in the morning
before breakfast. The levels of 8-hydroxy-2'-deoxyguanosine (8-OH-dG) in the
urine and leukocytes were measured as markers of oxidative DNA damage. Blood
malondialdehyde and lipid peroxide levels and the level of total urinary
biopyrrins were also measured as markers of systemic oxidative stress. The mean
levels of all markers were compared among the four groups. There was a
significant trend showing that the level of urinary 8-OH-dG rose with increased
duration of engagement in jobs with exposure to MSWI fly ash (P<0.05).
Considering this result, we speculate that certain chemicals in fly ash might
have induced oxidative stress in the study subjects.
PMID: 14614189 [PubMed - indexed for MEDLINE]
97. Soc Sci Med. 2003 Dec;57(11):2173-82.
Inequalities in nonfatal work injury: the significance of race, human capital,
and occupations.
Oh JH, Shin EH.
Department of Sociology, Hunter College, The City University of New York, New
York, NY 10021, USA. goh@hunter.cuny.edu
Little research is conducted to examine the determinants of nonfatal injury on
the job. In particular, this study stresses the importance of race, human
capital, and occupational conditions in explaining nonfatal injury at work. It
measures nonfatal work injury as an episode of work injury, using the data from
the 1988 Occupational Health Supplement (1988 OHS) to the National Health
Interview Survey (NHIS). First, this study confirms no association between race
and nonfatal injury at work. Second, the findings show that human capital,
expressed through education and work experience, is the crucial determinant of
nonfatal injury at work. In general, workers of more years of schooling and more
work experience encounter less nonfatal injury at work than their counterparts.
Third, the results also demonstrate the significance of occupational conditions
(occupational positions and work activity) for nonfatal injury at work.
Specifically, workers in professional occupations experience less work injury
than workers in production occupations, but more work injury than workers engaged
in clerical jobs. Even after controlling for occupational positions, there is a
significant correlation between work activity and nonfatal work injury. Our study
is a first step towards the causation of nonfatal injury on the job in terms of
race, human capital, and occupational conditions. Therefore, the next step of
work injury study needs to consider the influence of the other important
determinants on nonfatal injury at work.
PMID: 14512247 [PubMed - indexed for MEDLINE]
98. Scand J Work Environ Health. 2003 Aug;29(4):270-9.
Trends in the Danish work environment in 1990-2000 and their associations with
labor-force changes.
Burr H, Bjorner JB, Kristensen TS, Tüchsen F, Bach E.
National Institute of Occupational Health, Copenhagen, Denmark. hb@ami.dk
OBJECTIVES: The aims of this study were (i) to describe the trends in the work
environment in 1990-2000 among employees in Denmark and (ii) to establish whether
these trends were attributable to labor-force changes. METHODS: The split-panel
design of the Danish Work Environment Cohort Study includes interviews with three
cross-sections of 6067, 5454, and 5404 employees aged 18-59 years, each
representative of the total Danish labor force in 1990, 1995 and 2000. In the
cross-sections, the participation rate decreased over the period (90% in 1990,
80% in 1995, 76% in 2000). The relative differences in participation due to
gender, age, and region did not change noticeably. RESULTS: Jobs with decreasing
prevalence were clerks, cleaners, textile workers, and military personnel. Jobs
with increasing prevalence were academics, computer professionals, and managers.
Intense computer use, long workhours, and noise exposure increased. Job
insecurity, part-time work, kneeling work posture, low job control, and skin
contact with cleaning agents decreased. Labor-force changes fully explained the
decline in low job control and skin contact to cleaning agents and half of the
increase in long workhours, but not the other work environment changes.
CONCLUSIONS: The work environment of Danish employees improved from 1990 to 2000,
except for increases in long workhours and noise exposure. From a specific work
environment intervention point of view, the development has been less encouraging
because declines in low job control, as well as skin contact to cleaning agents,
were explained by labor-force changes.
PMID: 12934720 [PubMed - indexed for MEDLINE]
99. J Med Libr Assoc. 2003 Jul;91(3):322-36.
Benchmarking information needs and use in the Tennessee public health community.
Lee P, Giuse NB, Sathe NA.
The Annette and Irwin Eskind Biomedical Library Vanderbilt University Medical
Center Nashville, Tennessee, USA. patricia.lee@vanderbilt.edu
OBJECTIVE: The objective is to provide insight to understanding public health
officials' needs and promote access to data repositories and communication tools.
METHODS: Survey questions were identified by a focus group with members drawn
from the fields of librarianship, public health, and informatics. The resulting
comprehensive information needs survey, organized in five distinct broad
categories, was distributed to 775 Tennessee public health workers from
ninety-five counties in 1999 as part of the National Library of Medicine-funded
Partners in Information Access contract. RESULTS: The assessment pooled responses
from 571 public health workers (73% return rate) representing seventy-two of
ninety-five counties (53.4% urban and 46.6% rural) about their
information-seeking behaviors, frequency of resources used, computer skills, and
level of Internet access. Sixty-four percent of urban and 43% of rural
respondents had email access at work and more than 50% of both urban and rural
respondents had email at home (N = 289). Approximately 70% of urban and 78% of
rural public health officials never or seldom used or needed the Centers for
Disease Control (CDC) Website. Frequency data pooled from eleven job categories
representing a subgroup of 232 health care professionals showed 72% never or
seldom used or needed MEDLINE. Electronic resources used daily or weekly were
email, Internet search engines, internal databases and mailing lists, and the
Tennessee Department of Health Website. CONCLUSIONS: While, due to the small
sample size, data cannot be generalized to the larger population, a clear trend
of significant barriers to computer and Internet access can be identified across
the public health community. This contributes to an overall limited use of
existing electronic resources that inhibits evidence-based practice.
PMCID: PMC164395
PMID: 12883562 [PubMed - indexed for MEDLINE]
100. Reprod Health Matters. 2003 May;11(21):37-48.
Integrating reproductive health services in a reforming health sector: the case
of Tanzania.
Oliff M, Mayaud P, Brugha R, Semakafu AM.
Clinical Research Unit, Department of Infectious and Tropical Diseases, London
School of Hygiene and Tropical Medicine (LSHTM), London, UK.
Universal access to comprehensive reproductive health services, integrated into a
well-functioning health system, remains an unfulfilled objective in many
countries. In 2000-2001, in Tanzania, in-depth interviews were conducted with
central level stakeholders and focus group discussions held with health
management staff in three regional and nine district health offices, to assess
progress in the integration of reproductive health services. Respondents at all
levels reported stalled integration and lack of synchronisation in the planning
and management of key services. This was attributed to fear of loss of power and
resources among national level managers, uncertainty as to continuation of donor
support and lack of linkages with the Health Sector Reform Secretariat. Among
reproductive health programmes, sexually transmitted infection (STI) control
alone retained its vertical planning, management and implementation structures.
District-level respondents expressed frustration in their efforts to coordinate
STI service delivery with other, more integrated programmes. They reported
contradictory directives and poor communication channels with higher levels of
the Ministry of Health; lack of technical skills at district level to undertake
supervision of integrated services; low morale due to low salaries; and lack of
district autonomy in decision-making. Integration requires a coherent policy
environment. The uncoordinated and conflicting agendas of donors, on whom
Tanzania is too heavily reliant, is a major obstacle.
PMID: 12800702 [PubMed - indexed for MEDLINE]
101. J Health Organ Manag. 2003;17(1):53-68.
Part-time work and job sharing in health care: is the NHS a family-friendly
employer?
Branine M.
Dundee Business School, University of Abertay Dundee, Dundee, UK.
This paper examines the nature and level of flexible employment in the National
Health Service (NHS) by investigating the extent to which part-time work and job
sharing arrangements are used in the provision and delivery of health care. It
attempts to analyse the reasons for an increasing number of part-timers and a
very limited number of job sharers in the NHS and to explain the advantages and
disadvantages of each pattern of employment. Data collected through the use of
questionnaires and interviews from 55 NHS trusts reveal that the use of part-time
work is a tradition that seems to fit well with the cost-saving measures imposed
on the management of the service but at the same time it has led to increasing
employee dissatisfaction, and that job sharing arrangements are suitable for many
NHS employees since the majority of them are women with a desire to combine
family commitments with career prospects but a very limited number of employees
have had the opportunity to job share. Therefore it is concluded that to attract
and retain the quality of staff needed to ensure high performance standards in
the provision and delivery of health care the NHS should accept the diversity
that exists within its workforce and take a more proactive approach to promoting
a variety of flexible working practices and family-friendly policies.
PMID: 12800280 [PubMed - indexed for MEDLINE]
102. Eur J Appl Physiol. 2003 Aug;89(6):536-47. Epub 2003 May 1.
Physical demands in working life and individual physical capacity.
Karlqvist L, Leijon O, Härenstam A.
National Institute for Working Life, 112 79 Stockholm, Sweden.
lena.karlqvist@niwl.se
The purpose of this study was to investigate the prevalence of the excess of
metabolic level (metabolic demands in work exceeding one-third of the
individual's aerobic capacity) of working men and women today and to describe the
population whose metabolic level is exceeded. A second aim was to explore how
externally assessed metabolic demands match with the physical function and
capacity of working men and women in jobs with the lowest and the highest
demands. The aerobic power of each individual (94 men and 94 women) was estimated
from heart rate and workload in sub-maximal tests from dynamic legwork on a cycle
ergometer. Physical activity was assessed using a task-oriented interview
technique. Physical function was measured by tests of muscle endurance in arms,
abdomen and legs, handgrip pressure, balance and coordination. The calculation of
individual metabolic demands during a "typical working day" showed that 27% of
the men and 22% of the women exceeded their metabolic level. The results indicate
that the physical fitness is low or somewhat low for two-thirds of the 94 men and
for more than one-half of the 94 women. Women in the group with the highest job
demands had significantly lower muscle endurance in the abdomen and legs and
worse coordination than women in the group with the lowest job demands. Metabolic
demands in working life today remain high. This is reflected in a mismatch
between individual physical capacity and the physical demands of work for 25% of
the population.
PMID: 12728324 [PubMed - indexed for MEDLINE]
103. Nurs Manag (Harrow). 2003 Feb;9(9):14-9.
Recruitment and retention in the NHS. A study in motivation.
Joshua-Amadi M.
PMID: 12640935 [PubMed - indexed for MEDLINE]
104. Can J Clin Pharmacol. 2002 Winter;9(4):205-13.
A retrospective survey of the use of bupropion slow release by members of the
Canadian Armed Forces.
Vaillancourt R, Wagenaar H, Fisher C, Conway RD, Plemel J.
Canadian Forces Health Services, Ottawa, Ontario, Canada.
ab672@issc.debbs.ndhg.dnd.ca
BACKGROUND: Since the addition of bupropion slow release (Zyban, GlaxoSmithKline,
Mississauga) to the Department of National Defence (DND) smoking cessation
program (Butt Out), utilizing bupropion (Zyban) in combination with behaviour
modification counselling, the Directorate of Medical policy has received several
anecdotal reports from pharmacists and Canadian Forces members attributing
significant side effects to the use of Zyban. As a result, the DND wished to
assess the benefits versus the risks of using Zyban as part of the smoking
cessation program. Subsequently, a retrospective review of the use of Zyban
within the Canadian Forces over a one-year period was solicited to assess current
policies. METHODS: Surveys were sent to Canadian Forces members receiving Zyban
between September 1, 1998 and August 31, 1999. Members were questioned about
smoking history and current status, perceived effectiveness of bupropion and both
positive and negative experiences with the drug. Those reporting side effects and
who had consented were contacted for an interview to obtain further details and
information regarding the use of medical resources and effects on job
performance. Members of the Canadian Forces visiting a doctor due to side effects
were asked for permission to review their medical charts. RESULTS: Zyban was
dispensed to approximately 1171 members over the one-year period and 357
responded to the survey. The point prevalence smoking cessation rate was 47% at
the time of the survey and ex-smokers had been smoke-free for a mean of 181 days.
Approximately 91% of ex-smokers and 52% of smokers found Zyban helpful in
quitting. Side effects were reported by 252 members and 160 interviews were
completed. Forty-three interviewees had seen a doctor because of side effects.
Sixteen of the 43 charts were audited. Fifty-two respondents stated that side
effects affected their ability to do their primary job. Two individuals were
hospitalized for a total of six days. CONCLUSIONS: In light of the demonstrated
effectiveness of Zyban and the overwhelming health benefits associated with
smoking cessation, it is recommended that the current policies of funding for the
DND smoking cessation program be left in place. The impact of Zyban's side
effects on job performance and medical resources should be minimized through
close monitoring and Zyban prescriptions should be dispensed in two-week
quantities.
PMID: 12584579 [PubMed - indexed for MEDLINE]
105. J Adv Nurs. 2002 Nov;40(4):475-83.
An evaluation of the role of the Clinical Placement Coordinator in student nurse
support in the clinical area.
Drennan J.
School of Nursing and Midwifery, University College Dublin, Dublin, Ireland.
jonathan.drennan@ucd.ie
PURPOSE OF THE STUDY: The purpose of this study was to evaluate the role of the
Clinical Placement Coordinator (CPC) and the continued development of the role in
the context of the provision of student support in the clinical area. BACKGROUND:
Following the introduction of the Registration/Diploma in Nursing Studies
programme in the Republic of Ireland in 1994 the post of CPC was created to
support student nurses in the clinical area. The CPC is an experienced nurse who
provides dedicated support to student nurses in a variety of clinical settings
however, unlike the role of mentor/preceptor they do not have a client/patient
caseload. To date no major evaluation of the post has taken place. Therefore the
Department of Health and Children commissioned a national evaluation of the post
of which part of the findings are reported in this paper. METHODOLOGY: A
two-stage study is described utilizing a mixed-methods approach. Data collection
included individual and focus group interviews and questionnaires. Interviews
were analysed using thematic content analysis and data collected from
questionnaires were analysed utilizing descriptive and inferential statistics.
FINDINGS: An analysis of the data identified the responsibilities and functions
of CPC were multivariate, however, core elements of the role were evident. The
core elements were identified as student support and practice development. The
central and most frequent finding from the data collected was the individual
support students received from CPCs throughout their clinical placement.
CONCLUSION: The role of CPC was evaluated as a positive addition to the realm of
student support and the clinical team. The positioning of the post in the
clinical area also adds the dimension of a CPC being a link between student
nurses and the various groups that provide student support, this is essential in
light of the changing role of the nurse tutor following the full integration of
preregistration nurse education into the third-level sector and the development
of a formal preceptorship role for clinical nurses in the Republic of Ireland.
PMID: 12421407 [PubMed - indexed for MEDLINE]
106. Health Soc Care Community. 2002 Sep;10(5):370-81.
The research potential of practice nurses.
Davies J, Heyman B, Bryar R, Graffy J, Gunnell C, Lamb B, Morris L.
St Bartholomew School of Nursing and Midwifery, City University, London, UK.
Little is known about the research aspirations and experiences of practice
nurses. The study discussed in the present paper had three main aims: (1) to
assess the level of research interest among practice nurses working in Essex and
East London, UK; (2) to identify practice nurses' research priorities; and (3) to
explore factors which facilitate and impede the development of practice nursing
research. All practice nurses (n = 1,054) in the above areas were sent a
questionnaire, and a total of 40% (n = 426) responded after two follow-up
letters. Fifty-five respondents who volunteered for further participation were
interviewed, either individually or in focus groups. About half (n = 207) of the
survey respondents expressed an interest in undertaking research. One-third (n =
145) reported previous participation in research, and 20% (n = 85) had initiated
their own research. Logistic regression showed that practice nurses educated to
graduate level, and those working in practices with nurse training or
participation in external research, were most likely to want to undertake
research. Working in a medical training practice was found to be a negative
predictor of research interest. Respondents prioritised research into long-term
health problems with a high prevalence in the local population; for example,
diabetes. Their reasons for wishing to engage in research included improving the
service, career development, making work more interesting and reducing isolation.
The main barriers identified were lack of time, lack of support from some general
practitioners and poor access to higher education resources outside formal
courses. The development of practice nurse research would provide a distinctive
perspective on health need and service provision. It would contribute to the
achievement of the national strategic objective of improving the quality of
primary care, enhance the status of the profession, utilise the enthusiasm of
individuals, increase job satisfaction and staff retention, and answer real
questions.
PMID: 12390223 [PubMed - indexed for MEDLINE]
107. Occup Environ Med. 2002 Oct;59(10):680-8.
Working hours spent on repeated activities and prevalence of back pain.
Guo HR.
Graduate Institute of Environmental and Occupational Health, Medical College,
National Cheng Kung University, Taiwan. hrguo@mail.ncku.edu.tw
BACKGROUND AND AIMS: Back pain is the most common reason for filing workers'
compensation claims in the United States and affects large numbers of workers in
many other countries. To evaluate the associations between working hours spent on
repeated activities and back pain, data gathered through the 1988 National Health
Interview Survey were analysed. The data were also used to identify high risk
occupations. METHODS: A total of 30 074 workers participated in the survey. They
were asked to provide information on their job, including the time spent on
repeated strenuous physical activities (RSPA) and the time spent on repeated
bending, twisting, or reaching (RBTR) on a typical job. A case of back pain was
defined as a worker who had back pain every day for a week or more during the
past 12 months. Each case was asked to report the cause of back pain. Those who
attributed their back pain to repeated activities (RA) or a single accident or
injury (AI) were asked to recall whether they performed RA or had the AI at work.
RESULTS: Whereas the prevalence of back pain increased as the number of working
hours spent on RSPA or RBTR increased, the dose-response relations were not
linear for either factor, suggesting the involvement of other unmeasured factors.
The estimated overall prevalence of RA back pain was 8.9% among male workers and
5.9% among female workers. "Carpenters" had the highest prevalence (19.2%) and
most cases (338 000) among the major occupations of men, and "nursing aides,
orderlies, and attendants" had the highest prevalence (15.2%) and most cases (217
000) among the major occupations of women. CONCLUSIONS: The number of hours spent
on repeated activities at work was associated with the prevalence of back pain.
This study identified high risk occupations for future research and intervention.
PMCID: PMC1740219
PMID: 12356929 [PubMed - indexed for MEDLINE]
108. Health Serv Manage Res. 2002 Aug;15(3):147-64.
Reconceptualizing case management in theory and practice: a frontline
perspective.
Yarmo Roberts D.
The University of Melbourne, Department of General Practice and Public Health,
Melbourne, Victoria, Australia.
'Case management' in the health and social service sector is controversial,
highly political and saturated with conflicting agendas among stakeholders.
Research was conducted recently to explore the role of case managers in three
evolving, Australian-based, long-term care, case management models. The findings
have relevance to countries worldwide that contend with delivering quality care
that is cost effective. The research captures the perspectives of 51 open-ended
interviews with front-line case managers who have first-hand knowledge of the
models' effect on their clients and on their own roles. Contrary to the rhetoric
that case management is client-centred, case management is concluded to be
'system centred' based on a unilateral approach taken by each of the three
models. Case managers had a limited ability to attain necessary services for
clients. Success was dependent on the range of case managers' skills and
experience, relationship with the client, degree of job satisfaction, level of
influence in the health and social system and ability to collaborate with
relevant professionals. The relationship between the three primary influences
(system, model, client) affecting case managers' pursuit of achieving appropriate
client services was also reviewed. A reconceptualized multidimensional approach,
or 'neo-process-centred' case management, is proposed. The revised approach can
be applied to existing and new models and has direct implications for policy
makers, management and practitioners aspiring to improve client care within
existing constraints.
PMID: 12184835 [PubMed - indexed for MEDLINE]
109. Int Arch Occup Environ Health. 2002 Sep;75(7):511-4. Epub 2002 May 25.
A validation of information on occupation--data from a nested case-control study.
Soll-Johanning H, Hannerz H.
National Institute of Occupational Health, Lersĝ Parkalle 105, 2100 Copenhagen,
Denmark. hsj@ami.dk
OBJECTIVES: To evaluate the validity of information about employment obtained
from self-respondents and proxies in a nested case-control study. METHODS: We
interviewed 230 self-respondents and 652 proxies covering 237 cancer cases and
645 controls. Questions about employment as a bus driver, other jobs, and
residence were asked. Golden standard was employment data obtained from personnel
records. RESULTS: All categories of respondents tended to over-report the length
of employment, and respondents aged above 70 years had significantly decreased
odds ratio for disagreement between interview and company files compared with
respondents below the age of 60 years. There were no significant differences in
whether the respondent was a case or control as there were no differences in
whether the respondent was a self-respondent or a proxy. The validity of the
reported employment time was statistically independent of the interval between
death and proxy contact. Compared with the self-responders, the proxies reported
significantly fewer jobs and residential areas. CONCLUSIONS: In general, data
obtained from cases and controls not knowing that the study was about cancer and
without the interviewer's knowing who were cases and who were controls appeared
good. The quality of information obtained from proxies appeared good as well.
There seems to be no problem in interviewing very old people about a specific job
when they are mentally prepared for it. The time interval between death and proxy
contact was without importance.
PMID: 12172899 [PubMed - indexed for MEDLINE]
110. Health Soc Care Community. 2002 May;10(3):144-50.
Comparing and contrasting the role of family carers and nurses in the domestic
health care of frail older people.
Pickard S, Glendinning C.
National Primary Care Research and Development Centre, University of Manchester,
Manchester, UK. Susan.pickard@man.ac.uk
Care in the community has been constructed on the basis of professional support
for carers who, as a result of community care policy that has released highly
dependant people from residential care and long-stay wards, are carrying out a
wide range of tasks, including complex health care activities. The present paper
examines the health care activities currently undertaken by family carers and the
way in which they work with, and are supported by, professional nurses in the
home. It compares and contrasts the approaches of both groups to care-giving for
this client group. The authors conclude by making some suggestions for improving
the way in which family carers and nurses work together in the home.
PMID: 12121250 [PubMed - indexed for MEDLINE]
111. Health Serv Manage Res. 2002 May;15(2):93-105.
The NHS Plan: nurse satisfaction, commitment and retention strategies.
Newman K, Maylor U.
Middlesex University Business School, The Burroughs, London NW4 4BT, UK.
k.newman@mdx.ac.uk
The NHS Plan envisages a paradigm shift from a centralized, producer-led National
Health Service (NHS) to a devolved, patient-centred health care service, fuelled
by a substantial investment in human resources, beds, hospitals and
infrastructure. The planned net increase of 20,000 nurses by 2004 is examined in
the light of findings from a qualitative study of nurse satisfaction, commitment
or intention to leave their hospital, nursing or the NHS, involving 124 nurses in
four London hospitals. This paper presents nurses' perceptions and rankings of
retention strategies and we compare these with the Plan's proposals. Lastly we
propose an integrated approach to examining and dealing with the complex issue of
nurse recruitment, retention and quality of patient care, based on a conceptual
framework, the Nurse Satisfaction, Service Quality and Nurse Retention Chain,
which highlights the scope of the challenges confronting the Plan, in both design
and implementation of proposals designed to improve working conditions as a
foundation for nurse recruitment and retention. Our principal findings are that
just 57% of our interviewees may be viewed as 'core loyals' to the profession,
12% are serious in their intention to leave and the remainder may be sensitive to
further deterioration in working conditions or a failure to meet expectations on
pay. Such findings if realized clearly threaten the Plan's success.
PMID: 12028798 [PubMed - indexed for MEDLINE]
112. Br Dent J. 2002 Feb 23;192(4):191-6.
Better opportunities for women dentists: a review of the contribution of women
dentists to the workforce.
Murray JJ.
Dertal School, Newcastle upon Tyne. j.murray@ncl.ac.uk
In June 2000 the Department of Health commissioned a review to examine the need
for improvements to the employment opportunities for women dentists in the
National Health Service (NHS) across England. Dame Margaret Seward carried out
the review, which was published in September 2001. The review was considered
necessary for four main reasons. Firstly, workforce panning, because now more
than 50% of new entrants to dental undergraduate courses in the UK are female and
by 2020 over 50% of all practising dentists will be female. Secondly, evidence
that 50% of women in dentistry work for no more than two days per week for the
NHS. Thirdly, most women work either as associates in general dental practice
(GDP) or in the Community Dental Service (CDS). Lastly, the perception that women
find it difficult to return to dentistry after taking a career break.
PMID: 11931482 [PubMed - indexed for MEDLINE]
113. Int J Obes Relat Metab Disord. 2002 Feb;26(2):247-52.
The relationship of overweight and obesity with subjective health and use of
health-care services among Spanish women.
Guallar-Castillón P, López García E, Lozano Palacios L, Gutiérrez-Fisac JL,
Banegas Banegas JR, Lafuente Urdinguio PJ, Rodriguez Artalejo F.
Centro Universitario de Salud Pública, Consejería de Sanidad y Universidad
Autónoma de Madrid, Madrid, Spain.
OBJECTIVE: To examine the relationship of overweight and obesity with subjective
health and use of health-care services among women in Spain. METHODS: Data were
drawn from the 1993 Spanish National Health Survey, covering a 13 244-woman
sample representative of the non-institutionalised Spanish population aged 16 y
and over. Information was collected through home-based interviews. Multiple
logistic regression models were used to calculate odds ratios for suboptimal
health (fair, poor or very poor) and utilisation of health-care services by women
with normal weight (BMI 18.5-24.9 kg/m(2)), overweight (BMI 25.0-29.9 kg/m(2))
and obesity (BMI>or=30 kg/m(2)). Analyses were adjusted for age, education level,
occupation, civil status, social support, tobacco use, alcohol consumption,
physical activity at work and during leisure time, job status and town of
residence. RESULTS: Frequency of suboptimal health was higher in women with
overweight (OR 1.7; 95% CI 1.5-1.9) and obesity (OR 2.1; 95% CI 1.8-2.5) than in
those with normal weight. Overweight and obese women visited the physician, used
hospital emergency services and took medication with greater frequency than did
women of normal weight. There was a positive dose-response relationship (P<0.05)
of BMI>or=18.5 kg/m(2) with suboptimal health and utilisation of health-care
services. These associations were not wholly explained by BMI-related risk
factors and chronic diseases, since their statistical significance remained
unchanged and their magnitude was only slightly reduced after adjustment for
those factors. The association of overweight and obesity with the use of
health-care services did not vary with age, educational level or presence of
chronic disease. CONCLUSION: Overweight and obese women have worse subjective
health and make greater use of health-care services. This finding is an
additional argument for implementing weight-control programmes in Spain.
PMID: 11850758 [PubMed - indexed for MEDLINE]
114. J Adv Nurs. 2002 Mar;37(5):485-93.
Inequalities in health care provision: the relationship between contemporary
policy and contemporary practice in maternity services in England.
Hart A, Lockey R.
Centre for Nursing and Midwifery Research, University of Brighton Falmer,
Brighton, UK. a.hart@brighton.ac.uk
AIM: The project Addressing Inequalities in Health: new directions in midwifery
education and practice (Hart et al. 2001) was commissioned by the English
National Board for Nursing, Midwifery and Health Visiting (ENB). Here, we draw on
those research findings to consider current midwifery policy and practice in
England. BACKGROUND: Little guidance on providing equality of care exists for
midwives. The Code of Conduct [United Kingdom Central Council for Nursing,
Midwifery and Health Visiting (UKCC) 1992] makes no specific requirement for
midwives to address issues of inequalities of health in their practice. Recent
policy documents emphasize the need to work towards reducing inequalities and to
target practice to 'disadvantaged clients' without giving guidelines on how to
identify and care for target groups. METHODS: In-depth studies of midwifery
education and service provision were conducted in three very different parts of
England. Three months of fieldwork were undertaken at each site, comprising a
series of interviews with midwifery educators, managers, students, midwives and
service users. Focus groups were also held and observation of classroom sessions
and midwifery practice undertaken. Findings. A lack of clear and specific
strategies concerning inequalities in health was evident at managerial level.
Patchy knowledge of current policy was also evident amongst practising midwives.
Specific projects with disadvantaged clients usually resulted from a particular
midwife's personal interest or evident local need. All midwives emphasized the
importance of 'equality of care'. How this was operationalized varied, and
'individualized' or 'woman-centred' care was assumed to encompass the concept. In
the few examples where care was systematically targeted in accordance with policy
directives, the midwife's public health role was increased. CONCLUSION: In the
absence of a co-ordinated strategic vision driven by managers, practitioners find
difficulty in prioritizing care and targeting resources to disadvantaged clients
in line with policy directives. Tensions between policy and practice in the care
of 'disadvantaged' women clearly exist. Successful implementation of policy at
practice level needs: commitment from managers; clarity of purpose in
documentation; and provision of specific targets for practitioners. However, the
latter should remain flexible enough for the delivery of care to be appropriate
and sensitive to individual needs.
PMID: 11843988 [PubMed - indexed for MEDLINE]
115. Br J Gen Pract. 2001 Apr;51(465):286-90.
Rural general practitioners' experience of the provision of out-of-hours care: a
qualitative study.
Cuddy NJ, Keane AM, Murphy AW.
Department of General Practice, National University of Ireland, Galway.
general.practice@nuigalway.ie
BACKGROUND: Published research into the provision and utilisation of out-of-hours
services shows long-term trends towards decreasing personal commitment among
general practitioners (GPs). However, the on-call commitments of rural GPs remain
especially onerous. There has been little research relating to either rural
out-of-hours services or the implications of such services for the families of
the providers. AIM: To explore and describe how rural GPs in Ireland perceive and
experience out-of-hours care provision. DESIGN OF STUDY: A qualitative study was
conducted with 10 rural GPs and their spouses in their homes or practices using
one-to-one in-depth interviews. SETTING: Ten general practices in rural Ireland.
METHOD: The interviews were guided by an interview schedule that was based on
pertinent themes that had emerged from previous relevant literature. The
interviews were audiotaped, transcribed, and analysed for themes and issues.
RESULTS: Results indicated that rural GPs experience a wide variety of
satisfactions from work related to the provision of out-of-hours care. However,
the large proportion of time committed to out-of-hours care greatly infringes on
their social and family life. The key stressors identified related to
organisational system difficulties, especially with regard to locum cover, and
unrealistic patient expectations. The stressors were mainly expressed as lack of
time off, restrictions on family life, and interruptions. CONCLUSION: System
difficulties, such as difficulty with obtaining locums and rota extension, need
to be addressed at an organisational level. Patient expectations of the role of
the rural GP have significant implications for practitioners and their families.
PMCID: PMC1313978
PMID: 11458481 [PubMed - indexed for MEDLINE]
116. J Adv Nurs. 2001 Apr;34(1):7-17.
The changing training needs of clinical nurse managers: exploring issues for
continuing professional development.
Gould D, Kelly D, Goldstone L, Maidwell A.
Faculty of Health, South Bank University, London, UK. dinah.gould@sbu.ac.uk
AIMS OF THE STUDY: To identify areas where clinical nurse managers perceived that
they would benefit from further training and to make recommendations for planning
future programmes to meet their needs. BACKGROUND: The effectiveness of the
clinical nurse manager has traditionally been associated with maintaining
standards of care. Continuing professional development (CPD) is essential to
ensure this important group feel adequately prepared to perform their role and
has been recognized as an important factor in maintaining job satisfaction and
reducing wasteful staff turnover. A review of the literature indicated that since
the 1980s the CPD needs of clinical nurse managers have tended to be overlooked
despite increasing complexity of the tasks expected of them. Thus it appeared
that a fresh study to address these needs would be justified and should take into
account sources of work-related stress and variables relating to job
satisfaction. METHODS: The study involved clinical nurse managers employed in all
four acute hospital National Health Service (NHS) trusts where training needs
were served by a major inner city educational consortium. Data collection
proceeded in two stages. Initially interviews were undertaken with a random
sample of 15 clinical nurse managers to provide in-depth, qualitative data. This
information was used to develop a survey questionnaire distributed to the
remaining 182 clinical nurse managers in each of the trusts. RESULTS: Data from
the interviews indicated that clinical nurse managers appeared to feel clinically
competent but generally experienced lack of confidence when dealing with a range
of issues, in particular; human resources, managing budgets, deputizing for
senior colleagues across the trust ('acting up') and using information technology
in everyday practice. Response rate to the survey was good (65%). The results
corroborated the interview findings, indicating a need for updating in the same
wide range of topics. There were few differences in training needs across all
four trusts. Clinical nurse managers who perceived that they had been
well-prepared for their role demonstrated higher levels of job satisfaction.
Perceived preparation for clinical leadership was the same irrespective of the
employing trust, length of time in post and other sociodemographic variables.
CONCLUSIONS: The study findings confirm that CPD remains a major issue for
clinical nurse managers in the United Kingdom (UK) and that providing
opportunities for such development may be an important factor in enhancing job
satisfaction. The study findings should help those providing CPD to plan more
effectively for this group and have implications for staff recruitment and
retention.
PMID: 11430609 [PubMed - indexed for MEDLINE]
117. Am J Epidemiol. 2001 Jun 15;153(12):1227-32.
Comparison of assessment methods for pesticide exposure in a case-control
interview study.
Daniels JL, Olshan AF, Teschke K, Hertz-Picciotto I, Savitz DA, Blatt J.
Epidemiology Branch, National Institute of Environmental Health Sciences,
Research Triangle Park, NC 27709, USA. daniels1@niehs.nih.gov
In epidemiologic studies, much of the variation in disease risk estimates
associated with occupational pesticide exposure may be due to variation in
exposure classification. The authors compared five different methods of using
interview information to assess occupational pesticide exposure in a US-Canada
case-control study of neuroblastoma (1992-1994). For each method, exposure
assignment was compared with that of a reference method, and neuroblastoma effect
estimates were calculated. Compared with the reference method, which included a
complete review of occupation, industry, job tasks, and exposure-specific
activities, the use of occupation-industry groups alone or in combination with
general job task information diluted the exposed group by including individuals
who were unlikely to have been truly exposed. The effect estimates representing
associations between each exposure method and neuroblastoma were different enough
to influence the study's conclusions, especially when the exposure was rare (for
maternal occupational pesticide exposure, the odds ratio was 0.7 using the
reference exposure assessment method and 3.2 using the occupation-industry group
exposure assessment method). Exposure-specific questions about work activities
can help investigators distinguish truly exposed individuals from those who
report exposure but are unlikely to have been exposed above background levels and
from those who have not been exposed but are misclassified as exposed because of
their employment in an occupation-industry group determined a priori to be
exposed.
PMID: 11415959 [PubMed - indexed for MEDLINE]
118. J Adv Nurs. 2001 Jun;34(5):621-8.
Whither nursing? Discourses underlying the attribution of master's level
performance in nursing.
Ashworth PD, Gerrish K, McManus M.
Professor of Educational Research, Learning and Teaching Research Institute,
Sheffield Hallam University, Sheffield, UK.
AIM: Drawing upon the selected findings from a multidisciplinary study that
sought to explore the meaning of master's level performance in health
professional practice, the characteristics which nurse educators attributed to
the practice of master's level nursing graduates are analysed to reveal
underlying discourses. BACKGROUND: Although master's level programmes for nurses
have been available in the United Kingdom (UK) for the past three decades and
current heath policy directives link master's level qualifications with senior
clinical nursing roles, the contribution that master's level education might make
to the future direction of nursing is unclear. RESEARCH DESIGN AND METHODS:
In-depth interviews were undertaken with a purposive sample of 18 nurse lecturers
drawn from eight universities in the UK who were responsible for master's level
programmes in nursing. The interview agenda explored participants' perspectives
of the characteristics of master's level performance. Drawing upon the
methodology of discourse analysis, interview transcripts were interpreted in such
a way as to show the implicit discourses underlying the participants' claims
regarding their graduate's attributes of professional practice. FINDINGS: The
characteristics attributed to master's graduates were categorized under (a)
cognitive competencies, (b) practice-related competencies, (c) research
orientation and (d) personal dynamism. However, these attributions are not
empirical generalizations, developed inductively. Rather, they draw on socially
available discourses regarding the future direction of the profession.
CONCLUSION: The nurse educators drew on the following socially available
discourses: (a) a discourse in which nursing is construed as involving great
competence in practice, but without radicality of thought. Associated with this
is a pervasive rhetoric of pragmatism; (b) a discourse of interprofessional
practice in which nursing has a role of leadership. This is associated with a
view of the location and power of nursing within the structure of the National
Health Service and (c) notably lacking were discourses of care-giving, and of
academic/intellectual aspiration. The implications of these discourses for the
future direction of nursing are considered.
PMID: 11380730 [PubMed - indexed for MEDLINE]
119. Med J Aust. 2001 Apr 16;174(8):407-9.
Job-sharing in paediatric training in Australia: availability and trainee
perceptions.
Whitelaw CM, Nash MC.
Department of General Peadiatrics, Royal Children's Hospital, Melbourne, VIC.
Comment in:
Med J Aust. 2001 Sep 3;175(5):284; author reply 285.
Med J Aust. 2001 Sep 3;175(5):284; author reply 285.
Med J Aust. 2001 Apr 16;174(8):376-7.
Med J Aust. 2001 Sep 3;175(5):284-5.
OBJECTIVE: To examine the current availability of job-sharing in paediatric
training hospitals in Australia and to evaluate job-sharing from the trainees'
perspective. DESIGN: National survey with structured telephone interviews and
postal questionnai res. SETTING: The eight major paediatric training hospitals in
Australia. PARTICIPANTS: Directors of Paediatric Physician Training (DPPTs) at
each hospital (or a staff member nominated by them) provided information by phone
interview regarding job-sharing. All paediatric trainees who job-shared in 1998
(n=34) were sent written questionnaires, of which 25 were returned. RESULTS:
Hospitals differed in terms of whether a trainee was required to give a reason
for wishing to job-share, and what reasons were acceptable. One hospital stated
that two specialty units (Intensive Care and Neonatal Intensive Care) were
excluded from job-sharing, and another stated that certain units were unlikely to
be allocated job-sharers. The remaining six hospitals said that all units were
available for job-sharing, but the majority of their trainees disagreed. Only one
hospital had a cap on the number of job-share positions available yearly.
Trainees perceived benefits of job-sharing to include decreased tiredness,
increased enthusiasm for work, and the ability to strike a balance between
training and other aspects of life. Trainees believed job-sharing did not
adversely affect the quality of service provided to patients, and that part-time
training was not of lower quality than full-time training. CONCLUSIONS:
Job-sharing in Australian paediatric training hospitals varies in terms of the
number of positions available, eligibility criteria, and which units are
available for job-sharing. In our survey, trainees' experience of job-sharing was
overwhelmingly positive.
PMID: 11346087 [PubMed - indexed for MEDLINE]
120. Women Health. 2000;31(2-3):153-66.
Challenges of recruitment: focus groups with research study recruiters.
Brown BA, Long HL, Weitz TA, Milliken N.
UCSF National Center of Exellence in Women's Health, University of California,
San Francisco, USA. brownb@obgyn.ucsf.edu
To rectify the historic lack of research on women's health and the exclusion of
women from many significant clinical trials, regulations have been promulgated
requiring the inclusion of women and minorities in research studies.
Acknowledging that the National Institutes of Health (NIH) mandate has resulted
in more inclusive research, the unintended consequences associated with
implementation of these regulations must also be explored. While the requirements
preclude the use of cost as a reason for excluding women and/or minorities, the
additional funding necessary to recruit adequate numbers of study participants
has not been provided. Consequently, study recruiters often face unacknowledged
expectations and job pressures as they attempt to meet recruitment goals. While
it is important to support the NIH mandate, the additional stress imposed upon
research study recruiters must also be recognized. Focus groups with study
recruiters from various backgrounds and types of research provide an
understanding of the challenges recruiters face when attempting to recruit
diverse populations of women into research, and provide an understanding of the
impact of recruitment goals on study recruiters' job satisfaction.
PMID: 11289684 [PubMed - indexed for MEDLINE]
121. Ment Retard. 2001 Feb;39(1):32-9.
National estimates of vocational service utilization and job placement rates for
adults with mental retardation.
Olney MF, Kennedy J.
Department of Community, Health, University of Illinois, Urbana-Champaign,
College of Applied Life Studies, 1206 S. Fourth St., Champaign, IL 61820, USA.
Data from the 1994 and 1995 Disability Supplements of the National Health
Interview Survey (NHIS) were used to estimate rates of utilization of vocational
services and examine employment outcomes for adults with disabilities who have
received vocational services. Those living outside the formal long-term care
system, and who were self or proxy identified as having mental retardation, were
compared with other adults with disabilities. Analyses suggest that compared to
other working-age persons with disabilities, adults with mental retardation (a)
have a different population profile, (b) receive different types of services, (c)
experience similar levels of satisfaction, (d) have much lower rates of
competitive employment, and (e) are much more likely to be employed in segregated
work settings. Research and policy implications of findings are discussed.
PMID: 11270212 [PubMed - indexed for MEDLINE]
122. Acad Med. 2001 Mar;76(3):259-65.
Understanding the careers of physician educators in family medicine.
Simpson DE, Rediske VA, Beecher A, Bower D, Meurer L, Lawrence S, Wolkomir M.
Office of Educational Services, Medical College of Wisconsin, Milwaukee, WI
53226, USA. dsimpson@mail.mcw.edu
PURPOSE: Little is known about what contributes to the career decisions of
physician educators in family medicine. This study sought to understand the
variables that influence these decisions and to identify key sources of vitality
for physician educators in family medicine. METHOD: A national sample of randomly
selected physician educators in family medicine responded to a postcard survey
regarding their contribution(s) to education and career satisfaction. A series of
exclusion criteria were applied to 399 useable responses, yielding 24 physician
educators who participated in a semi-structured telephone interview focusing on
their careers. Using qualitative research methods, themes were identified and
categorized from the transcribed interviews and investigators' field notes.
RESULTS: The career decisions and actions of physician educators in family
medicine emanated from an underlying set of values and beliefs associated with
"making the world better." Participants sought challenging, diverse, and
stimulating positions from which they could have an impact in ways that were
consistent with their values. Three major sources of vitality (learners,
colleagues, and patients) complemented the desire for challenging positions.
Physician educators in family medicine, however, continually struggled to balance
their personal and professional lives. CONCLUSION: The study results highlight
the key variables that draw faculty into education and sustain their vitality,
and the professional and personal challenges that can derail or support their
careers. This information can be used to recruit, develop, and retain successful
and productive physician educators in family medicine.
PMID: 11242579 [PubMed - indexed for MEDLINE]
123. Aust Health Rev. 2000;23(3):113-21.
Community and consumer participation in Australian health services--an overview
of organisational commitment and participation processes.
Johnson A, Silburn K.
National Resource Centre for Consumer Participation in Health, Bundoora.
This article briefly describes recent initiatives to improve consumer
participation in health services that have led to the establishment of the
National Resource Centre for Consumer Participation in Health. The results of a
component of the needs assessment undertaken by the newly established Centre are
presented. They provide a 'snapshot' of the types of feedback and participation
processes mainly being utilised by Australian health services at the different
levels of seeking information, information sharing and consultation, partnership,
delegated power and consumer control. They also allow identification of the
organisational commitment made by Australian health services to support a more
coordinated approach to community and consumer feedback and participation at
different levels of health services such as particular emphasis on determining
the presence of community and consumer participation in key organisational
statements, specific consumer policies and plans, identifiable leadership,
inclusion into job descriptions, allocation of resources, and staff development
and consumer training. Discussion centres around four key observations and some
of the key perceived external barriers.
PMID: 11186043 [PubMed - indexed for MEDLINE]
124. Am J Public Health. 2000 Nov;90(11):1765-70.
Psychosocial work environment and depression: epidemiologic assessment of the
demand-control model.
Mausner-Dorsch H, Eaton WW.
Department of Health Policy and Management, Johns Hopkins University School of
Public Health, Baltimore, MD 21205, USA. hmausner@jhsph.edu
Erratum in:
Am J Public Health 2001 May;91(5):828.
OBJECTIVES: This study examined the relation between occupational variables and 3
forms of depression (major depressive episode, depressive syndrome, and
dysphoria). It was hypothesized that individuals working in occupations with high
psychologic strain (high psychologic demands and low decision authority) would
have a higher prevalence of depression relative to those working in occupations
with the other 3 possible conditions. METHODS: The analysis was based on data for
905 respondents who were employed full-time in the year before the follow-up
interview for the Epidemiologic Catchment Area Program in Baltimore, Md, between
1993 and 1996. Psychosocial work environment, sociodemographic variables, and
psychopathology were assessed in a household interview that included the National
Institute of Mental Health Diagnostic Interview Schedule. Subscales for the
demand-control model for psychosocial work environment were modified slightly
after factor analysis. RESULTS: High job strain was associated with greater
prevalence of all 3 forms of depression, especially major depressive episode. The
results were stronger for women; for men, being unmarried was the strongest
prevalence correlate. CONCLUSIONS: Major depressive episode, depressive syndrome,
and dysphoria are strongly associated with the psychosocial dimensions of the
demand-control model.
PMCID: PMC1446399
PMID: 11076247 [PubMed - indexed for MEDLINE]
125. Prehosp Emerg Care. 2000 Oct-Dec;4(4):345-51.
A statewide study of EMS oversight: medical director characteristics and
involvement compared with national guidelines.
Stone RM, Seaman KG, Bissell RA.
Division of Emergency Medicine, University of Maryland Medical System, Baltimore,
USA. emsrog@x-press.net
INTRODUCTION: From their inception, advanced life support (ALS) programs have had
oversight by emergency medical services (EMS) medical directors. Position
statements about medical direction have been published in the medical literature,
initially by the American College of Emergency Physicians (ACEP). Most recently,
the National Association of EMS Physicians (NAEMSP) published a position paper to
serve as a guideline for the medical directors' tasks, describing qualifications
and areas of involvement. OBJECTIVE: To study the baseline status of EMS
oversight in Maryland as the position paper was disseminated, to view how local
directors meet the published guidelines. METHODS: Twenty-two of the 23 (96%)
jurisdictional EMS medical directors (JMDs) in Maryland were interviewed in
face-to-face meetings. Information was collected about their qualifications and
their regular involvement in activities within various EMS subsystems. RESULTS:
Sixteen (73%) JMDs are members of ACEP and four (18%) are members of NAEMSP. Six
(27%) received EMS medical director training. Three (14%) went through a formal
application process for their positions. Activities of relatively high
involvement were investigations of variance from protocols (100% of JMDs
involved), runsheet review (15 [68%]), liaison duties (20 [91%]), and disaster
drills (15 [68%]). Most other subsystems, including dispatch, public health,
administration, system evaluation, and quality programs, showed relatively low
regular involvement (0-59%). CONCLUSION: In Maryland, significant increases in
active physician involvement in EMS are necessary to meet the national job
description. These data provide supportive evidence of the need for further
commitment by state and local agencies, as well as trained EMS physicians in
national societies, to enable all JMDs to reach the goals set forth for their
important roles in EMS systems.
PMID: 11045415 [PubMed - indexed for MEDLINE]
126. Am J Psychiatry. 2000 Sep;157(9):1485-91.
Understanding disability in mental and general medical conditions.
Druss BG, Marcus SC, Rosenheck RA, Olfson M, Tanielian T, Pincus HA.
benjamin.druss@yale.edu
OBJECTIVE: This study characterized the prevalence, characteristics, and impact
of mental and general medical disabilities in the United States. METHOD: The
1994-1995 National Health Interview Survey of Disability was the largest
disability survey ever conducted in the United States. A national sample was
screened for disability, defined as limitation or inability to participate in a
major life activity. Analyses compared cohorts who attributed their disability to
physical, mental, or combined conditions. RESULTS: Of 106,573 adults, 1.1%
reported functional disability from mental conditions, 4.8% from general medical
conditions, and 1.2% from combined mental and general medical conditions.
Disabilities attributed to a mental condition were predominantly associated with
social and cognitive difficulties, those attributed to general medical conditions
with physical limitations, and combined disabilities with deficits spanning
multiple domains. In multivariate models, comorbid medical and mental conditions
were associated with a twofold increase in odds of unemployment and a two-thirds
increase in odds of support on disability payments compared to respondents with a
single form of disability. More than half the nonworking disabled reported that
economic, social, and job-based barriers contributed to their inability to work.
One-fourth of working disabled people reported discrimination on the basis of
their disability during the past 5 years. CONCLUSIONS: An estimated three million
Americans (one-third of disabled people) reported that a mental condition
contributes to their disability. Mental, general medical, and combined conditions
are associated with unique patterns of functional impairment. Social and economic
factors and job discrimination may exacerbate the functional impairments
resulting from clinical syndromes.
PMID: 10964866 [PubMed - indexed for MEDLINE]
127. Rev Epidemiol Sante Publique. 2000 Jun;48(3):227-37.
Hearing status of French youth aged from 18 to 24 years in 1997: a
cross-sectional epidemiological study in the selection centres of the army in
Vincennes and Lyon.
Job A, Raynal M, Tricoire A, Signoret J, Rondet P.
Centre de recherches du service de santé des armées Emile Pardé, 24, Avenue des
maquis du Grésivaudan, BP 87, 38702 La Tronche cedex France.
BACKGROUND: It is currently thought that young adults are at increasing risk of
exposure to deleterious sources of noise. To test this possibility we have
assessed hearing status of young French men aged between 18 and 24 years in 1997
and study risk factors of deafness in a cross-sectional epidemiological study at
selection centres for aptitudes to National Service. METHODS: During the time of
the study, 1208 subjects were examined. For each subject, data of an interview,
an otoscopy and audiograms were collected. We compared hearing thresholds between
subjects with different noise exposures and we determined risk factors of
deafness in this population. RESULTS: The prevalence of hearing loss was 9% at
medium frequencies (0.5-2 kHz) and 15% at high frequencies (4-8 kHz).We found
that 60% of the subjects were regularly exposed to at least one source of loud
noise. Acoustic trauma (6%) mostly explained hearing losses. Repeated episodes of
otitis media in childhood (17%) also emerged as an important risk factor
apparently due to increased sensitivity to noise. In subjects with antecedent of
otitis media, hearing impairments were significant in personal stereo users (>1
hour per day) (p<0.001), in those who went to discos and rock concerts (>2 times
per month) (p=0.01) and in those who worked in noisy places (p=0.01). In
contrast, in subjects without antecedent of otitis, we found no difference in
hearing thresholds between noise exposed and non noise exposed subjects.
CONCLUSIONS: Loud sound exposure is a true risk factor of early deafness in
subjects that had had repeated episodes of otitis media in childhood. This study
stresses the need for both prevention policies and information of health
professionals and practitioners.
PMID: 10891783 [PubMed - indexed for MEDLINE]
128. Ann Intern Med. 2000 Mar 21;132(6):451-9.
Understanding economic and other burdens of terminal illness: the experience of
patients and their caregivers.
Emanuel EJ, Fairclough DL, Slutsman J, Emanuel LL.
Department of Clinical Bioethics, National Institutes of Health, Bethesda,
Maryland 20892-1156, USA.
BACKGROUND: Terminal illness imposes substantial burdens--economic and
otherwise--on patients and caregivers. The cause of these burdens is not
understood. OBJECTIVE: To determine the mechanism for economic and noneconomic
burdens of terminal illness and to identify potential ameliorating interventions.
DESIGN: In-person interviews of terminally ill patients and their caregivers.
SETTING: Six randomly selected U.S. sites: Worcester, Massachusetts; St. Louis,
Missouri; Tucson, Arizona; Birmingham, Alabama; Brooklyn, New York; and Mesa
County, Colorado. PARTICIPANTS: 988 terminally ill patients and 893 caregivers.
MEASUREMENTS: Needs for transportation, nursing care, homemaking, and personal
care; subjective perception of economic burden; expenditure of more than 10% of
household income on health care costs; caregiver depression and sense of
interference with his or her life; and patient consideration of euthanasia or
physician-assisted suicide. RESULTS: Of all patients, 34.7% had substantial care
needs. Patients who had substantial care needs were more likely to report that
they had a subjective sense of economic burden (44.9% compared with 35.3%;
difference, 9.6 percentage points [95% CI, 3.1 to 16.1]; P = 0.005); that 10% of
their household income was spent on health care (28.0% compared with 17.0%;
difference, 11.0 percentage points [CI, 4.8 to 17.1]; P < or = 0.001); and that
they or their families had to take out a loan or mortgage, spend their savings,
or obtain an additional job (16.3% compared with 10.2%; difference, 6.1
percentage points [CI, 1.4 to 10.6]; P = 0.004). Patients with substantial care
needs were more likely to consider euthanasia or physician-assisted suicide (P =
0.001). Caregivers of these patients were more likely to have depressive symptoms
(31.4% compared with 24.8%; difference, 6.6 percentage points [CI, 0.4 to 12.8];
P = 0.01) and to report that caring for the patients interfered with their lives
(35.6% compared with 24.3%; difference, 11.3 percentage points [CI, 5.0 to 17.7];
P = 0.001). Caregivers of patients whose physicians listened to patients' and
caregivers' needs had fewer burdens. CONCLUSIONS: Substantial care needs are an
important cause of the economic and other burdens imposed by terminal illness.
Through empathy, physicians may be able to ameliorate some of these burdens.
PMID: 10733444 [PubMed - indexed for MEDLINE]
129. Pediatrics. 2000 Mar;105(3 Suppl E):687-91.
Evaluation of children's health insurance: from New York State's CHild Health
Plus to SCHIP.
Szilagyi PG, Holl JL, Rodewald LE, Shone LP, Zwanziger J, Mukamel DB, Trafton S,
Dick AW, Raubertas RF.
Department of Pediatrics, University of Rochester School of Medicine and
Dentistry, Rochester, New York 14642, USA. peter_szilagyi@urmc.rochester.edu
BACKGROUND: The legislation and funding of the State Children's Health Insurance
Program (SCHIP) in 1997 resulted in the largest public investment in child health
care in 30 years. The program was designed to provide health insurance for the
estimated 11 million uninsured children in the United States. In 1991 New York
State implemented a state-funded program-Child Health Plus (CHPlus)-intended to
provide health insurance for uninsured children who were ineligible for Medicaid.
The program became one of the prototypes for SCHIP. This study was designed to
measure the association between CHPlus and access to care, utilization of care,
quality of care, and health care costs to understand the potential impact of one
type of prototype SCHIP program. METHODS: The study took place in the 6-county
region of upstate New York around and including the city of Rochester. A
before-and-during design was used to compare children's health care for the year
before they enrolled in CHPlus versus the first year during enrollment in CHPlus.
The study included 1828 children (ages 0-6.99 years at enrollment) who enrolled
between November 1, 1991 and August 1, 1993. A substudy involved 187 children 2
to 12.99 years old who had asthma. Data collection involved: 1) interviews of
parents to obtain information about demographics, sources of health care,
experience and satisfaction with CHPlus, and perceived impact of CHPlus; 2)
medical chart reviews at all primary care offices, emergency departments, and
health department clinics in the 6-county region to measure utilization of health
services; 3) claims analysis to assess costs of care during CHPlus and to impute
costs before CHPlus; and 4) analyses of existing datasets including the Current
Population Survey, National Health Interview Survey, and statewide
hospitalization datasets to anchor the study in relation to the statewide CHPlus
population and to assess secular trends in child health care. Logistic regression
and Poisson regression were used to compare the means of dependent measures with
and without CHPlus coverage, while controlling for age, prior insurance type, and
gap in insurance coverage before CHPlus. RESULTS. ENROLLMENT: Only one third of
CHPlus-eligible children throughout New York State had enrolled in the program by
1993. Lower enrollment rates occurred among Hispanic and black children than
among white children, and among children from lowest income levels. PROFILE OF
CHPlus ENROLLEES: Most enrollees were either previously uninsured, had Medicaid
but were no longer eligible, or had parents who either lost a job and related
private insurance coverage or could no longer afford commercial or private
insurance. Most families heard about CHPlus from a friend, physician, or insurer.
Television, radio, and newspaper advertisements were not major sources of
information. Nearly all families had at least 1 employed parent. Two thirds of
the children resided in 2-parent households. Parents reported that most children
were in excellent or good health and only a few were in poor health. The enrolled
population was thus a relatively low-risk, generally healthy group of children in
low-income, working families. ACCESS AND UTILIZATION OF HEALTH CARE: Utilization
of primary care increased dramatically after enrollment in CHPlus, compared with
before CHPlus. Visits to primary care medical homes for preventive, acute, and
chronic care increased markedly. Visits to medical homes also increased for
children with asthma. There was, however, no significant association between
enrollment in CHPlus and changes in utilization of emergency departments,
specialty services, or inpatient care. QUALITY OF CARE: CHPlus was associated
with improvements in many measures involving quality of primary care, including
preventive visits, immunization rates, use of the medical home for health care,
compliance with preventive guidelines, and parent-reported health status of the
child. (ABSTRACT TRUNCATED)
PMID: 10699145 [PubMed - indexed for MEDLINE]
130. Nurs Ethics. 1999 Sep;6(5):411-22.
Changing values for nursing and health promotion: exploring the policy context of
professional ethics.
Molloy J, Cribb A.
Royal College of Nursing Institute, London, UK.
In this article we illustrate, and argue for, the importance of researching the
social context of health professionals' ethical agendas and concerns. We draw
upon qualitative interview data from 20 nurses working in two occupational health
sites, and our discussion focuses mainly upon aspects of the shifting 'ethical
context' for those nurses with a health promotion remit who are working in the
British National Health Service. Within this discussion we also raise a number of
potentially substantive issues, including the risks of colluding in 'double
standards', and the tensions between the practitioner and managerial roles in
nursing. Overall, we hope to pose questions about the best ways to understand the
ethical agency and responsibilities of health professionals.
PMID: 10696188 [PubMed - indexed for MEDLINE]
131. Psychol Med. 1999 Nov;29(6):1411-6.
Job strain and psychiatric morbidity.
Cropley M, Steptoe A, Joekes K.
Department of Psychology, St George's Hospital Medical School, University of
London.
BACKGROUND: This study examined the association between job strain and
psychiatric morbidity using interview-based assessments of mental health. We
assessed the prevalence of neurotic disorder in high job strain (high demand, low
control) and low job strain (low demand, high control) school teachers, and
compared these rates with data from individuals with similar educational
qualifications from the National Psychiatric Morbidity Survey of Great Britain.
METHODS: One hundred and sixty primary and secondary school teachers were
selected from a larger survey on the basis of high or low job strain, and were
assessed for psychiatric morbidity using the Revised Clinical Interview Schedule
(CIS-R). The prevalence of neurotic symptoms and a total psychiatric morbidity
score were calculated. RESULTS: After adjusting for age, gender and occupational
grade, the prevalence of psychiatric morbidity was greater in high job strain
than low job strain individuals. The prevalence of severe anxiety, worry and
fatigue symptoms was significantly greater in the high job strain teachers. In
comparison with the British psychiatric morbidity survey, the prevalence of
neurotic disorders was greater in the high job strain, but not in low job strain
teachers. Individuals in the low job strain group were more likely to report
severe anxiety, irritability and fatigue in the week prior to interview, than
comparably educated individuals in the national survey. CONCLUSION: Job strain is
associated with psychiatric morbidity. The high levels of neurotic
psychopathology among teachers is consistent with previous research that has
found teaching to be a highly stressful occupation.
PMID: 10616947 [PubMed - indexed for MEDLINE]
132. Am J Health Promot. 1999 Jul-Aug;13(6):358-65.
Health promotion programs in small worksites: results of a national survey.
Wilson MG, DeJoy DM, Jorgensen CM, Crump CJ.
Department of Health Promotion and Behavior, University of Georgia, Athens
30602-3422, USA.
PURPOSE: This study documents the prevalence of workplace health promotion
activities at small worksites with 15 to 99 employees. DESIGN: A random sample of
U.S. worksites stratified by size and industry (n = 3628) was drawn using
American Business Lists. MEASURES: Each worksite was surveyed using a
computer-assisted telephone interview system to document activities related to
health promotion and related programs, worksite policies regarding health and
safety, health insurance, and philanthropic activities. SUBJECTS: Participation
varied by industry and size, with an overall response rate for eligible worksites
of 78% for a total sample of 2680 worksites. DATA ANALYSIS: Data were analyzed
using SUDAAN statistical software. RESULTS: Approximately 25% of worksites with
15 to 99 employees offered health promotion programs to their employees, compared
with 44% of worksites with 100+ employees. As with the larger worksites, the most
common programs for worksites with 15 to 99 employees were those related to
occupational safety and health, back injury prevention, and CPR. The majority of
worksites in both size categories had alcohol, illegal drug, smoking, and
occupant protection policies. The majority of both small and large worksites also
offered group health insurance to their employees (92% and 98%, respectively),
with many of the worksites also extending benefits to family members and
dependents (approximately 80% for both business sizes). CONCLUSIONS: The results
indicated that small worksites are providing programs to their employees, with a
primary focus on job-related hazards. Small worksites also have formal policies
regarding alcohol, drug use, smoking, and seatbelt use and offer health insurance
to their employees at a rate only slightly lower than that of large worksites.
PMID: 10557508 [PubMed - indexed for MEDLINE]
133. Nippon Koshu Eisei Zasshi. 1999 Jul;46(7):551-62.
[Comparison of characteristics between respondents and nonrespondents in a
national survey of Japanese elderly using six year follow-up study]
[Article in Japanese]
Sugisawa H, Kishino H, Sugihara Y, Okabayashi H, Shibata H.
Department of Health Sociology, Tokyo Metropolitan Institute of Gerontology.
PURPOSES: The purpose of this study were twofold: 1) to examine differences
between respondents and nonrespondents in sociodemographic or health
characteristics, 2) to study nonresponse effects on relationships between
variables, using a 6 year follow-up study for both respondents and nonrespondents
at the initial survey. METHODS: The data were collected in 1987 through a
national survey of Japanese adults aged 60 and over. A total of 2,200 interviews
were completed from the list of 3,288 names. In 1993, 1,010 nonrespondents
excluding persons who had died, moved, or whose addresses were unknown in the
prior interview, were recontacted through a mail questionnaire. A total of 559
persons completed the mail questionnaire. Of the original 2,200 baseline
interviewees, some by proxy interviews, 2,260 persons were reinterviewed, at the
same time as the mail survey. Sociodemographic and health variables (age and
sex), social indicators (educational attainment, marital status, and job status),
health status (mortality, existence of diseases, and activities of daily living),
subjective well-being (life satisfaction, self-rated health, and economic
satisfaction) were compared between respondents and nonrespondents. Relationships
between self-rated health and sociodemographic or health variables were examined
by multiple regression analysis. RESULTS: 1. Compared to people who participated
in the survey, norespondents were likely to be male, in the lower age categories,
and with higher educational attainment at the follow-up survey. Also, life
satisfaction and self-rated health were lower in nonrespondents than in
respondents. Reasons for nonresponse varied but appeared to be somewhat related
to characteristics of nonrespondents. 2. No significant relationships between
self-rated health and sociodemographic or health variables appeared for the
respondent group and also when including the nonrespondent group. CONCLUSION:
While differences between respondents and nonrespondents on certain variables
were significant, relationships between self-rated health and sociodemographic
variables were not observed.
PMID: 10550979 [PubMed - indexed for MEDLINE]
134. Am Ind Hyg Assoc J. 1999 Sep-Oct;60(5):673-8.
Differences in the association between psychosocial work conditions and physical
work load in female- and male-dominated occupations. MUSIC-Norrtälje Study Group.
Josephson M, Pernold G, Ahlberg-Hultén G, Härenstam A, Theorell T, Vingċrd E,
Waldenström M, Hjelm EW.
National Institute for Working Life, Solna, Sweden.
This study investigated whether there is a relationship between high physical
work load and adverse psychosocial work factors, and whether this relationship is
different for women and men. Separate analyses for female registered nurses and
assistant nurses were made because these are common occupations involving high
physical and psychological demands. This study was part of the MUSIC-Norrtälje
study, a population study with the overall aim of identifying risk factors for
musculoskeletal disorders. The respondents, 1423 gainfully employed men and
women, were randomly selected from the study population. The exposure assessments
referred to a typical workday during the previous 12 months. Physical exposure
was investigated by interview, psychosocial work factors by interview and
questionnaire. For the women, but not the men, mainly routine work and a job
strain situation, according to the model of Karasek and Theorell, increased the
probability of having a high physical work load, assessed as a time-weighted
average of energy expenditure in multiples of the resting metabolic rate. Results
indicated that in female-dominated occupations, high physical work load might
also imply adverse psychosocial conditions. A higher frequency of high physical
work load and job strain was observed among assistant nurses compared with
registered nurses. Covariance between physical and psychosocial demands makes it
difficult to determine the relative influence of each in health problems. Results
of the present study imply that this is a larger problem in studies of women than
men.
PMID: 10530000 [PubMed - indexed for MEDLINE]
135. Int J Geriatr Psychiatry. 1999 Aug;14(8):662-7.
EUROCARE: a cross-national study of co-resident spouse carers for people with
Alzheimer's disease: II--A qualitative analysis of the experience of caregiving.
Murray J, Schneider J, Banerjee S, Mann A.
Section of Epidemiology and General Practice, Institute of Psychiatry, London,
UK.
BACKGROUND: Spouses caring for a partner with dementia are subject to physical,
psychological and social stresses. In view of the part played by spouse carers in
preventing admission to institutional care, a fuller understanding of the
subjective experience of caring is an important area of enquiry. Qualitative
analysis of their accounts of the difficulties and rewards in looking after their
partners may indicate strategies to support them and to alleviate the stresses
that they experience. METHOD: Twenty co-resident spouses of people with
NINCDS-ADRDA probable dementia of the Alzheimer's type, who had been diagnosed as
such within the past 12-36 months, were recruited from service contacts in each
of 14 out of the 15 countries of the EU. All completed a semi-structured
interview that included open-ended questions about the experience of caring.
RESULTS: Overall, the most commonly expressed difficulties reflected: loss of
companionship through diminished quality of communication; loss of reciprocity as
carers experienced their partners' growing dependency; and deterioration in their
partners' social behaviour. Satisfaction from caring stemmed from: a feeling of
job satisfaction; continued reciprocity and mutual affection; companionship; and
the fulfillment of a sense of duty. CONCLUSION: Spouse carers in the 14 countries
described the difficulties and rewards of caring in similar terms. This suggests
commonality of experience, in spite of diversity in informal and statutory
provision of care for older people between different countries.
PMID: 10489657 [PubMed - indexed for MEDLINE]
136. Health Manpow Manage. 1998;24(1):20-5.
The logic of job-sharing in the provision and delivery of health care.
Branine M.
Department of Management and Organization, University of Stirling, UK.
By definition the practice of job-sharing starts from the premiss that there is a
full-time job to be shared by those who want to balance their work with other
commitments. In a public sector institution, such as the National Health Service
(NHS), where most employees are female, it seems logical to believe that a
job-sharing policy would be able to promote equal opportunities, to increase
employee job satisfaction and to reduce labour costs. Hence, this paper attempts
to discuss the advantages and disadvantages of having a job-sharing policy, and
to analyse the reasons for the limited number of job-sharers in the NHS despite
the apparent benefits of job-sharing to both the employees and the employer. This
study was carried out in 15 NHS Trusts in northern England and Scotland, by the
use of questionnaires and interviews, and found that most NHS managers did not
see the practice of job-sharing as a major cost-saving opportunity or as a
working pattern that would enhance employee satisfaction and commitment. They saw
job-sharing as just a routine equal opportunities request which did not deserve
such managerial attention or long-term strategic thinking. It is argued in this
paper that job-sharing is a potentially useful option against a background of
demographic and other social and economic changes which require the development
and use of long-term strategic policies. Therefore it is concluded that, in the
NHS, there is a need for a more active and creative approach to job-sharing
rather than the reactive and passive approach that has dominated the practice so
far.
PMID: 10346296 [PubMed - indexed for MEDLINE]
137. J Cult Divers. 1998 Winter;5(4):127-31.
Voices from an Afghan community.
Perry CM, Shams M, DeLeon CC.
California State University, Hayward 94542, USA. cperry@csuhayward.edu
A major role of the community health nurse is advocating to meet the needs of
population groups. This article describes how community health nurses utilized
two assessment tools, a windshield survey, a semi-structured interview protocol,
and the Healthy People 2000 National Health Objectives to collect pertinent
information and recommend program strategies at the primary, secondary and
tertiary prevention levels to reduce the prevalence of domestic violence in an
Afghan community.
PMID: 10196935 [PubMed - indexed for MEDLINE]
138. Ergonomics. 1999 Jan;42(1):171-82.
Under-reporting of work-related disorders in the workplace: a case study and
review of the literature.
Pransky G, Snyder T, Dembe A, Himmelstein J.
Department of Family and Community Medicine, University of Massachusetts Medical
Center, Worcester 01655-0309, USA.
Accurate reporting of work-related conditions is necessary to monitor workplace
health and safety, and to identify the interventions that are most needed.
Reporting systems may be designed primarily for external agencies (OSHA or
workers' compensation) or for the employer's own use. Under-reporting of
workplace injuries and illnesses is common due to a variety of causes and
influences. Based on previous reports, the authors were especially interested in
the role of safety incentive programmes on under-reporting. Safety incentive
programmes typically reward supervisors and employees for reducing workplace
injury rates, and thus may unintentionally inhibit proper reporting. The authors
describe a case study of several industrial facilities in order to illustrate the
extent of under-reporting and the reasons for its occurrence. A questionnaire and
interview survey was administered to 110 workers performing similar tasks and
several managers, health, and safety personnel at each of three industrial
facilities. Although less than 5% of workers had officially reported a
work-related injury or illness during the past year, over 85% experienced
work-related symptoms, 50% had persistent work-related problems, and 30% reported
either lost time from work or work restrictions because of their ailment. Workers
described several reasons for not reporting their injuries, including fear of
reprisal, a belief that pain was an ordinary consequence of work activity or
ageing, lack of management responsiveness after prior reports, and a desire not
to lose their usual job. Interviews with management representatives revealed
administrative and other barriers to reporting, stemming from their desire to
attain a goal of no reported injuries, and misconceptions about requirements for
recordability. The corporate and facility safety incentives appeared to have an
indirect, but significant negative influence on the proper reporting of workplace
injuries by workers. A variety of influences may contribute to under-reporting;
because of under-reporting, worker surveys and symptom reports may provide more
valuable and timely information on risks than recordable injury logs. Safety
incentive programmes should be carefully designed to ensure that they provide a
stimulus for safety-related changes, and to discourage under-reporting. A
case-control study of similar establishments, or data before and after
instituting safety incentives, would be required to more clearly establish the
role of these programmes in under-reporting.
PMID: 9973879 [PubMed - indexed for MEDLINE]
139. Am J Ind Med. 1999 Feb;35(2):112-23.
Concerns of the dry-cleaning industry: a qualitative investigation of labor and
management.
Goldenhar LM, Ruder AM, Ewers LM, Earnest S, Haag WM, Petersen MR.
Division of Surveillance, Hazard Evaluation, and Field Studies, National
Institute for Occupational Safety and Health, Cincinnati, Ohio, USA.
Comment in:
Am J Ind Med. 1999 Oct;36(4):482-3.
BACKGROUND: Occupational scientists agree there are hazards associated with
dry-cleaning, but do dry-cleaning owners and workers concur? Knowledge of owners'
and workers' perceptions can help guide intervention efforts to reduce worker
exposure. To better understand these issues, a qualitative study was conducted
using focus group methodology and constant comparative analysis. METHODS: Two
owner and four worker focus groups were held. RESULTS: Findings suggest that
overall, health and safety issues were not of great concern. Owners were
primarily concerned with the economic impact of regulations. Workers did express
some anxiety about solvent exposure and burns, but most felt that these hazards
were "just part of the job." Also, other than the installation of
air-conditioning in the shops and the provision of health benefits, workers could
not think of ways health and safety on the job could be improved. CONCLUSIONS:
These findings will be used to develop comprehensive safety and health
interventions (e.g., engineering plus education and training) in dry-cleaning
shops.
PMID: 9894534 [PubMed - indexed for MEDLINE]
140. Am J Psychiatry. 1998 Dec;155(12):1775-7.
Mental disorders and access to medical care in the United States.
Druss BG, Rosenheck RA.
Northeast Program Evaluation Center, VA Connecticut Healthcare System, and the
Department of Psychiatry, Yale University, West Haven, CT 06516, USA.
OBJECTIVE: The authors examined the barriers to receipt of medical services among
people reporting mental disorders in a representative sample of U.S. adults.
METHOD: The sample was drawn from adults who responded to the 1994 National
Health Interview Survey (N=77,183). The authors studied the association between
report of a mental disorder and 1) access to health insurance and a primary
provider, and 2) actual receipt of medical care. Multivariate techniques were
used to model problems with access as a function of mental disorders, controlling
for demographic, insurance, and health variables. RESULTS: While people who
reported mental disorders showed no difference from those without mental
disorders in likelihood of being uninsured or of having a primary care provider,
they were twice as likely to report having been denied insurance because of a
preexisting condition or having stayed in their job for fear of losing their
health benefits. Among respondents with insurance, those who reported mental
illness were no less likely to have a primary care provider but were about two
times more likely to report having delayed seeking needed medical care because of
cost or having been unable to obtain needed medical care. CONCLUSIONS: People who
reported mental disorders experienced significant barriers to receipt of medical
care. Efforts to measure and improve access to health care for this population
may need to go beyond simply providing insurance benefits or access to general
medical providers.
PMID: 9842793 [PubMed - indexed for MEDLINE]
141. Br Dent J. 1998 Oct 24;185(8):404-6.
New stressors for GDPs in the past ten years: a qualitative study.
Humphris GM, Cooper CL.
Department of Clinical Psychology, University of Liverpool.
OBJECTIVE: To identify new stressors that general dental practitioners have
experienced from those reported in the UK national surveys of 1986 and 1996.
DESIGN: Series of interviews. SETTING: General dental practices from suburban and
inner city areas in two health authorities of the North West of England.
SUBJECTS: A random sample of ten general dental practitioners participated; there
were no refusals. METHOD: In-depth interviews employing a research psychologist
were conducted to invite comment on the areas of work pressure they had
experienced during the past ten years. Interviews were audio-taped, transcribed
and content analysed. RESULTS: More than 130 statements categorised into 29
topics referred to pressures related to work. There was good agreement (93%)
between authors and an independent assessor when a sort of the statements into
the defined categories was completed. The most referred area of stress was the
system changes of running a practice and the possibility of further changes.
Patient expectations were considered to be rising. Aggression exhibited by some
patients in the practice, the risk of cross-infection, litigation and the dentist
working as a team member were newly identified stressors not included in original
classifications of dental work pressure. CONCLUSIONS: Dental practitioners from
this small study identified uncertainty in the future of the organisation of
dental care provision as the most important new pressure of work.
PMID: 9828501 [PubMed - indexed for MEDLINE]
142. Scand J Work Environ Health. 1997 Dec;23(6):421-7.
Respiratory symptoms, spirometry and chronic occupational paraquat exposure.
Castro-Gutiérrez N, McConnell R, Andersson K, Pacheco-Antón F, Hogstedt C.
Department of Preventive Medicine, National Autonomous University of Nicaragua,
León.
OBJECTIVES: A cross-sectional study was conducted to evaluate the relationship
between respiratory health and paraquat exposure. METHODS: The study population
was selected from among workers at 15 Nicaraguan banana plantations which relied
on paraquat for the control of weeds. All the workers were interviewed after they
received their job assignment for the day of the survey, and all who reported
never having applied paraquat and all who reported more than 2 years of
cumulative exposure as applicators of paraquat with knapsack sprayers were
invited for medical evaluation. One hundred and thirty-four exposed workers and
152 unexposed workers were administered a questionnaire interview asking about
exposure and respiratory symptoms, and they underwent spirometric testing of
forced expiratory volume in 1 s (FEV1.0) and forced vital capacity (FVC).
RESULTS: In the exposed group 53% reported having experienced a skin rash or burn
resulting from paraquat exposure, 25% reported epistaxis, 58% nail damage, and
42% paraquat splashed in the eyes. There was a consistent dose-response
relationship between intensity of exposure (as indicated by a history of skin
rash or burn) and the prevalence of dyspnea. This relationship was more marked
for more severe dyspnea. There was a 3-fold increase in episodic wheezing
accompanied by shortness of breath among the more intensely exposed workers.
There was no relationship between exposure and FEV1.0 or FVC. CONCLUSIONS: The
high prevalence of respiratory symptoms associated with exposure, in the absence
of spirometric abnormalities associated with exposure, could be a result of
unmeasured gas exchange abnormalities among workers with long-term exposure to
paraquat.
PMID: 9476805 [PubMed - indexed for MEDLINE]
143. Vital Health Stat 3. 1997 Dec;(31):1-91.
Women: work and health.
Wagener DK, Walstedt J, Jenkins L, Burnett C, Lalich N, Fingerhut M.
National Center for Health Statistics, National Institute for Occupational Safety
and Health, USA.
OBJECTIVES: This report describes the sociodemographics, household
characteristics, and health of women according to workforce status and job
conditions. The report also presents data on men for comparison. METHODS: This
report combines data from numerous data systems, including: The National Health
Interview Survey, National Health and Nutrition Examination Survey, National
Maternal and Infant Health Survey, National Hospital Ambulatory Medical Care
Survey, National Traumatic Occupational Fatalities Surveillance System, and the
National Occupational Mortality Surveillance System, which are conducted by the
U.S. Department of Health and Human Services; the Census of Fatal Occupational
Injuries and Annual Survey of Occupational injuries and illnesses conducted by
the U.S. Department of Labor; and the Current Population Survey conducted by the
U.S. Department of Commerce. The report also presents selected tables from
publications of the Women's Bureau and the Bureau of Labor Statistics, U.S.
Department of Labor. RESULTS: The report presents summary data on physical
conditions and exposures, health conditions attributed to work, other health
conditions that impact on work, health promotion in the workplace, and
health-related benefits provided by employers. Most estimates are shown according
to sex, age, race, ethnicity, educational attainment, and major occupational
group.
PMID: 9470482 [PubMed - indexed for MEDLINE]
144. Am Ind Hyg Assoc J. 1998 Jan;59(1):39-44.
Questionnaires for collecting detailed occupational information for
community-based case control studies.
Stewart PA, Stewart WF, Siemiatycki J, Heineman EF, Dosemeci M.
Occupational Studies Section, National Cancer Institute, Bethesda, MD 20892-7364,
USA.
In case control studies, collection of information on the workplace environment
has generally been limited to self-reports of exposures or to job title, type of
employer, and the dates the jobs were held, supplemented sometimes by work
activities. This information, however, may be insufficient to assess the
potential and level of exposure accurately due to recall difficulties and the
variability of exposures within a job. A solution to this problem is to use
job-specific questionnaires. The organization of a series of such questionnaires
developed for a case control study of brain tumors is described. Three types of
questionnaires, or modules, were developed, task-based, industry-based, and
modules based on jobs with nonspecific types of tasks (e.g., laborer). The format
of these modules starts with questions on the general work environment (type of
employer) and proceeds to questions on tasks. More detailed information is then
gathered on materials and equipment used, sensory descriptions, dermal exposure,
work practices, engineering controls, and personal protective equipment use. The
questionnaires cover a wide variety of exposures including solvents, heavy
metals, polycyclic aromatic hydrocarbons, machining fluids, electromagnetic
frequency fields, and many other exposures and, therefore, can be used in other
case control studies.
PMID: 9438334 [PubMed - indexed for MEDLINE]
145. J Manag Med. 1998;12(1):63-72, 4.
The logic of job-sharing in the provision and delivery of health care.
Branine M.
Department of Management and Organization, University of Stirling, UK.
By definition the practice of job-sharing starts from the premiss that there is a
full-time job to be shared by those who want to balance their work with other
commitments. In a public sector institution, such as the National Health Service
(NHS), where most employees are female, it seems logical to believe that a
job-sharing policy would be able to promote equal opportunities, to increase
employee job satisfaction and to reduce labour costs. Hence, this paper attempts
to discuss the advantages and disadvantages of having a job-sharing policy, and
to analyse the reasons for the limited number of job-sharers in the NHS despite
the apparent benefits of job-sharing to both the employees and the employer. This
study was carried out in 15 NHS Trusts in northern England and Scotland, by the
use of questionnaires and interviews, and found that most NHS managers did not
see the practice of job-sharing as a major cost-saving opportunity or as a
working pattern that would enhance employee satisfaction and commitment. They saw
job-sharing as just a routine equal opportunities request which did not deserve
such managerial attention or long-term strategic thinking. It is argued in this
paper that job-sharing is a potentially useful option against a background of
demographic and other social and economic changes which require the development
and use of long-term strategic policies. Therefore, it is concluded that, in the
NHS, there is a need for a more active and creative approach to job-sharing,
rather than the reactive and passive approach that has dominated the practice so
far.
PMID: 10185761 [PubMed - indexed for MEDLINE]
146. Soc Sci Med. 1997 Jan;44(2):251-60.
Measuring the human cost of a weak economy: does unemployment lead to alcohol
abuse?
Ettner SL.
Harvard Medical School, Department of Health Care Policy, Boston, MA 02115, USA.
This paper uses two-stage instrumental variables methods to examine whether
unemployment affects alcohol use and symptoms of dependence, and if so, in which
direction. Data were obtained from the 1988 National Health Interview Survey. The
outcomes examined were average daily consumption during the previous two weeks
and a summary measure of the number of symptoms related to alcohol dependence
during the previous year. After eliminating potential bias due to reverse
causality, evidence was found that non-employment significantly reduces both
alcohol consumption and dependence symptoms, probably due to an income effect.
Involuntary unemployment had a mixed effect-job loss increased the consumption of
alcohol in the overall sample but reduced dependence symptoms among single
respondents. Studies of the impact of alcohol use on economic outcomes should
take potential reverse causality into account.
PMID: 9015877 [PubMed - indexed for MEDLINE]
147. J Occup Environ Med. 1996 Nov;38(11):1098-107.
Occupational factors of anxiety and depressive disorders in the French National
Electricity and Gas Company. The Anxiety-Depression Group.
Chevalier A, Bonenfant S, Picot MC, Chastang JF, Luce D.
Service Général de Médecine de Contrôle, Electricité de France-Gaz de France,
Paris, France.
Very few studies described the prevalence of mental disorders in the workplace by
using standard diagnostic criteria. A two-stage case-control study of anxiety and
depression was initiated by Electricité de France and Gaz de France, the French
Nationwide Company producing electricity and gas, using the General Health
Questionnaire with 12 items as a screening test and the Composite International
Diagnostic Interview as diagnostic instrument. Its aim was to point out
occupational situations that promote the occurrence of anxiety and depression
crises. Annual prevalence of depression was estimated at 7.6% in men (95%
confidence interval [CI], 5.5 to 9.7) and at 17.9% in women (95% CI, 9.9 to
25.8), and that of anxiety at 9.6% (95% CI, 6.9 to 12.3) in men and 26.3% (95%
CI, 17.2 to 35.4) in women. Workers in hazardous occupations were found to be
protected from these disorders, whereas supervisory staff tended to be prone to
developing them. Important changes in work or in its organization seemed to be
risk factors. Extra-professional variables and occupational characteristics were
included in a logistic regression model. The odds ratios corresponding to recent
job changes and a supervisory position were significantly elevated (odds ratios =
1.7 and 2.4, respectively). These results suggest that some occupational events,
such as major changes in work content or organization may cause or precipitate
anxiety and/or depressive disorders.
PMID: 8941899 [PubMed - indexed for MEDLINE]
148. J Adv Nurs. 1996 Nov;24(5):1054-62.
The changing academic role of the nurse teacher in the United Kingdom.
Kirk S, Carlisle C, Luker KA.
National Primary Care Research and Development Centre, University of Manchester,
England.
This paper presents findings from a national study conducted over a 3-year period
(1991-94) which examined the changing role of the nurse teacher. The study used
multiple methods to collect data from a wide variety of respondents (nurse
teachers, midwife teachers, clinical nurses, health service managers and higher
education lecturers). This paper presents the findings relating to the
development of the nurse teacher's academic role following the introduction of
Project 2000. The issues presented and discussed include specialization within
the nurse teacher's role, the nature of this specialization and the development
of academic credibility and scholarship. The implications of these changes in
terms of the development of nursing as an academic subject area and the
opportunity to contribute to the establishment of research based practice are
explored.
PMID: 8933267 [PubMed - indexed for MEDLINE]
149. Am J Psychiatry. 1996 Nov;153(11):1411-7.
Socioeconomic burden of subsyndromal depressive symptoms and major depression in
a sample of the general population.
Judd LL, Paulus MP, Wells KB, Rapaport MH.
Department of Psychiatry, University of California, San Diego 92093-0603, USA.
OBJECTIVE: The authors' goal was to evaluate the association between impairment
in daily function and subsyndromal depressive symptoms as well as major
depression to determine the economic and societal significance of these
conditions. METHOD: Using 12-month prevalence data gathered by the National
Institute of Mental Health (NIMH) Epidemiologic Catchment Area Program (ECA),
based on responses to the NIMH Diagnostic Interview Schedule, the authors divided
the 2,393 subjects from the Los Angeles ECA site into three groups: subjects with
subsyndromal depressive symptoms (N = 270), major depression (N = 102), and no
depressive disorder or symptoms (N = 2,021). The groups were compared on 10
domains of functional outcome and well-being. RESULTS: Significantly more
subjects with depressive symptoms than subjects who had no disorder reported high
levels of household strain, social irritability, and financial strain as well as
limitations in physical or job functioning, restricted activity days, bed days,
and poor health status. Significantly more subjects with major depression than
subjects with no disorder reported major financial losses, bed days, high levels
of financial strain, limitations in physical or job functioning, and poor health
status. Except for lower self-ratings of health status, no significant
differences were found between subjects with subsyndromal symptoms and those with
major depression. CONCLUSIONS: Significantly more people with subsyndromal
depressive symptoms or major depression reported impairment in eight of 10
functional domains than did subjects with no disorder. The high 1-year prevalence
of subsyndromal depressive symptoms, combined with the associated functional
impairment, emphasizes the clinical and public health importance and need for
additional investigations into these symptoms.
PMID: 8890673 [PubMed - indexed for MEDLINE]
150. Am J Ind Med. 1996 Sep;30(3):362-8.
Self-reported carpal tunnel syndrome: predictors of work disability from the
National Health Interview Survey Occupational Health Supplement.
Blanc PD, Faucett J, Kennedy JJ, Cisternas M, Yelin E.
Division of Occupational and Environmental Medicine, School of Medicine,
University of California San Francisco 94143-0924, USA.
The objective of this study was to identify risk factors for work disability
among persons with carpal tunnel syndrome (CTS). The study was designed to
analyze data from the Occupational Health Supplement of the National Health
Interview Survey, a nationwide, population-based survey. Subjects included 544
survey respondents with self-report of CTS and 32,688 survey respondents without
CTS, all aged 18-64 years, and with a history of labor force participation.
Measurements were as follows: Dependent variables were work disability, defined
either as cessation of employment without attribution of cause or, alternatively,
as cessation of employment or job change specifically attributed to CTS by the
survey respondent. Independent variables were ergonomic risk of work disability,
defined by minutes of workplace repetitive hand and wrist bending for the most
recent job held. This measure was derived from responses categorized by an
occupation and industry matrix independent of CTS status. Socio-demographic and
health status risk factors for work disability were based on the respondent
report. The main results were as follows: Among 544 persons with CTS, 58 (11%, CI
8-13%) reported work disability specifically attributed to CTS, representing an
estimated national prevalence of 240,578 persons with this limitation. Workplace
ergonomic risk, measured as repetitive hand or wrist bending in the occupation
and industry of last employment, was a significant factor predictive of
CTS-attributed work disability (per 120 min of daily exposure, OR 1.7, CI
1.1-2.6), even after taking into account socio-demographic factors and health
status. The conclusions were that work disability among persons with CTS is
common. For those with CTS, working conditions characterized by repetitive
bending of the hand or wrist may increase the risk of work disability associated
with this condition.
PMID: 8876807 [PubMed - indexed for MEDLINE]
151. Int J Epidemiol. 1996 Aug;25(4):744-52.
A novel approach to data collection in a case-control study of cancer and
occupational exposures.
Stewart PA, Stewart WF, Heineman EF, Dosemeci M, Linet M, Inskip PD.
National Cancer Institute, Epidemiology and Biostatistics Program, Rockville, MD
20892, USA.
BACKGROUND: In community and hospital-based case-control studies, the
occupational data collected in interviews are usually limited to responses to
general questions asked of all study subjects. A procedure is described in which
more detailed information can be collected in an efficient, standardized and
systematic way. METHODS: A generic work history is initially collected from all
subjects using a computer-assisted interview. The work history includes job
title, type of business, job activities, materials and chemicals, and tools and
equipment used. After responses are entered into the computer by the interviewer,
the computer searches a synonym file to identify possible job-specific modules
relevant to the reported job. The modules are detailed questionnaires that
address specific jobs administered after obtaining the generic work history. The
modules are used to ask questions about the work environment; sources of
exposure; factors affecting the movement of the agent from the source to the
subject, such as local exhaust ventilation; and individual and job
characteristics. After the interview is completed, the work history and responses
to the modules are sent electronically to an industrial hygienist who reviews the
information using a custom-designed software package. Where ambiguities or
contradictions occur in information reported by the respondent, or for jobs for
which no module had been developed, the industrial hygienist generates up to 10
additional questions per job. These questions are sent back to the interviewer
for administration of a short, second interview. CONCLUSIONS: These procedures,
which are being successfully implemented in an on-going case-control study of
brain tumours, should improve disease risk estimates over those derived from more
traditional approaches to exposure assessment.
PMID: 8921451 [PubMed - indexed for MEDLINE]
152. J Nerv Ment Dis. 1995 May;183(5):325-31.
Age-related variation in recent life events preceding suicide.
Heikkinen ME, Isometsä ET, Aro HM, Sarna SJ, Lönnqvist JK.
National Public Health Institute, Department of Mental Health, Helsinki, Finland.
Recent life events as reported by the next of kin were explored in male and
female suicide victims to see how these factors varied across age groups by
decade of age. The study population comprised all 1022 suicide victims aged 20
years and older in Finland during a 12-month period who had life event data
assessed as reliable by the interviewing mental health professionals. Age-related
patterns of variation of life events were found: separation, serious family
arguments, financial trouble, job problems, unemployment, and residence change
were more common among younger victims, whereas somatic illness and retirement
were more common among older victims. Mean number of life events, greater among
men than women, tended to decline gradually across the age range. In terms of sex
differences, somatic illness was more common among elderly men, while separation,
financial trouble, and unemployment were more common among younger men. Most life
events among younger age groups were possibly dependent upon the victims' own
behavior. Logistic regression indicated association between specific life events
and alcohol misuse: separation, serious family arguments, financial trouble and
unemployment were especially related to alcohol misuse. Violent suicide method
lacked association with life events, being commoner only among males and those
not having misused alcohol. Age- and sex-specific control groups and
multidimensional life event interview schedules are needed to further investigate
the relative risk of life events in suicide.
PMID: 7745388 [PubMed - indexed for MEDLINE]
153. Ergonomics. 1995 Apr;38(4):793-805.
A national cross-sectional study in the Danish wood and furniture industry on
working postures and manual materials handling.
Christensen H, Pedersen MB, Sjĝgaard G.
National Institute of Occupational Health, Department of Physiology, Copenhagen,
Denmark.
Musculoskeletal disorders constitute a major problem in the wood and furniture
industry and identification of risk factors is needed urgently. Therefore,
exposures to different work tasks and variation in the job were recorded based on
an observation survey in combination with an interview among 281 employees
working in wood working and painting departments. A questionnaire survey
confirmed high frequencies of symptoms from the musculoskeletal system: The
one-year prevalence of symptoms from the low back was 42% and symptoms from the
neck/shoulder was 40%. The exposure was evaluated based on: (1) classification of
work tasks, (2) work cycle time, (3) manual materials handling, (4) working
postures, and (5) variation in the job. Among the employees 47% performed feeding
or clearing of machines, 35% performed wood working or painting materials, and
18% performed various other operations. Among the employees 20% had no variation
in their job while 44% had little variation. Manual materials handling of 375
different burdens was observed, which most often occurred during feeding or
clearing of machines. The weight of burdens lifted was 0.5-87.0 kg, where 2% had
a weight of more than 50 kg. Among the lifting conditions 30% were evaluated as
implying a risk of injury. An additional risk factor was the high total tonnage
lifted per day, which was estimated to range from 132 kg to 58,800 kg. Working
postures implied a risk of injury due to prolonged forward and lateral flexions
of the neck, which was seen most frequently during wood working or painting
materials. These data substantiate the finding that work tasks mainly during
feeding or clearing of machines imply a risk of injury to the low back and a risk
of injury to the neck and shoulder area mainly during wood working or painting
materials. Optimal strategies for job redesign may be worked out by using these
data in order to prevent occupational musculoskeletal disorders.
PMID: 7729404 [PubMed - indexed for MEDLINE]
154. Occup Med (Lond). 1995 Apr;45(2):75-80.
Audit of pre-employment assessments by occupational health departments in the
National Health Service.
Whitaker S, Aw TC.
Institute of Occupational Health, University of Birmingham, Edgbaston, UK.
Pre-employment health assessment of applicants to the National Health Service
(NHS) is one of the functions of occupational health departments in the NHS. This
paper describes the results of a process and outcome audit of this activity,
concentrating on the current practice of occupational health departments. The
audit was carried out by 40 NHS occupational health units who provided
information on a standard questionnaire on all pre-employment assessments
undertaken over a three-month period. This produced 9139 questionnaire returns.
The analysis showed that the most common method of assessment was the use of a
self-administered questionnaire alone (49.4%). A self-administered questionnaire
followed by a nurse interview as standard practice was the next most common
method (34.1%), but referral to a physician was uncommon. The outcome of the
assessments for 98% of all applicants was 'fit for work'. A total of 120
individuals (1.3%) were assessed as 'fit to work, but with some restriction' and
65 individuals (0.7%) were considered 'unfit'. The most common reasons for
rejection were abnormal body mass index (40%), skin conditions (21.5%) and
psychiatric conditions (10.8%). The most common reasons for restriction were
musculoskeletal conditions (27.5%), skin conditions (15%) and abnormal body mass
index and psychiatric conditions (both 10.8%). The audit identified wide
variation between occupational health departments in the NHS in the practice of
restriction and rejection. A decision on the value of pre-employment assessment
in the NHS mus take into consideration the ability of the process to achieve its
aim, the time and manpower involved in the process, and the probability of low
restriction and rejection rates.(ABSTRACT TRUNCATED AT 250 WORDS)
PMID: 7718823 [PubMed - indexed for MEDLINE]
155. Int Psychogeriatr. 1995 Summer;7(2):287-300.
Recent life events in elderly suicide: a nationwide study in Finland.
Heikkinen ME, Lönnqvist JK.
National Public Health Institute, Department of Mental Health, Helsinki, Finland.
The primary objectives of this study were to examine recent stressful life events
and to explore possible social interaction factors across age groups in a
population of suicides. Life events during the last 3 months preceding suicide
(32 items) and factors related to social interaction (6 items) among 219 suicide
victims aged 60 years and older were compared with those of 803 victims aged 20
to 59 years. The study population comprised all adult suicides who had life
events interview data assessed as reliable by the interviewers in a nationwide
total suicide population (1,397) of 1 year in Finland. Differences in life events
were found across age groups: Family discord, loss (separation, death), financial
trouble, job problems, unemployment, and residence change were more common among
younger victims, and somatic illness was more common among elderly victims. Age
groups were similar with regard to proportions of persons living alone,
availability of confidants and friends with common interests, and reports of
loneliness. Similarly, few differences were found among persons aged 60-74
compared to age 75+ with regard to rates of life events, living alone,
opportunities for social interaction, and complaints of loneliness. loneliness
was reported for persons who experienced loss among both younger and older
suicides. In terms of age differences, younger men were more likely to have
experienced job-related events, whereas older men were more likely to have had a
somatic illness. Somatic illness appeared to be the most important stressor in
elderly suicides, particularly for men. Living alone and diminished opportunity
for social interaction were not common factors in late-life suicides. Controlled
studies with age-matched comparisons are needed to further investigate how life
events and social interaction factors vary in their risk for suicide across the
life course.
PMID: 8829434 [PubMed - indexed for MEDLINE]
156. Accid Anal Prev. 1994 Oct;26(5):655-65.
Heavy drinking and the risk of occupational injury.
Dawson DA.
Division of Biometry and Epidemiology, National Institute on Alcohol Abuse and
Alcoholism, Rockville, MD 20892.
This study evaluated the association between the frequency of heavy drinking and
the risk of occupational injury, using nationally representative data from the
1988 National Health Interview Survey (NHIS). The sample consisted of 29,192
adults who were employed at some time during the year preceding the NHIS
interview. Overall, 7.2% reported an on-the-job injury during the preceding year,
but the rates were higher--about 13%--for those employed as skilled or unskilled
laborers or who reported engaging in repeated strenuous physical activity at
work. Slightly more than one-fourth of the employed adults reported at least one
occasion of drinking five or more drinks during the preceding year. After
adjusting for the effects of age, gender, education, occupation, and strenuous
job activity, the odds of occupational injury increased with frequency of heavy
drinking, with odds ratios varying from 1.08 (one occasion of heavy drinking) to
1.74 (daily heavy drinking). Odds ratios were decreased slightly by the inclusion
of smoking as a control variable, indicating that some of the excess risk of
injury among heavy drinkers may reflect their greater propensity to take
health-related risks rather than direct effects of ethanol. The odds ratios also
were slightly lower when the analysis was restricted to current drinkers,
suggesting that the risk of work injury was increased by light or moderate as
well as heavy drinking.
PMID: 7999210 [PubMed - indexed for MEDLINE]
157. J Ambul Care Mark. 1994;5(2):115-36.
Recruitment and retention of allied health personnel.
Oakerlund VW, Jackson PB, Parsons RJ.
National Research Association, USA.
PMID: 10165476 [PubMed - indexed for MEDLINE]
158. Soc Psychiatry Psychiatr Epidemiol. 1993 Oct;28(5):231-8.
Work environment and schizophrenia: an extension of the arousal hypothesis to
occupational self-selection.
Muntaner C, Pulver AE, McGrath J, Eaton WW.
Laboratory of Socio-Environmental Studies, National Institute of Mental Health,
Bethesda, MD 20892.
The present study investigated a possible mechanism underlying the occupational
self-selection of future schizophrenic patients prior to their first admission.
More precisely, we explored whether schizophrenic patients are more likely than
other psychotic patients to work in environments with a low potential for arousal
(low complexity environments) in the last full-time job that preceded their
hospitalization. All first admissions with psychotic symptoms to 15 hospitals
providing inpatient psychiatric services in the Baltimore-Washington area were
surveyed during a 6-year period. Patients diagnosed with schizophrenia were
compared to patients diagnosed with bipolar disorder and other psychotic
disorders to evaluate the suspected association. Study participants were assessed
with a modified version of the Diagnostic Interview Schedule. Standard survey
questions were used to assess occupational background. A measure based on the
dictionary of occupational titles (DOT) was used to estimate the degree of
complexity to which patients had been exposed in their last full-time occupation.
Data were analyzed using multinomial logistic regression. After adjustment for
age, gender, marital status, unemployment, socioeconomic status, hospital type,
and physical demands and hazards on the job, patients with schizophrenia were
more likely to have been working in low complexity environments in their last
full-time jobs (e.g., janitors, gardeners, guards) than patients with bipolar
disorder or with other psychotic disorders. Alternative explanations and
potential implications regarding which work environments might be best suited to
the social behavior of patients with schizophrenia are examined.
PMID: 8284736 [PubMed - indexed for MEDLINE]
159. Am J Ind Med. 1993 Jul;24(1):25-39.
Health characteristics by longest held occupation and industry of employment:
United States, 1980.
Cooper SP, Buffler PA, Lee ES, Cooper CJ.
Health Law and Policy Institute, University of Houston, Texas.
Occupational and industrial hazards are unevenly distributed in the workplace.
National estimates for selected health indices of persons aged 17 years and over
in the civilian noninstitutionalized population are presented for categories of
longest held occupation and industry of employment. These estimates were based on
data collected by the National Center for Health Statistics (NCHS) in the 1980
National Health Interview Survey (NHIS) and the Occupational Supplement, the
first survey to collect data on longest held, in addition to current, occupation
and industry of employment. Data on length of longest held job, limitation of
activity, disability days, incidence of acute conditions, persons injured,
hospitalizations, and utilization of medical and dental services are presented.
PMID: 8352291 [PubMed - indexed for MEDLINE]
160. Nurse Educ Today. 1993 Feb;13(1):30-9.
Selecting potential nurses: a review of the methods.
Land LM.
The following paper presents an overview of the literature in relation to
personnel selection and its particular application to the selection of candidates
for nurse education. In industry and indeed general management circles within the
National Health Service, dynamic methods are being used to select middle and
higher management personnel. Yet the largest group of National Health Service
employees to be selected, nurses, whose training costs represent no small amount
in annual budgets, appear to be accepted on highly inconsistent and subjective
grounds. Material derived from personnel management and occupational psychology
demonstrates the importance of systematic staff selection and the resulting
discussion questions why nursing retains such methods for selecting student
nurses.
PMID: 8455538 [PubMed - indexed for MEDLINE]
161. J Clin Epidemiol. 1991;44(2):155-66.
Job dimensions associated with severe disability due to cardiovascular disease.
Murphy LR.
National Institute for Occupational Safety and Health, Division of Biomedical and
Behavioral Science, Cincinnati, OH 45226.
This study explored associations among job activities and disability due to
cardiovascular disease by merging national disability data with
independently-obtained job activity data. Disability data were taken from a 1978
U.S. health interview survey (n = 9855). Expert ratings of job activities
(dimensions) were obtained from a job analysis database (n = 2485 occupations).
The two databases were merged such that job dimension data were imputed to each
occupation in the disability database. Odds ratios for cardiovascular disability
were calculated for scores in the second, third, and fourth quartiles for each of
the 32 job dimensions, using scores in the first quartile as the standard. Job
dimensions associated with cardiovascular disability were (a) hazardous
situations; (b) vigilant work and responsibility for others; (c) exchanging
job-related information; and (d) attention to devices. Occupations identified
with high scores on these job dimensions included transportation jobs (air
traffic controllers, airline pilots and attendants, bus drivers, locomotive
engineers, truck drivers), teachers (preschool, adult education), and
craftsmen/foremen (machinists, carpenters, and foremen).
PMID: 1825324 [PubMed - indexed for MEDLINE]
162. Drug Alcohol Depend. 1990 Nov;26(3):217-25.
The prevalence and self-reported consequences of cocaine use: an exploratory and
descriptive analysis.
Trinkoff AM, Ritter C, Anthony JC.
Center for Nursing and Health Services Research, University of Maryland School of
Nursing, Baltimore 21201.
In this study, prevalence rates for cocaine use were estimated by sex and race,
as well as for selected social role and lifestyle characteristics, including
educational level, martial status, living arrangements, job type and employment
status. Prevalence rates were based on an estimation procedure that made the
age-race-sex distributions balanced to that of the nation as a whole. Data were
gathered from a multi-site probability sample of adults interviewed in 1981-1984
as part of the National Institute of Mental Health Epidemiologic Catchment Area
Program (ECA) (n = 14,333). In addition to prevalence of use, rates of
self-reported consequences of cocaine use were generated, by level of cocaine
use. Striking differences in prevalence were found by education and marital
status, which remained after controlling for age of respondent. Respondents who
were employed full-time had a higher prevalence of cocaine use than those who
were not. Individuals residing in households at the time of interview had a 6.4%
lifetime prevalence of cocaine use, vs. hospitalized respondents (22%) and
incarcerated respondents (40%). Cocaine use consequence rates varied greatly
across survey sites, with self-reported tolerance (28%-51%) and withdrawal
sickness (8%-33%) figuring prominently among sustained daily users.
PMID: 2265589 [PubMed - indexed for MEDLINE]
163. Physician Exec. 1990 Mar-Apr;16(2):27-30.
Between jobs: the search for a management position.
Sommaripa AM.
Being out of work for physicians traditionally has meant that period after a
severe illness or disability and before resumption of practice. As physician
executives, we should think of the unthinkable. It also can mean being
unemployed. That possibility is quite real, and yet we are ill-prepared to handle
it. By inference from the national unemployment rate, there may be 200-300
members of the College who are "between jobs" at any given time.
PMID: 10160624 [PubMed - indexed for MEDLINE]
164. Vital Health Stat 10. 1989 Jun;(168):1-105.
Health characteristics by occupation and industry of longest employment.
Cooper SP, Buffler PA, Cooper CJ.
Includes estimates on length of longest job held, limitation of activity,
disability days, incidence of acute conditions, persons injured,
hospitalizations, and utilization of medical and dental services of persons aged
17 years and over in the civilian noninstitutionalized population. These
estimates are presented by occupation and industry of longest employment for
those who had ever worked. Estimates are based on data collected in the National
Health Interview Survey of 1980.
PMID: 2763471 [PubMed - indexed for MEDLINE]
165. J Occup Med. 1989 Apr;31(4):339-46.
Agreement of latest and longest occupation and industry as reported in the 1980
National Health Interview Survey.
Burnett CA, Crouse WE.
Division of Surveillance, National Institutes for Occupational Safety and Health,
Cincinnati, OH 45226.
The effectiveness of using the latest occupation instead of usual in studies of
chronic disease was assessed by comparing latest and usual occupation for
agreement. The 1980 National Health Interview Survey Occupational Supplement
collected information on both latest and longest job and the lengths of the jobs.
We compared the latest occupation and industry with the longest (usual)
occupation and industry for agreement. For men, the industry agreement was 68.1%
and the occupation agreement was 69.9%. Women had slightly higher agreement:
70.3% for industry and 70.5% for occupation. The percent of agreement varied by
industry or occupation and age, sex, race, respondent, and length of latest job.
We conclude that the percentage of agreement of latest occupation and industry
with usual is sufficient for analyses of National Health Interview Survey chronic
disease data using latest occupation or industry.
PMID: 2715840 [PubMed - indexed for MEDLINE]
166. Am J Ind Med. 1988;13(1):5-41.
Smoking characteristics of US workers, 1978-1980.
Brackbill R, Frazier T, Shilling S.
National Institute for Occupational Safety and Health, Cincinnati, OH 45226.
Data from the 1978-1980 National Health Interview Survey smoking questionnaire
were used to analyze prevalence and levels of cigarette smoking among groups of
US workers. This information is valuable for indirect adjustment in occupational
epidemiology studies as well as for describing smoking patterns of workers in a
wide range of job settings. Although there was a higher percentage of current
smokers among men than women in the general population, there were few
differences in prevalence of smoking among men and women for specific
occupations. Also, race and employment status had an influence on prevalence of
smoking, where both the currently unemployed and blacks generally had a higher
proportion of current smokers, although blacks generally had a higher proportion
of current smokers, although blacks smoked fewer cigarettes. Industry also played
a major role in the variation of smoking habits. For instance, the percentage of
current smokers of a given occupation had as much as a 25% difference depending
on the industry they were employed, such as 52% vs 26% for managers and
administrators. Detailed data will be made available as microcomputer files for
interested researchers.
PMID: 3344755 [PubMed - indexed for MEDLINE]
167. Public Health Rep. 1987 Jan-Feb;102(1):36-46.
Occupational health and safety risks and potential health consequences perceived
by U.S. workers, 1985.
Shilling S, Brackbill RM.
Data from the Health Promotion and Disease Prevention Questionnaire, part of the
1985 National Health Interview Survey, were used to report workers' perceptions
of occupational risk in their present jobs. This information will be used to
monitor progress between 1985 and 1990 toward achieving broad goals in health
promotion and disease prevention. The proportions of currently employed persons
who perceived exposure to health-endangering substances, work conditions, or
risks of injuries were reported for age, race, sex, and occupation groups.
Occupational groups were further characterized by the proportion of men and women
who reported specific exposures (such as exposure to chemicals or to loud noise)
and specific health consequences of exposure (such as risk of developing cancer
or hearing impairment). Greater proportions of men than women reported perceived
risk from exposure to health-endangering substances, work conditions, and
injuries in their present job. Also, a greater proportion of workers perceived
risk of injury in their present job than other occupational risk categories. The
greatest proportions of perceived exposure to occupational risk were reported by
farm operators and managers, police and firefighters, and by workers in forestry
and fishing occupations. Among workers reporting perceived exposures, chemicals,
noise, and risk of injuries from vehicles were cited by the greatest proportion
of workers, as were such health consequences as lung and respiratory problems and
hearing impairment. Data from this study may be used to target employment groups
for health promotion or education and to develop indepth studies of specific
occupational groups to reduce or prevent risk at the worksite.
PMCID: PMC1477725
PMID: 3101121 [PubMed - indexed for MEDLINE]
168. Women Health. 1986 Spring;11(1):27-45.
Health and health care of employed adults: occupation and gender.
Muller C.
This paper reports on a study of health and health care of employed women and men
that used the National Health Interview Survey of 1975-1977 as the data source.
Materials from the Dictionary of Occupational Titles and other government sources
were used to develop scales for psychosocial and physical health features of
individual occupations. Multiple regressions were then used to study the relation
of occupational factors and gender along with family factors, to health status,
chronic limitations, and use of physician and hospital services. The study shows
a correlation of the jobs that are more complex and challenging and offer more
autonomy with better health status. The current job structure shows more
variation in psychological level of occupations than in physical healthiness;
women are concentrated in the less desirable occupations. The study also examines
gender differences in illness-day measures and health care utilization in 36
occupations with substantial employment of both sexes, and finds considerable
variability among occupations in the extent of gender differences.
PMID: 3739359 [PubMed - indexed for MEDLINE]
169. Nurs Clin North Am. 1985 Sep;20(3):585-94.
The job search and information systems opportunities for nurses.
Hersher BS.
It is important to continually upgrade your skills and goals, examine career
options, and be flexible. This is an ideal point in the growth of health care
information systems for nurses to consider before becoming actively involved. The
future of our industry will be total health care systems expanding far beyond
hospitals. There is and will be a greater need to provide information for
decision making in the vast areas of alternative delivery, preventative medicine,
industrial and occupational medicine, and the adult long-term care market. Large,
non-health care corporations and business coalitions will have a strong influence
on our industry. Terminals will be set up in the workplace for early detection of
disease and to provide wellness programs. Due to severe financial pressures, we
will finally be forced to use our technology for medical research and to provide
access to national data bases to provide better health care and allow for
prevention, early detection, and a faster cure of some diseases. The nurse
consultant will play a major role in this area. This evolution will happen only
over time. As many mergers take place among the major health care vendors, we can
only wonder what this does to our industry. As larger consolidated corporations
sort their priorities, entrepreneurs will have the ideal opportunity to use their
creative ability to provide products and services to the industry. The survivors
will be those firms and institutions providing the best and most flexible service
at a competitive price. What is important in this market is the people. They must
be global thinkers with an understanding of the present and future of the health
care market. They must be managers who are flexible and able to creatively use
resources and technology. In both a profit and nonprofit environment, these
leaders will be required to be risk takers, decision makers, and operate in a
proactive manner. They will need to be entreprenurial and be open to joint
venturing. The health care systems industry will only gain in importance in the
next 4 years and will be nothing less than dynamic.
PMID: 3851394 [PubMed - indexed for MEDLINE]
170. East Econ J. 1984 Jan-Mar;10(1):31-41.
A new approach to household fertility behavior.
Seiver DA, Cymrot DJ.
PIP: A 1st step is taken in this discussion towards the explicit theoretical
recognition that fertility decisions are made by pairs of individuals who
conceivably have different preferences or are in different circumstances. The
focus is on disagreements between spouses over desired family size. The
discussion begins by identifying the costs and benefits of child services to each
spouse, which involves consideration of the type of interdependency of the
utility functions as well as the nature of the externality problem in the
production of child service. Specific examples are included of situations in
which disagreement is likely to occur. Using the National Fertility Survey of
1965, it is possible to test whether disagreements are more likely to occur in
these identified cases. 2 types of fertility conflict are predicted: the wife
desires fewer children than the husband and the reverse. The National Fertility
Survey (NFS) data set contains 5617 interview records. A sample of 1559 women who
were married once, husband present, nonmenopausal, aged 25-39 with valid answers
to all questions were selected. Husband's schooling in excess of wife's increased
the probability that conflict of the husband demanding fewer children type will
arise and the probability was increased at higher levels of income. The demand
for quality rose with income and placed additional pressure on a husband with
more education to assist (via lost leisure time) in the creation of quality. The
effects were highly nonlinear. Higher levels of status of the wife's (potential)
job had the predicted effect of making wife demands fewer children conflict more
likely, but only through intermediate levels of status. Another variable which
had a significant influence on the probability of conflict was the husband's age,
with higher husband's age leading to husband demanding fewer children than wife
conflict.
PMID: 12267729 [PubMed - indexed for MEDLINE]
171. Women Health. 1984 Spring;9(1):17-41.
Physical health of clerical workers in the U.S., Framingham, and Detroit.
Verbrugge LM.
The Framingham Heart Study has reported high rates of coronary heart disease
among clerical women, compared to other working women and housewives. Using data
from the National Health Interview Survey, we find that U.S. clerical women have
the best overall profile compared to other occupation groups. They have low
injury and chronic limitation rates, little restricted activity, and average
health services use. The Framingham clerical women worked mostly before 1960 when
clerical work was devalued and the combination of job and family roles put great
pressures on women; contemporary clerical women may have more job satisfactions
and fewer pressures from multiple roles, and thus lower health risks. In contrast
to women, clerical men have a poor health profile compared to other employed men.
They have more recent hospitalization and job limitations from chronic
conditions. This suggests that men with serious health problems take clerical
jobs that are not physically demanding. A health survey of Detroit adults
indicates that Detroit clerical men match the national profile, but Detroit
clerical women do not. Both groups are dissatisfied with their jobs, compared to
other workers. The Detroit data suggests that role pressures and dissatisfactions
contribute to poor health, and that people with health problems (especially men)
gravitate toward clerical jobs. We need to know more about how perceived role
burdens, role dissatisfactions, and weak coping skills influence health.
PMID: 6702206 [PubMed - indexed for MEDLINE]
172. Am J Clin Oncol. 1983 Jun;6(3):339-45.
Assessment of the quality of life in long-term survivors after definitive
radiotherapy.
Danoff B, Kramer S, Irwin P, Gottlieb A.
An interview questionnaire was developed to assess quality of life both in
objective and subjective terms in cancer patients. Standardized measures were
employed and allowed for comparison with a national baseline. Three hundred
thirty-nine patients who were alive without evidence of disease 3 or more years
following initial treatment were interviewed. There was no difference in terms of
educational level, marital status, or satisfaction with local government, family,
job, friends, community, health, recreation, or activities when compared to the
age-adjusted national baseline. The patients were more satisfied with region,
self, and life as a whole. There was no evidence of a diminished quality of life
in these patients.
PMID: 6846252 [PubMed - indexed for MEDLINE]