1. Psychosom Med. 2009 Oct 29. [Epub ahead of print]
Effect of Depression Treatment on Chronic Pain Outcomes.
Teh CF, Zaslavsky AM, Reynolds CF 3rd, Cleary PD.
RAND Corporation (C.F.T.), Pittsburgh, PA; Department of Health Care Policy
(A.M.Z.), Harvard Medical School, Boston, MA; Department of Psychiatry (C.F.R.),
University of Pittsburgh School of Medicine, Pittsburgh, PA; Yale School of
Public Health (P.D.C.), Yale School of Medicine, New Haven, CT.
Objective: To examine the effect of depression treatment on medical and social
outcomes for individuals with chronic pain and depression. People with chronic
pain and depression have worse health outcomes than those with chronic pain
alone. Little is known about the effectiveness of depression treatment for this
population. Methods: Propensity score-weighted analyses, using both waves
(1997-1998 and 2000-2001) of the National Survey of Alcohol, Drug, and Mental
Health Problems, were used to examine the effect of a) any depression treatment
and b) minimally adequate depression treatment on persistence of depression
symptoms, depression severity, pain severity, overall health, mental health
status, physical health status, social functioning, employment status, and number
of workdays missed. Analyses were limited to those who met Composite
International Diagnostic Interview Short-Form criteria for major depressive
disorder, reported having at least one chronic pain condition, and completed both
interviews (n = 553). Results: Receiving any depression treatment was associated
with higher scores on the mental component summary of the Medical Outcomes Study
Short Form-12, indicating better mental health (difference = 2.65 points, p =
.002) and less interference of pain on work (odds ratio = 0.57, p = .02). Among
those receiving treatment, minimal adequacy of treatment was not significantly
associated with better outcomes. Conclusions: Depression treatment improves
mental health and reduces the effects of pain on work among those with chronic
pain and depression. Understanding the effect of depression treatment on outcomes
for this population is important for employers, healthcare providers treating
this population, and policymakers working in this decade of pain control and
research to improve care for chronic pain sufferers.
PMID: 19875633 [PubMed - as supplied by publisher]
2. COPD. 2009 Oct;6(5):380-7.
Prevalence of chronic obstructive pulmonary disease in the U.S. working
population: an analysis of data from the 1997-2004 National Health Interview
Survey.
Bang KM, Syamlal G, Mazurek JM.
National Institute for Occupational Safety and Health, Centers of Disease Control
and Prevention, Morgantown, West Virginia, 26505, USA. kmb2@cdc.gov
To estimate the prevalence and the population attributable fraction of chronic
obstructive pulmonary disease (COPD) in the U.S. adult workers, we analyzed data
obtained from the National Health Interview Surveys for the period 1997-2004. The
overall COPD prevalence was 4.0% (95% confidence interval [CI] 3.9-4.1%). The
prevalence was higher in females (5.4%, 95% CI 5.3-5.6%) than in males (2.8%, 95%
CI 2.7-2.9%); in Whites (4.2%, 95% CI 4.1-4.3%) than in Blacks (3.4%, 95% CI
3.1-3.7%) and other races (2.4%, 95% CI 2.1-2.8%). Compared with insurance, real
estate and other finance industry, the top three industries associated with
significantly higher prevalence odds ratios (PORs) (adjusted for age, sex, race,
and smoking) were other educational services (POR = 1.5, 95% CI 1.0-2.3);
transportation equipment (POR = 1.4, 95% CI 1.1-1.8); and social services,
religious and membership organizations (POR = 1.4, 95% CI 1.1-1.7). Compared with
managers and administrators, except public administration occupation, the top
three occupations with significantly higher PORs were health service (1.8, 95% CI
1.5-2.1), other protective service (POR = 1.6, 95% CI 1.2-2.2), and material
moving equipment operators (POR = 1.6, 95% CI 1.1-2.3). The overall population
attributable fraction for association of COPD with employment was 12.2% for
industry and 17.4% for occupation. Further studies are needed to determine
specific risk factors associated with COPD in industries and occupations with
elevated prevalence and POR.
PMID: 19863367 [PubMed - in process]
3. J Gen Intern Med. 2009 Nov;24 Suppl 3:561-6.
Heterogeneity in health insurance coverage among US Latino adults.
Bustamante AV, Fang H, Rizzo JA, Ortega AN.
UCLA School of Public Health, 650 Charles E. Young Drive South Room 31-299C, Box
951772, Los Angeles, CA, 90095, USA. avb@ucla.edu
OBJECTIVE: We sought to determine the differences in observed and unobserved
factors affecting rates of health insurance coverage between US Latino adults and
US Latino adults of Mexican ancestry. Our hypothesis was that Latinos of Mexican
ancestry have worse health insurance coverage than their non-Mexican Latino
counterparts. METHODS: The National Health Interview Survey (NHIS) database from
1999-2007 consists of 33,847 Latinos. We compared Latinos of Mexican ancestry to
non-Mexican Latinos in the initial descriptive analysis of health insurance
coverage. Disparities in health insurance coverage across Latino categories were
later analyzed in a multivariable logistic regression framework, which adjusts
for confounding variables. The Blinder-Oaxaca technique was applied to parse out
differences in health insurance coverage into observed and unobserved components.
RESULTS: US Latinos of Mexican ancestry consistently had lower rates of health
insurance coverage than did US non-Mexican Latinos. Approximately 65% of these
disparities can be attributed to differences in observed characteristics of the
Mexican ancestry population in the US (e.g., age, sex, income, employment status,
education, citizenship, language and health condition). The remaining disparities
may be attributed to unobserved heterogeneity that may include unobserved
employment-related information (e.g., type of employment and firm size) and
behavioral and idiosyncratic factors (e.g., risk aversion and cultural
differences). CONCLUSIONS: This study confirmed that Latinos of Mexican ancestry
were less likely to have health insurance than were non-Mexican Latinos.
Moreover, while differences in observed socioeconomic and demographic factors
accounted for most of these disparities, the share of unobserved heterogeneity
accounted for 35% of these differences.
PMCID: PMC2764037
PMID: 19842007 [PubMed - in process]
4. AIDS Educ Prev. 2009 Oct;21(5):415-29.
Sociocultural contexts and communication about sex in China: informing HIV/STD
prevention programs.
Lieber E, Chin D, Li L, Rotheram-Borus MJ, Detels R, Wu Z, Guan J; National
Institute of Mental Health (NIMH) Collaborative HIV Prevention Trial Group.
Center for Culture and Health, Department of Psychiatry and Biobehavioral
Sciences, University of California, Los Angeles, CA 90024-1759, USA.
elieber@ucla.edu
HIV may be particularly stigmatizing in Asia because of its association with
"taboo" topics, including sex, drugs, homosexuality, and death (Aoki, Ngin, Mo, &
Ja, 1989). These cultural schemata expose salient boundaries and moral
implications for sexual communication (Chin, 1999, Social Science and Medicine,
49, 241-251). Yet HIV/STD prevention efforts are frequently conducted in the
public realm. Education strategies often involve conversations with health
"experts" about condom use, safe sex, and partner communication. The gap between
the public context of intervention efforts and the private and norm-bound nature
of sex conversation is particularly challenging. Interviews with 32 market
workers in eastern China focused on knowledge, beliefs, and values surrounding
sexual practices, meanings, and communication. Sex-talk taboos, information
seeking, vulnerability, partner communication, and cultural change emerged as
central to understanding intervention information flow and each theme's relative
influence is described. Findings illustrate the nature of how sexual
communication schemata in Chinese contexts impact the effectiveness of sexual
health message communication.
PMID: 19842826 [PubMed - indexed for MEDLINE]
5. 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]
6. J Occup Environ Med. 2009 Sep;51(9):1066-74.
Prevalence of lifetime asthma and current asthma attacks in U.S. working adults:
an analysis of the 1997-2004 National Health Interview Survey data.
Syamlal G, Mazurek JM, Bang KM.
Surveillance Branch, Division of Respiratory Disease Studies, National Institute
for Occupational Safety and Health, Centers for Disease Control and Prevention,
Morgantown, WV 26505, USA. gos2@cdc.gov
OBJECTIVE: To estimate national prevalences of lifetime asthma and asthma attacks
among workers by age, sex, race, occupation and industry, and estimate population
attributable fraction to employment for asthma attacks in the United States.
METHODS: The 1997-2004 National Health Interview Survey data for currently
working adults aged > or = 18 years were analyzed. RESULTS: Lifetime asthma
prevalence was 9.2%; the social services religious and membership organizations
industry and the health service occupation had the highest asthma prevalence.
Asthma attack prevalence among workers with asthma was 35.4%; the primary metal
industry and the health assessment and treating occupation had the highest attack
prevalence. Approximately, 5.9% of cases reporting an asthma attack were
attributed to employment when considering industries and 3.8% when considering
occupations. CONCLUSIONS: Future studies and intervention strategies should
address the higher prevalence of asthma in certain industries and occupations.
PMID: 19730397 [PubMed - indexed for MEDLINE]
7. 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]
8. J Epidemiol Community Health. 2009 Aug 13. [Epub ahead of print]
Socioeconomic status and the risk of major depression: The Canadian National
Populatoin Health Survey.
Wang JL, Schmitz N, Dewa C.
Canada;
BACKGROUND: There are few longitudinal studies investigating the risk of major
depression by socioeconomic status (SES). We used data from the longitudinal
cohort of Canadian National Population Health Survey (NPHS) to estimate the risk
of major depressive episode (MDE) over 6 years by SES levels. METHODS: The NPHS
used a nationally representative sample of the Canadian general population. In
this analysis, participants (n = 9,589) were followed from 2000/01 (baseline) to
2006/07. MDE was assessed using the Composite International Diagnostic Interview
- Short Form for Major depression. RESULTS: Low education level (OR = 1.86, 95%
CI: 1.28, 2.69) and financial strain (OR = 1.65, 95% CI: 1.19, 2.28) were
associated with an increased risk of MDE in participants who worked in the past
12 months. In those who did not work in the past 12 months, participants with low
education were at a lower risk of MDE (OR = 0.43, 95% CI: 0.25, 0.76), compared
to those with high education. Financial strain was not associated with MDE in
participants who did not work. Working men who reported low household income
(12.9%) and participants who did not work and reported low personal income (5.4%)
had a higher incidence of MDE than others. CONCLUSIONS: SES inequalities in the
risk of MDE exist in the general population. However, the inequalities may depend
on measures of SES, gender and employment status. These should be considered in
interventions of reducing inequalities in MDE. MDE history is an important factor
in studies examining inequalities in MDE.
PMID: 19679710 [PubMed - as supplied by publisher]
9. 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]
10. J Epidemiol Community Health. 2009 Nov;63(11):912-9. Epub 2009 Jul 30.
Prevalence of chronic medical conditions among jail and prison inmates in the USA
compared with the general population.
Binswanger IA, Krueger PM, Steiner JF.
Division of General Internal Medicine, Department of Medicine, University of
Colorado Denver School of Medicine, Aurora, CO 80045, USA.
Ingrid.Binswanger@ucdenver.edu
BACKGROUND: Despite growing inmate populations in the USA, inmates are excluded
from most national health surveys and little is known about whether the
prevalence of chronic disease differs between inmates and the
non-institutionalised population. METHODS: Nationally representative,
cross-sectional data from the 2002 Survey of Inmates in Local Jails, 2004 Survey
of Inmates in State and Federal Correctional Facilities and 2002-4 National
Health Interview Survey Sample Adult Files on individuals aged 18-65 were used.
Binary and multinomial logistic regression were used to compare the prevalence of
self-reported chronic medical conditions among jail (n = 6582) and prison (n =
14,373) inmates and non-institutionalised (n = 76 597) adults after adjusting for
age, sex, race, education, employment, the USA as birthplace, marital status and
alcohol consumption. Prevalence and adjusted ORs with 95% CIs were calculated for
nine important chronic conditions. RESULTS: Compared with the general population,
jail and prison inmates had higher odds of hypertension (OR(jail) 1.19; 95% CI
1.08 to 1.31; OR(prison) 1.17; 95% CI 1.09 to 1.27), asthma (OR(jail) 1.41; 95%
CI 1.28 to 1.56; OR(prison) 1.34; 95% CI 1.22 to 1.46), arthritis (OR(jail) 1.65;
95% CI 1.47 to 1.84; OR(prison) 1.66; 95% CI 1.54 to 1.80), cervical cancer
(OR(jail) 4.16; 95% CI 3.13 to 5.53; OR(prison) 4.82; 95% CI 3.74 to 6.22), and
hepatitis (OR(jail) 2.57; 95% CI 2.20 to 3.00; OR(prison) 4.23; 95% CI 3.71 to
4.82), but no increased odds of diabetes, angina or myocardial infarction, and
lower odds of obesity. CONCLUSIONS: Jail and prison inmates had a higher burden
of most chronic medical conditions than the general population even with
adjustment for important sociodemographic differences and alcohol consumption.
PMID: 19648129 [PubMed - in process]
11. J Clin Oncol. 2009 Sep 1;27(25):4130-4. Epub 2009 Jul 27.
Major depressive disorder in long-term cancer survivors: analysis of the National
Comorbidity Survey Replication.
Pirl WF, Greer J, Temel JS, Yeap BY, Gilman SE.
Department of Biostatistics, Massachusetts General Hospital, Yawkey 9A, 55 Fruit
St, Boston, MA 02114, USA. wpirl@partners.org
PURPOSE: Prior research is mixed as to whether long-term cancer survivors (LCSs)
have higher rates of depression than the general population. This is the first
study to compare the rates of major depressive disorder (MDD) between LCSs and
people without cancer histories in a nationally representative cross-sectional
multistage cluster survey sample, the National Comorbidity Survey-Replication
(NCS-R). METHODS: Between 2001 and 2003, face-to-face interviews were conducted
for the NCS-R in a national sample of 9,282 people, of whom 5,692 were assessed
for a history of cancer. Participants with cancer diagnoses at least 5 years
before the interview were considered LCSs. Survivors of childhood cancers were
excluded. Comparing LCSs to those without a cancer history, odds ratios for
having a MDD episode in the last 12 months before interview were obtained using
multiple logistic regression controlling for demographic and medical variables.
Differences in characteristics of those MDD episodes were also compared between
groups. RESULTS: Of participants age 23 years or older, 243 LCSs and 4,890 adults
without a cancer history were identified in the sample. Adjusting for demographic
variables and medical comorbidities, LCSs did not have increased odds of MDD in
the last 12 months, with an odds ratio of (OR) 0.99 (95% CI, 0.55 to 1.79). LCSs
reported higher mean levels of impairment from MDD in their home, social, and
work life, but these differences were not significant. CONCLUSION: LCSs do not
appear to have elevated rates of MDD. However, they may experience greater
impairment from MDD compared to those without cancer. Longitudinal studies are
needed to confirm these findings.
PMCID: PMC2734424 [Available on 2010/9/1]
PMID: 19636024 [PubMed - indexed for MEDLINE]
12. Soc Sci Med. 2009 Aug;69(4):604-12.
HIV prevention while the bulldozers roll: exploring the effect of the demolition
of Goa's red-light area.
Shahmanesh M, Wayal S, Andrew G, Patel V, Cowan FM, Hart G.
University College London, London WC1E 6AU, United Kingdom.
bamaryjoon@yahoo.co.uk
Interventions targeting sex-workers are pivotal to HIV prevention in India.
Community mobilisation is considered by the National AIDS Control Programme to be
an integral component of this strategy. Nevertheless societal factors, and
specifically policy and legislation around sex-work, are potential barriers to
widespread collectivisation and empowerment of sex-workers. Between November 2003
and December 2005 we conducted participatory observation and rapid ethnographic
mapping with several hundred brief informant interviews, in addition to 34
semi-structured interviews with key-informants, 16 in-depth interviews with
female sex-workers, and 3 focus-group-discussions with clients and mediators.
This provides a detailed examination of the demolition of Baina, one of India's
large red-light areas, in 2004, and one of the first accounts of the effect of
dismantling the red-light area on the organisation of sex-work and sex-workers'
sexual risk. The results suggest that the concentrated and homogeneous
brothel-based sex-work environment rapidly evolved into heterogeneous,
clandestine and dispersed modes of operation. The social context of sex-work that
emerged from the dust of the demolition was higher risk and less conducive to HIV
prevention. The demolition acted as a negative structural intervention; a
catastrophic event that fragmented sex-workers' collective identity and agency
and rendered them voiceless and marginalised. The findings suggest that an
abolitionist approach to sex-work and legislation or policy that either
criminalises this large group of women, or renders them as invisible victims,
will increase the stigma and exclusion they experience. For the targeted HIV
prevention approaches advocated by the National AIDS Control Programme to be
effective, there is a need for legislation and policy that supports sex-workers'
agency and self-organisation and enables them to create a safer working
environment for themselves.
PMID: 19596167 [PubMed - indexed for MEDLINE]
13. Arch Gen Psychiatry. 2009 Jul;66(7):785-95.
Cross-national associations between gender and mental disorders in the World
Health Organization World Mental Health Surveys.
Seedat S, Scott KM, Angermeyer MC, Berglund P, Bromet EJ, Brugha TS, Demyttenaere
K, de Girolamo G, Haro JM, Jin R, Karam EG, Kovess-Masfety V, Levinson D, Medina
Mora ME, Ono Y, Ormel J, Pennell BE, Posada-Villa J, Sampson NA, Williams D,
Kessler RC.
Medical Research Council Research Unit on Anxiety and Stress Disorder, Cape Town,
South Africa.
CONTEXT: Gender differences in mental disorders, including more anxiety and mood
disorders among women and more externalizing disorders among men, are found
consistently in epidemiological surveys. The gender roles hypothesis suggests
that these differences narrow as the roles of women and men become more equal.
OBJECTIVES: To study time-space (cohort-country) variation in gender differences
in lifetime DSM-IV mental disorders across cohorts in 15 countries in the World
Health Organization World Mental Health Survey Initiative and to determine if
this variation is significantly related to time-space variation in female gender
role traditionality as measured by aggregate patterns of female education,
employment, marital timing, and use of birth control. DESIGN: Face-to-face
household surveys. SETTING: Africa, the Americas, Asia, Europe, the Middle East,
and the Pacific. PARTICIPANTS: Community-dwelling adults (N = 72,933). MAIN
OUTCOME MEASURES: The World Health Organization Composite International
Diagnostic Interview assessed lifetime prevalence and age at onset of 18 DSM-IV
anxiety, mood, externalizing, and substance disorders. Survival analyses
estimated time-space variation in female to male odds ratios of these disorders
across cohorts defined by the following age ranges: 18 to 34, 35 to 49, 50 to 64,
and 65 years and older. Structural equation analysis examined predictive effects
of variation in gender role traditionality on these odds ratios. RESULTS: In all
cohorts and countries, women had more anxiety and mood disorders than men, and
men had more externalizing and substance disorders than women. Although gender
differences were generally consistent across cohorts, significant narrowing was
found in recent cohorts for major depressive disorder and substance disorders.
This narrowing was significantly related to temporal (major depressive disorder)
and spatial (substance disorders) variation in gender role traditionality.
CONCLUSIONS: While gender differences in most lifetime mental disorders were
fairly stable over the time-space units studied, substantial intercohort
narrowing of differences in major depression was found to be related to changes
in the traditionality of female gender roles. Additional research is needed to
understand why this temporal narrowing was confined to major depression.
PMID: 19581570 [PubMed - indexed for MEDLINE]
14. Med Care Res Rev. 2009 Oct;66(5):561-77. Epub 2009 Jun 25.
Understanding observed and unobserved health care access and utilization
disparities among US Latino adults.
Vargas Bustamante A, Fang H, Rizzo JA, Ortega AN.
University of California, Los Angeles, CA, USA. avb@ucla.edu
This study hypothesizes that differences in health care access and utilization
exist across Latino adults (>18 years), with U.S. Latino adults of Mexican
ancestry demonstrating the worst patterns of access and utilization. The analyses
use the National Health Interview Survey (NHIS) data from 1999 to 2007 (N =
33,908). The authors first estimate the disparities in health care access and
utilization among different categories of Latinos. They also implement
Blinder-Oaxaca techniques to decompose disparities into observed and unobserved
components, comparing Latinos of Mexican ancestry with non-Mexican Latinos.
Latinos of Mexican ancestry consistently demonstrate lower health care access and
utilization patterns than non-Mexican Latinos. Health insurance and region of
residence were the most important factors that explained observable differences.
In contrast, language and citizenship status were relatively unimportant.
Although a significant share of these disparities may be explained by observed
characteristics, disparities because of unobserved heterogeneity among the
different Latino cohorts are also considerable.
PMID: 19556553 [PubMed - indexed for MEDLINE]
15. 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]
16. Ophthalmic Epidemiol. 2009 May-Jun;16(3):156-62.
Epidemiology of lifetime work-related eye injuries in the U.S. population
associated with one or more lost days of work.
Forrest KY, Cali JM.
Department of Health and Safety, Slippery Rock University of Pennsylvania, 1
Morrow Way, Slippery Rock, PA 16057, USA. kimberly.forrest@sru.edu
PURPOSE: Eye injuries are one of the most common types of work-related injuries.
This study examined the lifetime prevalence rate of eye injuries at work and
associated factors in the general population of the United States. METHODS: The
data from the 2002 National Health Interview Survey (NHIS) were analyzed for
individuals aged 18 years or older (n = 28,913). Lifetime prevalence rates of
work-related eye injuries were determined by different factors, calculated as the
percentage of the weighted number of people who reported to have an eye injury at
work divided by the weighted total number of people in the corresponding
category. RESULTS: The overall lifetime prevalence rate of work-related eye
injuries was 4.4%. The lifetime age-specific prevalence rates of work-related eye
injuries ranged from 2%, 3.8%, 4.9%, 6.0%, 5.4%, 4.0%, and 3.1% for ages 18-24,
25-34, 35-44, 45-54, 55-64, 65-74, and 75+ years, respectively, with the highest
rate in the age of 45-54 years. Men had a more than four-times higher rate of eye
injury at work than women. Workers with less than a high-school education,
non-Hispanic whites, self-employed, and in the midwest region were more likely to
experience eye injuries (all p-values < 0.001). Occupations of precision
production, transportation, or farming, and industries of mining or construction
also increased the risk of eye injuries at work. CONCLUSION: Findings of the
current study underscore the need of education and prevention program on eye
protection at workplaces, targeting male workers, especially those who have a low
education level and are self-employed.
PMID: 19437310 [PubMed - indexed for MEDLINE]
17. 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]
18. 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]
19. Eur J Public Health. 2009 Apr;19(2):206-11.
The effect of the Irish smoke-free workplace legislation on smoking among bar
workers.
Mullally BJ, Greiner BA, Allwright S, Paul G, Perry IJ.
Department of Epidemiology & Public Health, National University of Ireland,
Brookfield Health Sciences Complex, Cork, Republic of Ireland. b.mullally@ucc.ie
BACKGROUND: On 29 March 2004, the Republic of Ireland (ROI) became the first EU
country to introduce a nationwide ban on workplace smoking. While the focus of
this measure was to protect worker health by reducing exposure to second-hand
smoke, other effects such as a greater reduction in smoking prevalence and
consumption were likely among bar workers. METHODS: A random sample of bar
workers from Cork city were surveyed before (n = 129) and after (n = 107; 82.9%
follow-up rate) implementation of the smoke-free legislation. Self report and
combined self report and cotinine concentration were used to determine smoking
status. For comparison a cross-sectional random telephone survey of the general
population (ROI) was conducted before and 1 year after the smoke-free
legislation. There were 1240 pre- and 1221 participants post-ban in the
equivalent age and occupational subset of the general population. RESULTS: There
was a non-significant decline in smoking prevalence among bar workers 1 year
post-ban (self report: -2.8% from 51.4% to 48.6%, P = 0.51; combined self report
and cotinine: -4.7% from 56.1% to 51.4%, P = 0.13), but a significant decline in
consumption of four cigarettes (95% CI 2.21-6.36) per day. Within the
occupationally equivalent general population sub-sample there was a significant
drop (3.5%, P = 0.06) in smoking prevalence but no significant change in
consumption. CONCLUSIONS: Ireland's smoke-free workplace legislation was
accompanied by a drop in smoking prevalence in both bar workers and the general
population sub-sample.
PMCID: PMC2720734 [Available on 2010/4/1]
PMID: 19307250 [PubMed - indexed for MEDLINE]
20. Vital Health Stat 10. 2008 Nov;(238):1-104.
Summary health statistics for the U.S. population: National Health Interview
Survey, 2007.
Adams PF, Barnes PM, Vickerie JL.
Division of Health Interview Statistics, U.S. Department of Health & Human
Services, Centers for Disease Control and Prevention, National Center for Health
Statistics, Hyattsville, MD 20782, USA.
OBJECTIVES: This report presents both age-adjusted and unadjusted health
statistics from the 2007 National Health Interview Survey (NHIS) for the civilian
noninstitutionalized population of the United States, classified by sex, age,
race, Hispanic or Latino origin and race, education, family income, poverty
status, health insurance coverage (where appropriate), place of residence, and
region of residence. The topics covered are respondent-assessed health status,
limitations in activities, special education or early intervention services,
injury and poisoning episodes, health care access and utilization, and health
insurance coverage. SOURCE OF DATA: NHIS is a household, multistage probability
sample survey conducted annually by interviewers of the U.S. Census Bureau for
the Centers for Disease Control and Prevention's National Center for Health
Statistics. In 2007, household interviews were completed for 75,764 persons
living in 29,266 households, reflecting a household response rate of 87.1%.
SELECTED HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health
in 2007. About 36 million persons (12%) were limited in their usual activities
due to one or more chronic health conditions. About 4 million persons (2%)
required the help of another person with activities of daily living, and about 9
million persons (4%) required the help of another person with instrumental
activities of daily living. About 6% of children received special education or
early intervention services. Among persons under age 65 years, about 43 million
(17%) did not have any health insurance coverage. The most common reason for
lacking health insurance was cost, followed by a change in employment.
PMID: 19275089 [PubMed - indexed for MEDLINE]
21. Clin J Am Soc Nephrol. 2009 Mar;4(3):645-50. Epub 2009 Mar 4.
The comprehensive dialysis study (CDS): a USRDS special study.
Kutner NG, Johansen KL, Kaysen GA, Pederson S, Chen SC, Agodoa LY, Eggers PW,
Chertow GM.
Rehabilitation/Quality of Life Special Studies Center, United States Renal
DataSystem, Emory University, Atlanta, Georgia, USA.
BACKGROUND AND OBJECTIVES: The Comprehensive Dialysis Study (CDS) aimed to
understand factors contributing to physical, functional, and nutritional health
status among patients starting dialysis. DESIGN, SETTING, PARTICIPANTS, &
MEASUREMENTS: A phone interview survey was conducted with patients from a
geographically stratified national random sample of dialysis units, and quarterly
serum samples were obtained for patients at a preidentified subset of units. The
phone survey collected standardized measures of physical activity, employment and
disability status, perceived health and well-being, and dietary intake. Serum
samples were obtained to measure prealbumin, albumin, creatinine, normalized
protein catabolic rate, and C-reactive protein. To comply with restrictions
required under the Health Insurance Portability and Accountability Act (HIPAA),
dialysis unit personnel could not participate in any research-related activities.
RESULTS: Overall participation rate was 18.5%. One thousand six hundred forty-six
patients affiliated with 295 dialysis units completed the phone survey; 361
patients affiliated with 68 dialysis units also completed a dietary intake
survey, with 269 providing serum samples. Despite challenges in the design and
implementation of CDS, the population was diverse and results should be
generalizable. CONCLUSIONS: Constraints within the dialysis industry and HIPAA
requirements render the assembly of nationally representative cohorts extremely
difficult. Nevertheless, the CDS represents the largest cohort of incident
dialysis patients containing detailed information on self-reported physical
activity and dietary intake and is one of few cohorts simultaneously measuring
laboratory proxies of nutrition and inflammatory status. Data from CDS can be
used to inform the design of interventions addressing several conditions that
affect longevity and health status in ESRD.
PMCID: PMC2653653 [Available on 2010/3/1]
PMID: 19261814 [PubMed - indexed for MEDLINE]
22. Int Nurs Rev. 2009 Mar;56(1):81-7.
Restructuring nurses' worklives and knowledge: case studies from England and
Spain.
Norrie C, Muller J, Goodson I, Hernandez F.
Education Research Centre (ERC), Mayfield House, University of Brighton,
Brighton, UK. c.norrie@brighton.ac.uk
AIM: To compare the relationship between restructuring of health care and the
worklives and professional knowledge of nurses in England and Spain. BACKGROUND:
Healthcare governance and systems are being modernized across Europe. At the same
time European populations are changing in terms of ageing societies, more
demanding patients, increased technologicalization and new roles for women. This
is changing the positionality of nurses situated between the state and the
citizen. METHODS: This data was produced as part of an EU-funded research
project. Data collection methods included literature reviews, national policy
summaries and surveys. In addition, life-history interviews and observations were
carried out with nurses belonging to different generations in case-study
hospitals in England and Spain. Data were analysed using an interpretative,
narrative approach. Results juxtapose analysis of global and national policy
narratives with individual nurses' worklife narratives. FINDINGS: Analysis of the
policy narratives position nurses in England and Spain as having moved from
traditional to re-framed professionals. Worklife narrative analysis meanwhile
demonstrates that in England restructuring narratives have worked their way deep
into nurses' lives. In contrast, in Spain there is a large gap between the
rhetoric of change and the reality on the ground so narratives can be described
as de-coupled.
PMID: 19239520 [PubMed - indexed for MEDLINE]
23. Health Soc Care Community. 2009 Jul;17(4):396-405. Epub 2009 Feb 12.
The providers' profile of the disability support workforce in New Zealand.
Jorgensen D, Parsons M, Reid MG, Weidenbohm K, Parsons J, Jacobs S.
School of Nursing, The University of Auckland, Auckland, New Zealand.
d.jorgensen@auckland.ac.nz
To understand one of the predominant groups supporting people with disabilities
and illness, this study examined the profile of New Zealand paid caregivers,
including their training needs. Paid caregivers, also known as healthcare
assistants, caregivers and home health aides, work across several long-term care
settings, such as residential homes, continuing-care hospitals and also private
homes. Their roles include assisting with personal care and household management.
New Zealand, similar to other countries, is facing a health workforce shortage. A
three-phased design was used: phase I, a survey of all home-based and residential
care providers (N = 942, response rate = 45%); phase II, a targeted survey of
training needs (n = 107, response = 100%); phase III, four focus groups and 14
interviews with 36 providers, exploring themes arising from phases I and II.
Findings on 17,910 paid caregivers revealed a workforce predominantly female
(94%), aged between 40 and 50, with 6% over the age of 60. Mean hourly pay
NZ$10.90 (minimum wage NZ$10.00 approx. UK3.00 at time of study) and 24 hours per
week. The national paid caregiver turnover was 29% residential care and 39%
community. Most providers recognised the importance of training, but felt their
paid caregivers were not adequately trained. Training was poorly attended;
reasons cited were funding, family, secondary employment, staff turnover, low pay
and few incentives. The paid caregiver profile described reflects trends also
observed in other countries. There is a clear policy direction in New Zealand and
other countries to support people with a disability at home, and yet the
workforce which is facilitating this vision is itself highly vulnerable. Paid
caregivers have minimum pay, are female, work part-time and although it is
recognised that training is important for them, they do not attend, so
consequently remain untrained.
PMID: 19220491 [PubMed - indexed for MEDLINE]
24. Compr Psychiatry. 2009 Mar-Apr;50(2):158-63. Epub 2008 Sep 23.
Are personality dimensions associated with sleep length in a large nationally
representative sample?
Vincent N, Cox B, Clara I.
Department of Clinical Health Psychology, University of Manitoba, Manitoba,
Canada. nvincent@exchange.hsc.mb.ca
OBJECTIVES: The purpose of this hypothesis-generating study was to determine
whether personality domains and specific personality traits are uniquely
associated with sleep duration using data obtained from the National Comorbidity
Survey (NCS). METHODS: Using trained interviewers, we administered to the 5877
noninstitutionalized adults living in the United States the Composite
International Diagnostic Interview (World Health Organization. Composite
International Diagnostic Interview. Geneva, Switzerland: WHO, 1990) to assess for
any DSM-III-R psychiatric diagnoses, and they completed self-report measures of
personality and sleep. This was a secondary data analysis using information from
a large existing public use data set (NCS-part II). The NCS-part II was an
epidemiologic survey based on a stratified multistage area probability method
with a response rate of 82.4%. RESULTS: Using a multivariate logistic regression
technique, we found significant and positive associations between short sleep
(defined as <or=6 hours of sleep per 24-hour period) and self-criticism (odds
ratio [OR] = 1.36), the presence of a medical condition (OR = 1.35), neuroticism
(OR = 1.30), and the use of sedating medication in the past 12 months (OR =
1.26). Significant and positive associations were found for long sleep (defined
as >or=9 hours per 24 hour period) and a diagnosis of dysthymia (OR = 1.52), the
use of a sedating medication in the past 12 months (OR = 1.52), emotional
reliance on another person (OR = 1.37), employment status (OR = 1.31), and
marital status (OR = 1.20). CONCLUSIONS: Findings suggest that personality, even
after controlling for psychiatric and medical conditions, is associated with
sleep length and may be an additional factor to consider when assessing any
individual patient.
PMID: 19216893 [PubMed - indexed for MEDLINE]
25. Diabetes Res Clin Pract. 2009 Jan;83(1):e23-5. Epub 2008 Dec 16.
Long-term projections for diabetes-related work loss and limitations among U.S.
adults.
Tunceli K, Zeng H, Habib ZA, Williams LK.
Center for Health Services Research, Henry Ford Hospital, Detroit, MI 48202, USA.
We used data from the U.S. National Health Interview Survey to estimate the
effect of diabetes on labor market outcomes. In the year 2050 an estimated 1.46
million U.S. adults will not be working; 597,000 will be work disabled; and
780,000 will have work limitations as a result of diabetes.
PMID: 19091438 [PubMed - indexed for MEDLINE]
26. Qual Life Res. 2009 Mar;18(2):179-89. Epub 2008 Dec 12.
The relative contributions of race/ethnicity, socioeconomic status, health, and
social relationships to life satisfaction in the United States.
Barger SD, Donoho CJ, Wayment HA.
Department of Psychology, Northern Arizona University, P.O. Box 15106, Flagstaff,
AZ, 86011, USA. steven.barger@nau.edu
PURPOSE: To evaluate racial/ethnic disparities in life satisfaction and the
relative contributions of socioeconomic status (SES; education, income,
employment status, wealth), health, and social relationships (social ties,
emotional support) to well-being within and across racial/ethnic groups. METHODS:
In two cross-sectional, representative samples of U.S. adults (the 2001 National
Health Interview Survey and the 2007 Behavioral Risk Factor Surveillance System;
combined n > 350,000), we compared life satisfaction across Whites, Hispanics,
and Blacks. We also evaluated the extent to which SES, health, and social
relationships 'explained' racial/ethnic group differences and compared the
magnitude of variation explained by life satisfaction determinants across and
within these groups. RESULTS: Relative to Whites, both Blacks and Hispanics were
less likely to be very satisfied. Blacks were somewhat more likely to report
being dissatisfied. These differences were reduced or eliminated with adjustment
for SES, health, and social relationships. Together, SES and health explained
12-15% of the variation in life satisfaction, whereas social relationships
explained an additional 10-12% of the variance. CONCLUSIONS: Racial/ethnic life
satisfaction disparities exist for Blacks and Hispanics, and these differences
are largest when comparing those reporting being 'satisfied' to 'very satisfied'
versus 'dissatisfied' to 'satisfied.' SES, health, and social relationships were
consistently associated with life satisfaction, with emotional support having the
strongest association with life satisfaction.
PMID: 19082871 [PubMed - indexed for MEDLINE]
27. BMC Public Health. 2008 Dec 8;8:402.
Implementation of a workplace smoking ban in bars: the limits of local
discretion.
Montini T, Bero LA.
New York University, 423 East 23rd Street, VET-16N, New York, NY 10010, USA.
theresa.montini@nyu.edu
BACKGROUND: In January 1998, the California state legislature extended a
workplace smoking ban to bars. The purpose of this study was to explore the
conditions that facilitate or hinder compliance with a smoking ban in bars.
METHODS: We studied the implementation of the smoking ban in bars by interviewing
three sets of policy participants: bar employers responsible for complying with
the law; local government officials responsible for enforcing the law; and
tobacco control activists who facilitated implementation. We transcribed the
interviews and did a qualitative analysis of the text. RESULTS: The conditions
that facilitated bar owners' compliance with a smoking ban in bars included: if
the cost to comply was minimal; if the bars with which they were in competition
were in compliance with the smoking ban; and if there was authoritative,
consistent, coordinated, and uniform enforcement. Conversely, the conditions that
hindered compliance included: if the law had minimal sanctions; if competing bars
in the area allowed smoking; and if enforcement was delayed or inadequate.
CONCLUSION: Many local enforcers wished to forfeit their local discretion and
believed the workplace smoking ban in bars would be best implemented by a state
agency. The potential implication of this study is that, given the complex nature
of local politics, smoking bans in bars are best implemented at a broader
provincial or national level.
PMCID: PMC2633292
PMID: 19063716 [PubMed - indexed for MEDLINE]
28. Ergonomics. 2008 Dec;51(12):1926-43.
Studying work practices: a key factor in understanding accidents on the level
triggered by a balance disturbance.
Derosier C, Leclercq S, Rabardel P, Langa P.
French National Research and Safety Institute (INRS), Working Life Department,
Biomechanics and Ergonomics Laboratory, Vandoeuvre, France.
carine.derosier@inrs.fr
Accidents on the level (AOL) rank second amongst the most numerous and serious
occupational accidents with days lost in France and are a major health and safety
problem in every sector of activity. The case study described in this paper was
conducted at a metallurgical company with 300 employees. The aims of this work
were dual: 1) to extend the general knowledge required for preventing these
accidents; 2) to propose prevention measures to this company. Existing data on
company occupational accidents were gathered and analysed to identify a work
situation that appeared likely to cause AOL. This work situation was analysed in
detail. Several risk factors were identified within this work situation, by way
of interviews with 12 operators. These risk factors concerned various dimensions
of the work situation, particularly its physical dimension (e.g. templates
structure) and organisational dimension (e.g. parts availability). Interviews
were conducted, focusing on risk factors perceived by operators and involving
allo-confrontations based on accounts of four AOL occurring in this situation.
Allo-confrontations were interviews confronting operators with a risk
occupational situation that was accidental for one of their colleagues, the
latter being absent from the interview. Results highlighted the fact that the
work practices implemented are key factors in understanding these accidents. This
study underlines the role of work practices in AOL causality and prevention. It
also provides explanations associated with various work situation dimensions
involving adoption of more or less safe work practices. AOL are serious and
frequent in occupational situations. Injury claims analysis and interviews in an
industrial company emphasise the specific characteristics of an occupational
situation and of prevention actions forming the basis of an intervention. The
need for a better understanding of factors affecting work practice is highlighted
in relation to research.
PMID: 19034785 [PubMed - indexed for MEDLINE]
29. Rehabil Nurs. 2008 Nov-Dec;33(6):260-7.
Case management quality-of-life outcomes for adults with a disability.
Borglund ST.
Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton,
FL, USA. sborglun@fau.edu
The increasing number of working-age adults with a long-term disability has
created a need for case management focused on quality-of-life issues as well as
functionality. An adaptation of the Quality Health Outcomes Model was used to
explore relationships between case manager types and services and characteristics
of adults with a disability. Outcome measures included social participation,
health maintenance behaviors, and economic productivity. Secondary data analysis
of the 1994 National Health Interview Survey Disability Supplement provided a
purposive sample of 371 working-age adults with a disability (AWDs). Problems
with instrumental activities of daily living and activities of daily living were
reported by 74.7% of participants, with activity limitations a main predictor of
outcome achievement. Although family members or friends were chosen by 78% of the
sample to coordinate their medical care, case manager type demonstrated no
influence on the outcome measures. Rehabilitation nurses should use their knowing
of person to develop, implement, and evaluate interventions and systems focused
on the ability of AWDs to achieve quality-of-life outcomes.
PMID: 19024241 [PubMed - indexed for MEDLINE]
30. Am J Public Health. 2009 Jan;99(1):59-65. Epub 2008 Nov 13.
Cancer screening in US workers.
Vidal L, LeBlanc WG, McCollister KE, Arheart KL, Chung-Bridges K, Christ S,
Caban-Martinez AJ, Lewis JE, Lee DJ, Clark J 3rd, Davila EP, Fleming LE.
Department of Epidemiology & Public Health, Miller School of Medicine, University
of Miami, Clinical Research Building, 10th Floor (R669), 1120 NW 14th St, Miami,
FL 33136, USA.
Regular cancer screening can prevent the development of some cancers and increase
patient survival for other cancers. We evaluated the reported cancer screening
prevalence among a nationally representative sample of all US workers with data
from the 2000 and 2005 Cancer Screening Supplements of the National Health
Interview Survey. Overall, workers with the lowest rates of health insurance
coverage (in particular, Hispanic workers, agricultural workers, and construction
workers) reported the lowest cancer screening. There was no significant
improvement from 2000 to 2005.
PMID: 19008502 [PubMed - indexed for MEDLINE]
31. Rev Epidemiol Sante Publique. 2008 Oct;56(5):345-55. Epub 2008 Oct 21.
[Role of employment or scholar status and gender: Drug use among 18 to 25
year-olds in France in 2005]
[Article in French]
Legleye S, Beck F, Peretti-Watel P, Chau N.
Observatoire français des drogues et toxicomanies (OFDT), France; Inserm, U669,
75014 Paris, France. stleg@ofdt.fr
BACKGROUND: In France, drug use levels of college students remain quite unknown,
mainly because of the lack of representative samples of this specific part of the
population. There is also a lack of studies concerning gender and drug use.
METHODS: The Health barometer 2005 is a wide national telephone survey which is
representative of the 12-75-year-olds (n=30,514). Among the 18-25-year-olds, 1290
students were surveyed, besides 1480 employed and 538 unemployed people. Various
licit and illicit drug use levels of these three groups were compared using
logistic regression models for men and women, controlling for age, level of
diploma, category of area of residence, living in couple, religion and type of
phone equipment. These results were compared with those obtained in the Health
Barometer 2000, with exactly the same variables and definitions. RESULTS:
Analysis showed that among women, alcohol and cannabis use as well as drunkenness
were more frequent among unemployed and college students than among workers. For
men, drug use, and especially illicit drug use, appeared more frequent among
unemployed. As a consequence, gender differences for alcohol and cannabis use
were lower among students than among workers or unemployed. For both sexes,
logistic models controlling for age showed that alcohol consumption as well as
daily tobacco smoking were less frequent among students than among employed
people, contrarily to drunkenness and cannabis use. For almost all drug uses,
differences between genders are smaller among students. Except for alcohol and
tobacco use, these differences disappeared when controlling for other
sociodemographic variables. Compared with data from year 2000, differences among
the three groups appeared smaller, especially for drunkenness and cannabis
smoking among college students. CONCLUSION: Alchol and tobacco uses are less
frequent among students than active people, employed or not, but there is no
significant difference for drunkenness and cannabis use. For both genders,
unemployment is associated with increased levels of drug use, but pursuing higher
education is associated with an increased level of alcohol and cannabis use among
women, which is not the case among men.
PMID: 18945566 [PubMed - indexed for MEDLINE]
32. J Adolesc Health. 2008 Nov;43(5):498-505. Epub 2008 Jul 23.
Alcohol and tobacco use among rural Mexican adolescents: individual, familial,
and community level factors.
Ozer EJ, Fernald LC.
UC-Berkeley School of Public Health, Berkeley, California 94720-7360, USA.
eozer@berkeley.edu
PURPOSE: We investigated the contributions of individual, family, and
community-level factors for explaining alcohol use and smoking among rural
Mexican adolescents. METHODS: As part of a national survey, 3922 adolescents and
their mothers from 333 poor, rural communities in seven Mexican states provided
cross-sectional data on family-level, socioeconomic, and psychosocial factors,
and individual-level data on substance use and psychological symptoms. Community
standard of living was also assessed. RESULTS: Generalized linear models adjusted
for sampling design indicated that adolescents' use of alcohol was associated
with being male, older, employment, and having a mother who used alcohol. Being
from an indigenous family living in a majority-indigenous community was
associated with less alcohol use. Family income, family size, and community
standard of living were not directly associated with adolescents' alcohol use.
Current smoking was associated with being male, older, and more anxious, having a
mother who smoked, and having a mother with higher educational attainment.
Further analyses indicated patterns in which adolescents' alcohol use was
moderated by gender and ethnicity. CONCLUSIONS: Beyond the contribution of male
gender and age as risk factors, maternal substance use uniquely explained
variability in alcohol and cigarette use among Mexican adolescents from rural
communities. Indigenous ethnicity and living in majority-indigenous community
settings appeared to confer protective benefits with respect to alcohol. These
findings extend prior research in Mexico and in other countries that identify the
combined importance of developmental contexts and individual-level factors for
adolescent health.
PMID: 18848679 [PubMed - indexed for MEDLINE]
33. 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, Aarø 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]
34. Soc Sci Med. 2008 Nov;67(10):1630-40. Epub 2008 Sep 7.
Gender-specific responses to social determinants associated with self-perceived
health in Taiwan: a multilevel approach.
Chen DR, Chang LY, Yang ML.
National Taiwan University, Graduate Institute of Health Care Organization
Administration, Hsu-Chu Road, Taipei, Taiwan. duan@ntu.edu.tw
There are well-documented gender differences in health. However, few studies have
considered that the associations of personal and household characteristics with
perceived health may vary between men and women because of their different
socialized gender roles. This study investigates gender differences in health and
addresses gender-specific responses to individual- and household-level
determinants of health. We analyze the data of the 2001 Social Development Survey
on Health and Safety, which consists of a representative sample of all registered
households in Taiwan. Our findings give limited support to the hypothesis that
women and men are differently associated with social determinants of health. We
observe a significant gender gap in self-perceived health even after controlling
for various health determinants. Notwithstanding, men and women are similar in
many important aspects in relation to social determinants of health.
Gender-specific responses are found only in the impacts of employment status,
stressful life events, own disability, and number of family members with a
disability. Men report having poorer health than women when being disabled and
facing stressful events. Women's perceived health is at a higher risk when family
members require short-term, intensive care. Further consideration of the
observed, gender-specific responses to health determinants shed insight on the
possible social and cultural relevance behind gender differences in
self-perceived health.
PMID: 18782648 [PubMed - indexed for MEDLINE]
35. 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]
36. Public Health Rep. 2008;123 Suppl 2:71-7.
Public health and social work: training dual professionals for the contemporary
workplace.
Ruth BJ, Sisco S, Wyatt J, Bethke C, Bachman SS, Piper TM.
Boston University School of Social Work, Boston, MA 02215, USA. bjruth@bu.edu
OBJECTIVES: The emergence of new, complex social health concerns demands that the
public health field strengthen its capacity to respond. Academic institutions are
vital to improving the public health infrastructure. Collaborative and
transdisciplinary practice competencies are increasingly viewed as key components
of public health training. The social work profession, with its longstanding
involvement in public health and emphasis on ecological approaches, has been a
partner in many transdisciplinary community-based efforts. The more than 20
dual-degree programs in public health and social work currently offered reflect
this collaborative history. This study represents an exploratory effort to
evaluate the impact of these programs on the fields of public health and social
work. METHODS: This study explored motivations, perspectives, and experiences of
41 graduates from four master of social work/master of public health (MSW/ MPH)
programs. Four focus groups were conducted using traditional qualitative methods
during 2004. RESULTS: Findings suggest that MSW/MPH alumni self-selected into
dual programs because of their interest in the missions, ethics, and practices of
both professions. Participants highlighted the challenges and opportunities of
dual professionalism, including the struggle to better define public health
social work in the workplace. CONCLUSIONS: Implications for academic public
health focus on how schools can improve MSW/MPH programs to promote
transdisciplinary collaboration. Increased recognition, better coordination, and
greater emphasis on marketing to prospective employers were suggested. A national
evaluation of MSW/MPH graduates could strengthen the roles and contributions of
public health social work to the public health infrastructure. A conceptual
framework, potentially based on developmental theory, could guide this evaluation
of the MSW/MPH training experience.
PMCID: PMC2431100
PMID: 18770920 [PubMed - indexed for MEDLINE]
37. Inquiry. 2008 Summer;45(2):184-97.
Health insurance and access to care among welfare leavers.
Danziger S, Davis MM, Orzol S, Pollack HA.
National Poverty Research Center at the Gerald R. Ford School of Public Policy,
University of Michigan, USA.
This analysis explores the effects of the 1996 welfare reform on health insurance
coverage and access to care among former recipients of cash aid. Using panel data
from the Women's Employment Study, which conducted five interviews between 1997
and 2003 in one Michigan county, we find that 25% of welfare leavers lacked
health insurance coverage in fall 2003. Uninsured adults were significantly more
likely than others to report that they could not afford a medical or dental visit
during the year prior to the 2003 interview. Fixed-effect logistic regression
analysis indicates that women who had been off the welfare rolls for at least 12
months (the duration of transitional Medicaid) were significantly more likely to
be uninsured than women who had made more recent welfare exits, and were
significantly more likely to report financial obstacles to the receipt of medical
and dental care.
PMID: 18767383 [PubMed - indexed for MEDLINE]
38. 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]
39. Health Commun. 2008 Jul;23(4):307-12.
A communication matrix intervention to increase adoption of federal government
safety recommendations.
Booth-Butterfield S, Welbourne JL, Ott S, Hartley T, Thomas KC, Lawryk NJ.
Healthy Influence, LLC, Morgantown, West Virginia, USA.
A 3-year, multichannel intervention project assessed adoption of federal
government workplace safety testing methods among 3 randomly drawn samples of
industrial hygienists. A communication matrix (McGuire, 1985, 1989) framework
focusing on stages of reception, processing, and response was used to create,
implement, and evaluate the intervention. Participants were interviewed by phone
during 3 waves: baseline, immediately following year 1 of the intervention, and
immediately following year 2 of the intervention. Results indicate a gain in
reception over the course of the intervention. Increases in attitudes, control
beliefs, intentions, and self-reported behavior were found between baseline and
the 1st year of the intervention, and were maintained (although not increased)
during the 2nd year of the intervention. Strengths and weaknesses of the
intervention are viewed through the scope of the communication matrix.
PMID: 18701995 [PubMed - indexed for MEDLINE]
40. Science. 2008 Aug 8;321(5890):775.
Sociology. Scientific misconduct: do the punishments fit the crime?
Redman BK, Merz JF.
College of Nursing, Wayne State University, Detroit, MI, 48202 USA.
ae9080@wayne.edu
PMID: 18687942 [PubMed - indexed for MEDLINE]
41. Psychiatr Serv. 2008 Aug;59(8):886-92.
Key factors for implementing supported employment.
Marshall T, Rapp CA, Becker DR, Bond GR.
Westat, 1650 Research Blvd., Rockville, MD 20850, USA. tina.marshall@comcast.net
OBJECTIVE: This study examined strategies and barriers for implementing supported
employment in routine mental health services. METHODS: Qualitative and fidelity
data from a two-year period (2002-2004) were examined for nine sites
participating in the National Evidence-Based Practices Project. RESULTS: At
baseline, none of the sites were providing high-fidelity supported employment.
However, by the two-year follow-up, eight of the nine sites successfully
implemented high-fidelity programs. Three factors, leadership, mastery, and
attitudes, were identified as strongly influencing the implementation (both
positively and negatively) across the nine sites. CONCLUSIONS: The findings
indicate the need for strong leadership on both the administrative and program
levels, an in-depth understanding of the nature and level of training and
consultation needed for program leaders and employment specialists, and the value
of hiring staff with clinical or business skills. The study also demonstrated
that employing staff who doubt and challenge the evidence-based model slows down
the implementation process, suggesting the critical role of hiring staff who
believe in recovery and supported employment principles.
PMID: 18678686 [PubMed - indexed for MEDLINE]
42. Health Econ. 2009 May;18(5):535-48.
Weight and wages: fat versus lean paychecks.
Han E, Norton EC, Stearns SC.
Institute for Health Research and Policy, University of Illinois at Chicago,
Chicago, IL 60608, USA. eunahan@uic.edu
Past empirical work has shown a negative relationship between the body mass index
(BMI) and wages in most cases. We improve on this work by allowing the marginal
effect of non-linear BMI groups to vary by gender, age, and type of interpersonal
relationships required in each occupation. We use the National Longitudinal
Survey of Youth 1979 (1982-1998). We find that the often-reported negative
relationship between the BMI and wages is larger in occupations requiring
interpersonal skills with presumably more social interactions. Also, the wage
penalty increases as the respondents get older beyond their mid-twenties. We show
that being overweight and obese penalizes the probability of employment across
all race-gender subgroups except black women and men. Our results for the
obesity-wage association can be explained by either consumers or employers having
distaste for obese workers. (c) 2008 John Wiley & Sons, Ltd.
PMID: 18677723 [PubMed - indexed for MEDLINE]
43. Health Policy. 2009 Mar;89(3):261-70. Epub 2008 Jul 25.
Use of economic evaluation in local health care decision-making in England: a
qualitative investigation.
Eddama O, Coast J.
National Perinatal Epidemiology Unit, University of Oxford, Old Road, Headington,
Oxford OX3 7LF, United Kingdom. Oya.Eddama@npeu.ox.ac.uk
OBJECTIVE: To explore decision-making and the use of economic evaluation at the
local health care decision-making level in England (UK). METHODS: Data collection
was over a 16-month period (January 2003 to April 2004). Data collection
comprised 29 in-depth interviews with a range of decision makers, 13 observations
of decision-making meetings, and analysis of documents produced at meetings. A
constant comparative approach was used to identify broad themes and sub-themes
arising from the data. Data were analysed using Microsoft Word. RESULTS: National
Institute for Health and Clinical Excellence (NICE) guidance provides the main
way in which economic evaluation is used at a local level in the UK, although
following NICE guidance is often regarded as detrimental to pursuing local
priorities. Other than through NICE, economic evaluation is not considered at the
local level; we found no evidence for use at the meeting group (by individuals).
Although decision makers appear to understand notions of scarcity, with some also
referring to value for money, the process of decision-making departs from these
principles in practice. Disinvestment decisions are not made nor are decisions
weighted against pre-defined criteria. Options appraisal is conducted, but it
does not embody the principles of economic evaluation, since options are not
considered in terms of their costs and benefits and opportunity cost is not
accounted for. There appear to be two reasons why economic evaluation is not used
at the local level: (1) the nature of management decisions concerned with the
employment of extra staff and new equipment, rather than the choice of medicines
or specific interventions usually assessed in published economic evaluation; (2)
lack of awareness of the economic evaluation approach to decision-making. These
two factors point to a lack of freedom in decision-making at the local level and
a lack of understanding of how priority setting can be achieved in practice.
CONCLUSION: A more detailed and rigorous approach to prioritisation at the local
level is required. Whilst, PCTs have been given greater responsibility for
priority setting, they lack the necessary power and understanding of the ways in
which long term solutions to problems in health care can be achieved. Economics
can be a valuable asset to priority setting and has already filtered into the
jargon used by decision makers. Whilst most concepts are understood, the leap to
adopting these concepts into the practice of decision-making needs to be made.
PMID: 18657336 [PubMed - indexed for MEDLINE]
44. Vital Health Stat 10. 2008 Jan;(236):1-104.
Summary health statistics for the U.S. population: National Health Interview
Survey, 2006.
Adams PF, Lucas JW, Barnes PM.
Division of Health Interview Statistics, U.S. Department of Health and Human
Services, Centers for Disease Control and Prevention, National Center for Health
Statistics, Hyattsville, Maryland 20782, USA.
OBJECTIVE: This report presents both age-adjusted and unadjusted health
statistics from the 2006 National Health Interview Survey (NHIS) for the civilian
noninstitutionalized population of the United States, classified by sex, age,
race, Hispanic or Latino origin and race, education, family income, poverty
status, health insurance coverage (where appropriate), place of residence, and
region of residence. The topics covered are respondent-assessed health status,
limitations in activities, special education or early intervention services,
injury and poisoning episodes, health care access and utilization, and health
insurance coverage. SOURCE OF DATA: NHIS is a household, multistage probability
sample survey conducted annually by interviewers of the U.S. Census Bureau for
the Centers for Disease Control and Prevention's National Center for Health
Statistics. In 2006, household interviews were completed for 75,716 persons
living in 29,204 households, reflecting a household response rate of 87.3%.
SELECTED HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health
in 2006. About 36 million persons (12%) were limited in their usual activities
due to one or more chronic health conditions. About 4 million persons (2%)
required the help of another person with activities of daily living, and about 8
million persons (4%) required the help of another person with instrumental
activities of daily living. About 6% of children received special education or
early intervention services. Among persons under age 65 years, about 43 million
(17%) did not have any health insurance coverage. The most common reason for
lacking health insurance was cost, followed by a change in employment.
PMID: 18624012 [PubMed - indexed for MEDLINE]
45. Am J Ind Med. 2008 Aug;51(8):555-67.
Occupational segregation as a determinant of US worker health.
Chung-Bridges K, Muntaner C, Fleming LE, Lee DJ, Arheart KL, LeBlanc WG, Christ
SL, McCollister KE, Caban AJ, Davila EP.
Department of Epidemiology & Public Health, University of Miami, Leonard M Miller
School of Medicine, Miami, Florida 33136, USA.
BACKGROUND: Racial segregation provides a potential mechanism to link occupations
with adverse health outcomes. METHODS: An African-American segregation index
(I(AA)) was calculated for US worker groups from the nationally representative
pooled 1986-1994 National Health Interview Survey (n = 451,897). Ranking and
logistic regression analyses were utilized to document associations between I(AA)
and poor worker health. RESULTS: There were consistent positive associations
between employment in segregated occupations and poor worker health, regardless
of covariate adjustment or stratification (e.g., age, gender, income, education,
or geographic region). This association between segregation and poor health was
stronger for White as compared to African-American workers. CONCLUSIONS:
Occupational segregation negatively affects all workers. Potential mechanisms
need to be identified through which occupational segregation may adversely impact
worker health.
PMID: 18553362 [PubMed - indexed for MEDLINE]
46. Eur J Epidemiol. 2008;23(8):565-72. Epub 2008 Jun 14.
Characteristics of women who binge drink before and after they become aware of
their pregnancy.
Strandberg-Larsen K, Rod Nielsen N, Nybo Andersen AM, Olsen J, Grønbaek M.
Centre for Alcohol Research, National Institute of Public Health, University of
Southern Denmark, Copenhagen K, Denmark. kal@niph.dk
BACKGROUND: Consumption of high doses of alcohol on a single occasion (binge
drinking) may harm the developing foetus and pregnant women are advised to avoid
binge drinking while pregnant. We present characteristics of Danish women who
binge drank in the pre-and post recognised part of their pregnancy. METHODS:
During the years 1996-2002 approximately 100,000 pregnant women were enrolled
into the Danish National Birth Cohort. Women with information on binge drinking,
time of recognition of pregnancy, age, reproductive history, marital status,
smoking, occupational status, pre-pregnancy BMI, alcohol consumption before
pregnancy, and mental disorders (n = 85,334) were included in the analyses.
RESULTS: Approximately one quarter of the women reported binge drinking at least
once during pregnancy; most of these in the pre-recognised part of pregnancy.
Weekly alcohol consumption before pregnancy, single status and smoking were
predictors for binge drinking in both the unrecognised and recognised part of
pregnancy. Moreover, binge drinking in the pre-recognised part of pregnancy was
more common among women aged 25-29 years, who were nulliparous, well educated in
good jobs or skilled workers. Binge drinking after recognition of pregnancy was
more common among women who were unintended pregnant, multiparous unskilled
workers, had been unemployed for more than one year, or had mental/neurotic
disorder. CONCLUSIONS: In order to prevent binge drinking during pregnancy,
health care providers should target their efforts towards pregnant women as well
as pregnancy-planners. It is important to be aware that women who binge drink
before versus after the pregnancy is recognised have different social
characteristics.
PMID: 18553140 [PubMed - indexed for MEDLINE]
47. Psychol Med. 2009 Feb;39(2):287-99. Epub 2008 May 28.
Mental disorders in young adulthood.
Suvisaari J, Aalto-Setälä T, Tuulio-Henriksson A, Härkänen T, Saarni SI, Perälä
J, Schreck M, Castaneda A, Hintikka J, Kestilä L, Lähteenmäki S, Latvala A,
Koskinen S, Marttunen M, Aro H, Lönnqvist J.
Department of Mental Health and Alcohol Research, National Public Health
Institute, Helsinki, Finland. jaana.suvisaari@ktl.fi
BACKGROUND: The effect of mental disorders may be particularly detrimental in
early adulthood, and information on mental disorders and their correlates in this
age group is important. METHOD: A questionnaire focusing on mental health was
sent to a nationally representative two-stage cluster sample of 1863 Finns aged
19 to 34 years. Based on a mental health screen, all screen-positives and a
random sample of screen-negatives were asked to participate in a mental health
assessment, consisting of the Structured Clinical Interview for DSM-IV (SCID-I)
interview and neuropsychological assessment. We also obtained case-notes from all
lifetime mental health treatments. This paper presents prevalences,
sociodemographic associations and treatment contacts for current and lifetime
mental disorders. RESULTS: Forty percent of these young Finnish adults had at
least one lifetime DSM-IV Axis I disorder, and 15% had a current disorder. The
most common lifetime disorders were depressive disorders (17.7%) followed by
substance abuse or dependence (14.2%) and anxiety disorders (12.6%). Of persons
with any lifetime Axis I disorder, 59.2% had more than one disorder. Lower
education and unemployment were strongly associated with current and lifetime
disorders, particularly involving substance use. Although 58.3% of persons with a
current Axis I disorder had received treatment at some point, only 24.2% had
current treatment contact. However, 77.1% of persons with a current Axis I
disorder who felt in need of treatment for mental health problems had current
treatment contact. CONCLUSIONS: Mental disorders in young adulthood are common
and often co-morbid, and they may be particularly harmful for education and
employment in this age group.
PMID: 18507875 [PubMed - indexed for MEDLINE]
48. J Occup Environ Med. 2008 Apr;50(4):381-90.
The prevalence and correlates of workplace depression in the national comorbidity
survey replication.
Kessler RC, Merikangas KR, Wang PS.
Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.
Kessler@hcp.med.harvard.edu
OBJECTIVE: To review evidence on the workplace prevalence and correlates of major
depressive episodes, with a particular focus on the National Comorbidity Survey
Replication, the most recent national survey to focus on these issues. METHOD:
Nationally representative survey of Diagnostic and Statistical Manual, 4th
Revision Mental Disorders. RESULTS: A total of 6.4% of employed National
Comorbidity Survey Replication respondents had 12-month major depressive
disorder. An additional 1.1% had major depressive episodes due to bipolar
disorder or mania-hypomania. Only about half of depressed workers received
treatment. Fewer than half of treated workers received care consistent with
published treatment guidelines. CONCLUSIONS: Depression disease management
programs can have a positive return-on-investment from the employer perspective,
but only when they are based on best practices. Given the generally low
depression treatment quality documented here, treatment quality guarantees are
needed before expanding workplace depression screening, outreach, and treatment
programs.
PMCID: PMC2742688
PMID: 18404010 [PubMed - indexed for MEDLINE]
49. Harefuah. 2008 Feb;147(2):125-30, 183.
[Do the emergency medical services need more paramedics? An examination of supply
and demand]
[Article in Hebrew]
Nirel N, Goldwag R, Feigenberg Z, Abadi D, Halpern P.
Myers-JDC-Brookdale Institute. nuritn@jdc.org.il
BACKGROUND: Paramedics are a critical national resource. The paramedic workforce
is dynamic and has never been studied, thereby limiting the possibility of
appropriate planning. OBJECTIVES: To examine the present and projected supply and
demand for paramedics, the balance between supply and demand, and how this
affects the planning of the paramedic workforce. METHODS: Supply was assessed by
the annual number of graduates of paramedic training programs, the duration of
stay in the profession and the likelihood of staying in the profession, using
data obtained by structured telephone interviews with a sample of graduates of
paramedic courses. Demand was assessed by interviewing key figures in the
emergency medical services (EMS). RESULTS: There are about 1000 certified
paramedics in Israel. Of them, 64% are active in the civilian labor market. If
the demand does not change beyond the natural annual increase of two advanced
life support (ALS) ambulances (which are staffed by paramedics), there may be a
surplus of 180 paramedics by 2010. Increased demand outside the EMS may
temporarily absorb this surplus, but it will reappear by 2015 or 2020.
Conversely, upgrading all ambulances to ALS vehicles will result in a shortage of
400-900 paramedics by 2010 (depending on the number of paramedics per vehicle) if
the number of paramedics trained annually is not increased. CONCLUSIONS: These
findings may provide a better basis for long-term planning for training,
recruitment, and employment of paramedics and may serve as an example for
workforce planning for other health professions.
PMID: 18357668 [PubMed - indexed for MEDLINE]
50. J Clin Nurs. 2008 Apr;17(7):967-75.
Community-based epidemiological study on breastfeeding and associated factors
with respect to postpartum periods in Taiwan.
Kuo SC, Hsu CH, Li CY, Lin KC, Chen CH, Gau ML, Chou YH.
Graduate Institute of Nurse-Midwifery, National Taipei College of Nursing,
Taipei, Taiwan. suchen@ntcn.edu.tw
AIMS: To explore the prevalence of breastfeeding in different geographical areas
and identify the factors influencing breastfeeding practices during in-hospital
stay and at one, four and six months postpartum in Taiwan. BACKGROUND: The
national data on prevalence for breastfeeding patterns are still unknown. DESIGN:
Community-based epidemiological survey design. METHODS: A total of 12,201 women
were sampled from the birth registration and surveyed between June-October 2004.
Data were collected through a computer-assisted telephone interview at four
different postpartum periods. Logistic regression modelling was applied to
determine factors influencing breastfeeding patterns and postpartum time-specific
odds ratios. RESULTS: Rates of breastfeeding practices were 29.4, 33.2, 16.9 and
13.1% for in-hospital stay, the first-, fourth- and sixth-month postpartum
respectively. Mother's intention to breastfeed was the most important factor to
lengthen breastfeeding practices over time. The effect of an advocate programme
in the hospital was significantly associated with breastfeeding only at the time
of in-hospital stay. Age, family support and singleton were found to be
significantly related to the continuation of breastfeeding at the fourth month
postpartum. Employment status was significantly associated with the termination
of breastfeeding, particularly at the later postpartum period. Geographical
variation in breastfeeding practices within the first month postpartum was
identified. In contrast, ethnic variation was more apparent at the later
postpartum period. CONCLUSIONS: This large-scale study revealed a significantly
decreasing trend after one month postpartum of breastfeeding rate in each
geographical area of Taiwan. Factors associated with women's decision and
continuation on breastfeeding patterns tended to be dependent on the
time-specific postpartum period and varied between geographical areas. RELEVANCE
TO CLINICAL PRACTICE: If breastfeeding rates are to increase, more attention
should be paid to establish early breastfeeding and counter the negative
influences of factors within the social environment.
PMID: 18321294 [PubMed - indexed for MEDLINE]
51. Soc Sci Med. 2008 Apr;66(8):1828-40. Epub 2008 Mar 4.
Social determinants of psychological distress in a nationally-representative
sample of South African adults.
Myer L, Stein DJ, Grimsrud A, Seedat S, Williams DR.
School of Public Health & Family Medicine, University of Cape Town, Cape Town,
South Africa. landon.myer@uct.ac.za
There is substantial evidence from developed countries that lower socioeconomic
status (SES) is associated with increased occurrence of mental illness, and
growing interest in the role of social support and social capital in mental
health. However, there are few data on social determinants of mental health from
low- and middle-income nations. We examined the association between psychological
distress and SES, social support and bonding social capital in a
nationally-representative sample of South African adults. As part of a national
survey of mental health, a probability sample of 4,351 individuals was
interviewed between 2002 and 2004. Non-specific psychological distress was
measured using the Kessler K-10 scale. SES was assessed from an aggregate of
household income, individual educational and employment status, and household
material and financial resources. Social support, bonding social capital and
traumatic life events were measured using multi-item scales. The mean age in the
sample was 37 years and 76% of participants were black African. Measures of SES
and social capital were inversely associated (p<0.001). Both recent and traumatic
life events were more common among individuals with low levels of SES and social
support. After adjusting for participant demographic characteristics and life
events, high levels of psychological distress were most common among individuals
with lower levels of SES and social capital. There was no independent association
between levels of social support and psychological distress. The occurrence of
recent life events appeared to partially mediate the association between SES and
psychological distress (p=0.035) but not the association involving social capital
(p=0.40). These data demonstrate persistent associations between levels of SES,
social capital and psychological distress in South Africa. The increased
frequency of recent life events appears to only partially explain higher levels
of psychological distress among individuals of lower SES. Additional research is
required to understand the temporality of this association as well as mechanisms
through which SES and social capital influence mental health in low- and
middle-income settings where high levels of poverty and trauma may contribute to
excess burden of mental illness.
PMID: 18299167 [PubMed - indexed for MEDLINE]
52. Pediatr Allergy Immunol. 2008 Dec;19(8):688-95. Epub 2008 Feb 18.
Maternal employment in child-care institutions and the risk of infant wheeze and
atopic dermatitis in the offspring.
Hersoug LG, Benn CS, Simonsen JB, Kamper-Jørgensen M, Linneberg A.
Research Centre for Prevention and Health, Copenhagen County, Denmark.
lagehe01@glo.regionh.dk
It has been proposed that exposure to infections and microbes protects against
atopic diseases, but epidemiological data has so far been conflicting. We
hypothesized that maternal exposure to infections and microbes before or during
pregnancy would be of particular importance. To test this hypothesis, we studied
the incidence of wheezing and atopic dermatitis (AD) in infants of mothers
employed in child-care institutions - and thus presumably being highly exposed to
infections and microbes - compared with infants of mothers not so employed. A
total of 31471 mother-child pairs enrolled in the Danish National Birth Cohort
were followed prospectively. Information on wheezing episodes, AD, maternal
employment, and other variables were collected by interview at 12 and 30 wk of
gestation, and 6 and 18 months of age, and by linkage to the Danish Medical Birth
Register and the Child-care Database. The relative risk was estimated in Cox
proportional hazard models. Analyses were stratified by sibling status (first
born or not), as older siblings are likely to be a significant source of
infectious agents. The adjusted relative risks of wheeze, recurrent wheeze and AD
was 1.14 (95% CI: 0.96-1.37), 1.37 (95% CI: 1.05-1.77), and 1.03 (95% CI:
0.81-1.31), respectively, for first-born infants of mothers employed in
child-care institutions compared with infants of mothers not so employed. There
was no effect of maternal employment in child-care institutions among infants
with older siblings. In conclusion, the results did not support the hypothesis
that maternal microbial exposure before or during pregnancy as reflected by
maternal employment in child-care institutions protects the offspring against
infant wheeze and AD.
PMID: 18298427 [PubMed - indexed for MEDLINE]
53. 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]
54. J Health Hum Serv Adm. 2007 Winter;30(3):306-26.
How well are we doing addressing disability in America? Examining the status of
adults with chronic disabling conditions, 1995 and 2005.
Bolin JN.
Texas A&M Health Sciences Center, USA.
Despite laws like the Americans with Disabilities Act (ADA), (1992), and The
Ticket to Work Act, (TTWA), (2001), working age adults who develop chronic
disabling conditions often find themselves faced with a choice of leaving the
labor market in order to qualify for public health insurance or continuing to
work, often on a "hit and miss" basis, disqualifying them from employee health
benefits. Federal and state policy makers continue to struggle to find solutions
addressing the needs of working age adults with disabling conditions and
illnesses. In this study we examine the work status of working age adults using
two National Health Interview Surveys conducted a decade apart (1995 & 2005) to
investigate and compare adults who have chronic, disabling conditions and
self-reported rates of work. Specifically, this research investigates whether
reported work activity among working age adults who report chronic health
conditions has improved in the decade between 1995 and 2005. The effects of
racial/ethnic differences, age, and region of residence on one's work status are
also examined.
PMID: 18236706 [PubMed - indexed for MEDLINE]
55. J Occup Environ Med. 2008 Jan;50(1):46-56.
Hearing difficulty attributable to employment by industry and occupation: an
analysis of the National Health Interview Survey--United States, 1997 to 2003.
Tak S, Calvert GM.
Division of Surveillance, Hazard Evaluations, and Field Studies, National
Institute for Occupational Safety and Health, Centers for Disease Control and
Prevention, 4676 Columbia Parkway, Cincinnati, OH 45226, USA. stak@cdc.gov
OBJECTIVE: To estimate the national burden of hearing difficulty among workers in
US industries and occupations. METHODS: Data on 130,102 employed National Health
Interview Survey respondents between the ages of 18 to 65 years who were
interviewed between 1997 and 2003 were analyzed to estimate the population
prevalence, adjusted prevalence ratios, and fractions of hearing difficulty
attributable to employment. RESULTS: The estimated population prevalence of
hearing difficulty was 11.4% (24% attributable to employment). The adjusted
prevalence ratios of hearing difficulty were highest for railroads, mining, and
primary metal manufacturing industry. Occupations with increased risk of hearing
difficulty were mechanics/repairers, machine operators, and transportation
equipment operators. CONCLUSIONS: Hearing difficulty was differentially
distributed across various industries. In industries with high rates, employers
and workers should take preventive action to reduce the risk of occupational
hearing loss.
PMID: 18188081 [PubMed - indexed for MEDLINE]
56. 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]
57. Rural Remote Health. 2007 Oct-Dec;7(4):818. Epub 2007 Dec 7.
Developing sustainable models of rural health care: a community development
approach.
Allan J, Ball P, Alston M.
Charles Sturt University, Wagga Wagga, New South Wales, Australia.
juallan@csu.edu.au
Globally, small rural communities frequently are demographically similar to their
neighbours and are consistently found to have a number of problems linked to the
international phenomenon of rural decline and urban drift. For example, it is
widely noted that rural populations have poor health status and aging
populations. In Australia, multiple state and national policies and programs have
been instigated to redress this situation. Yet few rural residents would agree
that their town is the same as an apparently similar sized one nearby or across
the country. This article reports a project that investigated the way government
policies, health and community services, population characteristics and local
peculiarities combined for residents in two small rural towns in New South Wales.
Interviews and focus groups with policy makers, health and community service
workers and community members identified the felt, expressed, normative and
comparative needs of residents in the case-study towns. Key findings include
substantial variation in service provision between towns because of historical
funding allocations, workforce composition, natural disasters and distance from
the nearest regional centre. Health and community services were more likely to be
provided because of available funding, rather than identified community needs.
While some services, such as mental illness intervention and GPs, are clearly in
demand in rural areas, in these examples, more health services were not needed.
Rather, flexibility in the services provided and work practices, role diversity
for health and community workers and community profiling would be more effective
to target services. The impact of industry, employment and recreation on health
status cannot be ignored in local development.
PMID: 18067401 [PubMed - indexed for MEDLINE]
58. Arch Phys Med Rehabil. 2007 Dec;88(12 Suppl 2):S50-6.
Barriers to return to work after burn injuries.
Esselman PC, Askay SW, Carrougher GJ, Lezotte DC, Holavanahalli RK,
Magyar-Russell G, Fauerbach JA, Engrav LH.
Department of Rehabilitation Medicine, University of Washington, Seattle, WA,
USA. esselman@u.washington.edu
OBJECTIVE: To identify barriers to return to work after burn injury as identified
by the patient. DESIGN: A cohort study with telephone interview up to 1 year.
SETTING: Hospital-based burn centers at 3 national sites. PARTICIPANTS:
Hospitalized patients (N=154) meeting the American Burn Association criteria for
major burn injury, employed at least 20 hours a week at the time of injury, and
with access to a telephone after discharge. INTERVENTION: Patients were contacted
via telephone every 2 weeks up to 4 months, then monthly up to 1 year after
discharge. MAIN OUTCOME MEASURES: A return to work survey was used to identify
barriers that prevented patients from returning to work. A graphic rating scale
determined the impact of each barrier. RESULTS: By 1 year, 79.7% of patients
returned to work. Physical and wound issues were barriers early after discharge.
Although physical abilities continued to be a significant barrier up to 1 year,
working conditions (temperature, humidity, safety) and psychosocial factors
(nightmares, flashbacks, appearance concerns) became important issues in those
with long-term disability. CONCLUSIONS: The majority of patients return to work
after a burn injury. Although physical and work conditions are important
barriers, psychosocial issues need to be evaluated and treated to optimize return
to work.
PMID: 18036982 [PubMed - indexed for MEDLINE]
59. J Clin Nurs. 2007 Dec;16(12):2221-8.
Engaging with a new reality: experiences of overseas minority ethnic nurses in
the NHS.
Alexis O, Vydelingum V, Robbins I.
School of Health and Social Care, Oxford Brookes University, Oxford, UK.
oalexis@brookes.ac.uk
AIM AND OBJECTIVE: The purpose of this study was to explore, describe and develop
a greater understanding of the experiences of overseas black and minority ethnic
nurses in the National Health Service (NHS) in the south of England. BACKGROUND:
For the past five decades, the NHS has been recruiting overseas black and
minority ethnic nurses from several former British colonies to alleviate the
manpower shortages. More recently there has been a shortage of nurses in the
labour force and as a result the NHS has once again recruited overseas nurses.
Despite this recruitment drive there are limited studies outlining how overseas
black and minority nurses have fared in the NHS. METHODS: This qualitative
phenomenological study used four purposeful focus groups and all participants
involved were interviewed at a place convenient for them. These all non-white
participants originated from Asia, Africa and the Caribbean. Each focus group
contained six participants with an overall total of 24 participants involved in
the study. RESULTS: Following thematic analysis, the findings revealed six themes
such as, the devaluation process, concept of self-blame, discrimination/lack of
equal opportunity, concept of invisibility, experiencing fear and benefits of
being here. Several overseas nurses felt devalued and indicated that white UK
nurses appeared to have placed little trust in them. They stated that both
discrimination and lack of equal opportunity were present in the workplace and
they also revealed that some white UK nurses were sometimes abusive. As a result
they tolerated such behaviour for fear of being thrown out with their families.
Despite such negative experiences participants indicated that the experiences
gained whilst working in the NHS were useful. CONCLUSIONS: There is a need for
overseas nurses to be treated fairly and with respect particularly in the light
of an acute labour shortage of nurses in the NHS. The findings suggest that
overseas minority ethnic nurses' experiences have been mixed, with some positive
as well as negative experiences, within a process that devalues them as workers.
RELEVANCE TO CLINICAL PRACTICE: This paper highlights a need for a re-evaluation
of equal opportunity policies and proposes more diversity training so as to
prepare nurses to cope with an increasingly complex and diverse workforce.
PMID: 18036112 [PubMed - indexed for MEDLINE]
60. Adm Policy Ment Health. 2008 Mar;35(1-2):84-97. Epub 2007 Nov 14.
A survey of the infrastructure for children's mental health services:
implications for the implementation of empirically supported treatments (ESTs).
Schoenwald SK, Chapman JE, Kelleher K, Hoagwood KE, Landsverk J, Stevens J,
Glisson C, Rolls-Reutz J; Research Network on Youth Mental Health.
Family Services Research Center, Medical University of South Carolina, 67
President Street, Ste MC 406, P.O. Box 250861, Charleston, SC 29425, USA.
schoensk@musc.edu
Comment on:
Adm Policy Ment Health. 2008 Mar;35(1-2):73-83.
A structured interview survey of directors of a large national sample (n = 200)
of mental health service organizations treating children examined the governance,
financing, staffing, services, and implementation practices of these
organizations; and, director ratings of factors important to implementation of
new treatments and services. Descriptive analyses showed private organizations
financing services with public (particularly Medicaid) funds are prevalent and
that employment of professional staff, clinical supervision and training,
productivity requirements, and outcomes monitoring are common. Results of random
effects regression models (RRMs) evaluating associations between governance,
financing, and organizational characteristics and the use of new treatments and
services showed for-profit organizations more likely to implement such
treatments, and organizations with more licensed clinical staff and weekly
clinical supervision in place less likely to do so. Results of RRMs evaluating
relations between director ratings of the importance to new treatment and service
implementation of three factors-fit with existing implementation practices,
infrastructure support, and organizational mission and support-suggest greater
importance to public than private organizations of these factors. Implications
for EST implementation and future research are described.
PMID: 18000750 [PubMed - indexed for MEDLINE]
61. J Occup Environ Med. 2007 Oct;49(10):1165-75.
Racial and ethnic disparities in the prevalence and management of cardiovascular
risk factors in the United States workforce.
Hertz RP, McDonald M, Unger AN, Lustik MB.
Evidence-Based Strategies, Pfizer Inc, New York, NY 10017, USA.
robin.hertz@pfizer.com
OBJECTIVE: To assess racial or ethnic differences in workers with respect to
awareness, treatment, and control of hypertension, diabetes, and dyslipidemia,
and to identify factors associated with these disparities. METHODS: Analysis of
nationally representative data collected from employed persons participating in
the National Health and Nutrition Examination Survey 1999 to 2002, with
sub-analyses by race and ethnicity. RESULTS: Mexican-American workers are less
likely than non-Hispanic whites to be aware of their hypertension (odds ratio
[OR] = 0.60; 95% confidence interval [CI] = 0.39-0.94) and less likely to be
treated (OR = 0.45; 95% CI = 0.23-0.85); less likely to be aware (OR = 0.56; 95%
CI = 0.33-0.93) and treated (OR = 0.33; 95% CI = 0.14-0.78) for dyslipidemia; and
more likely to be aware of diabetes (OR = 3.01; 95% CI = 1.14-7.95). Non-Hispanic
blacks treated for hypertension are less likely than whites to reach blood
pressure goal (OR = 0.47; 95% CI = 0.33-0.66). Having a usual place of care is
independently associated with awareness and treatment for hypertension, and
treatment for dyslipidemia. CONCLUSION: Understanding cardiovascular health
disparities in the workforce can help employers structure appropriate workplace
screening and prevention programs.
PMID: 18000422 [PubMed - indexed for MEDLINE]
62. Salud Publica Mex. 2007;49 Suppl 4:S436-47.
[Mexican older adults with a wide socioeconomic perspective: health and aging]
[Article in Spanish]
Wong R, Espinoza M, Palloni A.
Maryland Population Research Center, University of Maryland, College Park, MD
20742, USA. wongr@umd.edu
OBJECTIVES: Describe the Estudio Nacional de Salud y Envejecimiento en México
(ENASEM), also known by its name in English as the Mexican Health and Aging Study
(MHAS). MATERIALS AND METHODS: This article summarizes the study design, its
fieldwork protocol, survey contents, scope and analytical potential. It also
presents descriptive results on selected topics. This is a prospective panel
study on persons aged 50 or older in the year 2000. RESULTS: In the baseline
survey, completed in 2001 with a national and urban-rural representation, about
15 200 interviews were completed. In the follow-up survey of the same persons in
2003, 90% of the attempted contacts resulted in successful interviews, and 546
interviews were completed about individuals who had died between the 2001 and
2003 visits. Descriptive results are presented on demographic characteristics,
health, life style, institutional support, pensions, employment, family help, and
two-year changes in health. CONCLUSIONS: There is evidence of large heterogeneity
among older adults in Mexico, which is illustrated in a brief and precise way in
the results presented. This study and its data bases have great analytical
potential for exploring multiple dimensions in the health of older adults.
PMID: 17724516 [PubMed - indexed for MEDLINE]
63. 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]
64. Int J Epidemiol. 2007 Dec;36(6):1292-9. Epub 2007 Sep 26.
Survey error in measuring socio-economic risk factors of health status: a
comparison of a survey and a census.
Lorant V, Demarest S, Miermans PJ, Van Oyen H.
Public Health School, Université Catholique de Louvain, Belgium.
vincent.lorant@uclouvain.be
BACKGROUND: Individuals of lower socio-economic status (SES) are less likely to
participate in health surveys than individuals of a higher SES. It is, however,
not known whether this difference in participation is associated with health
status. This study sets out to assess whether a population health survey gives
biased estimates of socio-economic inequalities in self-reported health. METHODS:
We compared two independent cross-national data collections, a national health
interview survey (n = 10,164) and a census (n = 8,491,528), both carried out in
Belgium in 2001 and posing the same health question. We computed the prevalence
ratios of poor subjective health among socio-economic groups. To estimate the
bias, a relative odds ratio (ROR) was computed as the ratio of the survey
prevalence ratio to the census prevalence ratio. RESULTS: Less-educated
individuals had a lower risk of poor health status in the survey [Prevalence
ratio = 1.66, 95% confidence interval (CI): 1.48-1.86] than in the census
(Prevalence ratio = 2.23) leading to an underestimation of the risk associated
with low education (ROR = 0.74, 95% CI 0.66-0.83). Compared with better-off
groups, those who were not working or who were less educated were generally less
likely to participate in the survey when they had a poor health status.
CONCLUSIONS: Overall, the health survey underestimated the effects of low SES on
poor health status, due to selection bias. We conclude that strategies to improve
participation among disadvantaged socio-economic groups should be identified.
PMID: 17898025 [PubMed - indexed for MEDLINE]
65. Health Rep. 2007 Aug;18(3):9-24.
Smoking bans: influence on smoking prevalence.
Shields M.
Health Information and Research Division, Statistics Canada, Ottawa, Ontario, K1A
0T6. Margot.Shields@statcan.ca
OBJECTIVES: This article reports trends in smoking prevalence and smoking
restrictions in Canada since 2000, and examines associations between home and
workplace restrictions and smoking cessation. DATA SOURCES: Data are from the
Canadian Tobacco Use Monitoring Survey and the longitudinal component of the
National Population Health Survey. ANALYTICAL TECHNIQUES: Trends in smoking
prevalence and smoking restrictions were calculated. Associations between home
and workplace smoking restrictions and smoking cessation were examined in the
context of the Transtheoretical Model, which proposes that smokers go through
five distinct stages in attempting to quit. The likelihood of current and former
smokers being at specific stages was studied in relation to smoking restrictions
at home and at work. Longitudinal data were used to determine if home and
workplace smoking restrictions were predictors of quitting over a two-year
period. MAIN RESULTS: Since 2000, Canadians smokers have faced a growing number
of restrictions on where they can smoke. Bans at home and at work were associated
with a reduced likelihood of being in the initial "stages of change," and an
increased likelihood of being in the latter stages. Smokers who reported newly
smoke-free homes or workplaces were more likely to quit over the next two years,
compared with those who did not encounter such restrictions at home or at work.
PMID: 17892249 [PubMed - indexed for MEDLINE]
66. Gen Hosp Psychiatry. 2007 Sep-Oct;29(5):409-16.
Major depression in individuals with chronic medical disorders: prevalence,
correlates and association with health resource utilization, lost productivity
and functional disability.
Egede LE.
Charleston VA TREP, Ralph H. Johnson VA Medical Center, Charleston, SC 29403,
USA. egedel@musc.edu
OBJECTIVE: The objective of this study was to determine the prevalence and odds
of major depression and the incremental effect of major depression on
utilization, lost productivity and functional disability in individuals with
common chronic medical disorders. METHOD: Data on 30,801 adults from the 1999
National Health Interview Survey were analyzed. The 12-month prevalence and
age/sex-adjusted odds of major depression were calculated for adults with
hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD),
congestive heart failure (CHF), stroke or cerebrovascular accident (CVA), chronic
obstructive pulmonary disease (COPD) and end-stage renal disease (ESRD). The
association between chronic condition status (with and without major depression)
and utilization, lost productivity and functional disability was determined by
controlling for covariates. RESULTS: The 12-month prevalence and age/sex-adjusted
odds of major depression by chronic conditions were as follows: CHF, 7.9% [odds
ratio (OR)=1.96]; HTN, 8.0% (OR=2.00); DM, 9.3% (OR=1.96); CAD, 9.3% (OR=2.30);
CVA, 11.4% (OR=3.15); COPD, 15.4% (OR=3.21); ESRD, 17.0% (OR=3.56); any chronic
condition, 8.8% (OR=2.61). Compared to adults without chronic conditions, those
with chronic conditions plus major depression had greater odds of > or = 1
ambulatory visit [OR=1.50; 95% confidence interval (95% CI)=1.28, 1.77]; > or = 1
emergency room visit (OR=1.94; 95% CI=1.55, 2.45); and > or = 1 day in bed due to
illness (OR=1.60; 95% CI=1.28, 2.00); and functional disability (OR=2.48; 95%
CI=1.96, 3.15). CONCLUSION: The 12-month prevalence and odds of major depression
are high in individuals with chronic medical conditions, and major depression is
associated with significant increases in utilization, lost productivity and
functional disability.
PMID: 17888807 [PubMed - indexed for MEDLINE]
67. Spine (Phila Pa 1976). 2007 Aug 1;32(17):E495-500.
Comorbidity and impact of chronic spinal pain in Nigeria.
Gureje O, Akinpelu AO, Uwakwe R, Udofia O, Wakil A.
Department of Psychiatry, University of Ibadan, Ibadan, Nigeria.
ogureje@comui.edu.ng
STUDY DESIGN: A cross-sectional survey of households selected using multistage
stratified sampling. OBJECTIVE: This paper investigates the prevalence of chronic
spinal pain, its profile of comorbidity, and its impact on role disability in
Nigeria. SUMMARY OF BACKGROUND DATA: Study was conducted in 21 states
representing 57% of the national population. A probability sample (n = 2143) was
interviewed. METHODS: Self-reports of chronic spinal pain, other pain conditions,
as well as comorbid medical conditions were obtained. Composite International
Diagnostic Interview, version 3, was used to evaluate mood, anxiety, and
substance use disorders. Functional role impairment was assessed with questions
about days out of role. RESULTS: Chronic spinal pain was present in 16.4% (95%
confidence interval, 14.5%-18.5%) of the sample. Prevalence increased with age of
respondents, with 1 in 3 persons 60 years of age and older reporting chronic
spinal pain. Persons with chronic spinal pain were at elevated risk to have
chronic pain at other anatomic sites, to have a range of medical comorbidities,
and to have mood and substance use disorders. Even though about one third of the
decrement in functional role performance associated with chronic pain condition
was attributable to demographics and comorbid conditions, chronic spinal pain was
independently associated with significant role impairment. CONCLUSION: Chronic
spinal pain is a common problem in the Nigerian community, and persons 60 years
of age and older may be at particularly elevated risk. Chronic spinal pain is
associated with increased probability of comorbid physical and mental disorders.
These comorbid conditions partly but do not fully explain the disability
associated with chronic spinal pain, which therefore constitutes a substantial
health burden on the society.
PMID: 17762283 [PubMed - indexed for MEDLINE]
68. J Health Care Poor Underserved. 2007 Aug;18(3):609-19.
Leaving Medicaid without health insurance: TANF policies and recipients'
vulnerabilities.
Cheng T.
Department of Anthropology and Social Work at University of Alabama at
Birmingham, 1530 3rd Ave. S., Birmingham, AL 35294-3350, USA. tcheng@uab.edu
This study identifies factors predicting health insurance coverage of TANF
recipients leaving Medicaid programs. A sample of 785 Medicaid spells of
enrollment by able-bodied, non-elderly adults is drawn from a national survey.
Employing event history analysis and multinomial logistic regression, the study
finds that those who left Medicaid were three times more likely to become
uninsured than to become privately insured. Recipients leaving TANF were 24 times
more likely to leave Medicaid than to remain on Medicaid. The impact of leaving
TANF upon becoming uninsured was moderated by restrictive TANF policies.
Recipients who were White and employed part-time were 41-42% more likely to
become uninsured than were their counterparts. A high unemployment rate increased
a recipient's chance of becoming uninsured by 27.5%. Married people, African
Americans, those with full-time jobs, and those with earnings above the poverty
line were at least 32% more likely to acquire private coverage than their
respective counterparts.
PMID: 17675717 [PubMed - indexed for MEDLINE]
69. 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]
70. Aust Health Rev. 2007 Aug;31(3):430-9.
The case for Aboriginal Health Workers in palliative care.
McGrath PD, Patton MA, Ogilvie KF, Rayner RD, McGrath ZM, Holewa HA.
International Program of Psycho-Social Health Research (IPP-SHR), Central
Queensland University, PO Box 1307 Kenmore, Brisbane, QLD 4069, Australia.
pam_mcgrath@bigpond.com
OBJECTIVES: The findings are drawn from a 2-year research project, funded by the
National Health and Medical Research Council (NHMRC), which aimed to develop an
innovative model for Indigenous palliative care. The findings presented in this
article explore one important strategy for putting Aboriginal families and their
communities at the centre of the model: that is, the employment of Aboriginal
Health Workers (AHWs) in relation to the provision of palliative care in the
Northern Territory. METHODS: The data were collected from 72 qualitative
interviews conducted throughout the regional, rural and remote areas of the
Northern Territory with Indigenous patients and carers in the Northern Territory
and the health professionals who care for them. RESULTS: While highlighting the
valuable role of AHWs, the findings emphasise that the current lack of
availability of such workers for palliative care provision for Indigenous peoples
needs serious consideration.
PMID: 17669066 [PubMed - indexed for MEDLINE]
71. Int J Law Psychiatry. 2007 Jul-Oct;30(4-5):385-99. Epub 2007 Jul 26.
Organisational restructuring/downsizing, OHS regulation and worker health and
wellbeing.
Quinlan M.
School of Organisation and Management, University of New South Wales, Sydney,
Australia; Business School, Middlesex University, United Kingdom.
m.quinlan@unsw.edu.au
A growing body of international evidence indicates that downsizing and related
forms of organisational restructuring are having profound adverse effects on
worker safety, health and wellbeing. In particular, evidence links downsizing to
poorer mental health outcomes, including bullying and other forms of occupational
violence. In Australia federal, state and territory occupational health and
safety (OHS) legislation imposes obligations on employers who make changes to the
workplace or work processes to identify hazards, undertake risk assessment,
consult with employee representatives and take appropriate steps to manage any
significant hazards that are identified, including psychosocial hazards. This
study shows that while Australian regulators are aware of the problems posed by
downsizing they have made only modest efforts to pursue compliance with
legislative duties, producing some guidance material that refers to restructuring
and workloads and launching a small number of prosecutions. At the same time,
there is an increased willingness to address staffing levels and other impacts of
downsizing (like working in isolation). Employer and union responses were also
examined. The article concludes by identifying a number of initiatives that would
enable regulators, unions and employers to address the problems posed by
downsizing more effectively.
PMID: 17662403 [PubMed - indexed for MEDLINE]
72. J Asthma. 2007 Jul-Aug;44(6):433-6.
Prevalence of asthma among German adults: analysis of the German National
Telephone Survey.
Hoffmann F.
University of Bremen, Drug Utilization Research Unit, Bremen, Germany.
hoffmann@zes.uni-bremen.de
OBJECTIVE: The purpose of this study was to estimate the prevalence of asthma in
German adults. METHODS: This analysis used data of 8,318 German adults 18 years
of age and older who had participated in the German National Telephone Survey, a
nationally representative cross-sectional study. RESULTS: The overall lifetime
prevalence of asthma in German adults was 5.7%. It ranges between 4.3% in East
and 6.0% in West Germany. Logistic regression analysis showed that asthma was
associated with unemployment, younger age, and living in West Germany.
CONCLUSION: This study provides further evidence that differences exist in the
prevalence of asthma between East and West Germany.
PMID: 17654128 [PubMed - indexed for MEDLINE]
73. Cad Saude Publica. 2007 Aug;23(8):1931-45.
[Evaluation of Brazilian public policies to promote food security and fight
hunger, 1995-2002. 2 - the Workers' Nutrition Program]
[Article in Portuguese]
Pacheco Santos LM, Nazaré Araújo Mda P, Martins MC, Veloso IS, Assunção MP,
Chaves dos Santos SM.
Departamento de Nutrição, Universidade de Brasília, Brasília, Brasil.
leopac@unb.br
This study evaluated the Workers' Nutrition Program in Brazil from 1995 to 2002,
from a structure-process-results perspective. The methodology involved documental
research and a case study in 45 municipalities in the State of Bahia, resulting
in 2,389 household interviews. In relation to structure, we analyzed the
program's normative evolution until 2002. As for nutritional recommendations, the
program shifted from insufficient calorie supply in the 1980s to a positive
association between overweight and employment in companies adopting the Workers'
Nutrition Program. In Bahia, overall program coverage was insufficient among the
5,120 adults 20 years or older who were interviewed. A significant difference was
observed in access to food benefits among workers in the interior of the State
(6.1%) as compared to the State capital, Salvador (26.1%). However, targeting was
adequate: all workers benefiting from the program in the interior and 92.4% of
those in Salvador earned less than five times the minimum wage (approximately US
dollars 950/month). It is necessary to improve the program's coverage in the
target population in order to raise workers' awareness about their rights and the
actions developed by the program.
PMID: 17653411 [PubMed - indexed for MEDLINE]
74. Policy Polit Nurs Pract. 2007 May;8(2):130-9.
The impact of health care restructuring and baccalaureate entry to practice on
nurses in New Brunswick.
Rhéaume A, Dykeman M, Davidson P, Ericson P.
Ecole de Science Infirmière, Faculté des Sciences de la Santé et des Services
Communautaires, Université de Moncton, Moncton, New Brunswick, Canada.
Health care restructuring during the 1990s resulted in major changes in the way
nurses' work is defined and implemented. The adoption of the baccalaureate degree
as basic preparation for entry into nursing has further complicated the lives of
nurses. The purpose of this qualitative study is to explore the impact of health
care reforms and changing educational requirements on nurses in New Brunswick,
Canada. Sixty-three nurses representing different practice settings were
interviewed and three focus groups were held with the nurses that were
interviewed. Study findings indicate that nurses' practice has changed as a
result of the reforms. Nurses give less direct care to patients and have taken on
a greater administrative role. The requirement of a baccalaureate degree for
entry to practice has placed a strain on working relationships between older and
younger nurses, accentuating differences in working knowledge and work ethic
among these groups.
PMID: 17652630 [PubMed - indexed for MEDLINE]
75. Taehan Kanho Hakhoe Chi. 2007 Apr;37(3):381-90.
[The experiences of mental health hospital workers]
[Article in Korean]
Kim YH, Chang KO, Koo MJ, Kim SH, Kim YM, Lee NY.
Department of Nursing, Busan National University, Korea.
PURPOSE: The purpose of this study was to understand the experiences of mental
health hospital workers. METHODS: Participants in the study were a total of 8
mental health hospital workers who consisted of nurses, social welfare workers
and health managers. To prevent them from being omitted, the interviews were all
recorded under the participants prior agreement. The method was analysis using
the phenomenological method proposed by Colaizzi(1978). RESULTS: The experiences
of the participants of this study were classified into 15 significant areas, from
which 10 subjects hard work, conflicts, heavy feeling, irritability, getting
familiar, changes of recognition, aptitude determination, feeling of achievement
and sense of pride were drawn out. These subjects were then grouped into 5
themes. These five themes were finally grouped into 5 categories, negative
emotion, depressive emotion, changes of thinking, delight and value discovery.
CONCLUSIONS: The study tried to analyze the experiences of key informants like
nurses, social welfare workers and health managers all of whom were serving at
mental health hospitals, contribute to social recognition about the special
medical establishment, promote qualitative mental health nursing and further
provide educational information necessary for understanding mental health
hospital workers.
PMID: 17615459 [PubMed - indexed for MEDLINE]
76. Health Serv Res. 2007 Aug;42(4):1483-98.
The relationship between work hours and utilization of general practitioners in
four Canadian provinces.
Fell DB, Kephart G, Curtis LJ, Bower K, Muhajarine N, Reid R, Roos L.
Department of Community Health & Epidemiology, Dalhousie University, c/o 5980
University Avenue, Room G-7105.1, Halifax, NS, Canada B3H 4N1.
OBJECTIVE: To assess whether long work hours act as a barrier to accessing
general practitioner (GP) services. DATA SOURCES: Secondary data from the
1996/1997 National Population Health Survey (NPHS) and administrative health
services utilization data from four Canadian provinces. STUDY DESIGN: This study
was cross-sectional, however, employment variables and GP utilization were
reflective of the 12-month period preceding the NPHS interview date. Negative
binomial regression was used to model the relationship between the number of GP
visits in a 1-year period and employment-related variables while adjusting for
other determinants of GP utilization including education, income, and health
status. DATA EXTRACTION METHODS: NPHS and administrative data were linked to
create an analysis file. PRINCIPAL FINDINGS: Subjects with long, standard work
hours (>45 hours/week, with most hours during the day) had significantly lower GP
utilization rates compared with full-time workers. White-collar workers with long
work hours visited a GP significantly less often than white-collar workers with
regular hours. CONCLUSIONS: Long work hours may act as a nonfinancial barrier to
accessing GP services independent of health status.
PMCID: PMC1955285
PMID: 17610434 [PubMed - indexed for MEDLINE]
77. J Adv Nurs. 2007 Sep;59(5):463-73. Epub 2007 Jul 2.
A survey of school nursing provision in the UK.
Merrell J, Carnwell R, Williams A, Allen D, Griffiths L.
School of Health Science, University of Wales Swansea, Swansea, UK.
j.a.merrell@swansea.ac.uk
AIM: This paper is a report of a study to map school nursing provision across the
health and education sectors in Wales to identify the number, age,
qualifications, terms of employment, location, functions and access to continuing
professional development and clinical supervision of school nurses. BACKGROUND:
School nurses are important in promoting the health of school-aged children.
Increased demands have arisen from changes in patterns of health, illness and
lifestyles. METHODS: An interview survey was conducted with a purposive sample of
school nursing/health visiting managers from 13 healthcare sector providers,
senior personnel officers from 22 Local Education Authorities and 45 head
teachers/school nurses from independent schools. Data were collected between
March and June 2004 and the overall response rate exceeded 80%. RESULTS: A total
of 249 school nurses were identified: 90% employed by the healthcare sector and
10% by the education sector. An ageing, under-developed and under-resourced
service was identified. Disparity in practice within and across the sectors was
evident, resulting from lack of policy direction regarding the scope and content
of school nursing services. Workforce size, age and educational profile pose
challenges for service delivery. CONCLUSION: Investment in recruitment and
education is required if school nurses are to meet increasing demands and fulfil
their public health role. The low percentage of school nurses aged under 30 years
may reflect lack of a career pathway and understanding of school nursing. The
findings enable national and international comparisons in terms of numbers, size
of caseload, age, qualifications, terms of employment and activities and
functions.
PMID: 17608687 [PubMed - indexed for MEDLINE]
78. 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]
79. Psychiatr Serv. 2007 Jul;58(7):914-21.
The state policy context of implementation issues for evidence-based practices in
mental health.
Isett KR, Burnam MA, Coleman-Beattie B, Hyde PS, Morrissey JP, Magnabosco J, Rapp
CA, Ganju V, Goldman HH.
Department of Health Policy and Management, Columbia University, 600 W. 168th
St., 6th Floor, New York, NY 10032, USA. ki2129@colum
OBJECTIVES: This study analyzed implementation issues related to several
evidence-based practices for adults with serious mental illness that were
included in a national demonstration project. The five evidence-based practices
included in this investigation are assertive community treatment, family
psychoeducation, illness management and recovery, integrated dual diagnosis
treatment, and supported employment. The objective of the study was to assess the
role of state mental health authorities as agents of change. METHODS: Two-person
teams conducted interviews with state mental health authorities, consumers,
families, representatives of local mental health authorities, and representatives
of other relevant state agencies--more than 30 individuals at each of the eight
sites. Interviews took place at two time points at least one year apart and
probed the facilitators and barriers to implementation at the state level. Data
were assessed qualitatively to identify common trends and issues across states
related to leadership, training, and regulatory issues for each evidence-based
practice. RESULTS: Each of the five practices has different critical
contingencies for statewide implementation and requires unique assets to address
those contingencies by the state mental health authorities. The contingencies are
related to these critical areas: financing and regulations, leadership, and
training and quality. CONCLUSIONS: States are key to implementing evidence-based
practices, but state mental health authorities should note that each of the
practices requires different skill sets and involves different stakeholders. Thus
implementing many evidence-based practices at once may not yield economies of
scale.
PMID: 17602006 [PubMed - indexed for MEDLINE]
80. Paediatr Perinat Epidemiol. 2007 Jul;21(4):319-29.
The combined effect of employment status and transcultural marriage on breast
feeding: a population-based survey in Taiwan.
Chuang CH, Chang PJ, Hsieh WS, Guo YL, Lin SH, Lin SJ, Chen PC.
Institute of Occupational Medicine and Industrial Hygiene, National Taiwan
University College of Public Health, Taipei, Taiwan.
In recent decades there has been a marked rise in both the labour market
participation of women with infants and transcultural marriage in Taiwan. The
objectives of this study were to explore the combined effect of employment status
and transcultural marriage on the prevalence and factors relating to initiation
and continuation of breast feeding in Taiwan. We used multistage stratified
systematic sampling to recruit 2048 postpartum women from the Taiwan National
Birth Registration database for the period November to December 2003. They were
interviewed at home within 6 months of delivery using a structured questionnaire;
87% of the sampled population completed the interview. We used logistic
regression analysis to estimate the odds ratio (OR) of breast-feeding initiation
and Cox regression (survival) analysis to predict continued breast feeding. The
prevalences of initial breast feeding for employed Taiwanese mothers, unemployed
Taiwanese mothers, employed foreign-born mothers and unemployed foreign-born
mothers were 84.4%, 83.7%, 79.1% and 79.7%, respectively. Among the four groups
of mothers who initiated breast feeding, 12.9%, 27.2%, 14.7% and 39.7% of their
infants, respectively, were still breast feeding at the age of 6 months. Factors
associated with initiation of breast feeding were high maternal education (OR
3.80; 95% confidence interval [CI] 1.81, 7.98) and normal spontaneous delivery
(OR 1.36; 95% CI 1.04, 1.78). The main reason for not breast feeding in 52% of
the mothers was insufficient or no milk. There existed a combined effect of
employment status and transcultural marriage on the continuation of breast
feeding. Employed Taiwanese mothers were earlier than others at weaning.
Unemployed foreign-born mothers breast fed the longest [hazard ratio (HR) 0.54;
95% CI 0.42, 0.70]. Other factors related to late weaning were high maternal
education (HR 0.67; 95% CI 0.47, 0.96), older maternal age (HR 0.76; 95% CI 0.61,
0.94), mother sleeping with baby at night (HR 0.68; 95% CI 0.59, 0.78), and no
supplemental baby food before the age of 6 months (HR 0.78; 95% CI 0.68, 0.90).
The initiation of breast feeding was high but it decreased dramatically after the
postpartum period in Taiwan. There was a significant combined effect of
employment status and transcultural marriage on the continuation of breast
feeding. Employment is a persistent barrier to continued breast feeding.
PMID: 17564588 [PubMed - indexed for MEDLINE]
81. New Dir Youth Dev. 2007 Spring;(113):77-88, 11-2.
Transition without status: the experience of youth leaving care without Canadian
citizenship.
Hare FG.
School of Child and Youth Care, Ryerson University, Toronto, Canada.
The origins of the project reviewed in this chapter lie in discussions with a
Toronto agency that has a mandate to serve youth in transition from the care of
the Children's Aid Society. This service system, also known in various
jurisdictions as child welfare, child protection, or foster care, includes among
its clients children and youth who are living in Canada without legal Canadian
status. This could have occurred because the child arrived alone and was taken
into care on arrival or because the child arrived with a family but was taken
into care before status was obtained. While the child is in care, this lack of
status is relatively inconsequential in that health, educational, and other
services are provided through the Children's Aid Societies. Once the transition
is made from care, the youth's vulnerability increases dramatically if legal
status has not been obtained. Health services, educational opportunities, and
legal employment are often beyond reach, and the youth is subject to deportation.
The major objectives of the project were to explore the national and
international literature to discover the dimensions of this issue, interview
youth and service providers to gain insight into their experience, and discover
ways to minimize the number of youth who leave care without having obtained
status.
PMID: 17523523 [PubMed - indexed for MEDLINE]
82. Med Trop (Mars). 2007 Feb;67(1):48-52.
[Retrospective study of urogenital fistula in Burkina Faso from 2001 to 2003]
[Article in French]
Sombie I, Kambou T, Conombo SG, Sankara O, Ouedraogo L, Zoungrana T, Hounton S,
Meda N.
Centre Muraz, 01 BP 390 Bobo-Dioulasso 01, Burkina Faso. isombie.muraz@fasonet.bf
The purpose of this study was to analyze aspects of obstetric urogenital fistulae
to provide a foundation for implementation of a national control program in
Burkina Faso. A cross-sectional study with quantitative and qualitative
components was carried out in 47 hospitals in January 2004. The quantitative
component consisted of analyzing available data for 2001, 2002 and 2003. The
qualitative component consisted of interviewing women with fistulae to evaluate
the impact of the disease on the quality of life and persons in charge of the
health reference centers to identify the difficulties and needs of the facility.
In the 3-year study period, 1,500,000 deliveries were attended and 347 fistulae
were identified in the health reference centers. The incidence rate of obstetric
fistulae was 23.1 per 100 000 deliveries (CI 95% 20.8-25.7). Women with fistulae
were young and usually without paid employment. Many had a history of dystocia
during the labor. Most fistulae were recent, small or average in size and located
at the level of the vesico-vaginal septum. The failure rate of surgical treatment
was about 17.5%. Four of the 12 women interviewed reported social alienation and
ostrasization. Only 4 of the 47 hospitals studied had a personnel qualified to
manage women with urogenital fistula on a daily basis. One NGO assisted women in
obtaining care. Proposals for improvement of the situation were considered at a
national validation workshop. These findings support the need to implement a
national program that should be evaluated to see lessons learned from this study.
PMID: 17506273 [PubMed - indexed for MEDLINE]
83. J Public Health Manag Pract. 2007 May-Jun;13(3):296-306.
The 2005 British Columbia Smoking Cessation Mass Media Campaign and short-term
changes in smoking.
Gagné L.
School of Public Administration at University of Victoria, British Columbia,
Canada. lgagne@uvic.ca
OBJECTIVE: The objective of this study was to evaluate the impact of the 2005
British Columbia Ministry of Health Smoking Cessation Mass Media Campaign on
short-term smoking behavior. METHOD: National cross-sectional data are used with
a quasi-experimental approach to test the impact of the campaign. RESULTS AND
DISCUSSION: Findings indicate that prevalence and average number of cigarettes
smoked per day deviated upward from trend for the rest of Canada (P = .08; P =
.01) but not for British Columbia. They also indicate that British Columbia
smokers in lower risk groups reduced their average daily consumption of
cigarettes over and above the 1999-2004 trend (-2.23; P = .10), whereas smokers
in the rest of Canada did not, and that British Columbia smokers in high-risk
groups did not increase their average daily consumption of cigarettes over and
above the 1999-2004 trend, whereas smokers in the rest of Canada did (2.97; P =
.01). CONCLUSION: The overall poorer performance of high-risk groups is
attributed to high exposure to cigarette smoking, which reduces a smoker's
chances of successful cessation. In particular, high-risk groups are by
definition more likely to be exposed to smoking by peers, but are also less
likely to work in workplaces with smoking bans, which are shown to have a
substantial impact on prevalence. Results suggest that for mass media campaigns
to be more effective with high-risk groups, they need to be combined with other
incentives, and that more prolonged interventions should be considered.
PMID: 17435497 [PubMed - indexed for MEDLINE]
84. 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 Bulhões 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]
85. J Nurs Manag. 2007 Mar;15(2):169-79.
Irish nurses' and midwives' understanding and experiences of empowerment.
Corbally MA, Scott PA, Matthews A, Gabhann LM, Murphy C.
School of Nursing, Dublin City University, Dublin, Ireland.
melissa.corbally@dcu.ie
AIM: This study explored conceptualizations of empowerment among Irish nurses and
midwives. BACKGROUND: Current literature on the meaning of empowerment lacks
consensus. As a result there is a likelihood that empowerment will be
conceptualized differently between managers and subordinates. METHOD: In order to
get a sense of how Irish practitioners viewed empowerment, 10 focus groups were
held in locations throughout Ireland (n = 93). A national distribution of
participants was obtained. RESULTS: Twenty-one different responses emerged
representing what nurses and midwives understood by the term empowerment. In
relation to experiences of empowerment, six themes were found to impact on
empowerment experiences. Three themes emerged as central to empowerment. One
theme (education for practice) was identified as an antecedent to empowerment.
CONCLUSION: Empowerment is a complex concept and its meaning is contextually
determined. Managers play a key role in impacting on the empowerment perceptions
of Irish nurses and midwives.
PMID: 17352700 [PubMed - indexed for MEDLINE]
86. Am J Ind Med. 2007 Apr;50(4):285-92.
Potential work-related exposures to bloodborne pathogens by industry and
occupation in the United States Part II: A telephone interview study.
Chen GX, Jenkins EL.
National Institute for Occupational Safety and Health, Division of Safety
Research, Morgantown, West Virginia, USA. gchen@cdc.gov
BACKGROUND: The companion surveillance portion of this study [Chen and Jenkins,
2007] reported the frequency and rate of potential work-related exposures to
bloodborne pathogens (BBP) treated in emergency departments (EDs) by industry and
occupation, but it lacks details on the circumstances of the exposure and other
relevant issues such as BBP safety training, use of personal protective equipment
(PPE) or safety needles, or reasons for seeking treatment in a hospital ED.
METHODS: Telephone interviews were conducted with workers who had been treated in
EDs for potential work-related exposures to BBP in 2000-2002. Respondents were
drawn from the National Electronic Injury Surveillance System. RESULTS: Of the
593 interviews, 382 were from hospitals, 51 were from emergency medical
service/firefighting (EMS/FF), 86 were from non-hospital healthcare settings
(e.g., nursing homes, doctors' offices, home healthcare providers, etc.), 22 were
from law enforcement (including police and correctional facilities), and 52 were
from other non-healthcare settings (i.e., schools, hotels, and restaurants).
Needlestick/sharps injuries were the primary source of exposure in hospitals and
non-hospital healthcare settings. Skin and mucous membrane was the primary route
of exposure in EMS/FF. Human bites accounted for a significant portion of the
exposures in law enforcement and other non-healthcare settings. In general,
workers from non-hospital settings were less likely to use PPE, to have BBP
safety training, to be aware of the BBP standards and exposure treatment
procedures, and to report or seek treatment for a work-related exposure compared
to hospital workers. CONCLUSIONS: This study suggests that each industry group
has unique needs that should be addressed.
PMID: 17340611 [PubMed - indexed for MEDLINE]
87. BMC Med Res Methodol. 2007 Feb 28;7:13.
Factors affecting study efficiency and item non-response in health surveys in
developing countries: the Jamaica national healthy lifestyle survey.
Wilks R, Younger N, Mullings J, Zohoori N, Figueroa P, Tulloch-Reid M, Ferguson
T, Walters C, Bennett F, Forrester T, Ward E, Ashley D.
Tropical Medicine Research Institute, the University of the West Indies, Mona,
Kingston 7, Jamaica. rainfordw@cwjamaica.com
BACKGROUND: Health surveys provide important information on the burden and
secular trends of risk factors and disease. Several factors including survey and
item non-response can affect data quality. There are few reports on efficiency,
validity and the impact of item non-response, from developing countries. This
report examines factors associated with item non-response and study efficiency in
a national health survey in a developing Caribbean island. METHODS: A national
sample of participants aged 15-74 years was selected in a multi-stage sampling
design accounting for 4 health regions and 14 parishes using enumeration
districts as primary sampling units. Means and proportions of the variables of
interest were compared between various categories. Non-response was defined as
failure to provide an analyzable response. Linear and logistic regression models
accounting for sample design and post-stratification weighting were used to
identify independent correlates of recruitment efficiency and item non-response.
RESULTS: We recruited 2012 15-74 year-olds (66.2% females) at a response rate of
87.6% with significant variation between regions (80.9% to 97.6%; p < 0.0001).
Females outnumbered males in all parishes. The majority of subjects were
recruited in a single visit, 39.1% required multiple visits varying significantly
by region (27.0% to 49.8% [p < 0.0001]). Average interview time was 44.3 minutes
with no variation between health regions, urban-rural residence, educational
level, gender and SES; but increased significantly with older age category from
42.9 minutes in the youngest to 46.0 minutes in the oldest age category. Between
15.8% and 26.8% of persons did not provide responses for the number of sexual
partners in the last year. Women and urban residents provided less data than
their counterparts. Highest item non-response related to income at 30% with no
gender difference but independently related to educational level, employment
status, age group and health region. Characteristics of non-responders vary with
types of questions. CONCLUSION: Informative health surveys are possible in
developing countries. While survey response rates may be satisfactory, item
non-response was high in respect of income and sexual practice. In contrast to
developed countries, non-response to questions on income is higher and has
different correlates. These findings can inform future surveys.
PMCID: PMC1821035
PMID: 17328814 [PubMed - indexed for MEDLINE]
88. Prev Med. 2007 May;44(5):432-6. Epub 2007 Jan 18.
Leisure-time physical activity levels of the US workforce.
Caban-Martinez AJ, Lee DJ, Fleming LE, LeBlanc WG, Arheart KL, Chung-Bridges K,
Christ SL, McCollister KE, Pitman T.
Department of Epidemiology and Public Health, University of Miami Miller School
of Medicine, 1801 NW 9th Avenue, Highland Professional Building, Suite 200,
Miami, FL 33136, USA. acaban@med.miami.edu
BACKGROUND: Few studies in the US have assessed physical activity levels across
worker groups, despite the increasingly sedentary milieu of contemporary US
occupations and increasing obesity rates among US workers. The present study
determined the proportion of US workers meeting the Healthy People 2010
Guidelines for leisure-time physical activity levels in major US occupational
groups. METHODS: Self-reported leisure-time physical activity was defined as: a)
light-moderate activity > or =30 min five or more times per week; and/or b)
vigorous activity > or =20 min three or more times per week. Findings collected
on over 150,000 US workers, who participated in the 1997-2004 National Health
Interview Surveys, were stratified by occupational group. RESULTS: On average,
the proportions of US workers meeting recommended leisure-time physical activity
levels were 31% in female and 36% in male US workers. There was substantial
variation in the gender-specific rates of leisure-time physical activity levels
by occupation (range: 16-55%) with the lowest rates noted in blue collar groups.
CONCLUSIONS: Leisure-time physical activity levels were sub-optimal among all
major US worker groups, with substantial variability across occupations. As part
of disease prevention, health professionals should promote increased physical
activity levels among those occupations identified with very low rates of
leisure-time physical activity.
PMID: 17321584 [PubMed - indexed for MEDLINE]
89. Health Policy. 2007 Oct;83(2-3):186-95. Epub 2007 Feb 20.
Understanding differences in income-related health inequality between geographic
regions in Taiwan using the SF-36.
Lee MC, Jones AM.
Department of Social Welfare, National Chung Cheng University, 168 University
Road, Min-Hsiung, Chia-Yi 621, Taiwan. mclee@sw.ccu.edu.tw
This paper measures and decomposes socio-economic inequality in general and
mental health of Taiwan residents using concentration indices. The data from the
2001 Taiwanese National Health Interview Survey is based on multi-stage
systematic sampling: 18,142 subjects aged 12 and above provided answers to
questions on general and mental health domains of SF-36 Taiwan version.
Significant inequalities favouring higher income groups emerge in both general
and mental health, but these are particularly high for residents in remote areas.
The decomposition analysis shows that in both areas income itself accounts for a
significant and sizeable contribution (40-73%) of general and mental health
inequality. The second largest contribution comes from inequality in education
(15-22%) for general health and from employment status (17-18%) for mental
health. Apart from these factors, age, and lifestyles are also important
contributors for both general and mental health. We also find important regional
disparities in income-related inequalities.
PMID: 17316884 [PubMed - indexed for MEDLINE]
90. Vital Health Stat 10. 2007 Jan;(233):1-104.
Summary health statistics for the U.S. population: National Health Interview
Survey, 2005.
Adams PF, Dey AN, Vickerie JL.
Division of Health Interview Statistics, Center for Disease Control and
Prevention, National Center for Health Statistics, Hyattsville, MD 20782, USA.
OBJECTIVES: This report presents both age-adjusted and unadjusted health
statistics from the 2005 National Health Interview Survey (NHIS) for the civilian
noninstitutionalized population of the United States, classified by sex, age,
race, Hispanic or Latino origin and race, education, family income, poverty
status, health insurance coverage (where appropriate), place of residence, and
region of residence. The topics covered are respondent-assessed health status,
limitations in activities, special education or early intervention services,
injury and poisoning episodes, health care access and utilization, and health
insurance coverage. SOURCE OF DATA: NHIS is a household, multistage probability
sample survey conducted annually by interviewers of the U.S. Census Bureau for
the Centers for Disease Control and Prevention's National Center for Health
Statistics. In 2005, household interviews were completed for 98,649 persons
living in 38,509 households, reflecting a household response rate of 86.5%.
SELECTED HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health
in 2005. About 34 million persons (12%) were limited in their usual activities
due to one or more chronic health conditions. About 4 million persons (2%)
required the help of another person with activities of daily living, and about 8
million persons (4%) required the help of another person with instrumental
activities of daily living. About 6% of children received special education or
early intervention services. Among persons under age 65 years, about 42 million
(17%) did not have any health insurance coverage. The most common reason for
lacking health insurance was cost, followed by a change in employment.
PMID: 17315515 [PubMed - indexed for MEDLINE]
91. Afr J Health Sci. 2002 Jan-Jun;9(1-2):51-60.
Influence of biomedical sciences on National Health Insurance Scheme in Ghana.
Edoh D, Toku F.
Zoology Department, University of Ghana, Box 67, Legon, Accra, Ghana.
domedoh2@yahoo.com
Health insurance becomes a viable alternative for financing health care amidst
the high cost of health care. This study, conducted in 1997, uses a valuation
method to assess the willingness of individuals from the working sector in Accra,
Ghana, to join and pay premium for a proposed National Health Insurance Scheme
(NHIS). Over 97%of the respondents agreed to join the scheme and 62. 8% were
willing to contribute 2%of their income as premium. Respondents were mostly aged
30-50 years and 68% in the formal sector with 77% having monthly incomes ranging
from currency 100,000 to currency 500,000 ($1=currency 2,400). Only 23.6% had
their health care expenditure financed by their employers. Most, 83% indicated
they visited hospitals more regularly than laboratories and a 14.5% of the
irregular hospital visitors admitted spending over currency 100,000 per year on
self-medication. Respondents revealed they spent on the average currency 100,000
and currency 50,000 per year for hospital and laboratory services respectively.
The estimated individual health expenditure by biomedical methods was nearly
currency 10,000 per month. Estimating individual health expenditure is necessary
to set meaningful premiums and biomedical science as laboratory services provided
could be a useful tool for such a purpose.
PMID: 17298145 [PubMed - indexed for MEDLINE]
92. Afr J Health Sci. 2002 Jan-Jun;9(1-2):41-50.
A community-based feasibility study of National Health Insurance Scheme in Ghana.
Edoh D, Brenya A.
Zoology Department, University of Ghana, Box 67, Legon, Accra, Ghana.
domedoh2@yahoo.com
In a community based study at Legon in 1997, a valuation method was used to
assess the willingness of students on study leave to pay a percentage premium of
their income towards a National Health Insurance Scheme (NHIS). Thirty-five
percent of the respondents were aged 30-40 years, 97% were males, 45% were
resident in Accra, 17% in Kumasi and 12% in Cape Coast. Respondents were 84% in
formal public employment with 44% majority as teachers. Their monthly income was
distributed as 33% earned below currency 200,000, 50% between currency
200,000-currency 400,000 and 7% above currency 400,000. More than 74% were
willing to contribute to the scheme with 38% and 37% willing to pay 1% and 2 of
their income as monthly premium respectively. Those willing to pay 2% premium, 14
(n=33) earned below currency 200,000, 18 (n=50) between currency 200,000-currency
400,000, and 5 (n=17) above currency 400,000. Malaria was the commonest disease
with 86% incidence, however 30%of respondents revealed they did not spend money
on hospital services except 39% who spent currency 20,000-currency 100,000 on
hospital laboratory services. Over 65% of respondents indicated they self
financed their health expenditure. The premium level was found to be influenced
positively by financier, sex, age, income, and negatively by health expenditure,
but not occupation. In an elite community with inadequate infrastructure and
water supply problems but probably with better personal hygiene and sanitation,
although respondents hardly spend on health services they were willing to
contribute 2% of their incomes as premium towards an insurance scheme.
PMID: 17298144 [PubMed - indexed for MEDLINE]
93. Can J Nurs Res. 2006 Dec;38(4):96-117.
Violence prevention in the mental health setting: the New York state experience.
Lipscomb J, McPhaul K, Rosen J, Brown JG, Choi M, Soeken K, Vignola V, Wagoner D,
Foley J, Porter P.
School of Nursing, University of Maryland, Baltimore, USA.
In 1996 the NewYork State Office of Mental Health issued a policy requiring all
State-operated psychiatric facilities to develop and implement a proactive
violence-prevention program based on guidelines issued by the US Occupational
Safety and Health Administration. This presented an opportunity to evaluate the
impact of the guidelines on worker health and safety. The authors report the
findings of a mixed-method study to evaluate the feasibility and impact of a
participatory intervention to prevent workplace violence. They describe the
implementation of the intervention in 3 in-patient facilities, including an
extensive worksite analysis, staff focus groups, and a baseline and
post-intervention survey of changes in staff perception of the quality of the
program's elements and physical assault following implementation of the program.
The authors provide evidence for the feasibility and positive impact of a
comprehensive violence-prevention program in the in-patient mental health
workplace. Staff perception of the quality of management commitment and employee
involvement in violence-prevention was significantly improved in all worksites
post-implementation.
PMID: 17290957 [PubMed - indexed for MEDLINE]
94. Diabetes Care. 2007 Feb;30(2):245-51.
Impact of self-reported patient characteristics upon assessment of glycemic
control in the Veterans Health Administration.
Maney M, Tseng CL, Safford MM, Miller DR, Pogach LM.
VA HSR&D Center for Healthcare Knowledge Management Research, VA New Jersey
Healthcare System, 385 Tremont Avenue, East Orange, NJ, USA.
OBJECTIVE: The purpose of this article was to evaluate the impact of
self-reported patient factors on quality assessment of Veterans Health
Administration medical centers in achieving glycemic control. RESEARCH DESIGN AND
METHODS: We linked survey data and administrative records for veterans who
self-reported diabetes on a 1999 national weighted survey. Linear regression
models were used to adjust A1C levels in fiscal year 2000 for socioeconomic
status (education level, employment, and concerns of having enough food), social
support (marital status and living alone), health behaviors (smoking, alcohol
use, and exercise level), physical and mental health status, BMI, and diabetes
duration. Medical centers were ranked by deciles, with and without adjustment for
patient characteristics, on proportions of patients achieving A1C <7 or <8%.
RESULTS: There was substantial medical center level variation in patient
characteristics of the 56,740 individuals from 105 centers, e.g., grade school
education (mean 15.3% [range 2.3-32.7%]), being retired (38.3% [19.9-59.7%]) or
married (65.2% [43.7-77.8%]), food insufficiency (13.9% [7.2-24.6%]), and no
reported exercise (43.2% [31.1-53.6%]). The final model had an R(2) of 7.8%. The
Spearman rank coefficient comparing the thresholds adjusted only for age and sex
to the full model was 0.71 for <7% and 0.64 for <8% (P < 0.0001). After risk
adjustment, 4 of the 11 best-performing centers changed at least two deciles for
the <7% threshold, and 2 of 11 changed two deciles for the <8% threshold.
CONCLUSIONS: Adjustment for patient self-reported socioeconomic status and health
impacts medical center rankings for glycemic control, suggesting the need for
risk adjustment to assure valid inferences about quality.
PMID: 17259489 [PubMed - indexed for MEDLINE]
95. J Egypt Public Health Assoc. 2003;78(1-2):55-72.
Women empowerment and marital fertility in Oman.
Al Riyami A, Afifi M.
International studies have the inverse relationship of women education and
empowerment on fertility. Our aim is to study the association of women education
and empowerment with some of fertility indicators or determinants namely; total
number of children ever-born, age of women at her first birth and the last closed
birth interval length in a community based survey (National Health Survey, 2000)
A cross-sectional survey of the health status of Omani community was designed.
Face to face interview to 2037 ever married women including demographic data,
fertility patterns, family planning, two women empowerment indices (decision
making and freedom of movement), and other reproductive health modules. About 31%
of the sample was considered highly empowered in decision- making and the mean
number of decisions taken in the household was 4.46 for the overall sample. For
freedom of movement, 29% of the sample was highly empowered with a mean number of
3.88 for the overall sample. The mean values of both indices varied significantly
according to age, residence, level of education and work status. Higher freedom
of movement score women was more likely to have less number of children in the
first 20 years of marriage. Women of 'higher score of decision making index were
more likely to have longer closed birth interval. Those scored low in the
decision making index were more likely to get a child at an earlier age. In
developing countries where fertility limitation depend on "modern" methods,
women's education and autonomy are considered as strong tools to make changes in
demographic transition.
PMID: 17219911 [PubMed - indexed for MEDLINE]
96. J Occup Environ Med. 2007 Jan;49(1):75-81.
Smoking rate trends in U.S. occupational groups: the 1987 to 2004 National Health
Interview Survey.
Lee DJ, Fleming LE, Arheart KL, LeBlanc WG, Caban AJ, Chung-Bridges K, Christ SL,
McCollister KE, Pitman T.
Sylvester Comprehensive Cancer Center, Department of Epidemiology & Public
Health, University of Miami Leonard M. Miller School of Medicine, Miami, FL
33101, USA. dlee@med.miami.edu
OBJECTIVE: It is unknown if the gap in smoking rates observed between United
States blue- and white-collar workers over the past four decades has continued
into the new millennium. METHODS: The National Health Interview Survey is a
nationally representative survey of the US civilian population. Smoking and
current occupational status were assessed over survey periods 1987 to 1994 and
1997 to 2004 (n= 298,042). RESULTS: There were significant annual reductions in
smoking rates for all adult US workers in both survey periods. Several
blue-collar groups had greater annual smoking rate reductions in the most recent
survey period relative to the earlier survey period. However, the majority of
blue-collar worker groups had pooled 1997 to 2004 smoking rates in excess of the
24.5% smoking prevalence noted for all workers. CONCLUSION: Development of
effective smoking prevention strategies specifically targeting blue-collar groups
is warranted.
PMID: 17215716 [PubMed - indexed for MEDLINE]
97. 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]
98. Gac Sanit. 2006 Nov-Dec;20(6):427-34.
[Gender systems and/in the Spanish National Health Interview Survey]
[Article in Spanish]
Ruiz Cantero MT, Papí Gálvez N, Carbrera Ruiz V, Ruiz Martínez A, Alvarez-Dardet
Díaz C.
Departamento de Salud Pública, Universidad de Alicante, Alicante, España.
cantero@ua.es
OBJECTIVE: To analyze the Spanish National Health Interview Survey (NHIS) from a
gender perspective, with special emphasis on gender division of labor. METHOD: We
analyzed the 2003 Spanish NHIS from the perspective of the levels of gender
observation, with gender understood as: a) the basis of social norms
(responsibilities by sex, health risks, and problems related to
masculine/feminine roles); b) the organizer of the social structure: gender
division of labor, work overload, vertical/horizontal segregation, time spent in
activities according to social times, access to resources), and c) a component of
individual identity (conflicts due to multiple roles, body image dissatisfaction,
self-esteem, self-perceived recognition of the work performed, assimilation of
the sexual gender role, sex differences in health conditions). RESULTS: The
Spanish NHIS is centered on the main provider, referred to in masculine
grammatical form. Gender division of domestic labor is identified only by a
general question. When using the concept of main activity for productive or
reproductive work, the survey requires respondents to evaluate them and select
only one, thus losing information and hampering analysis of the impact of an
overload of work on health. Information on time used for reproductive work and
leisure is not solicited. Assaults (intentional) and accidents (non-intentional)
are combined in the same question, thus preventing research on gender-related
violence. CONCLUSIONS: The Spanish NHIS includes the variable of sex, but its
more descriptive than analytic focus limits gender analysis. The survey allows
specific circumstances of employment-related inequalities between sexes to be
measured, but does not completely allow other indicators of gender inequalities,
such as the situation of housewives or work overload, to be measured.
PMID: 17198619 [PubMed - indexed for MEDLINE]
99. Chronobiol Int. 2006;23(6):1203-15.
Diurnal urinary 6-sulfatoxymelatonin levels among healthy Danish nurses during
work and leisure time.
Marie Hansen A, Helene Garde A, Hansen J.
National Institute of Occupational Health, Copenhagen, Denmark. aamh@ami.dk
The present study aims to examine the influence of evening and night shift work,
compared to day shift work, on melatonin secretion in nurses in a field setting.
Effects were examined during a workday and during a day off. Both fixed schedules
and mixed or rotating schedules were studied. In total, 170 nurses were studied:
89 nurses worked fixed schedules, 27 nurses worked the day shift, 12 nurses
worked the evening shift, 50 nurses worked the night shift, and 82 nurses worked
mixed schedules, with data collected during a day (n = 17), evening (n = 14), or
night shift (n = 50). All spot urine samples were collected during 24 h from the
participants on a work day and on a day off and were analyzed for
6-sulphatoxymelatonin. On the day of urine sampling, participants filled in the
Karolinska Sleep Diary. Additional information was collected through a telephone
interview. Data were analyzed using a mixed procedure with autoregressive
covariance structure. The present study showed that shift work affected the
concentrations of 6-sulphatoxymelatonin in the short term by lower excretion in
urine from nurses working the night compared to day shift on a workday and on a
day off as well. No significant differences were observed between a workday and a
day off when doing day and evening shifts, irrespective of mixed and fixed
schedules. Sleep length was reduced workdays (from 6.1-6.8 h) among all nurses,
compared to days off (from 7.8-8.7 h).
PMID: 17190706 [PubMed - indexed for MEDLINE]
100. 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]
101. Subst Use Misuse. 2006;41(14):1861-79.
VEdeTTE, a longitudinal study on effectiveness of treatments for heroin addiction
in Italy: study protocol and characteristics of study population.
Bargagli AM, Faggiano F, Amato L, Salamina G, Davoli M, Mathis F, Cuomo L,
Schifano P, Burroni P, Perucci CA; VEdeTTE Study Group.
Department of Epidemiology, ASL Rome E, Rome, Italy. bargagli@asplazio.it
The aim of this study was to provide a methodological overview of the study
design of the national evaluation large-scale study VEdeTTE and a description of
the VEdeTTE study population and to compare enrollments with refusals and the
study population with the overall clients at the National Health System (NHS)
treatment centers. VEdeTTE is a longitudinal study of heroin addicts recruited in
115 NHS treatment centers in Italy, 1998-2001; 11,903 people were enrolled, 3876
refused to participate; data were analysed on 10,454. Information from refusals
was compared to enrollments. The characteristics of the cohort were compared to
those of all patients treated in 1999 in Italy. Refusals had a lower educational
level and less regular occupational status than those enrolled. Fourteen percent
of enrolled patients were women; heroin users in the VEdeTTE study were older
than patients attending all NHS treatment centers in Italy; incident cases were
less represented. The majority of participants had more than 8 years of
education, 33.5% were regularly employed, and only 2% did not have a fixed
address. Injectors were 72.3%; 40.6% had a previous overdose, and 14.3% had been
imprisoned for life; 15.7% shared injection equipment during the previous 6
months. The proportion of participants reporting heroin use approximately halved
from the beginning of the current treatment to the time of the interview. The
VEdeTTE study is the biggest cohort of heroin addicts attending treatment centers
in Europe. The Italian heroin-addicted population under treatment seems to have
low level of education but good social integration. Compared with men, women show
a higher severity. Participants show a beneficial effect of treatment.
PMID: 17162594 [PubMed - indexed for MEDLINE]
102. 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]
103. J Altern Complement Med. 2006 Nov;12(9):895-902.
National patterns and correlates of complementary and alternative medicine use in
adults with diabetes.
Garrow D, Egede LE.
Department of Medicine, Division of General Internal Medicine and Center for
Health Disparities Research, Medical University of South Carolina, Charleston, SC
29425, USA.
OBJECTIVE: The aim of this study was to determine national patterns and
correlates of complementary and alternative medicine (CAM) use among adults with
diabetes. METHODS: The authors compared CAM use in 2474 adults with and 28,625
adults without diabetes who participated in the most comprehensive national
survey on CAM use (2002 National Health Interview Survey). Eight CAM use
categories were created, including dietary, herbal, chiropractic, yoga,
relaxation, vitamin, prayer, and other (acupuncture, Ayurveda, biofeedback,
chelation, energy healing or Reiki therapy, hypnosis, massage, naturopathy, and
homeopathy). An overall CAM use category also was created that excluded vitamins
and prayer. Patterns of use were compared with chi-square and independent
correlates of CAM use with multiple logistic regression controlling for relevant
covariates. STATA was used for analysis to account for the complex survey design.
RESULTS: Prevalence of overall use of CAM did not differ significantly by
diabetes status (47.6 versus 47.9%, p = 0.81). Diabetes was not an independent
predictor of overall use of CAM (OR 0.93, 95% confidence interval [CI] 0.83,
1.05). However, persons with diabetes were more likely to use prayer (OR 1.19,
95% CI 1.05, 1.36), but less likely to use herbs (OR 0.86, 95% CI 0.75, 0.99),
yoga (OR 0.56, 95% CI 0.43, 0.72), or vitamins (OR 0.82, 95% CI 0.72, 0.93) than
people without diabetes after controlling for relevant covariates. Independent
correlates of overall use of CAM differed by age, income, employment,
comorbidity, and health status between people with and without diabetes.
CONCLUSIONS: This study found that there has been a dramatic increase in overall
use of CAM in adults with diabetes; diabetes was not an independent predictor of
overall use of CAM; and people with diabetes were more likely to use prayer, but
less likely to use herbs, yoga, or vitamins compared to persons without diabetes.
PMID: 17109581 [PubMed - indexed for MEDLINE]
104. AIDS. 2006 Nov 14;20(17):2199-206.
Population-based surveillance for cryptococcosis in an antiretroviral-naive South
African province with a high HIV seroprevalence.
McCarthy KM, Morgan J, Wannemuehler KA, Mirza SA, Gould SM, Mhlongo N, Moeng P,
Maloba BR, Crewe-Brown HH, Brandt ME, Hajjeh RA.
Mycology Reference Unit, National Institute for Communicable Diseases, National
Health Laboratory Service, Division of Virology and Communicable Diseases
Surveillance, University of the Witwatersrand, Johannesburg 2000, South Africa.
kerriganm@nicd.ac.za
OBJECTIVES: To measure the burden of disease and describe the epidemiology of
cryptococcosis in Gauteng Province, South Africa. DESIGN AND METHODS: The study
was an active, prospective, laboratory-based, population-based surveillance. An
incident case of cryptococcosis was defined as the first isolation by culture of
any Cryptococcus species from any clinical specimen, a positive India ink
cryptococcal latex agglutination test or a positive histopathology specimen from
a Gauteng resident. Cases were identified prospectively at all laboratories in
Gauteng. Case report forms were completed using medical record review and patient
interview where possible. RESULTS: Between 1 March 2002 and 29 February 2004,
2753 incident cases were identified. The overall incidence rate was 15.6/100 000.
Among HIV-infected persons, the rate was 95/100 000, and among persons living
with AIDS 14/1000. Males and children under 15 years accounted for 49 and 0.9% of
cases, respectively. The median age was 34 years (range, 1 month-74 years).
Almost all cases (97%) presented with meningitis. Antifungal therapy was given to
2460 (89%) cases of which 72% received fluconazole only. In-hospital mortality
was 27% (749 cases). Recurrences occurred in 263 (9.5%) incident cases. Factors
associated with death included altered mental status, coma or wasting; factors
associated with survival included employment in the mining industry, visual
changes or headache on presentation. CONCLUSIONS: This study demonstrates the
high disease burden due to cryptococcosis in an antiretroviral-naive South
African population and emphasizes the need to improve early recognition,
diagnosis and treatment of the condition.
PMID: 17086060 [PubMed - indexed for MEDLINE]
105. Qual Manag Health Care. 2006 Oct-Dec;15(4):268-77.
Processes influencing the development of graduate nurse capabilities in clinical
risk management: an Australian study.
Johnstone MJ, Kanitsaki O.
Division of Nursing and Midwifery, School of Health Sciences, RMIT
University-Bundoora West Campus, Melbourne, Victoria, Australia.
megan.johnstone@rmit.edu.au
OBJECTIVES: To explore and describe key processes influencing the development of
graduate nurse capabilities in clinical risk management (CRM). METHODS: This
study was undertaken using an exploratory descriptive case study method. Four
sample units of analysis were used, notably: 2 cohorts of graduate nurses (n =
11) undertaking a 12-month graduate nurse transition program; key stakeholders (n
= 34), that is, nurse unit managers, clinical teachers, preceptors, a quality
manager, a librarian, and senior nurse administrators employed by the
participating health service; patient outcome data; and pertinent literature.
RESULTS: Data strongly suggested that graduate nurse capabilities in CRM were
most influenced not by their supposed lack of clinical knowledge and skills but
by their lack of corporate knowledge. The failure to provide new graduate nurses
with pertinent information on CRM at the beginning of their employment and
thereafter at pertinent intervals during the graduate nurse year program aslo
hindered the development of their capabilities to manage clinical risk.
CONCLUSIONS: Management and educational processes pertinent to informing and
involving new graduate nurses in a hospital's local CRM program (including
information about the organization's local policies and procedures) need to be
implemented systematically at the very beginning of a new graduate's employment
and thereafter throughout the remainder of the graduate nurse year.
PMID: 17047501 [PubMed - indexed for MEDLINE]
106. Can J Psychiatry. 2006 Feb;51(2):84-90.
Descriptive epidemiology of major depression in Canada.
Patten SB, Wang JL, Williams JV, Currie S, Beck CA, Maxwell CJ, El-Guebaly N.
Department of Community Health Sciences, University of Calgary, Alberta.
patten@ucalgary.ca
OBJECTIVE: The Canadian Community Health Survey: Mental Health and Well-Being
(CCHS 1.2) is the first national study to use a full version of the Composite
International Diagnostic Interview. For this reason, and because of its large
sample size, the CCHS 1.2 is capable of providing the best currently available
description of major depression epidemiology in Canada. Using the CCHS 1.2 data,
our study aimed to describe the epidemiology of major depression in Canada.
METHOD: All estimates used appropriate sampling weights and bootstrap variance
estimation procedures. The analysis consisted of estimating proportions
supplemented by logistic regression modelling. RESULTS: The lifetime prevalence
of major depressive episode was 12.2%. Past-year episodes were reported by 4.8%
of the sample; 1.8% reported an episode in the past 30 days. As expected, major
depression was more common in women than in men, but the difference became
smaller with advancing age. The peak annual prevalence occurred in the group aged
15 to 25 years. The prevalence of major depression was not related to level of
education but was related to having a chronic medical condition, to unemployment,
and to income. Married people had the lowest prevalence, but the effect of
marital status changed with age. Logistic regression analysis suggested that the
annual prevalence may increase with age in men who never married. CONCLUSIONS:
The prevalence of major depression in the CCHS 1.2 was slightly lower than that
reported in the US and comparable to pan-European estimates. The pattern of
association with demographic and clinical variables, however, is broadly similar.
An increasing prevalence with age in single (never-married) men was an unexpected
finding.
PMID: 16989107 [PubMed - indexed for MEDLINE]
107. Suicide Life Threat Behav. 2006 Aug;36(4):377-85.
Sooner versus later: factors associated with temporal sequencing of suicide.
Kaplan MS, McFarland BH, Huguet N, Newsom JT.
School of Community Health, Portland State University, P.O. Box 751, Portland, OR
97207, USA. kaplanm@pdx.edu
There are few (if any) population-based prospective studies that provide
information on factors associated with temporal sequencing of suicide. In this
prospective population-based study, the National Health Interview Survey (NHIS),
1986-1994, was linked to the National Death Index (NDI), 1986-1997, to assess
factors that predict recent (within 12 months of interview, termed sooner)
suicide versus suicide further in the future (more than 12 months after
interview, termed later). Of the 653 completed suicides in the NHIS cohort, 13.4
percent completed suicide within a year of interview, and 86.6 percent did so
after a year. Sooner decedents were more likely to be White, less educated,
unemployed, and to use firearms than any other method compared with later
decedents. Surprisingly, sooner decedents had higher levels of self-rated health
at baseline. These results have substantial implications for clinicians and other
professionals who interact with people at highest risk of suicide. Unfortunately,
it may be unrealistic to expect that health care providers can modify the
behavior of individuals at highest risk of suicide.
PMID: 16978092 [PubMed - indexed for MEDLINE]
108. Am J Psychiatry. 2006 Sep;163(9):1561-8.
Prevalence and effects of mood disorders on work performance in a nationally
representative sample of U.S. workers.
Kessler RC, Akiskal HS, Ames M, Birnbaum H, Greenberg P, Hirschfeld RM, Jin R,
Merikangas KR, Simon GE, Wang PS.
Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave.,
Boston, MA 02115, USA. kessler@hcp.med.harvard.edu
Comment in:
Am J Psychiatry. 2006 Sep;163(9):1490-1.
OBJECTIVE: Research on the workplace costs of mood disorders has focused largely
on major depressive episodes. Bipolar disorder has been overlooked both because
of the failure to distinguish between major depressive disorder and bipolar
disorder and by the failure to evaluate the workplace costs of mania/hypomania.
METHOD: The National Comorbidity Survey Replication assessed major depressive
disorder and bipolar disorder with the World Health Organization (WHO) Composite
International Diagnostic Interview (CIDI) and work impairment with the WHO Health
and Work Performance Questionnaire. A regression analysis of major depressive
disorder and bipolar disorder predicting Health and Work Performance
Questionnaire scores among 3,378 workers was used to estimate the workplace costs
of mood disorders. RESULTS: A total of 1.1% of the workers met CIDI criteria for
12-month bipolar disorder (I or II), and 6.4% meet criteria for 12-month major
depressive disorder. Bipolar disorder was associated with 65.5 and major
depressive disorder with 27.2 lost workdays per ill worker per year. Subgroup
analysis showed that the higher work loss associated with bipolar disorder than
with major depressive disorder was due to more severe and persistent depressive
episodes in those with bipolar disorder than in those with major depressive
disorder rather than to stronger effects of mania/hypomania than depression.
CONCLUSIONS: Employer interest in workplace costs of mood disorders should be
broadened beyond major depressive disorder to include bipolar disorder.
Effectiveness trials are needed to study the return on employer investment of
coordinated programs for workplace screening and treatment of bipolar disorder
and major depressive disorder.
PMCID: PMC1924724
PMID: 16946181 [PubMed - indexed for MEDLINE]
109. Vital Health Stat 10. 2006 Aug;(229):1-104.
Summary health statistics for the U.S. population: National Health Interview
Survey, 2004.
Adams PF, Barnes PM.
Division of Health Interview Statistics, US Department of Health & Human
Services, Centers for Disease Control and Prevention, National Center for Health
Statistics, Hyattsville, MD 20782, USA.
OBJECTIVES: This report presents both age-adjusted and unadjusted health
statistics from the 2004 National Health Interview Survey (NHIS) for the civilian
noninstitutionalized population of the United States, classified by sex, age,
race, Hispanic or Latino origin and race, education, family income, poverty
status, health insurance coverage (where appropriate), place of residence, and
region of residence. The topics covered are respondent-assessed health status,
limitations in activities, special education or early intervention services,
injuries and poisonings, health care access and utilization, and health insurance
coverage. SOURCE OF DATA: NHIS is a household, multistage probability sample
survey conducted annually by interviewers of the U.S. Census Bureau for the
Centers for Disease Control and Prevention's National Center for Health
Statistics. In 2004, household interviews were completed for 94,460 persons
living in 36,579 households, reflecting a household response rate of 86.9%.
SELECTED HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health
in 2004. About 34 million persons (12%) were limited in their usual activities
due to one or more chronic health conditions, and about 4 million persons (2%)
required the help of another person with activities of daily living. About 6% of
children received special education or early intervention services. Among persons
under age 65 years, about 41 million (17%) did not have any health insurance
coverage. The most common reason for lacking health insurance was cost, followed
by a change in employment.
PMID: 16918080 [PubMed - indexed for MEDLINE]
110. J Altern Complement Med. 2006 Jul-Aug;12(6):549-54.
Demographic characteristics and perceived health status of users of folk
therapies in Taiwan.
Tsai PS, Ke TL, Huang CJ, Hsaio FH, Wang MY, Cheng YH.
College of Nursing, Taipei Medical University and Taipei Municipal Wang Fang
Hospital, Taipei, Taiwan. ptsai@tmu.edu.tw
Erratum in:
J Altern Complement Med. 2006 Sep;12(7):705.
OBJECTIVES: This study examined the prevalence of folk therapy use among
Taiwanese adults and factors associated with such use. SUBJECTS AND METHODS: The
data used in this study were from the 2001 National Health Interview Survey in
Taiwan, which utilized a multistaged stratified systematic sampling scheme.
Included in the current analysis were 11,290 individuals from 20 to 65 years.
RESULTS: Only 1.3% of those surveyed were classified as users of folk therapy.
Users of folk therapies were older (p = 0.002), had higher annual incomes (p <
0.001), and experienced more health problems (p = 0.006) than nonusers. The two
groups were comparable in the areas of marital status, employment status, gender,
and educational level. Users had lower scores in the physical functioning (p <
0.001), role physical (p = 0.041), general health perception (p = 0.002), and
bodily pain (p < 0.001) domains of the Medical Outcome Studies 36-Item Short-Form
Health Survey. The two groups were not significantly different regarding the
utilization and satisfaction with conventional medical resources and the domain
scores of the brief version of the World Health Organization Quality of Life
(QOL) questionnaire. CONCLUSIONS: Less than 2% of adult Taiwanese population
reported relying primarily on folk therapies for their common physical
discomfort. Users of folk therapies are older, have higher incomes, and have more
health problems and poorer health-related QOL, but they neither make more
frequent use of conventional medical services nor are they dissatisfied with the
available services.
PMID: 16884346 [PubMed - indexed for MEDLINE]
111. J Clin Nurs. 2006 Aug;15(8):946-53.
Family and paid caregivers of hospitalized patients in Korea.
Cho SH, Kim HR.
Department of Nursing, Hanyang University, Seoul, Korea. sunghcho@hanyang.ac.kr
AIM: To examine patient need for family and paid caregivers during
hospitalization and determine factors related to caregiver use and the economic
burden for paid caregivers. BACKGROUND: Provision of nursing care is influenced
by the characteristics of the society and its health care system. An influencing
factor in Korea is the involvement of family caregivers in inpatient care. Korean
society has preserved the strong tradition of family bonds and filial
responsibility for caregiving. However, the ability of Korean families to assist
hospitalized family members has decreased as the society becomes more
industrialized. DESIGN: A cross-sectional study design was used, employing data
from the Seoul Citizens' Health Survey, a community-based interview survey with
3,203 inpatients in Seoul, conducted in 2001. METHODS: Distributions of
caregivers and related factors were explored by employing univariate comparisons
and multivariate logistic regression analyses. RESULTS: During hospitalization,
87% of patients needed caregivers. A greater need for caregivers was found in
children, women giving birth and patients with disability, longer length of stay
and discharge from general hospitals. Family members were the primary caregivers
while 3% of inpatients used private paid caregivers. Having paid caregivers was
associated with being female, older, high household income, disability, longer
stay and discharge from general hospitals. The average daily expense for paid
caregiver was 38.5 US dollars (USD) and 73% of patients perceived it as
burdensome. CONCLUSIONS: The demonstrated need for caregivers may suggest that
patients rely on family and paid caregivers in receiving assistance and care
during hospitalization. Therefore, implementation of policies to relieve the
burden of caregivers is necessary at both institutional and national levels.
Nursing services need to be redesigned in response to changing needs and
expectations of patients and their family members.
PMID: 16879538 [PubMed - indexed for MEDLINE]
112. Psychiatr Serv. 2006 Aug;57(8):1140-4.
Medical comorbidity in bipolar disorder: implications for functional outcomes and
health service utilization.
McIntyre RS, Konarski JZ, Soczynska JK, Wilkins K, Panjwani G, Bouffard B, Bottas
A, Kennedy SH.
Department of Psychiatry, University of Toronto, Ontario, Canada.
roger.mcintyre@uhn.on.ca
OBJECTIVE: This is the first cross-national population-based investigation
exploring the prevalence and functional implications of comorbid general medical
disorders in bipolar disorder. METHODS: Data were extracted from the Canadian
Community Health Survey (N = 36,984). Analyses were conducted to ascertain the
prevalence and prognostic implications of predetermined comorbid general medical
disorders among persons who screened positive for a lifetime manic episode
(indicative of a diagnosis of bipolar disorder). Within the subpopulation of
people who screened positive for a manic episode, the effect of medical
comorbidity on employment, functional role, psychiatric care, and medication use
was examined. RESULTS: When the data were weighted to be representative of the
household population of the ten provinces in 2002, an estimated 2.4 percent of
respondents screened positive for a lifetime manic episode. Rates of chronic
fatigue syndrome, migraine, asthma, chronic bronchitis, multiple chemical
sensitivities, hypertension, and gastric ulcer were significantly higher in the
bipolar disorder group (all p < .05). Chronic medical disorders were associated
with a more severe course of bipolar disorder, increased household and work
maladjustment, receipt of disability payments, reduced employment, and more
frequent medical service utilization. CONCLUSIONS: Comorbid medical disorders in
bipolar disorder are associated with several indices of harmful dysfunction,
decrements in functional outcomes, and increased utilization of medical services.
PMID: 16870965 [PubMed - indexed for MEDLINE]
113. Aust N Z J Psychiatry. 2006 Aug;40(8):648-56.
Hopelessness, demoralization and suicidal behaviour: the backdrop to welfare
reform in Australia.
Butterworth P, Fairweather AK, Anstey KJ, Windsor TD.
Centre for Mental Health Research, The Australian National University, Canberra,
Australian Capital Territory 0200, Australia. peter.butterworth@anu.edu.au
OBJECTIVES: To estimate rates of suicidal ideation and attempts, and
psychological characteristics of demoralization among Australian income support
recipients. To provide information for policy-makers to inform the current
welfare reform discussion. METHOD: Data from the 1997 National Survey of Mental
Health and Wellbeing were analysed using sequential logistic regression models,
comparing working age people dependent on government income support payments with
those having other main sources of income. RESULTS: Three groups of income
support recipients, unemployed, lone mothers and disability payment recipients,
reported significantly higher levels on all psychological measures related to
demoralization (hopelessness, worthlessness and dissatisfaction with life) than
non-recipients. A similar pattern was demonstrated for measures of suicidal
ideation and reported suicide attempts, with increased odds of between 3 and 9
for these high-risk groups of welfare recipients. The elevated rates of suicidal
ideation, attempts and demoralization among income support recipients were in
part explained by sociodemographic characteristics (socioeconomic status, age,
educational qualification, experience of serious violence, loneliness, experience
of psychiatric disorders), though the unemployed and disability payment
recipients remained elevated on the psychological measures. CONCLUSIONS:
Demoralization, poor mental health and suicidal behaviour are common among income
support recipients targeted by recently announced welfare reforms. This needs to
be considered in the design and implementation of Australian Government policies.
Psychiatric epidemiology has a key role in policy development and evaluation.
PMID: 16866760 [PubMed - indexed for MEDLINE]
114. Pain. 2006 Nov;125(1-2):172-9. Epub 2006 Jul 13.
Critical issues on opioids in chronic non-cancer pain: an epidemiological study.
Eriksen J, Sjøgren P, Bruera E, Ekholm O, Rasmussen NK.
Multidisciplinary Pain Centre, H:S Rigshospitalet, Copenhagen, Denmark.
Comment in:
Pain. 2006 Nov;125(1-2):3-4.
Pain. 2007 Apr;128(3):288; author reply 288-9.
Pain. 2007 May;129(1-2):226-7.
The aim of the study was epidemiologically to evaluate the long-term effects of
opioids on pain relief, quality of life and functional capacity in
long-term/chronic non-cancer pain. The study was based on data from the 2000
Danish Health and Morbidity Survey. As part of a representative National random
sample of 16,684 individuals (>16 years of age), 10,066 took part in an interview
and completed a self-administered questionnaire. Cancer patients were excluded.
The interview and the self-administered questionnaire included questions on
chronic/long-lasting pain (>6 months), health-related quality of life (SF-36),
use of the health care system, functional capabilities, satisfaction with medical
pain treatment and regular or continuous use of medications. Participants
reporting pain were divided into opioid and non-opioid users. The analyses were
adjusted for age, gender, concomitant use of anxiolytics and antidepressants and
pain intensity. Pain relief, quality of life and functional capacity among opioid
users were compared with non-opioid users. Opioid usage was significantly
associated with reporting of moderate/severe or very severe pain, poor self-rated
health, not being engaged in employment, higher use of the health care system,
and a negative influence on quality of life as registered in all items in SF-36.
Because of the cross-sectional nature causative relationships cannot be
ascertained. However, it is remarkable that opioid treatment of long-term/chronic
non-cancer pain does not seem to fulfil any of the key outcome opioid treatment
goals: pain relief, improved quality of life and improved functional capacity.
PMID: 16842922 [PubMed - indexed for MEDLINE]
115. 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]
116. Am J Nurs. 2006 Jul;106(7):40-9; quiz 50.
Can the use of LPNs alleviate the nursing shortage? Yes, the authors say, but the
issues--involving recruitment, education, and scope of practice--are complex.
Seago JA, Spetz J, Chapman S, Dyer W.
School of Nursing, University of California, San Francisco, USA.
jean.ann.seago@nursing.ucsf.edu
OVERVIEW: LPNs may be able to help fill some of the gaps caused by the nursing
shortage, but little research has been conducted on the demographic
characteristics of LPNs, their education and scope of practice, and the demand
for their services, all of which vary from state to state. In 2002 and 2003, the
authors conducted a comprehensive national study, Supply, Demand, and Use of
Licensed Practical Nurses, and have summarized that study's findings in this
article. They found that RNs and LPNs are similar in age and tend to have similar
numbers of children, but that racial and ethnic minorities, particularly African
Americans, and those who are single, widowed, divorced, or separated are better
represented among LPNs. Expanding LPN educational programs might draw more people
into nursing. Some LPNs would like to become RNs, so expanding LPN-to-RN "ladder"
programs could also be beneficial. LPNs can't replace RNs entirely, but they
could perform much of the work now performed by RNs. While long-term care
facilities already depend heavily on LPNs, hospitals could benefit from employing
more LPNs. The authors make several specific policy recommendations to improve
the education and employment of LPNs.
PMID: 16801785 [PubMed - indexed for MEDLINE]
117. J Occup Rehabil. 2006 Sep;16(3):425-38.
Prevalence and risk factors of work-related musculoskeletal disorders in massage
practitioners.
Jang Y, Chi CF, Tsauo JY, Wang JD.
School of Occupational Therapy, College of Medicine, National Taiwan University,
Taipei, Taiwan.
INTRODUCTION: Massage practitioners are at high risk for work-related
musculoskeletal disorders (WMSDs). We investigated the prevalence and risk
factors. METHODS: We randomly selected 161 visually impaired practitioners.
Demographics, musculoskeletal symptoms, and working postures were analyzed with
multivariate logistic regression. RESULTS: Results indicated that about 71.4% had
at least one WMSD in 12 months. Prevalence rates were finger or thumb, 50.3%;
shoulder, 31.7%; wrist, 28.6%; neck, 25.5%; arm or elbow, 23.6%; forearm, 20.5%;
and back, 19.3%. Working duration >20 years had an adjusted odds ratio (OR) for
finger or thumb 4.0-4.5 with 95% confidence interval (CI) 1.5-13.8, client
contact >4 h/day (adjusted OR for finger = 3.2, 95% CI=1.3-8.1), and < or =7-kg
pulp-pinch strength (adjusted OR for upper extremity = 2.9-3.2, 95% CI=1.2-8.3).
Adjusted ORs for lower-back symptoms were 3.1 (95% CI=1.3-7.8) and 3.6 (95%
CI=1.4-9.6), respectively, for lack of neutral neck posture and for inappropriate
working-table height. CONCLUSION: WMSDs were prevalent among massage
practitioners.
PMID: 16779682 [PubMed - indexed for MEDLINE]
118. Arthritis Rheum. 2006 Jun 15;55(3):442-50.
Health status, activity limitations, and disability in work and housework among
Latinos and non-Latinos with arthritis: an analysis of national data.
Abraído-Lanza AF, White K, Armbrister AN, Link BG.
Columbia University, Mailman School of Public Health, Department of Sociomedical
Sciences, New York, New York 10032, USA. aabraido@columbia.edu
OBJECTIVE: To document disparities in health status, activity limitations, and
disability in work and housework between Latinos and non-Latino whites with
arthritis. We examined whether sociodemographic factors (age, income, and
education) account for the disparities between the ethnic groups, and whether
comorbid conditions, disease duration, health care utilization, and functional
abilities predict health status, activity limitations, and work and housework
disability after controlling for sociodemographic variables. METHODS: We analyzed
data from the Condition file of the 1994 National Health Interview Survey on
Disability, Phase I. RESULTS: The risk of worse health, activity limitations, and
work and housework disability was >2 times greater among Latinos compared with
non-Latino whites. In the regression models accounting for potential confounders,
Latino ethnicity remained significantly associated with poorer health status, but
not activity limitations or disability in work or housekeeping. Of the
socioeconomic status variables, education had a significant protective effect on
work disability and health status. Comorbid conditions and health care
utilization increased the likelihood of worse health, activity limitations, and
work disability. Limitations in physical function were associated with poorer
health and disability in work and homemaking. CONCLUSION: Social status
differences between Latinos and non-Latinos may account for disparities in
activity limitations and disability in work and housework. Education may provide
various health benefits, including access to a range of occupations that do not
require physical demands. The findings help to address the great gap in knowledge
concerning factors related to the health and disability status of Latinos with
arthritis.
PMID: 16739212 [PubMed - indexed for MEDLINE]
119. Psychol Med. 2006 Jul;36(7):999-1009. Epub 2006 May 2.
Low prevalence of depression and anxiety is linked to statutory retirement ages
rather than personal work exit: a national survey.
Villamil E, Huppert FA, Melzer D.
Epidemiology for Policy Group, Department of Public Health and Primary Care,
University of Cambridge, Cambridge, UK.
BACKGROUND: Common mental disorder prevalence decreases substantially around the
conventional retirement age for men in the UK, but trends for older women are
more continuous. Prevalence changes in depression and anxiety around retirement
are less clear, as is the role of risk factors. The aim of this study was to
establish whether work status, age or other known risk factors account for the
reduced prevalence of depressive episode and anxiety disorder around retirement
ages for men and for women. METHOD: The British Psychiatric Morbidity Survey
(BPMS) 2000 was analysed, including 1875 men and 2253 women aged 45-75 years.
Diagnoses were from the Revised Clinical Interview Schedule (CIS-R). Logistic
models were adjusted for sociodemographic factors, social network, work status,
life events, physical illness and disability. RESULTS: There are marked
reductions in the prevalence of depressive episode after 60 years for women [60%
lower prevalence, 95% confidence interval (CI) 40-80] and 65 years for men (90%
lower prevalence, 95% CI 70-100), compared to the youngest age groups. For
anxiety disorder, the reduction in prevalence was 80% (95% CI 60-90) for men and
40% (95% CI 20-60) for women. In fully adjusted multivariate models, the strong
association between diagnoses and age groups remained, for both genders. Work
status was a significant factor for men but not for women. CONCLUSION: There is a
discontinuity in the prevalence of depressive episode for both men and women,
coinciding with statutory retirement ages. No studied risk factor reduced the
associations between age group and disorders. This population scale recovery may
provide a model for understanding non-genetic factors.
PMID: 16650345 [PubMed - indexed for MEDLINE]
120. Cancer. 2006 Jun 1;106(11):2466-75.
Health insurance coverage and cost barriers to needed medical care among U.S.
adult cancer survivors age<65 years.
Sabatino SA, Coates RJ, Uhler RJ, Alley LG, Pollack LA.
Division of Cancer Prevention and Control, National Centers for Chronic Disease
Prevention and Health Promotion, Centers for Disease Control and Prevention,
Atlanta, Georgia 30341, USA. bzo8@cdc.gov
BACKGROUND: The health insurance and cost barriers to care among cancer survivors
age <65 years were examined. METHODS: Using the 1998 and 2000 National Health
Interview Survey, survivors ages 18 to 64 years (n=1718) were compared with
similarly aged adults without cancer (n=50,276) to examine health insurance and
reported delayed/missed needed medical care within the previous year because of
cost. Findings were initially adjusted for age, sex, race, and ethnicity, and
further adjusted for employment, income, health status, marital status, and
region. RESULTS: Before adjustment, survivors were less likely to be uninsured
(12.4% vs. 18.0%) and more likely to have public insurance (11.2% vs. 6.2%).
After initial adjustment, survivors were as likely to lack insurance, less likely
to have private insurance, and more likely to have public insurance. After
further adjusting, differences in being uninsured were found to be small,
differences in having private insurance were eliminated, and differences in
having public insurance were reduced. Survivors most likely to lack insurance
were younger, female, African-American, or lower income. Survivors, particularly
uninsured or publicly insured survivors, were more likely to delay/miss care
because of cost. Overall, 20.9% of survivors, including 68% of uninsured
survivors, reported delaying/missing needed care. CONCLUSIONS: Health insurance
coverage among cancer survivors age<65 years appears to be comparable to that of
adults of similar age, sex, race, and ethnicity, but survivors may more likely be
publicly insured. Differences are attributable in part to employment, income, and
health status, factors potentially influenced by cancer. Unmet medical care needs
because of cost were common among survivors, particularly uninsured survivors.
Copyright (c) 2006 American Cancer Society.
PMID: 16639732 [PubMed - indexed for MEDLINE]
121. J Nurs Manag. 2006 May;14(4):255-61.
Locally targeted initiatives to recruit and retain nurses in England.
Gould D.
St Bartholomew's School of Nursing, City University, London, UK.
D.Gould@city.ac.uk
AIM: The aim of this study is to provide a detailed account of the locally
targeted strategies to improve staffing levels by senior nurses responsible for
recruitment and retention in acute trusts in the National Health Service in
England. BACKGROUND: There is a shortfall in nursing numbers throughout England.
Some trusts have employed senior nurses with a specific remit to improve
recruitment and retention, but little has been published about their work or its
success. METHODS: Data were collected by telephone using semi-structured
interviews with standard probes. The tape-recorded interview data were
transcribed verbatim and analysed by content. RESULTS: Of the 156 acute trusts in
England, 36 employed a senior nurse to deal with recruitment and retention.
Twenty-nine were interviewed. All were using a range of locally targeted
initiatives to attract and retain health-care assistants, newly qualified and
more experienced practitioners. They also worked closely with university staff to
attract and retain student nurses who would later seek employment locally.
Different approaches were used to secure the services of different types of
staff. CONCLUSION: This exploratory study has revealed a wealth of valuable data
concerning locally targeted recruitment and retention strategies. Further
research is needed to examine the effectiveness and cost-effectiveness of the
initiatives described.
PMID: 16629839 [PubMed - indexed for MEDLINE]
122. Am J Psychiatry. 2006 Apr;163(4):716-23.
The prevalence and correlates of adult ADHD in the United States: results from
the National Comorbidity Survey Replication.
Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV,
Greenhill LL, Howes MJ, Secnik K, Spencer T, Ustun TB, Walters EE, Zaslavsky AM.
Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave.,
Boston, MA 02115, USA. kessler@hcp.med.harvard.edu
Comment in:
Evid Based Ment Health. 2006 Nov;9(4):116.
OBJECTIVE: Despite growing interest in adult attention deficit hyperactivity
disorder (ADHD), little is known about its prevalence or correlates. METHOD: A
screen for adult ADHD was included in a probability subsample (N=3,199) of
18-44-year-old respondents in the National Comorbidity Survey Replication, a
nationally representative household survey that used a lay-administered
diagnostic interview to assess a wide range of DSM-IV disorders. Blinded clinical
follow-up interviews of adult ADHD were carried out with 154 respondents,
oversampling those with positive screen results. Multiple imputation was used to
estimate prevalence and correlates of clinician-assessed adult ADHD. RESULTS: The
estimated prevalence of current adult ADHD was 4.4%. Significant correlates
included being male, previously married, unemployed, and non-Hispanic white.
Adult ADHD was highly comorbid with many other DSM-IV disorders assessed in the
survey and was associated with substantial role impairment. The majority of cases
were untreated, although many individuals had obtained treatment for other
comorbid mental and substance-related disorders. CONCLUSIONS: Efforts are needed
to increase the detection and treatment of adult ADHD. Research is needed to
determine whether effective treatment would reduce the onset, persistence, and
severity of disorders that co-occur with adult ADHD.
PMID: 16585449 [PubMed - indexed for MEDLINE]
123. 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]
124. 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]
125. Minerva Pediatr. 2006 Feb;58(1):1-7.
Longitudinal psychosocial outcomes in two cohorts of adult survivors from
childhood acute leukemia treated with or without cranial radiation.
Massimo LM, Wiley TJ, Bonassi S, Caprino D.
Department of Pediatric Hematology and Oncology, G. Gaslini Research Children's
Hospital, Genova, Italy. luisamassimo@ospedale-gaslini.ge.it
AIM: In 1982, 60 children affected by acute lymphoblastic leukemia, treated
between 1974 and 1978 with or without cranial radiation, in complete remission,
and 2 years at least after stopping therapy, were submitted to a detailed
psychological investigation. All those who underwent cranial radiation showed
memory impairment. Twenty years after, 49 of them were still alive. On the
occasion of the 30th Anniversary of the Department, we contacted their parents
and invited them to an encounter: 43 agreed. We wished to learn as much as
possible about their current health and psychosocial status. The principal aim of
our research was to investigate if any differences existed between the 2 groups
and to measure the psychosocial performance of these subjects against comparable
Italian figures extracted from the last national census (Census 2001). METHODS:
We chose the narrative style for the encounters, because most of them knew about
us only from their parents, and we were afraid to use with them questionnaires
and official interviews. Most of them did not even know the name of their
disease. Our study shows that the whole group of adults had achieved good
physical, cognitive, emotional and behavioral development and adjustment.
Following the narrative approach, we were able to obtain detailed personal
information and the values of capacities of each subject. RESULTS: The results
showed no significant differences between the 2 groups and the corresponding
age-class in the 2001 Italian census as far as education and occupational group
were concerned. Only one unemployed subject (with a university degree) was
reported among them. The distribution of fathers' occupation perfectly reflected
national figures, and long-term survivors in most cases improved their social
level. As regards marriage and fertility no difference was seen between the 2
groups. All these statistics parallel, if not exceed, national figures.
CONCLUSIONS: The analysis and comparison of long-term cancer survivors' quality
of life can yield important clues and insight, and thus contribute to improved
approaches towards newly diagnosed patients, not only regarding treatment
protocols, but also psychosocial outcomes.
PMID: 16541001 [PubMed - indexed for MEDLINE]
126. Int Psychogeriatr. 2006 Dec;18(4):701-11. Epub 2006 Mar 16.
Psychiatric morbidity and acute hospitalization in elderly people.
Ng TP, Feng L, Chiam PC, Kua EH.
Gerontological Research Program, Faculty of Medicine, National University of
Singapore, Singapore.
BACKGROUND: Few studies have investigated the association of psychiatric
morbidity with acute hospitalization risk in elderly people. METHOD: We examined
this association using population-based data for 1092 older adults aged > or =60
years in Singapore, including subjects who reported at least one acute
hospitalization from any medical condition(s) in the 12 months prior to interview
(N = 136). Psychiatric morbid/comorbid disorders were diagnosed using the
Geriatric Mental State examination. RESULTS: In a multivariate analysis, comorbid
psychiatric disorders were independently associated with hospitalization
[adjusted odds ratio 2.76, 95% confidence interval 1.20-6.33], after controlling
for age, ethnicity, employment status, number of medical comorbidities, number of
activities of daily living limitations, hearing and visual impairment, SF-12
Physical and Mental Component Summary scores, social, productive, fitness and
health activities, and regular visits to health-care providers. Neither dementia
diagnosis nor cognitive impairment measured by the Mini-mental State Examination
was associated with increased hospitalization risk. CONCLUSION: Psychiatric
morbidity in old age was significantly associated with increased hospitalization
risk. This finding underlines the importance of treating psychiatric illness to
reduce the risk of acute hospitalization in elderly patients.
PMID: 16539748 [PubMed - indexed for MEDLINE]
127. 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]
128. 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]
129. Disabil Rehabil. 2006 Apr 15;28(7):423-36.
To work or not to work? The occupational trajectories of wheelchair users.
Ville I, Winance M.
INSERM (National Institute of Health and Medical Research), U.750, Villejuif,
France. ville@vjf.cnrs.fr
PURPOSE: To throw light upon the dynamic processes which may or may not lead
persons with severe motor disability to employment. METHOD: A qualitative
approach to the chronology of both the professional and non-professional
occupations of wheelchair users between acquisition of the disability and the
interview; this approach focuses upon actions and meanings, thus allowing the
authors to identify the diverse factors which help build the occupation situation
at the time of the study. The narratives of 36 wheelchair users of working age
were used. The objective of the analysis was to reconstitute the occupation
trajectories of the participants and hence to suggest a typology. This involved
pinpointing the various actors, the external and cognitive contexts of their
decisions and actions, and their consequences and related feelings. RESULTS: The
wide diversity found in the trajectories forced the authors to go beyond any
simple notion of 'work versus non-work' and to focus on the quality of the
individual's process of occupation appropriation. Indeed, it is possible to
successfully appropriate both work and non-work situations, just as, inversely,
it is possible for a person to fail to appropriate either type of situation.
Analysis of this process allows one to pinpoint different types of trajectory. On
the one hand, trajectories within which people appropriate their
occupations--gradual, intermittent, through rupture and successive
adjustment--and, on the other hand, unstable or endured occupation trajectories.
CONCLUSIONS: The findings suggest that with regard to rehabilitation practices,
we should be focussing as much on the appropriation process as on return to work.
PMID: 16507505 [PubMed - indexed for MEDLINE]
130. Arthritis Rheum. 2006 Feb 15;55(1):102-13.
Profile of arthritis disability: II.
Verbrugge LM, Juarez L.
Institute of Gerontology, University of Michigan, Ann Arbor, MI 48109, USA.
verbrugg@umich.edu
OBJECTIVE: Arthritis is the most common chronic condition and the most common
cause of disability among older US adults. We studied social participation,
disabilities in many life domains, accommodations used (buffers), and
accommodations needed (barriers) for US adults with arthritis disability compared
with adults with disability from other conditions. METHODS: The data source is
the National Health Interview Survey Disability Supplement Phase Two.
Arthritis-disabled individuals named arthritis as the main cause of > or =1
disabilities. Other-disabled individuals named only other conditions as causes of
their disabilities. We compared outcomes for the groups, taking sample weights
and complex variances into account. RESULTS: Arthritis-disabled individuals get
out and about less often than other-disabled individuals, but they manage to
maintain active social ties. They have more disabilities of all types (personal
care, household management, physical tasks, transportation, home, work), and the
disabilities often cause fatigue, long task time, and pain. Despite this,
arthritis-disabled individuals use less personal assistance than other-disabled
individuals; they do use more equipment assistance. Arthritis-disabled
individuals report more barriers in getting around outside their home and at
their workplace. CONCLUSION: The distinctive profile of arthritis disability
includes extensive and uncomfortable disabilities, yet there are active
management strategies to handle these disabilities. Problems away from home and
at work should inspire engineers and planners to improve public access and
equipment for persons with this high-prevalence disability.
PMID: 16463411 [PubMed - indexed for MEDLINE]
131. Psychosom Med. 2006 Jan-Feb;68(1):152-8.
Mental and physical comorbid conditions and days in role among persons with
arthritis.
Stang PE, Brandenburg NA, Lane MC, Merikangas KR, Von Korff MR, Kessler RC.
Department of Health, West Chester University and Galt Associates West Chester,
PA, USA. pstang@galt-assoc.com
OBJECTIVE: To estimate the prevalence of comorbidity among people with arthritis
in the US adult population and to determine the role of comorbidity in accounting
for the association of arthritis with days out of role (a measure of inability to
work or carry out normal activities). METHODS: Data come from the National
Comorbidity Survey Replication (NCS-R), a nationally representative household
survey of 9,282 respondents ages 18 and older carried out in 2001 to 2003.
Arthritis was assessed by self-report in a chronic-conditions checklist, along
with a wide range of other physical conditions. Mental and substance use
disorders were ascertained with the World Health Organization Composite
International Diagnostic Interview (CIDI). Number of days out of role was
assessed for the 30 days before the interview. RESULTS: Arthritis was reported by
27.3% of respondents, 80.9% of whom also reported at least one other physical or
mental disorder, including 45.6% with another chronic pain condition, 62.3% with
another chronic physical condition, and 24.3% with a 12-month mental disorder.
Arthritis was significantly associated with days out of role, but comorbidity
explained more than half of this association. No significant interactions were
found between arthritis and the other conditions in predicting days out of role.
CONCLUSION: Comorbidity is the rule rather than the exception among people with
arthritis. Comorbidity accounts for most of the days out of role associated with
arthritis. The societal burden of arthritis needs to be understood and managed
within the context of these comorbid conditions.
PMCID: PMC1941781
PMID: 16449426 [PubMed - indexed for MEDLINE]
132. 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]
133. BMC Public Health. 2006 Jan 3;6:1.
Association between health information, use of protective devices and occurrence
of acute health problems in the Prestige oil spill clean-up in Asturias and
Cantabria (Spain): a cross-sectional study.
Carrasco JM, Lope V, Pérez-Gómez B, Aragonés N, Suárez B, López-Abente G,
Rodríguez-Artalejo F, Pollán M.
Environmental Epidemiology and Cancer Unit, National Centre for Epidemiology,
Carlos III Institute of Health, Madrid, Spain. jmcarrasco@isciii.es
BACKGROUND: This paper examines the association between use of protective
devices, frequency of acute health problems and health-protection information
received by participants engaged in the Prestige oil spill clean-up in Asturias
and Cantabria, Spain. METHODS: We studied 133 seamen, 135 bird cleaners, 266
volunteers and 265 paid workers selected by random sampling, stratified by type
of worker and number of working days. Information was collected by telephone
interview conducted in June 2003. The association of interest was summarized,
using odds ratios (OR) obtained from logistic regression. RESULTS:
Health-protection briefing was associated with use of protective devices and
clothing. Uninformed subjects registered a significant excess risk of itchy eyes
(OR:2.89; 95%CI:1.21-6.90), nausea/vomiting/dizziness (OR:2.25; 95%CI:1.17-4.32)
and throat and respiratory problems (OR:2.30; 95%CI:1.15-4.61). There was a
noteworthy significant excess risk of headaches (OR:3.86: 95%CI:1.74-8.54) and
respiratory problems (OR:2.43; 95%CI:1.02-5.79) among uninformed paid workers.
Seamen, the group most exposed to the fuel-oil, were the worst informed and
registered the highest frequency of toxicological problems. CONCLUSION: Proper
health-protection briefing was associated with greater use of protective devices
and lower frequency of health problems. Among seamen, however, the results
indicate poorer dissemination of information and the need of specific guidelines
for removing fuel-oil at sea.
PMCID: PMC1368965
PMID: 16390547 [PubMed - indexed for MEDLINE]
134. J Nerv Ment Dis. 2005 Dec;193(12):825-32.
Postmigration living problems and common psychiatric disorders in Iraqi asylum
seekers in the Netherlands.
Laban CJ, Gernaat HB, Komproe IH, van der Tweel I, De Jong JT.
De Evenaar Day Clinic for Asylum Seekers and Refugees, GGZ-Drenthe, Institute of
Community Mental Health Care, Postbus 30000, 9410 RA Beilen, the Netherlands.
In a previous community-based, national study among Iraqi asylum seekers, a long
asylum procedure was found to have a higher risk for common psychiatric disorders
than adverse life events in Iraq. In the present article, the postmigration
period is considered in more detail and evaluated in relationship with
psychiatric disorders. Respondents were interviewed with fully structured,
culturally validated, translated questionnaires. With the use of a Post-
migration Living Problems questionnaire, worries about all kinds of problems were
gathered. Psychiatric (DSM-IV) disorders were measured with the Composite
International Diagnostic Interview 2.1. Factor analysis was done on the
postmigration living problems, and in univariate and multivariate analyses,
associations with psychopathology were calculated. Results show that clusters of
postmigration living problems could be identified: family issues, discrimination,
asylum procedure, socioeconomic living conditions, socioreligious aspects, and
work-related issues. There was a significant relationship between all clustered
postmigration living problems and psychopathology, except for socioreligious
aspects. Multivariate logistic regression showed that lack of work, family
issues, and asylum procedure stress had the highest odds ratios for
psychopathology. The findings appeal to governments to shorten the asylum
procedures, allow asylum seekers to work, and give preference to family reunion.
Mental health workers should recognize the impact of postmigration living
problems and consider focusing their treatment on coping with these problems
instead of traumas from the past.
PMID: 16319706 [PubMed - indexed for MEDLINE]
135. Nord J Psychiatry. 2005;59(6):486-91.
Major depressive episode related to long unemployment and frequent alcohol
intoxication.
Hämäläinen J, Poikolainen K, Isometsä E, Kaprio J, Heikkinen M, Lindeman S, Aro
H.
National Public Health Institute, Department of Mental Health and Alcohol
Research, Helsinki, Finland. Juha.Hamalainen@ktl.fi
We studied the association between two major problems--unemployment and major
depressive episode--and the impact of different timing of periods of unemployment
and risk factors, especially alcohol intoxication, for major depressive episode
among the unemployed. Major depressive episode during the last 12 months, plus
current and past employment status and frequency of alcohol intoxication, were
assessed within the nationally representative, cross-sectional 1996 Finnish
Health Care Survey, in which non-institutionalized individuals aged 15-75 years
were interviewed by using the Short Form of the University of Michigan version of
the Composite International Diagnostic Interview (the UM-CIDI Short Form). Of the
5993 subjects interviewed, 3818 (64%) were occupationally active and included in
the logistic regression analysis, showing that even after adjusting for other
potentially confounding variables, current unemployment was associated with major
depressive episode (odds ratio, OR=1.78, 95% confidence interval, CI, 1.38-2.29).
Further analysis revealed that the increased risk of major depressive episode was
only related to long-term unemployment. Frequent alcohol intoxication (at least
once a week) increased the risk of major depressive episode remarkably. Compared
with the group "Constantly employed, no frequent alcohol intoxication", long-term
unemployment with no frequent alcohol intoxication had moderately increased risk
of major depressive episode (OR=1.72 (95% CI 1.29-2.30) and those with frequent
alcohol intoxication had highly increased risk [OR=11.27 (95% CI 5.51-23.09) vs.
OR=1.72 (95% CI 1.29-2.30]. Long-term unemployment is associated with increased
risk of major depressive episode. Frequent alcohol intoxication among long-term
unemployed individuals greatly increases the risk of depression.
PMID: 16316902 [PubMed - indexed for MEDLINE]
136. J Health Care Poor Underserved. 2005 Nov;16(4):655-76.
The effect of socioeconomic status on the survival of people receiving care for
HIV infection in the United States.
Cunningham WE, Hays RD, Duan N, Andersen R, Nakazono TT, Bozzette SA, Shapiro MF.
Division of General Internal Medicine and Health Services Research, Department of
Medicine, Center for Health Sciences, School of Public Health, UCLA, Los Angeles,
CA 90095, USA. wcunningham@mednet.ucla.edu
HIV-infected people with low socioeconomic status (SES) and people who are
members of a racial or ethnic minority have been found to receive fewer services,
including treatment with Highly Active Antiretroviral Therapy (HAART), than
others. We examined whether these groups also have worse survival than others and
the degree to which service use and antiretroviral medications explain these
disparities in a prospective cohort study of a national probability sample of
2,864 adults receiving HIV care. The independent variables were wealth (net
accumulated financial assets), annual income, educational attainment, employment
status (currently working or not working), race/ethnicity, insurance status, use
of services, and use of medications at baseline. The main outcome variable was
death between January 1996 and December 2000. The analysis was descriptive and
multivariate adjusted Cox proportional hazards regression analysis of survival.
By December 2000, 20% (13% from HIV, 7% non-HIV causes) of the sample had died.
Those with no accumulated financial assets had an 89% greater risk of death
(RR=1.89, 95% CI=1.15-3.13) and those with less than a high school education had
a 53% greater risk of death (RR=1.53, 95% CI=1.15-2.04 ) than their counterparts,
after adjusting for sociodemographic and clinical variables only. Further
adjusting for use of services and antiretroviral treatment diminished, but did
not eliminate, the elevated relative risk of death for those with low SES by
three of the four measures. The finding of markedly elevated relative risks of
death for those with HIV infection and low SES is of particular concern given the
disproportionate rates of HIV infection in these groups. Effective interventions
are needed to improve outcomes for low SES groups with HIV infection.
PMID: 16311491 [PubMed - indexed for MEDLINE]
137. Psychol Med. 2006 Feb;36(2):231-8. Epub 2005 Nov 23.
Psychotic-like experiences in the general community: the correlates of CIDI
psychosis screen items in an Australian sample.
Scott J, Chant D, Andrews G, McGrath J.
Mater Child & Youth Mental Health Service, Mater Children's Hospital, South
Brisbane, Queensland, Australia.
BACKGROUND: Apart from individuals with clinical psychosis, community surveys
have shown that many otherwise well individuals endorse items designed to
identify psychosis. The aim of this study was to characterize the demographic
correlates of individuals who endorse psychosis screening items in a large
general community sample. METHOD: The National Survey of Mental Health and
Wellbeing interviewed 10641 individuals living in private dwellings in Australia.
As part of a diagnostic interview (the CIDI), respondents were asked between
three and six items originally designed to screen for potential psychosis. We
examined the impact of selected demographic variables on endorsement of these
items including sex, age, marital status, migrant status, urban/rural status,
employment, education, and socio-economic status. RESULTS: An estimated 11.7% of
the Australian population endorsed at least one psychosis-screening item.
Significantly higher endorsement was associated with younger age, migrants from
non-English-speaking backgrounds, those who had never married or who were
divorced/separated or unemployed, those living in urban regions and those from
the lowest socio-economic levels. CONCLUSIONS: Many of the correlates of
endorsement of psychosis-screen items are also associated with psychosis.
Unravelling the factors that contribute to this broader non-clinical phenotype
will aid our understanding of psychosis.
PMID: 16303059 [PubMed - indexed for MEDLINE]
138. Southeast Asian J Trop Med Public Health. 2005 Jul;36(4):1048-56.
Perceived industrial deafness and hearing loss among people in a small Queensland
rural community.
Jirojwong S, Joubert D, Anastasi S; Wowan/Dululu Community Volunteer Group Inc.
Faculty of Arts, Health and Sciences, Central Queensland University, Rockhampton
QLD, Australia. s.jirojwong@cqu.edu.au
This paper aims to describe chronic diseases including hearing loss reported by
people in a small rural community. It will present the results of audiometric
screening among a group of people in this community and their self reported risk
factors of hearing loss. Different risk factors experienced by men and women will
be compared. Two surveys were conducted in a small Queensland rural community.
The first survey gathered information relating to chronic diseases among 604
people using a telephone interview method. The second survey assessed the level
of hearing among 64 people who presented themselves for audiometric screening,
their history of exposure to loud noise and their previous use of hearing
protective measures. A higher rate of "industrial deafness" was reported (110.75
per 1,000 population) than the 1995 National rate (95.2 per 1,000 population). Of
64 people who attended the audiometric assessment, 60 (93.8%) had some level of
hearing loss using the 2000 International Standard of hearing level (ISO 7029:
2000) taking age and gender into account. However, 15 persons (23.4%) perceived
that they had good hearing. When compared to ISO 7029: 2000 standard, men and
women had a similar pattern of hearing loss. Compared to men, a lower percentage
of women were exposed to different sources of loud noise and were less likely to
use hearing protection devices.
PMID: 16295567 [PubMed - indexed for MEDLINE]
139. Eur J Public Health. 2006 Jun;16(3):295-305. Epub 2005 Oct 31.
Self-rated health in relation to employment status during periods of high and of
low levels of unemployment.
Ahs A, Westerling R.
Department of Public Health and Caring Sciences, Section for Social Medicine,
Uppsala University, Uppsala, Sweden. Annika.Ahs@pubcare.uu.se
BACKGROUND: There is a need for more research on the health impact of changes in
the national unemployment rate. Therefore, the present study was carried out to
compare levels of self-rated health during periods of high and low levels of
unemployment. METHODS: Data included cross-sectional interviews from the Swedish
Survey of Living Conditions, which were based on random samples of inhabitants
between 16 and 64 years of age living in Sweden. Data were collected for the
period 1983-89, when unemployment levels were low (n = 35 562; 2.5%) and for the
period 1992-97 when unemployment was high (n = 24 019; 7.1%). RESULTS: After
adjusting for sociodemographic variables as well as long-term disease or
handicap, the differences in self-rated health between the unemployed and
employed were larger when unemployment levels were high in the 1990s, than when
they were low in the 1980s. More groups of the unemployed were afflicted with
poor health when unemployment was high, compared with when it was low. In
1992-97, being married, living in larger cities, or not having a long-term
disease or handicap no longer buffered the negative effects on health among the
unemployed. CONCLUSIONS: Poorer self-rated health among the unemployed seems to
be an increasing public health problem during high levels of unemployment.
PMID: 16260444 [PubMed - indexed for MEDLINE]
140. Health Qual Life Outcomes. 2005 Oct 7;3:61.
Patients' perspectives on how idiopathic pulmonary fibrosis affects the quality
of their lives.
Swigris JJ, Stewart AL, Gould MK, Wilson SR.
Division of Pulmonary Medicine, National Jewish Medical and Research Center,
Denver, CO, USA. swigrisj@njc.org
BACKGROUND: Idiopathic pulmonary fibrosis (IPF) is a debilitating lung disease
with a survival of only three to five years from the time of diagnosis. Due to a
paucity of studies, large gaps remain in our understanding of how IPF affects the
quality of patients' lives. In only one other study did investigators ask
patients directly for their perspectives on this topic. Further, currently there
is no disease-specific instrument to measure health-related quality of life
(HRQL) in patients with IPF. A carefully constructed measurement instrument,
sensitive to underlying change, is needed for use in clinical trials and
longitudinal studies of patients with IPF. Before developing such an instrument,
researchers must improve their understanding of the relevant effects of IPF on
patients' lives. On a broader scale, to provide the best care for people with
IPF, clinicians must appreciate--from patients' perspectives--how this disease
affects various aspects of their lives. METHODS: We used focus groups and
individual in-depth interviews with 20 IPF patients to collect their perspectives
on how IPF affects their lives (with a focus on the quality of their lives). We
then analyzed these perspectives and organized them into a conceptual framework
for describing HRQL in patients with IPF. Next, we examined how well certain
existing measurement instruments--which have been administered to IPF patients in
prior studies--covered the domains and topics our patients identified. RESULTS:
In our framework, we identified 12 primary domains: symptoms, IPF therapy, sleep,
exhaustion, forethought, employment and finances, dependence, family, sexual
relations, social participation, mental and spiritual well-being, mortality. Each
domain is composed of several topics, which describe how IPF affects patients'
lives. When we compared the content of our conceptual framework with the existing
instruments, we found the coverage of the existing instruments to be inadequate
for several reasons, including they may tap general areas of QOL or HRQL but not
some areas that appear to be most directly affected by IPF, and they include
items that are relevant to symptoms and effects of other respiratory diseases but
not IPF. CONCLUSION: Collecting patients' perspectives and developing an
organized inventory of the relevant effects of IPF on patients' lives provides
valuable information for improving our understanding of the impact of this
disease on patients and their loved ones. We believe our findings will help alert
clinicians and researchers to IPF patients' experiences and concerns. Based on
the comparison or our conceptual framework with the content of four existing
instruments, it would appear that developing an IPF-specific measurement
instrument is justified. Our conceptual framework for describing health-related
quality of life in patients with IPF lays a solid foundation for constructing
such an instrument.
PMCID: PMC1276807
PMID: 16212668 [PubMed - indexed for MEDLINE]
141. Arthritis Rheum. 2005 Oct 15;53(5):673-81.
Pain exacerbation as a major source of lost productive time in US workers with
arthritis.
Ricci JA, Stewart WF, Chee E, Leotta C, Foley K, Hochberg MC.
Caremark, Hunt Valley, MD 21031, USA. judi.ricci@caremark.com
OBJECTIVE: To estimate the prevalence of arthritis and arthritis pain
exacerbations in US workers including impact on functioning and lost productive
work time (LPT). METHODS: The research was conducted as a nested case-control
study of participants in the Caremark American Productivity Audit, a US national
random-digit-dial survey of US workers. The sample included 329 workers ages
40-65 years meeting the First National Health and Nutrition Examination Survey
criteria for arthritis, and 91 workers not meeting arthritis inclusion criteria.
Participants completed a telephone interview to measure the prevalence of
arthritis and pain exacerbations, LPT (in hours and dollars), functional
disability using the Western Ontario and McMaster Universities Knee and Hip
Osteoarthritis Index (WOMAC) and the Australian/Canadian Osteoarthritis Hand
Index, and demographics. RESULTS: The prevalence of arthritis in US workers ages
40-65 years was 14.7% during the 2-week period. Pain exacerbation occurred among
38% of participants with arthritis. Workers with pain exacerbations were
significantly more likely to have higher WOMAC scores (38.6 versus 29.6; P =
0.0041) and report arthritis-related LPT (24.4% versus 13.3%; P = 0.0118) than
workers without exacerbations. Among those with LPT, average LPT did not differ
(4.1 hours per week) between persons with and without exacerbations. The
estimated annual LPT cost from arthritis in the US workforce was $7.11 billion,
with 65.7% of this cost attributed to the 38% of workers with pain exacerbations.
CONCLUSION: Workers with arthritis pain exacerbation account for a
disproportionate share of the arthritis-related LPT cost. Stratifying workers for
appropriate treatment management based on pain exacerbation status could
significantly decrease arthritis-related LPT and offer employees and employers an
effective return on health care use.
PMID: 16208644 [PubMed - indexed for MEDLINE]
142. 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]
143. Health Promot Int. 2005 Dec;20(4):351-9. Epub 2005 Sep 16.
Evaluation of empowerment processes in a workplace health promotion intervention
based on learning in Sweden.
Arneson H, Ekberg K.
Hanna Arneson National Centre for Work and Rehabilitation, Department of Health
and Society, University of Linköping, SE-581 83 Linköping, Sweden.
Hanna.Arneson@ihs.liu.se
The aim of this study was to evaluate a theory-based method for workplace health
promotion (WHP) with regard to possible facilitation of empowerment processes.
The intervention tool was the pedagogic method known as problem-based learning
(PBL). The aim of the intervention was to promote empowerment and health among
the employees. The intervention was implemented in three organizations within the
public sector in Sweden, in a bottom-up approach. All employees, including
management, in each organization, were offered the opportunity to participate (n
= 113) and 87% (n = 97) participated. The intervention was implemented in 13
groups of six to eight participants who met once a week over a period of 4
months. The predetermined overall goal of the intervention was to promote
employee health within the organizational setting. A facilitator in each group
and a group-specific mutual agreement guided the intervention, as did the problem
solving process. The participants set goals and developed strategies to reach
their goals between the meetings. Thirty informants were interviewed in seven
focus groups after the intervention about the intervention method and the
process, following a semi-structured theme guide. The phenomenographic analysis
resulted in six descriptive categories: reflection, awareness and insight,
self-direction and self-management, group coherence, social support and actions.
The results correspond to established theories of components of empowerment
processes. The method initiated processes of change at organizational, workplace
and individual levels as the participants examined their work situation,
determined problems and initiated solutions. Social support and group coherence
were expressed as essential in order to transform challenging strategies into
action and goal realization. The findings indicate that systematic improvements
of social support and group coherence among employees ought to be facilitated by
the organization as a health-promoting arena. PBL appears to be a profitable and
powerful instrument with the potential to enable empowerment.
PMID: 16169884 [PubMed - indexed for MEDLINE]
144. J Health Econ. 2006 May;25(3):500-19. Epub 2005 Sep 12.
Case management interviews and the return to work of disabled employees.
Høgelund J, Holm A.
Danish National Institute of Social Research, Herluf Trolles Gade 11, DK-1052
Copenhagen K, Denmark.
This study measures the effect of case management interview (CMI) on 1,000
long-term sick-listed employees' probability of returning to work. In contrast to
previous studies, we use instrumental variables to correct for selection effects
in CMI. Using a competing hazard rate model, we find that CMI increases the
probability of returning to work for the pre-sick leave employer, but has no
effect on the probability of resuming work for a new employer. We argue that CMI
either motivates the sick-listed employees to resume work or adjusts for
asymmetric information between the employee and the pre-sick leave employer.
PMID: 16159679 [PubMed - indexed for MEDLINE]
145. Qual Life Res. 2005 Aug;14(6):1641-7.
Assessment of quality of life among HIV-infected persons in Pune, India.
Kohli RM, Sane S, Kumar K, Paranjape RS, Mehendale SM.
National AIDS Research Institute, Indian Council of Medical Research, 73 G Block,
MIDC Bhosari, Pune 411026, Maharashtra, India. rewakohli@hotmail.com
OBJECTIVE: To study dimensions of Quality of Life (QOL) amongst HIV infected
persons, their relationship with socio-demographic characteristics and disease
progression. DESIGN: Cross-sectional study with one time assessment of QOL.
METHODS: Modified Medical Outcome Study (MOS) core instrument [The Medical
Outcome Study 116 core set of Measures of functioning and well being, Appendix A,
core survey instrument (internet)] was interview--administered to 100 HIV
infected individuals. RESULTS: The instrument showed significant positive
inter-domain correlations and desired linear association between QOL scores and
the CD4 counts. The scale had a Cronbach alpha value of 0.75. QOL was markedly
affected in the domains of physical health, work and earnings, routine activities
and appetite and food intake. Women had significantly lower QOL scores than men
despite having less advanced disease. The QOL scores were significantly lower
among persons with lower CD4 counts mainly in different domains of physical
health. CONCLUSIONS: The modified MOS scale had the desired reliability and
validity for evaluation of QOL in the HIV-infected persons in India. Low scores
in the domains of physical health compared to other domains suggest a strategy to
focus on medical intervention. A need for psychosocial intervention for women was
perceived. Longitudinal studies must be done to assess the impact of
anti-retroviral therapy being rolled out through the national programme on QOL.
PMID: 16110943 [PubMed - indexed for MEDLINE]
146. Scand J Caring Sci. 2005 Sep;19(3):223-9.
Hindrance for patient participation in nursing care.
Sahlsten MJ, Larsson IE, Plos KA, Lindencrona CS.
Institute of Nursing, Health Care Pedagogics, The Sahlgrenska Academy at Göteborg
University, Göteborg, Sweden. monika.sahlsten@swipnet.se
THE STUDY'S RATIONALE: Patients' influence in health care through participation,
freedom of choice and information, is laid down in laws, national and local
directives. In nursing care situations, the degree to which a patient
participates depends on the nursing staff. Accordingly, hindrances for patient's
participation during nursing care is an important question for the nursing
profession. AIMS AND OBJECTIVES: The aim was to focus on Swedish Registered
Nurses opinion of hindrances for patient participation in nursing care and to
uncover the informants' perspectives in depth. METHODOLOGICAL DESIGN AND
JUSTIFICATION: The study was limited to inpatient somatic care and has a
qualitative approach. Data were collected through seven focus group interviews
with 31 Registered Nurses from five hospitals. An analysis of the tape-recorded
interview material was made, combining elements of content analysis with aspects
of the Grounded Theory approach. ETHICAL ISSUES AND APPROVAL: The ethics of
scientific work was followed. The participants gave informed consent. Verbal and
written information was given as a guarantee that all information would be
treated confidentially outside the focus group. Formal approval by ethical
committee was not required according to national and local directives. RESULTS:
Hindrance for patient participation in nursing care comprised three themes:
Competence, Influence of significant others and Organization and work
environment, and their seven underlying subthemes. CONCLUSIONS: The study
clarified factors, which individually or combined may be hindrance for patient
participation in nursing practice. Professional nurses must be able to find a
balance for their patients' participation in nursing care activities through
identification and coping with the hindrances. The three themes and seven
subthemes here identified, can be used in patient care and its' evaluation, like
also quality assurance of care and work organization and in nursing education.
For further development replication studies are needed, like additional studies
of patients and significant others.
PMID: 16101850 [PubMed - indexed for MEDLINE]
147. N Engl J Med. 2005 Jul 28;353(4):382-91.
Children in the United States with discontinuous health insurance coverage.
Olson LM, Tang SF, Newacheck PW.
Department of Practice, American Academy of Pediatrics, Elk Grove Village, Ill
60007, USA. lolson@aap.org
Comment in:
N Engl J Med. 2005 Jul 28;353(4):418-9.
BACKGROUND: Estimates of the number of uninsured people in the United States
usually exclude those with discontinuous coverage. The effects of gaps in
insurance coverage for children on access to and use of ambulatory care are
poorly understood. METHODS: We analyzed a sample of 26,955 children under 18
years of age from the 2000 and 2001 National Health Interview Surveys. Children
with discontinuous health insurance coverage were compared with those who were
uninsured all year and with those who had public or private full-year coverage.
RESULTS: During the last 12 months before they were interviewed, 6.6 percent of
children in the United States had no insurance and an additional 7.7 percent had
gaps in insurance. Children who had full-year insurance coverage (private or
public) had low rates of unmet health care needs and good access to care (delayed
care, unmet medical care, and unfilled prescriptions were reported in <3 percent,
and <5 percent had no usual place of care). Access to care was much worse for
children who were uninsured for part of the year and for those who were uninsured
for the full year (delayed care, 20.2 percent and 15.9 percent, respectively;
unmet medical care, 13.4 percent and 12.6 percent, respectively; unfilled
prescriptions, 9.9 percent and 10.0 percent, respectively; P<0.01 for all
comparisons with children with full-year, private insurance coverage). In
multivariate analyses adjusting for age, income, race or ethnic group, region,
citizenship, family structure, parental employment, and health status, the
differences in access to care persisted. As compared with the parents of children
with full-year, private insurance, parents of children uninsured for the full
year were far more likely to report delaying care (adjusted odds ratio, 12.65; 95
percent confidence interval, 9.45 to 16.94), as were parents of children
uninsured for part of the year (adjusted odds ratio, 13.65; 95 percent confidence
interval, 10.41 to 17.90). CONCLUSIONS: Children with gaps in health insurance
coverage commonly do not seek medical care, including preventive visits, and do
not get prescriptions filled. These findings are important for both research and
policy and point to the need for more encompassing and sensitive measures of the
situation of being uninsured. Copyright 2005 Massachusetts Medical Society.
PMID: 16049210 [PubMed - indexed for MEDLINE]
148. Epilepsia. 2005 Jul;46(7):1133-9.
Psychological distress, comorbidities, and health behaviors among U.S. adults
with seizures: results from the 2002 National Health Interview Survey.
Strine TW, Kobau R, Chapman DP, Thurman DJ, Price P, Balluz LS.
Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop
K-66, Atlanta, GA 30341, U.S.A. tws2@cdc.gov
PURPOSE: To examine the association of seizures with health-related quality of
life (HRQOL), physical and psychiatric comorbidities, and health behaviors.
METHODS: We analyzed data obtained from adults aged 18 years or older (n =
30,445) who participated in the 2002 National Health Interview Survey, an
ongoing, computer-assisted personal interview of the noninstitutionalized U.S.
population. RESULTS: An estimated 1.4% of adults 18 years or older reported being
told by a health care professional that they had seizures. Persons with seizures
were significantly more likely than those without seizures to report lower levels
of education, higher levels of unemployment, pain, hypersomnia and insomnia, and
psychological distress (e.g., feelings of sadness, nervousness, hopelessness, and
worthlessness). In addition, they were significantly more likely to report
insufficient leisure-time physical activity as well as physical comorbidities
such as cancer, arthritis, heart disease, stroke, asthma, severe headaches, lower
back pain, and neck pain. CONCLUSIONS: Our findings suggest that it is advisable
for health care professionals to assess psychiatric and physical comorbidities
among patients with a history of seizures potentially to improve patient health
outcomes. Furthermore, public health surveillance systems should include
questions on seizures, epilepsy, and mental health to better examine associations
among these disorders and to better identify populations meriting further
assessment and intervention.
PMID: 16026567 [PubMed - indexed for MEDLINE]
149. Sociol Health Illn. 2005 Apr;27(3):324-50.
Biographical work and returning to employment following a spinal cord injury.
Ville I.
Centre of Research for Medicine, Sciences, Health and Society, National Institute
of Health and Medical Research, Paris, France. ville@vjf.cnrs.fr
The question of returning to work after the onset of severe impairment is
inseparable from the biographical work that disabled people need to achieve.
Qualitative analysis of interviews I carried out among people who had become
paraplegic and among rehabilitation professionals offered the following insights:
* During a period extending beyond rehabilitation, interviewees were absorbed by
the work of coming to terms with their impairment and delegated the question of
occupation to the professionals. At a later date, some of them manage to recast
their biographies and gain ownership of their occupations and activities for
themselves. An open environment, which offers negotiable opportunities and space
for relationships to form, encourages the development of biographical work.
Nowadays, the question of exclusion would appear to dominate the domain of
rehabilitation. The belief that prolonged inactivity engenders marginalisation
has led professionals to develop a doctrine whereby they encourage their patients
to plan for their professional activities from a very early stage. Struggling
with different time demands (for example, lengthy administrative procedures and
reduced rehabilitation time) professionals organise their work around a new time
frame which conflicts with their expertise and is difficult to reconcile with the
trajectories of disabled people.
PMID: 15953211 [PubMed - indexed for MEDLINE]
150. 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]
151. J Occup Environ Med. 2005 Jun;47(6):565-72.
The prevalence and effects of adult attention deficit/hyperactivity disorder on
work performance in a nationally representative sample of workers.
Kessler RC, Adler L, Ames M, Barkley RA, Birnbaum H, Greenberg P, Johnston JA,
Spencer T, Ustün TB.
Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
02115, USA. kessler@hcp.med.harvard.edu
OBJECTIVE: The prevalence and workplace consequences of adult attention
deficit/hyperactivity disorder (ADHD) are unknown. METHODS: An ADHD screen was
included in a national household survey (n = 3198, ages 18-44). Clinical
re-interviews calibrated the screen to diagnoses of Diagnostic and Statistical
Manual of Mental Disorders, 4th edition ADHD. Diagnoses among workers were
compared with responses to the WHO Health and Work Performance Questionnaire
(HPQ). RESULTS: A total of 4.2% of workers had ADHD. ADHD was associated with
35.0 days of annual lost work performance, with higher associations among blue
collar (55.8 days) than professional (12.2 days), technical (19.8 days), or
service (32.6 days) workers. These associations represent 120 million days of
annual lost work in the U.S. labor force, equivalent to dollar 19.5 billion lost
human capital. CONCLUSIONS: ADHD is a common and costly workplace condition.
Effectiveness trials are needed to estimate the region of interest of workplace
ADHD screening and treatment programs.
PMID: 15951716 [PubMed - indexed for MEDLINE]
152. Epilepsy Res. 2005 May;64(3):151-9.
Health related quality of life in adult patients with epilepsy compared with a
general reference population in Taiwan.
Liou HH, Chen RC, Chen CC, Chiu MJ, Chang YY, Wang JD.
Department of Neurology and Pharmacology, National Taiwan University Hospital and
National Taiwan University College of Medicine, No. 1, Sec. 1 Jan-Ai Road, Taipei
100, Taiwan ROC. hhliou@ha.mc.ntu.edu.tw
To compare the health-related quality of life (HRQL) for patients with epilepsy
and health subjects, we collected the clinical and demographic data and
information on health states by using the Taiwan version of World Health
Organization quality of life (WHOQOL)-BREF questionnaire in 296 patients (aged
19-73 years) with confirmed active epilepsy visiting the clinic of National
Taiwan University Hospital, and 296 age-, gender-, municipal- and
education-matched Taiwanese healthy subjects sampled from a national health
interview survey. Multiple regression analyses with stepwise selection strategy
were conducted to study risk factors for impairment of HRQL. Patients with
epilepsy have poorer HRQL than the healthy population in physical, psychological
and social domains but not in environment domain (p<0.005). Patients with less
than 4 attacks during the previous 1 month had a better score in the availability
and quality of health and social care in environment domain than healthy subjects
(p<0.05). After controlling other determinants, seizure frequency, and comobid
with other diseases are the important factors in predicting HRQL for epilepsy
patients. Patients with employment and married had a significantly better HRQL.
Effective control of seizure frequency and thoughtful promotion of positive
attitudes in community are essential to improve the HRQL of epilepsy patients.
PMID: 15935621 [PubMed - indexed for MEDLINE]
153. Tob Control. 2005 Jun;14 Suppl 1:i16-22.
Uncovering the relation between betel quid chewing and cigarette smoking in
Taiwan.
Wen CP, Tsai SP, Cheng TY, Chen CJ, Levy DT, Yang HJ, Eriksen MP.
Division of Health Policy Research, National Health Research Institutes, Taipei,
Taiwan. Cwengood@nhri.org.tw
OBJECTIVE: To describe the characteristics of betel quid chewers and to
investigate the behavioural and mortality relations between betel quid chewing
and cigarette smoking. METHOD: Prevalence and mortality risks of betel quid
chewers by smoking status were calculated, based on the National Health Interview
Survey in 2001 and a community based cohort, respectively. Cox's proportional
hazards model was used to adjust mortality risks for age, alcohol use, and
education. RESULTS: Almost all betel quid chewers were smokers, and most started
chewing after smoking. Chewers were predominantly male, mostly in their 30s and
40s, more likely being among the lowest educational or income group, and residing
in the eastern regions of Taiwan. On average, betel quid chewers who smoked
consumed 18 pieces of betel quid a day, and smoked more cigarettes per day. Far
more smokers use betel quid than non-smokers (27.5% v 2.5%), but ex-smokers quit
betel quid more than smokers (15.1% v 6.8%). The significantly increased
mortality of betel quid users who also smoked, for all causes, all cancer, oral
cancer, and cancer of the nasopharynx, lung, and liver, was the result of the
combined effects of chewing and smoking. Smokers who chewed betel quid nearly
tripled their oral cancer risks from a relative risk of 2.1 to 5.9. Increasing
the number of cigarettes smoked among betel quid chewers was associated with a
synergistic effect, reflective of the significant interaction between the two.
CONCLUSION: To a large extent, the serious health consequences suffered by betel
quid chewers were the result of the combined effects of smoking and chewing.
Betel quid chewing should not be considered as an isolated issue, but should be
viewed conjointly with cigarette smoking. Reducing cigarette smoking serves as an
important first step in reducing betel quid chewing, and incorporating betel quid
control into tobacco control may provide a new paradigm to attenuate the
explosive increase in betel quid use in Taiwan.
PMCID: PMC1766184
PMID: 15923442 [PubMed - indexed for MEDLINE]
154. Am J Ind Med. 2005 Jun;47(6):500-8.
Prevalence of asthma by industry in the US population: a study of 2001 NHIS data.
Bang KM, Hnizdo E, Doney B.
Division of Respiratory Disease Studies, National Institute for Occupational
Safety and Health, CDC, Morgantown, West Virginia 26505, USA. KMB2@CDC.GOV
BACKGROUND: The estimated number of US workers potentially exposed to asthmagens
ranges from 8 to 20 million. This study was undertaken to estimate the US
prevalence of asthma in adults by industry of employment and to identify
industries with elevated risk of asthma. METHODS: Prevalence analysis was
performed on 20,991 adults, 18 years of age and older who participated in the
2001 National Health Interview survey. We used SUDAAN software to estimate the
prevalence of self-reported physician diagnosed asthma by industry, and odds
ratios (ORs) for asthma and industry adjusted for age, sex, race, and smoking
status. RESULTS: The overall prevalence of physician diagnosed asthma was 6.5%
(95% CI 6.1-6.9); 4.7% (95% CI 4.1-5.3) for males and 8.5% (95% CI 7.9-9.1) for
females. In whites, the prevalence and ORs were significantly elevated for
printing, publishing, and allied industries (OR = 2.4, 95% CI 1.2-5.0) and health
care (OR = 1.3, 95% CI 1.0-1.7). In blacks, ORs were elevated for furniture,
lumber, and wood (OR = 5.9, 95% CI 1.4-25.4) and entertainment and recreation
industries (OR = 4.1, 95% CI 1.1-15.9). Other industries with elevated ORs
included automobile dealers and gasoline station; durable goods; elementary,
secondary schools, and colleges; other personal services; eating and drinking
places; entertainment and recreation services; and utility and sanitary.
CONCLUSIONS: Industries with elevated prevalence of asthma are identified. This
information helps to target workplaces where detailed investigations for
prevention and control may be appropriate.
PMID: 15898089 [PubMed - indexed for MEDLINE]
155. Vital Health Stat 10. 2005 Apr;(224):1-104.
Summary health statistics for the U.S. population: National Health Interview
Survey, 2003.
Schiller JS, Adams PF, Nelson ZC.
U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, National Center for Health Statistics, Division of Health Interview
Statistics, Hyattsville, MD 20782, USA.
OBJECTIVES: This report presents both age-adjusted and unadjusted health
statistics from the 2003 National Health Interview Survey (NHIS) for the civilian
noninstitutionalized population of the United States, classified by age, sex,
race and Hispanic or Latino origin, family income, poverty status, education,
place of residence, region of residence, and where appropriate, health insurance
coverage. The topics covered are health status and limitations in activities,
special education or early intervention services, injuries and poisonings, health
care access and utilization, and health insurance coverage. SOURCE OF DATA: The
NHIS is a household, multistage probability sample survey conducted annually by
interviewers of the U.S. Census Bureau for the Centers for Disease Control and
Prevention's National Center for Health Statistics. In 2003, household interviews
were completed for 92,148 persons living in 35,921 households, reflecting a
household response rate of 89.2%. SELECTED HIGHLIGHTS: Nearly 7 in 10 persons
were in excellent or very good health in 2003. About 34 million persons (12%)
were limited in their usual activities due to one or more chronic health
conditions, and about 4 million persons (2%) required the help of another person
with activities of daily living. About 6% of children received special education
or early intervention services. Among persons under age 65 years, about 41
million (17%) did not have any health insurance coverage. The most common reason
for lacking health insurance was cost, followed by a change in employment.
PMID: 15884478 [PubMed - indexed for MEDLINE]
156. Prev Med. 2005 Jun;40(6):860-6.
Do parents' perceptions of risks protect children engaged in farm work?
Zentner J, Berg RL, Pickett W, Marlenga B.
National Children's Center for Rural and Agricultural Health and Safety, 1000
North Oak Avenue, Marshfield, WI 54449, USA.
BACKGROUND: The purpose was to describe farm parents' perceptions of risks on
their farms and determine if these perceptions were associated with (1) using of
the North American Guidelines for Children's Agricultural Tasks (NAGCAT) and (2)
making NAGCAT-recommended changes to enhance the safety of farm work for their
children. METHODS: This is a secondary analysis of data collected by telephone
interview during a randomized trial that involved 450 farms in the United States
and Canada. RESULTS: While 81% of farm parents perceived farming to be more
dangerous than other occupations, only 66% of those parents felt that it was more
dangerous for children to work on a farm than at other work. Furthermore, risk
perception scores were only weakly associated with parents' use of NAGCAT and
making NAGCAT-recommended safety changes. CONCLUSION: Even with voluntary safety
guidelines in hand and the general perception of farming as a dangerous
occupation, many farm parents were not actively using NAGCAT to reduce the
exposure of their children to hazardous farm work. Together with the continuing
morbidity and mortality among farm children, this suggests that voluntary
guidelines alone may not be sufficient to protect children working on farms.
PMID: 15850888 [PubMed - indexed for MEDLINE]
157. Alcohol Alcohol. 2005 Jul-Aug;40(4):327-35. Epub 2005 Apr 11.
Epidemiology of heavy alcohol use in Ukraine: findings from the world mental
health survey.
Webb CP, Bromet EJ, Gluzman S, Tintle NL, Schwartz JE, Kostyuchenko S, Havenaar
JM.
Department of Psychiatry, State University of New York at Stony Brook, NY
11794-8790, USA. cwebb@notes.cc.sunysb.edu
AIMS: To describe the epidemiology of heavy alcohol use in Ukraine, using data
from the world mental health (WMH) survey in Ukraine. METHODS: The WMH composite
international diagnostic interview was administered in 2002 to a national
probability sample of Ukrainian adults (n=4725). An algorithm for classifying
heavy use in the past year was developed from self-reports about the quantity and
frequency of drinking, and its convergent validity was demonstrated. Prevalence
rates and socio-demographic risk factors were examined separately for men and
women. RESULTS: The 12-month rates of heavy alcohol use were 38.7% in men and
8.5% in women (22.0% overall). Among heavy alcohol users, 92% of men and 52% of
women consumed at least 80 g of ethanol in a typical drinking day on a monthly
basis in the year before the interview. The most significant risk factors in men
and women were age (26-54 years for men; 18-25 years for women), living in the
Southeast region, being in the labour force whether employed or unemployed, and
for men, low education and being the father of a young child. A highly
significant linear relationship of number of risk factors with heavy alcohol use
was found for both sexes. CONCLUSIONS: The rates for men were similar to those
reported in a Russian national survey with the exception of Southeast Ukraine
where the rate was >10% higher. The highest rates were among men who were
middle-aged, fathers and unemployed. Future prospective studies are needed to
assess the impact of heavy alcohol use on Ukrainian health, mental health and
occupational and social functioning.
PMID: 15824065 [PubMed - indexed for MEDLINE]
158. 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]
159. Ment Health Today. 2005 Mar:22-5.
Tackling the attitude problem. The achievements to date of Scotland's 'see me'
anti-stigma campaign.
Dunion L, Gordon L.
PMID: 15819531 [PubMed - indexed for MEDLINE]
160. Vital Health Stat 10. 2003 Dec;(217):1-82.
Summary health statistics for the U.S. population: National Health Interview
Survey, 2001.
Barnes PM, Adams PF, Schiller JS.
US Department of Health and Human Services, Centers for Disease Control and
Prevention, National Center for Health Statistics, Division of Health Interview
Statistics, Hyattsville, MD 20782, USA.
OBJECTIVES: This report presents health statistics from the 2001 National Health
Interview Survey for the civilian noninstitutionalized population of the United
States, classified by age, sex, race and Hispanic or Latino origin, family
income, poverty status, education, place of residence, region of residence, and,
where appropriate, health insurance coverage. The topics covered are health
status and limitations in activities, special education or early intervention
services, injuries and poisonings, health care access and utilization, and health
insurance coverage. SOURCE OF DATA: The NHIS is a household, multistage
probability sample survey conducted annually by interviewers of the U.S. Census
Bureau for the Centers for Disease Control's National Center for Health
Statistics. Household interviews were completed for 100,760 persons living in
38,932 households, reflecting a household response rate of 89%. SELECTED
HIGHLIGHTS: Nearly 7 in 10 persons were in excellent or very good health in 2001.
About 33 million persons (12%) were limited in their usual activities due to one
or more chronic health conditions, and about 4 million persons (2%) required the
help of another person with activities of daily living. Persons with the least
education and the lowest incomes were the most likely to be limited in their
ability to work. About 6% of children received special education or early
intervention services. The three leading causes of medically attended injury and
poisoning episodes were falls, transportation, and overexertion. Among persons
under age 65 years, about 39 million (16%) did not have any health insurance
coverage. The most common reason for lacking health insurance was cost, followed
by a change in employment.
PMID: 15791895 [PubMed - indexed for MEDLINE]
161. Vital Health Stat 10. 2004 May;(220):1-101.
Summary health statistics for the U.S. population: National Health Interview
Survey, 2002.
Schiller JS, Bernadel L.
U.S. Department of Health and Human Services, Centers for Disease Control and
Prevention, National Center of Health Statistics, Division of Health Interview
Statistics, Hyattsville, MD 20782, USA.
OBJECTIVES: This report presents both age-adjusted and unadjusted health
statistics from the 2002 National Health Interview Survey (NHIS) for the civilian
noninstitutionalized population of the United States, classified by age, sex,
race and Hispanic or Latino origin, family income, poverty status, education,
place of residence, region of residence, and, where appropriate, health insurance
coverage. The topics covered are health status and limitations in activities,
special education or early intervention services, injuries and poisonings, health
care access and utilization, and health insurance coverage. SOURCE OF DATA: The
NHIS is a household, multistage probability sample survey conducted annually by
interviewers of the U.S. Census Bureau for the Centers for Disease Control and
Prevention's National Center for Health Statistics. In 2002, household interviews
were completed for 93,386 persons living in 36,161 households, reflecting a
household response rate of 89.6%. SELECTED HIGHLIGHTS: Nearly 7 in 10 persons
were in excellent or very good health in 2002. About 34 million persons (12%)
were limited in their usual activities due to one or more chronic health
conditions, and about 4 million persons (2%) required the help of another person
with activities of daily living. About 6% of children received special education
or early intervention services. Among persons under age 65 years, about 40
million (17%) did not have any health insurance coverage. The most common reason
for lacking health insurance was cost, followed by a change in employment.
PMID: 15791772 [PubMed - indexed for MEDLINE]
162. 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]
163. Am J Public Health. 2005 Mar;95(3):453-7.
Moderate alcohol use and depression in young adults: findings from a national
longitudinal study.
Paschall MJ, Freisthler B, Lipton RI.
Prevention Research Center, Pacific Institute for Research and Evaluation, 1995
University Ave, Suite 450, Berkeley, CA 94704, USA. paschall@pire.org
OBJECTIVES: We examined the association between moderate alcohol use and
depressive mood among young adults before and after adjustment for demographic,
health, and socioeconomic factors that may act as confounders. METHODS: We
analyzed 2 waves of interview data collected from 13892 young adults who
participated in the National Longitudinal Study of Adolescent Health to compare
frequency of depressive symptoms in moderate drinkers with frequency of symptoms
in young adults in other alcohol use categories. RESULTS: With adjustment for
health and socioeconomic factors, frequency of depressive symptoms were similar
among moderate drinkers, lifetime and long-term abstainers, and heavy/heavier
moderate drinkers but remained significantly higher among heavy drinkers.
CONCLUSIONS: Moderate alcohol use may have no effect on depression in young
adults relative to abstinence from alcohol use.
PMCID: PMC1449201
PMID: 15727976 [PubMed - indexed for MEDLINE]
164. Work. 2005;24(1):71-6.
The impact of function on work status for community dwelling disabled persons
with arthritis: an analysis of the National Health Interview Survey Disability
Supplement.
Milidonis MK, Greene BL.
Cleveland State University, Department of Health Sciences, Cleveland, OH, USA.
m.milidonis@csuohio.edu
Arthritis is one of the most common diseases and a leading cause of disability in
adults. Returning injured workers to work and preventing work disability is the
primary mission of occupational health professionals. The purpose of this study
was to identify risk factors associated with work disability and intervention
strategies. This study is a retrospective cohort analysis of secondary individual
level data. The data for the study were collected by the National Health
Interview Survey, Disability Supplement (NHIS-D) 1995. Community dwelling
disabled persons with functional limitations due to arthritic conditions were
included in this analysis. A total of 286 records were available for logistic
regression analysis. The outcome variable was work status, either working or not
working. The significant predictors of working status were ability to lift 10
pounds (OR = 1.64), college education (OR = 0.21), age (OR = 1.03), and less than
high school education (OR = 2.48). Thirty-four percent of the variance in working
status was explained by the model that also included health status, difficulty
standing, difficulty walking up steps, difficulty walking 1/4 mile, ethnicity,
and gender. Younger disabled persons with arthritis, who have little difficulty
lifting 10 pounds, and have some college education have better odds of working.
Occupational health professionals need to look for ways to improve the
educational status and functional lifting ability of disabled individuals with
arthritis.
PMID: 15706074 [PubMed - indexed for MEDLINE]
165. 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]
166. Cancer Nurs. 2004 Sep-Oct;27(5):353-63.
Characteristics of participation in cervical cancer screening.
Lockwood-Rayermann S.
Texas Christian University-Harris School of Nursing, Fort Worth, TX 76129, USA.
s.lockwood@tcu.edu
Although Papanicolaou test screening rates are reportedly high, a significant
proportion of women remain unscreened. With recent revision of Papanicolaou test
guidelines, it is critical that interventions and programs for cervical cancer
directed toward low participating groups or individuals be developed. The purpose
of the study was to examine factors that influence participation in cervical
cancer screening by quantifying characteristics of women who engage in
Papanicolaou test screening in a 12-month period. Using the 2000 National Health
Interview Survey and Cancer Topical Module, the sample (N = 18,388) consisted of
women who were older than 18 years. The dependent variable was nominally
identified as whether a woman had had a Papanicolaou test in the last 12 months.
Independent variables examined were insurance, level of education, place for
care, age, race, employment, place of residence, and income level. Using logistic
regression, all variables except race and income level were found to be
significant for participation in cervical cancer screening (P < .000). Each
variable is discussed within the framework of the Institute of Medicine model of
access to personal healthcare services. Study findings provide insight and
guidance for the development and implementation of methods for accessing women
who have lower participation rates.
PMID: 15525862 [PubMed - indexed for MEDLINE]
167. Matern Child Health J. 2004 Sep;8(3):171-82.
How children with special health care needs affect the employment decisions of
low-income parents.
Loprest P, Davidoff A.
The Urban Institute, Washington, District of Columbia 20036, USA.
ploprest@ui.urban.org
OBJECTIVES: To better understand the impact of having a child with special health
care needs (CSHCN), on low-income parents' employment decisions. METHODS: Using
data from the 1999 and 2000 National Health Interview Survey (NHIS), we estimate
multivariate statistical regressions (logit and tobit models) to estimate the
relationship between having a CSHCN and the likelihood of employment and hours of
employment for a sample-of low-income single parents. RESULTS: Controlling for
differences in demographic and family characteristics, we find no significant
association between having a CSHCN and the probability of work or the number of
hours worked among low-income single-parent families. Separate analysis of
different dimensions of special health care needs shows that parents of children
with activity limitations are significantly less likely to work and work fewer
hours. This result does not hold true for the group of children defined based on
elevated or special service use, or for the group of children with specific
chronic conditions. CONCLUSIONS: These results indicate that only a specific
subset of children with special needs present difficulties for low-income
parents' work. This suggests that policies to help low-income single parents of
children with disabilities move into work should target this specific subset of
children with special health care needs.
PMID: 15499873 [PubMed - indexed for MEDLINE]
168. AAOHN J. 2004 Sep;52(9):373-82.
Sleep deprivation and injuries in part-time Kentucky farmers: impact of self
reported sleep habits and sleep problems on injury risk.
Spengler SE, Browning SR, Reed DB.
College of Public Health, University of Kentucky, Lexington, KY, USA.
Part-time farmers who hold off-farm jobs may be at risk for injuries because of
impaired performance resulting from inadequate sleep. For this study, 1004
part-time male Kentucky farmers completed a telephone interview for the 1994 to
1995 National Institute for Occupational Safety and Health-funded Farm Family
Health and Hazard Surveillance Project. Questions were included about
demographics, sleep habits, and injury occurrence. Twelve percent of the farmers
reported an injury requiring medical intervention in the previous year. Farmers
reported sleeping an average of 7.6 hours daily. Approximately 6.7% of the sample
had three symptoms of sleep apnea. Although hours of sleep were not related to
injury incidence, sleep medication use (odds ratio [OR] = 2.11, 95% confidence
interval [CI] = 1.01 to 4.40) and presence of three sleep apnea symptoms (OR =
2.48, 95% CI = 1.13 to 5.41) were related to injury incidence. These data support
the need for further research to examine sleep habits and promote strategies that
reduce the risk for injuries caused by lack of sleep.
PMID: 15469135 [PubMed - indexed for MEDLINE]
169. 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]
170. J Healthc Qual. 2004 Sep-Oct;26(5):18-21, 28.
Suzanne F. Delbanco on the Leapfrog Group and employer purchasing power.
Interview by Pamela K. Scarrow.
Delbanco SF.
Leapfrog Group, USA.
Suzanne F. Delbanco, PhD MPH, is the first executive director of The Leapfrog
Group, founded by the Business Roundtable. The Leapfrog Group's goal is to
mobilize employer purchasing power to initiate breakthrough improvements in the
safety, quality, and overall value of healthcare for American consumers. The
group's growing consortium of more than 155 Fortune 500 companies and other large
private and public healthcare purchasers provides health benefits to more than 34
million Americans; these companies spend more than 62 billion dollars on
healthcare annually. Dr. Delbanco is a member of the National Committee for
Quality Assurance Purchaser Advisory Council and a board member of Bridges to
Excellence. Before joining The Leapfrog Group, she was a senior manager at the
Pacific Business Group on Health (PBGH), where she worked on the quality team.
Prior to joining PBGH, she worked on reproductive health policy and the changing
healthcare marketplace initiative at the Henry J. Kaiser Family Foundation. She
has also consulted on health insurance coverage in the temporary employment
industry and on the first statewide survey in California of MediCal
beneficiaries, and worked as a community Liaison for Kaiser Permanente during the
establishment of one of California's first County Organized Health Systems. She
holds a PhD in public policy from the Goldman School of Public PoLicy and a MPH
from the School of Public Health at the University of California, Berkeley.
PMID: 15468651 [PubMed - indexed for MEDLINE]
171. J Rheumatol. 2004 Oct;31(10):1928-33.
Occupational risk factors for the development of systemic lupus erythematosus.
Cooper GS, Parks CG, Treadwell EL, St Clair EW, Gilkeson GS, Dooley MA.
Epidemiology Branch, National Institute of Environmental Health Sciences, Durham,
North Carolina 27709, USA. copper1@niehs.nih.gov
OBJECTIVE: There have been few studies of occupational exposures and systemic
lupus erythematosus (SLE). We examined the association between the risk of SLE
and occupational exposures (mercury, solvents, and pesticides), specific jobs
(ever worked in teaching, healthcare, and cosmetology), and working night or
rotating shifts. METHODS: Patients with recently diagnosed SLE (n = 265) were
recruited through 4 university based and 30 community based rheumatology
practices in North Carolina and South Carolina, USA. Controls (n = 355) were
identified through driver's license records and were frequency matched to
patients by age, sex, and state. Data collection included an in-person interview
with detailed farming and work histories. RESULTS: Associations were seen with
self-reported occupational exposure to mercury (OR 3.6, 95% CI 1.3, 10.0), mixing
pesticides for agricultural work (OR 7.4, 95% CI 1.4, 40.0), and among dental
workers (OR 7.1, 95% CI 2.2, 23.4). Although these associations were fairly
strong and statistically significant, the prevalence of these exposures was very
low and thus these estimates are based on a small number of exposed cases and
controls. Weaker associations were seen between SLE and shift work (OR 1.6, 95%
CI 0.99, 2.7) and among healthcare workers with patient contact (OR 1.7, 95% CI
0.99, 2.9). There was no association of SLE with use of solvents or among
teachers or cosmetologists. CONCLUSION: This study reveals the potential
contribution of occupational exposures to the development of SLE, and highlights
some exposures and experiences that should be examined in other studies using
more extensive exposure assessment techniques and in experimental studies of
autoimmunity.
PMID: 15468355 [PubMed - indexed for MEDLINE]
172. Med J Aust. 2004 Oct 4;181(7 Suppl):S52-6.
A National Depression Index for Australia.
Mackinnon A, Jorm AF, Hickie IB.
Mental Health Research Institute of Victoria, Department of Psychological
Medicine, Monash University, Locked Bag 11, Parkville, VIC 3052, Australia.
ajm@mhri.edu.au.
OBJECTIVE: To develop a National Depression Index for measuring the depression
status of the Australian population. DESIGN: Cross-sectional data were analysed
from two random samples of the Australian adult population - the National Survey
of Mental Health and Wellbeing (2000) and the National Health Survey (2001).
PARTICIPANTS: The National Survey of Mental Health and Wellbeing (2000) - 10 641
participants; and the National Health Survey (2001) - 17 918 participants. MAIN
OUTCOME MEASURES: Selected items from the Kessler Psychological Distress Scale
(K10); and diagnoses of a major depressive episode according to DSM-IV criteria
using a computerised interview. RESULTS: Six items from the K10 that were most
closely related to the DSM-IV diagnosis of "major depressive episode" were
identified. Scores on an index calculated from these items were rescaled to form
an index reflecting relative risk of depression and having a value of 100 for the
Australian adult population. Taking into account sex, employment status and
income, index values were higher in younger people, females, unemployed people
and those socioeconomically disadvantaged. This pattern provides additional
support for the validity of the index, as well as establishing benchmark levels
to which index values from future surveys and in other groups may be compared.
CONCLUSIONS: The proposed National Depression Index is a valid indicator of
depression and level of depressive symptoms. It is suitable for monitoring
depression at the population level. The scaling characteristics of the measure
ensure that it can be interpreted by members of the general public.
PMID: 15462643 [PubMed - indexed for MEDLINE]
173. Aviat Space Environ Med. 2004 Sep;75(9):806-10.
Self-reported flight hours vs. company records for epidemiologic studies of
flight attendants.
Grajewski B, Atkins DJ, Whelan EA.
National Institute for Occupational Safety and Health, 4676 Columbia Parkway,
Cincinnati, OH 45226, USA. bag2@cdc.gov
INTRODUCTION: Although there is increased interest in health effects studies of
aircrew members, the differences between self-reported work history and company
records, including effects on exposure assessment, are poorly characterized.
METHODS: We collected both self-reported work history and company records as part
of a National Institute for Occupational Safety and Health biomonitoring study of
reproductive hormones in 45 female flight attendants. These two sources of work
history information were compared to identify differences which might impact the
assessment of work exposures. RESULTS: There appeared to be consistent
overreporting of self-reported block time and number of flight segments compared
with company record-based estimates. Overreporting in turn inflated the
assessment of two important exposures: cosmic ionizing radiation estimated dose
and time zones crossed. Factors including domicile, block hours per year of work,
and length of employment affected the amount and direction of overreporting.
Comparison to compensated credit hours, including nonflight hours, did not fully
account for the overreporting. DISCUSSION: Self-report of block time may or may
not include compensated nonflight hours, resulting in differences when compared
to company records. Exposure bias is likely to result if the complexities of
self-report are not considered when writing questionnaires. Aircrew members
should be asked for additional occupational information, and a comparison of
self-report block time to a sample of company records should be considered prior
to exposure assessment and epidemiologic analysis.
PMID: 15460634 [PubMed - indexed for MEDLINE]
174. Pediatrics. 2004 Aug;114(2):e182-91.
The health of primary caregivers of children with cerebral palsy: how does it
compare with that of other Canadian caregivers?
Brehaut JC, Kohen DE, Raina P, Walter SD, Russell DJ, Swinton M, O'Donnell M,
Rosenbaum P.
Clinical Epidemiology Unit, Ottawa Health Research Institute, Ottawa Hospital,
Ottawa, Ontario, Canada. jbrehaut@ohri.ca
BACKGROUND: Caring for any child involves considerable resources, but the demands
for these resources are often increased when caring for a child with a
disability. These demands have implications for the psychologic and physical
health of the caregiver (CG). Although a number of recent trends in health care
stress the importance of studying and promoting the health of CGs of children
with disabilities, the literature in this area exhibits 2 major weaknesses, ie,
most studies draw conclusions from relatively small, potentially biased,
clinic-based samples and the majority of work has focused on the psychologic
health of CGs, whereas little research has been undertaken to study their
physical well-being. The goal of this study was to compare the physical and
psychologic health of CGs of children with cerebral palsy (CP) with that of the
general population of CGs. METHODS: Data on the physical and psychologic health
of 468 primary CGs of children with CP, drawn from 18 of 19 publicly funded
children's rehabilitation centers in Ontario, Canada, were collected with a
self-completed questionnaire and a face-to-face interview. Identical items and
scales had been administered previously to nationally representative samples of
the Canadian population in 2 large-scale Canadian surveys, ie, the National
Population Health Survey (NPHS) and the National Longitudinal Study of Children
and Youth (NLSCY). Subsamples of those data, restricted to adult residents of the
province of Ontario who were parents, allowed a comparison of our sample of CGs
of children with CP with parent samples from both the NLSCY (n = 2414) and the
NPHS (n = 5549). OUTCOME MEASURES: Demographic variables included CG age, gender,
education, income, and work-related variables. Psychologic health and support
variables included social support, family functioning, frequency of contacts,
distress, and emotional and cognitive problems. Physical health variables
included the number and variety of chronic conditions, vision, hearing, and
mobility problems, and experience of pain. RESULTS: CGs of children with CP had
lower incomes than did the general population of CGs (proportion with income over
60,000 dollars: CG: 40.9%; NLSCY: 51.4%), despite the absence of any important
differences in education between the 2 samples. Results showed that CGs of
children with CP were less likely to report working for pay (CG: 66%; NLSCY:
81.2%), less likely to be engaged in full-time work (CG: 67.5%; NLSCY: 73.2%),
and more likely to list caring for their families as their main activity (CG:
37.2%; NLSCY: 28.4%). Measures of support showed no difference in reported social
support (CG: mean score: 14.5; SD: 3.4; NLSCY: mean score: 14.3; SD: 2.7) or
family functioning (CG: mean score: 8.6; SD: 5.6; NLSCY: mean score: 9.0; SD:
4.9) between the 2 samples, although the CG sample did report a statistically
greater number of support contacts (CG: mean score: 4.5; SD: 0.7; NPHS: mean
score: 4.2; SD: 0.9). Measures of psychologic health showed greater reported
distress (CG: mean score: 4.7; SD: 4.4; NPHS: mean score: 2.2; SD: 2.7),
chronicity of distress (CG: mean score: 5.5; SD: 1.4; NPHS: mean score: 5.2; SD:
1.1), emotional problems (CG: 25.3% indicating problems; NPHS: 13.7%), and
cognitive problems (CG: 38.8%; NPHS: 14.3%) among CGs of children with CP. They
also reported a greater likelihood of a variety of physical problems, including
back problems (CG: 35.5% reporting the condition; SE: 2.2%; NLSCY: 12.2%; SE:
0.7%), migraine headaches (CG: 24.2%; SE: 2.0%; NLSCY: 11.2%; SE: 0.7%),
stomach/intestinal ulcers (CG: 8.4%; SE: 1.3%; NLSCY: 1.7%; SE: 0.3%), asthma
(CG: 15.8%; SE: 1.7%; NLSCY: 6.3%; SE: 0.5%), arthritis/rheumatism (CG: 17.3%;
SE: 1.8%; NLSCY: 7.3%; SE: 0.5%), and experience of pain (CG: 28.8%; SE: 2.1%;
NPHS: 11.0%; SE: 0.5), as well as a greater overall number of chronic physical
conditions (CG: 24.1% reporting no chronic conditions; NLSCY: 55.2%).
CONCLUSIONS: Although many families cope well despite the added challenges of
caring for a child with a disability, our findings suggest that the demands of
their children's disabilities can explain differences in the health status of
parents and that parents of children with CP are more likely to have a variety of
physical and psychologic health problems. Many of these findings are consistent
with a stress process model, in which stress from caregiving can directly or
indirectly affect a variety of measures of health, although some of the findings
(asthma and arthritis) seem to strain this hypothesis. Alternate interpretations
of these findings include the possibility that parents who are in regular contact
with the health care system may have more opportunities to discuss and receive
attention for their own health concerns than do comparison adults or that the
greater number of health issues reported by CGs is related to the nature of our
study, perhaps leading these parents to focus on their health and well-being in
more depth than is usually feasible in a population survey. CGs of children with
CP also had lower incomes, despite the absence of any important differences in
education. The findings are consistent with the idea that the financial burden of
caring for a child with a disability results in part from a reduced availability
of these parents to work for pay. IMPLICATIONS FOR SERVICE PROVIDERS: Physicians
and other health care professionals should be aware of the important relationship
between child disability and CG health. Family-centered policies and services
that explicitly consider CG health are likely to benefit the well-being of both
CGs and their families. Future work should address the extent to which the
family-centeredness of services, as experienced by CGs, is associated with better
health outcomes for parents and their families.
PMID: 15286255 [PubMed - indexed for MEDLINE]
175. Health Soc Care Community. 2004 Jul;12(4):318-26.
Is client-centred care planning for chronic disease sustainable? Experience from
rural South Australia.
Fuller J, Harvey P, Misan G.
Department of Public Health, University of Adelaide, Adelaide, South Australia.
jeffrey.fuller@adelaide.edu.au
This qualitative evaluation of a chronic disease self-management project in rural
South Australia considers the sustainability of client-centred care planning
under current organisational and funding arrangements. The study involved
consultation with a range of five stakeholder types over two stages (40 in the
beginning stage and 39 in the middle stage) about their satisfaction with the
care planning and self-management approach used in the project. All stakeholder
types valued the client-centred approach because they perceived that clients were
better able to accept and deal with the long-term management of their condition.
However, this required that care planning should deal with a wider range of
issues than just medical management, and so it took longer, which raised its
sustainability in general practice under the current funding through the national
health insurance programme (Medicare). The study concludes that sustainability
may be addressed through further research into the role of and funding for
peer-led self-management groups and the employment of care planners in
organisational settings that are conducive to a client-centred approach.
PMID: 15272887 [PubMed - indexed for MEDLINE]
176. Am J Public Health. 2004 Jul;94(7):1165-73.
Efficacy of a woman-focused intervention to reduce HIV risk and increase
self-sufficiency among African American crack abusers.
Wechsberg WM, Lam WK, Zule WA, Bobashev G.
RTI International, Research Triangle Park, NC 27709-2194, USA. wmw@rti.org
OBJECTIVES: This study compares 3- and 6-month outcomes of a woman-focused HIV
intervention for crack abusers, a revised National Institute on Drug Abuse
standard intervention, and a control group. METHODS: Out-of-drug-treatment
African American women (n = 620) who use crack participated in a randomized field
experiment. Risk behavior, employment, and housing status were assessed with
linear and logistic regression. RESULTS: All groups significantly reduced crack
use and high-risk sex at each follow-up, but only woman-focused intervention
participants consistently improved employment and housing status. Compared with
control subjects at 6 months, woman-focused intervention participants were least
likely to engage in unprotected sex; revised standard intervention women reported
greatest reductions in crack use. CONCLUSIONS: A woman-focused intervention can
successfully reduce risk and facilitate employment and housing and may
effectively reduce the frequency of unprotected sex in the longer term.
PMCID: PMC1448416
PMID: 15226138 [PubMed - indexed for MEDLINE]
177. J Stud Alcohol. 2004 May;65(3):345-52.
Gender composition of occupation and industry and working women's alcohol
consumption.
Cho YI.
Survey Research Laboratory (M/C 336), University of Illinois at Chicago, 412
South Peoria Street, Chicago, Illinois 60607, USA. youngcho@uic.edu
OBJECTIVE: This article examines the impact of the gender compositions of
occupation and industry on women workers' consumption of alcoholic beverages.
METHOD: A sample of 11,783 currently working women, aged 21 to 65, was obtained
from the 1990 National Health Interview Survey (NHIS). The gender compositions of
three-digit occupational and industrial categories were calculated based on a 1%
sample of the 1990 census and attached to the NHIS sample. A set of regression
analyses tests the relationship between gender composition of occupation or
industry and drinking behavior, such as the likelihood of being a drinker and the
level of alcohol consumption among the drinkers, and reported levels of stress.
RESULTS: When the demographic background variables are controlled for, the
percentage of men within each occupational classification is positively
correlated with stress levels. Curvilinear relationships were found between
percentage of men in both industry and occupation and the likelihood of drinking
in the past year. CONCLUSIONS: These findings suggest that the women working in
gender-balanced rather than gender-typed, jobs were more likely to drink due to
increased interaction between genders. The results also suggest that male
dominance of an occupation may be a source of stress, which may increase alcohol
consumption among women workers.
PMID: 15222591 [PubMed - indexed for MEDLINE]
178. Scand J Public Health. 2004;32(3):164-71.
Work environment and smoking cessation over a five-year period.
Albertsen K, Hannerz H, Borg V, Burr H.
Department of Psychology and Sociology, National Institute of Occupational
Health, Copenhagen, Denmark. ka@ami.dk
AIMS: The authors set out to estimate effects of occupational factors on smoking
cessation among Danish employees. METHODS: Data from 3,606 observations of
smokers gathered from the Danish National Work Environment Cohort Study in 1990,
1995, and 2000 were analysed by logistic regression. The model comprised
background variables, smoking variables, and measures of psychosocial and other
aspects of the work environment. RESULTS: Statistically significant odds ratios
(OR) for cessation were found for medium versus no exposure to noise (OR 0.71,
95% CI 0.54-0.93), for high versus low physical workload (OR 0.49, 95% CI
0.47-0.73), for high versus low psychological demands (OR 1.42, 95% CI
1.12-1.80), and for medium versus low levels of responsibility at work (OR 1.31,
95% CI 1.03-1.65). CONCLUSION: The probability of smoking cessation differs
between people with different exposures to certain work environmental factors.
PMID: 15204176 [PubMed - indexed for MEDLINE]
179. Ind Health. 2004 Apr;42(2):240-5.
An accident-risk assessment study of temporary piece rated workers.
Saha A, Ramnath T, Chaudhuri RN, Saiyed HN.
Occupational Medicine Division, National Institute of Occupational Health,
Meghani Nagar, Ahmedabad-380 016, Gujarat, India.
An occupational injury surveillance study (record study of five years duration)
was conducted involving the workers of a fertilizer producing industry in eastern
India to assess whether the risk of occupational accidents in temporary piece
rated workers was higher in comparison to the permanent time rated workers. At
the same time, to collect the personal details of the workers who have worked in
the industry in the study period, an interview was also conducted. Mean age of
temporary piece rated workers and permanent time rated workers were (35.9 +/-
12.5) and (35.3 +/- 11.4) respectively. Distribution of other variables like
nature of work, level of education, experience, habits were also very similar
between the two worker groups. Accident incidence rate, accident frequency rate
and accident severity rate were found to be significantly higher in temporary
piece rated workers. This difference was more prominent in case of time-loss
accidents than in no time-loss accidents. Relative risk has varied from 2.3 to
18.0 in case of time-loss accidents. In case of no time-loss accidents, it has
varied from 1.1 to 2.6. When relative risk is considered after taking both types
of accidents together, it has ranged from 1.2 to 3.5. This study concluded that
the temporary piece rated workers are more vulnerable to occupational accidents.
PMID: 15128175 [PubMed - indexed for MEDLINE]
180. Ambul Pediatr. 2004 Mar-Apr;4(2):181-7.
Parent's language of interview and access to care for children with special
health care needs.
Yu SM, Nyman RM, Kogan MD, Huang ZJ, Schwalberg RH.
Maternal and Child Health Bureau, Rockville, MD 20857, USA. syu@hrsa.gov
OBJECTIVE: To examine the association between the parent's language of interview
and the access to care for children with special health care needs (CSHCN).
METHODS: We used the 2001 National Survey of Children with Special Health Care
Needs to compare socio-demographic characteristics and health care access
variables among CSHCN with parents who interviewed in English and another
language. Additional multivariate analyses explored the effect of language of
interview on access to health care for the subgroup of Hispanic respondents.
RESULTS: CSHCN with non-English-speaking parents were from less-educated and
lower-income families and were more likely to lack insurance and have conditions
that greatly affected their activities. These children were also more likely to
have inadequate insurance (odds ratio [OR]=11.29), have an unmet need for family
support services (OR=1.88), lack a personal doctor or nurse (OR=1.98), lack a
usual source of care (OR=1.89), and lack family-centered care (OR=1.74).
Non-English-speaking parents were more likely to report having employment
consequences (OR=1.94) and spending over $500 out-of-pocket annually on the
child's health care needs (OR=1.49). The likelihood of Hispanic children
experiencing health care access barriers compared with non-Hispanic children was
reduced when language was controlled for and several disparities between Hispanic
children and other children became insignificant. CONCLUSIONS: CSHCN with
non-English-speaking parents were more likely to be from disadvantaged families
and to experience barriers to access than were CSHCN with English-speaking
parents. Systems of care for CSHCN should consider the needs and challenges
experienced by families whose primary language is not English.
PMID: 15018600 [PubMed - indexed for MEDLINE]
181. Am J Health Promot. 2004 Mar-Apr;18(4):312-5.
Increasing stair use in a worksite through environmental changes.
Kerr NA, Yore MM, Ham SA, Dietz WH.
Centers for Disease Control and Prevention, Division of Nutrition and Physical
Activity, Atlanta, Georgia 30341, USA.
PURPOSE: This study assessed the impact on stair use of four sequential
environmental interventions: (1) installing new carpet and painting the walls,
(2) adding framed art-work on stair landings, (3) displaying motivational signs
throughout the building, and (4) adding a stereo system and playing various types
of music in the stairwell. METHODS: We conducted a longitudinal study with no
comparison group to evaluate the impact of environmental changes on stairway use.
The setting was the main stairwell in the Centers for Disease Control and
Prevention's (CDC) Rhodes Building in Atlanta, Georgia. Proximity sensors were
installed in each stairwell entry to monitor traffic. The subjects were 554
permanent CDC employees and 110 temporary employees. Changes in stairwell use by
intervention were evaluated. RESULTS: Both motivational signs and music
significantly increased stair use by 8.9% over baseline (p < .05). The increase
in sign use occurred in the first 3 months of the intervention, whereas the
increase in music occurred after the first 3 months. DISCUSSION: These data
suggest that physical improvements to a stairwell, signage that encourages stair
use, and music may increase physical activity among building occupants.
PMID: 15011931 [PubMed - indexed for MEDLINE]
182. Pediatrics. 2004 Feb;113(2):291-7.
Gender and uninsurance among young adults in the United States.
Callahan ST, Cooper WO.
Division of Adolescent Medicine and Behavioral Science, Vanderbilt University
Medical Center, Nashville, Tennessee 37212-3100, USA.
todd.callahan@vanderbilt.edu
OBJECTIVE: Although one third of young adults in the United States are uninsured,
lack of insurance in this age group has been the subject of few published
studies. Because opportunities to obtain public and private insurance are likely
to differ for men and women, the objective of this study was to describe the
gender-specific relationship of sociodemographic variables and lack of insurance
among young adults. METHODS: We examined data for 6884 young adults (aged 19-24
years) who completed the Sample Adult Questionnaire of the National Health
Interview Survey for 1998, 1999, and 2000. Gender-stratified multiple logistic
regression was used to estimate the odds of being uninsured associated with
race/ethnicity, household income, major activity in the previous week, marital
status, and pregnancy (women). RESULTS: Overall, 32% of male participants and 27%
of female participants reported being uninsured at the time of the survey.
Uninsured men outnumbered insured men in several sociodemographic categories,
including Hispanic men (58% uninsured), men not attending high school (85%), and
men employed in a workplace that did not offer health insurance (51%). High rates
of uninsurance were reported by women not attending high school (65%), Hispanic
women (46%), those who were keeping house (41%), and women with a household
income between 10 000 dollars and 20 000 dollars (41%). In multiple logistic
regression models, many of the sociodemographic variables studied were similarly
correlated with health insurance for both men and women. Employment in a
workplace where the young adult was not offered health insurance coverage, low
household income, low educational attainment, and Hispanic ethnicity were
associated with increased odds of being uninsured for both genders. Having
attended college, higher household income, and being a student or employed in a
workplace that offers health insurance coverage were associated with lower odds
of being uninsured for both genders. CONCLUSION: This study suggests that
additional opportunities for health insurance coverage are needed for young
adults-particularly men, Hispanics, and those in low- and middle-income
households. Increasing the availability of employment-based health insurance,
discouraging attrition from primary and secondary education, and the creation of
insurance opportunities for minorities and near-poor and middle-income households
are potentially important target areas for programs that seek to reduce the
number of uninsured young adults.
PMID: 14754940 [PubMed - indexed for MEDLINE]
183. Pediatr Blood Cancer. 2004 Mar;42(3):230-40.
Self-concept in adult survivors of childhood acute lymphoblastic leukemia: a
cooperative Children's Cancer Group and National Institutes of Health study.
Seitzman RL, Glover DA, Meadows AT, Mills JL, Nicholson HS, Robison LL, Byrne J,
Zeltzer LK.
Department of Pediatrics, University of California at Los Angeles, California,
USA. seitzman@ucla.edu
BACKGROUND: Self-concept was compared between adult survivors of childhood acute
lymphoblastic leukemia (ALL) and sibling controls. Adult survivor subgroups at
greatest risk for negative self-concept were identified. PROCEDURE: Survivors (n
= 578) aged > or =18 years, treated before age 20 years on Children's Cancer
Group (CCG) ALL protocols, and 396 sibling controls completed a telephone
interview and the Harter Adult Self-Perception Profile (ASPP). RESULTS: Survivors
global self-worth scores were significantly lower than sibling controls (mean
3.09 vs. 3.18; P = 0.022). Unemployed survivors reported lower global self-worth
scores than employed (mean 2.77 vs. 3.12; P = 0.0001), whereas employment status
was not associated with self-worth in controls. Among survivors, predictors of
negative self-concept included unemployment (odds ratio (OR) = 2.87; 95% CI:
1.50-5.50), and believing that cancer treatment limited employability (OR = 3.17;
95% CI: 1.79-5.62). Unemployment increased the odds for negative self-concept
among survivors who received combinations of central nervous system (CNS)
irradiation (CRT) and intrathecal methotrexate (IT-MTX), except high CRT with no
or low dose IT-MTX. Employed survivors who perceived that treatment limited their
employability showed increased odds of negative self-concept for all treatment
groups compared to those who did not. Minority ethnic group membership was a
borderline significant predictor of negative self-concept (OR = 1.79; 95% CI:
0.94-3.33). CONCLUSIONS: Global self-worth was significantly lower in ALL
survivors than sibling controls, however, 81% of survivors had positive
self-concept. Survivor subgroups most vulnerable to negative self-concept were
the unemployed survivors, believing that cancer treatment affected employability,
and ethnic minority group members. Targeted intervention may have greater
clinical relevance for these subgroups. Copyright 2003 Wiley-Liss, Inc.
PMID: 14752860 [PubMed - indexed for MEDLINE]
184. Salud Publica Mex. 2003;45 Suppl 4:S477-89.
Breast-feeding practices in Mexico: results from the Second National Nutrition
Survey 1999.
González-Cossío T, Moreno-Macías H, Rivera JA, Villalpando S, Shamah-Levy T,
Monterrubio EA, Hernández-Garduño A.
Instituto Nacional de Salud Pública, Centro de Investigaciones en Nutrición y
Salud, Cuernavaca, Morelos, México. tgonzale@insp.mx
OBJECTIVE: To assess breast-feeding (BF) practices and determinants of exclusive
BF (EBF) < 4 and < 6 months (mo) among women and infants < 23 mo in the NNS-1999.
MATERIAL AND METHODS: BF practices from the day and night before the interview
were ascertained, and median duration estimated. Determinants of EBF < 4 and < 6
mo were analysed by logistic regression models for complex surveys. RESULTS:
Prevalence of EBF < 4 mo was 25.7%, and of < 6 mo 20.3%. The overall rate of
continued BF (second year) was 30.9%, median duration of BF 9 mo, and the
national proportion of children ever breast-fed 92.3%. The probability (p) of EBF
< 4 mo was determined by infant age and sex, by maternal socio-economic level
(SEL) and ethnicity, and by the interaction between infant sex and SEL. The pEBF
< 6 mo was determined by infant age and length, by maternal ethnicity, and
employment. CONCLUSIONS: EBF rates and duration are low in Mexico and have
improved only slightly in the last 20 y. Infant and maternal characteristics
determine the pEBF. If improvements in infant health are a national priority,
aggressive interventions to promote and protect BF are urgently needed in Mexico,
as well as formal evaluation of current initiatives. The English version of this
paper is available too at: http://www.insp.mx/salud/index.html.
PMID: 14746042 [PubMed - indexed for MEDLINE]
185. J Health Organ Manag. 2003;17(6):438-56.
Downsizing in the public sector: Metro-Toronto's hospitals.
Flint DH.
Faculty of Administration, University of New Brunswick, Fredericton, Canada.
This study has two objectives. First, to predict the outcomes of a public sector
downsizing; second to measure effects of downsizing at organizational and
inter-organizational levels. Primary data to assess the organizational level
effects was collected through interviews with senior executives at two of
Metro-Toronto's hospitals. Secondary data, to assess the inter-organizational
effects, was collected from government documents and media reports. Due to the
exploratory nature of the study's objectives a case study method was employed.
Most institutional downsizing practices aligned with successful outcomes.
Procedures involved at the inter-organizational level aligned with unsuccessful
outcomes and negated organizational initiatives. This resulted in an overall
alignment with unsuccessful procedures. The implication, based on private sector
downsizings, is that the post-downsized hospital system was more costly and less
effective.
PMID: 14730798 [PubMed - indexed for MEDLINE]
186. Aust N Z J Public Health. 2003 Dec;27(6):645-8.
Comparison of health estimates between Victorian Population Health Surveys and
National Health Surveys.
Serraglio A, Carson N, Ansari Z.
Rural and Regional Health and Aged Care Services, Department of Human Services,
Melbourne, Victoria. adrian.serraglio@dhs.vic.gov.au
OBJECTIVE: The computer-assisted telephone interviewing (CATI) method has grown
rapidly in recent years as an epidemiological tool for obtaining data on health
issues. However, it is still argued that coverage, methods and lower response
rates from CATI surveys compared with face-to-face interviewing may have an
impact on the validity of the health estimates obtained. This paper compares
demographic and health estimates from the Victorian Population Health Survey
(VPHS) 2001, using CATI, with the National Health Survey (NHS) 2001 that is based
on face-to-face interviews. METHODS: The profiles of the VPHS (2001) and NHS
(2001) respondents were compared, specifically demographic characteristics (age,
gender, marital status, country of birth, and employment status) and
health-related estimates such as self-reported health status, prevalence of
diabetes and asthma, smoking status, daily intake of fruit, categories of
psychological distress and private health insurance status. RESULTS: In both
surveys, the demographic characteristics and health-related estimates of the
adult population were remarkably similar as shown by the similarity of weighted
estimates and overlapping confidence intervals. CONCLUSIONS: The degree to which
derived estimates correspond in the two independent surveys lends support to the
reliability of the CATI method used for collection of routine population health
related data.
PMID: 14723415 [PubMed - indexed for MEDLINE]
187. J Adolesc Health. 2004 Jan;34(1):79-87.
Why is work intensity associated with heavy alcohol use among adolescents?
Paschall MJ, Flewelling RL, Russell T.
Prevention Research Center, 1995 University Avenue, Suite 450, Berkeley, CA
95704, USA. paschall@pire.org
PURPOSE: To examine and explain the relationship between work intensity (number
of hours worked per week) and heavy alcohol use among adolescents. METHODS:
Analyses were conducted with two waves of in-home interview data provided by a
representative sample of adolescents who participated in the National
Longitudinal Study of Adolescent Health. Multinomial logistic regression analyses
were conducted to determine whether a higher level of work intensity at Wave 1
predicted a higher level of past-year heavy drinking approximately 1 year later
at Wave 2, and the degree to which the relationship between work intensity and
heavy drinking persisted after adjusting for demographic characteristics, alcohol
use before Wave 1, and psychosocial risk and protective factors in family,
school, and peer-individual domains. RESULTS: Higher levels of work intensity at
Wave 1 (11-20 or more than 20 hours/week) were predictive of heavy drinking at
Wave 2. However, these effects were substantially attenuated after adjusting for
demographic characteristics and prior alcohol use. Risk and protective factors
such as school commitment, friends' drinking, and delinquency also partially
explained the effects of work intensity and background variables on heavy
drinking, suggesting that these factors may act as confounders and/or mediators.
CONCLUSIONS: This study suggests that working more than 10 h/week increases the
likelihood of heavy alcohol use among adolescents, and that the effect of work
intensity is largely, but not completely attributable to demographic
characteristics (e.g., age, race/ethnicity, personal income), prior alcohol use,
and family, school, and peer-individual factors.
PMID: 14706409 [PubMed - indexed for MEDLINE]
188. Aust N Z J Public Health. 2003;27(1):27-33.
Socio-economic differentials in the health-related quality of life of Australian
children: results of a national study.
Spurrier NJ, Sawyer MG, Clark JJ, Baghurst P.
Department of Paediatrics and Child Health, Flinders University, Bedford Park,
South Australia, 5042. nicola.spurrier@flinders.edu.au
OBJECTIVE: To examine differences in health-related quality of life (HRQL) of
children living in different socio-economic contexts in Australia. METHODS:
Parental reports describing the HRQL and socio-economic status of a random
national sample of 3,597 school-age children were obtained using the Child Health
Questionnaire (CHQ) and a standardised socio-economic interview. Response rate
was 70%. RESULTS: Children in families of higher income, whose parents had more
years of schooling and were employed and children who lived in two-parent,
original families had significantly higher HRQL across a range of domains
assessed by the CHQ. CONCLUSION: Children from lower socio-economic backgrounds
in Australia have a significantly more negative experience of health and
wellness. Such differences may well increase unless deliberate political
attention is given to addressing the widening differences in relative wealth in
Australia.
PMID: 14705264 [PubMed - indexed for MEDLINE]
189. Br J Psychiatry. 2004 Jan;184:70-3.
Mental health survey of the adult population in Iran.
Noorbala AA, Bagheri Yazdi SA, Yasamy MT, Mohammad K.
Tehran University of Medical Sciences, Tehran, Iran. noorbala@irrcs.org
BACKGROUND: No national data on the prevalence of mental disorders are available
in Iran. Such information may be a prerequisite for efficient national mental
health intervention. AIMS: To determine the mental health status of a population
sample aged 15 years and over. METHOD: Through random cluster sampling, 35 014
individuals were selected and evaluated using the 28-item version of the General
Health Questionnaire. A complementary semi-structured clinical interview was also
undertaken to detect learning disability ('mental retardation'), epilepsy and
psychosis. RESULTS: About a fifth of the people in the study (25.9% of the women
and 14.9% of the men) were detected as likely cases. The prevalence of mental
disorders was 21.3% in rural areas and 20.9% in urban areas. Depression and
anxiety symptoms were more prevalent than somatisation and social dysfunction.
The interview of families by general practitioners revealed that the rates of
learning disability, epilepsy and psychosis were 1.4%, 1.2% and 0.6%,
respectively. Prevalence increased with age and was higher in the married,
widowed, divorced, unemployed and retired people. CONCLUSIONS: Prevalence rates
are comparable with international studies. There is a wide regional difference in
the country, and women are at greater risk.
PMID: 14702230 [PubMed - indexed for MEDLINE]
190. Psychiatr Serv. 2004 Jan;55(1):29-34.
Depression and the ability to work.
Elinson L, Houck P, Marcus SC, Pincus HA.
Westat, 1441 West Montgomery Avenue, Westbrook Building, 2nd Floor, Rockville,
Maryland 20850, USA. lynnelinson@westat.com
OBJECTIVE: Depression can have a serious impact on a person's ability to work.
The purpose of this study was to describe depressed persons who work and
depressed persons who do not work and to identify factors related to depressed
persons' working. METHODS: The combined 1994 and 1995 National Health Interview
Survey Disability Supplement was used to identify persons aged 18 to 69 with
depression. Sociodemographic, health, functional, and disability characteristics
of working depressed persons and nonworking depressed persons were compared with
use of a chi square test of significance. After adjustment for sociodemographic
variables, multiple logistic regression analysis was used to identify factors
associated with work among depressed persons. RESULTS: Approximately half of the
persons who reported major depression were in the labor force. Compared with
nonworking depressed persons, working depressed persons tended to be younger, to
be male, to be better educated, to have a higher income, to live alone or with a
nonrelative, and to live in an urban or suburban location. They less often
perceived themselves as unable to work or as disabled and were healthier and less
impaired by social, cognitive, and physical limitations than their nonworking
counterparts. After sociodemographic factors were controlled for, health and
functional characteristics were strongly associated with depressed persons'
working. CONCLUSIONS: Depressed persons who work and who do not work differed
across sociodemographic, health, functional, and disability factors.
Understanding the factors associated with depressed persons' working and not
working may help policy makers, employers, and clinicians shape health care
benefits packages, employee assistance programs, disability programs, and
treatment programs appropriately. In particular, it may be important to focus on
individuals with depression and comorbid general health conditions.
PMID: 14699197 [PubMed - indexed for MEDLINE]
191. Pediatrics. 2003 Dec;112(6 Pt 2):e521.
The role of race and ethnicity in the State Children's Health Insurance Program
(SCHIP) in four states: are there baseline disparities, and what do they mean for
SCHIP?
Shone LP, Dick AW, Brach C, Kimminau KS, LaClair BJ, Shenkman EA, Col JF,
Schaffer VA, Mulvihill F, Szilagyi PG, Klein JD, VanLandeghem K, Bronstein J.
Strong Children's Research Center, Department of Pediatrics, University of
Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA.
laura_shone@urmc.rochester.edu
BACKGROUND: Elimination of racial and ethnic disparities in health has become a
major national goal. The State Children's Health Insurance Program (SCHIP) has
the potential to reduce disparities among the children who enroll if they exhibit
the same disparities that have been documented in previous studies of low-income
children. To determine the potential impact of SCHIP on racial and ethnic
disparities, it is critical to assess baseline levels of health disparities among
children enrolling in SCHIP. OBJECTIVE: To use data from the Child Health
Insurance Research Initiative (CHIRI) to 1) describe the sociodemographic profile
of new enrollees in SCHIP in Alabama, Florida, Kansas, and New York; 2) determine
if there were differences in health insurance and health care experiences among
white, black, and Hispanic SCHIP enrollees before enrollment in SCHIP; and 3)
explore whether race or ethnicity, controlled for other factors, affected
pre-SCHIP access to health coverage and health care. SETTING: SCHIP programs in
Alabama, Florida, Kansas, and New York, which together include 26% of SCHIP
enrollees nationwide. DESIGN: Telephone interview (mailed survey in Alabama)
about the child's health, health insurance, and health care experiences conducted
shortly after SCHIP enrollment to assess experience during the time period before
SCHIP. SAMPLE: New SCHIP enrollees (0-17.9 years old in Alabama, Kansas, and New
York and 11.5-17.9 years old in Florida). Stratified sampling was performed in
Kansas and New York, with results weighted to reflect statewide populations of
new SCHIP enrollees. MEASURES: Sociodemographic characteristics including income,
education, employment, and other characteristics of the child and the family,
race and ethnicity (white non-Hispanic, black non-Hispanic, and Hispanic [any
race]), prior health insurance, health care access and utilization, and health
status. ANALYSES: Bivariate analyses were used to compare baseline measures upon
enrollment for white, black, and Hispanic SCHIP enrollees. Multivariate analyses
were performed to assess health status and health care access measures (prior
insurance, presence of a usual source of care (USC), and use of preventive care),
controlling for demographic factors described above. Weighted analyses (where
appropriate) were performed by using SPSS, STATA, or SUDAAN. RESULTS: Racial and
ethnic composition varied across the SCHIP cohorts studied, with black and
Hispanic children comprising the following proportion of enrollees, respectively:
Alabama, 33% and <1%; Florida, 16% and 26%; Kansas, 12% and 15%; and New York,
24% and 36%. Black and Hispanic children were more likely to reside in
single-parent and lower-income families. With some variation by state, children
from minority groups were more likely to report poorer health status than were
white children. Relative to white children, children from minority groups in
Florida and New York were more likely to have been uninsured for the entire year
before SCHIP enrollment. In all states, children from minority groups who had
prior coverage were more likely to have previously been enrolled in Medicaid than
in private health insurance and were less likely to have had employer-sponsored
coverage compared with white children. Except in Alabama, there was a difference
in having a USC, with children from minority groups less likely to have had a USC
before SCHIP enrollment compared with white children. No consistent pattern of
health care utilization before SCHIP was noted across states with respect to race
or ethnicity. Findings from multivariate analyses, controlling for
sociodemographic factors, generally confirmed that black and Hispanic children
were more likely to have lacked insurance or a USC before enrollment in SCHIP and
to have poorer health status compared with white children. CONCLUSIONS: SCHIP is
enrolling substantial numbers of racial and ethnic minority children. There are
baseline racial and ethnic disparities among new enrollees in SCHIP, with black
and Hispanic children faring worse than white children on many sociodemographic
and health system measures, and there are differences among states in the
prevalence and magnitude of these disparities. After controlling for
sociodemographic factors, these disparities persisted. IMPLICATIONS FOR
MONITORING AND IMPROVING SCHIP: SCHIP has the potential to play a critical role
in efforts to eliminate racial and ethnic disparities in health among the
children it serves. However, study findings indicate that programmatic efforts
are necessary to ensure that disparities are not perpetuated. Program
effectiveness and outcomes should be monitored by race and ethnicity to ensure
equity in access, use, and outcomes across all racial and ethnic groups.
Assessing the health characteristics and needs of new SCHIP enrollees can provide
a benchmark for evaluating the program's impact on eliminating racial and ethnic
disparities in health and inform service delivery enhancements.
PMID: 14654674 [PubMed - indexed for MEDLINE]
192. Am J Public Health. 2003 Dec;93(12):2074-8.
Racial/ethnic differences in influenza vaccination coverage in high-risk adults.
Egede LE, Zheng D.
Departments of Medicine and of Biometry and Epidemiology, Medical University of
South Carolina, Charleston 29401, USA. egedel@musc.edu
OBJECTIVES: This study identified racial/ethnic disparities in influenza
vaccination in high-risk adults. METHODS: We analyzed data on influenza
vaccination in 7655 adults with high-risk conditions, using data from the 1999
National Health Interview Survey (NHIS). We stratified data by age and used
multiple logistic regression to adjust for gender, education, income, employment,
and health care access. RESULTS: After control for covariates, White patients
with diabetes, chronic heart conditions, and cancer had a higher prevalence of
influenza vaccination than did Black patients with the same conditions.
Similarly, White patients with 2 or more high-risk conditions were more likely to
receive the influenza vaccine than Black patients with the same conditions.
CONCLUSIONS: Significant racial/ethnic differences exist in influenza vaccination
of high-risk individuals, and missed vaccination opportunities seem to contribute
to the less-than-optimal influenza vaccination coverage in the United States.
PMCID: PMC1448155
PMID: 14652337 [PubMed - indexed for MEDLINE]
193. Nurs Stand. 2003 Oct 29-Nov 4;18(7):35-40.
Older nurses and employment decisions.
Watson R, Manthorpe J, Andrews J.
School of Nursing, Social Work and Applied Health Studies, University of Hull.
r.watson@hull.ac.uk
AIM: To investigate the options, decisions and outcomes for nurses aged over 50
in terms of remaining in, retiring from, or returning to, work in the NHS.
METHOD: Interviews were conducted with 18 employers, advisers and policy makers
linked to the nursing labour market. They were conducted by telephone (n = 14) or
face to face (n = 4), recorded (with consent), transcribed and analysed
thematically. Interviews were also held with 84 older nurses who were remaining
in nursing, had retired or had returned to nursing. One focus group was held with
older nurses who 'remained' in Scotland (n = 11) and the rest of the data were
collected in face-to-face and telephone interviews (n = 73). Again, interviews
were recorded (with consent), transcribed and analysed thematically. RESULTS:
There is a gap between the rhetoric of policy and the implementation of practice
in the employment of older nurses. CONCLUSION: Older nurses could continue to
make a valuable contribution to the NHS, especially in light of the shortage of
nurses, but their value is not always recognised. If older nurses are to continue
making a contribution then they need good advice about employment, retirement and
pension options.
PMID: 14639977 [PubMed - indexed for MEDLINE]
194. J Hum Nutr Diet. 2003 Dec;16(6):457-66.
Lay conception of hypertension and its significance to clients and professionals
in nutrition and health.
Rueda-Baclig MJ, Florencio CA.
Department of Food Science and Nutrition, University of the Philippines, Diliman,
Quezon City, Philippines.
BACKGROUND: In line with the Philippines' National Cardiovascular Disease
Prevention and Control Programme, a study was conducted among young adults to
determine their concepts and conceptualization of hypertension: its causation,
prevention and consequences. METHOD: Focus group discussions, conducted in the
region with the highest prevalence of hypertension in the Philippines, 73 males
and females were participated in the age group of 20-39 years, without medical
history of the disease and with no training or employment in a health-related
field. RESULTS: Hypertension was perceived not as a discrete disease but
interrelated with diseases having 'blood-origin' and common signs and symptoms.
It was conceptualized as having multiple causes, acting singly or in combination,
with too little or too much food and physical activity as among the causal
factors. Perceived pathways in its development were systematic and included both
traditional and scientific biomedical concepts. Hypertension was considered a
problem not only in the affected individual but also the family. CONCLUSION: The
concepts of hypertension of young adults are multidimensional, interconnected and
linked to their day-to-day living. In thus conceptualizing the disease, they are
able to make sense of it and, when respected by dietetic practitioners, provide
guidance for improved communication. The introduction of scientific concepts of
hypertension by nutrition and health professionals should draw from, inform and
build on, existing lay perceptions.
PMID: 19774756 [PubMed - indexed for MEDLINE]
195. Acta Neurol Scand. 2003 Dec;108(6):428-34.
Factors affecting the quality of life in patients with epilepsy in Seoul, South
Korea.
Choi-Kwon S, Chung C, Kim H, Lee S, Yoon S, Kho H, Oh J, Lee S.
College of Nursing, Seoul National University, Seoul, South Korea.
smi@plaza.snu.ac.kr
OBJECTIVES: The level of, and factors affecting the quality of life (QOL) in
patients with epilepsy may be different in Korea where social prejudice toward
them is still pronounced. However, these issues have not yet been addressed
properly. METHODS: We consecutively identified 154 epilepsy patients who visited
the outpatient clinic at the Seoul National University Hospital. An interview was
performed by two research nurses with the use of a standardized questionnaire,
which included data pertaining to seizure characteristics, symptoms of
depression/anxiety, social support, family life/social life satisfaction, and the
activities of daily living (ADLs). The QOL was assessed with the use of QOL in
Epilepsy Inventory (QOLIE-31). RESULTS: Factors affecting the QOL were: age
(P<0.01), education in years (P<0.01), employment status (P<0.05), employment
type (P<0.05), current economic status (P<0.05), seizure frequency (P<0.01), the
number of antiepileptic drugs (P<0.01), family life/social life dissatisfaction
(P<0.01, respectively), social support (P<0.01), the symptoms of anxiety and
depression (P<0.01, respectively) and ADL dysfunction (P<0.01). In multiple
regression analysis, the symptom of anxiety was the most important factor in
explaining lower QOL in patients with epilepsy, while depression (P<0.01), social
life dissatisfaction (P<0.01), ADL dysfunction (P<0.05) and seizure frequency
(P<0.05) were also significant factors. CONCLUSION: Psycho-social factors
outweighed the physical factors in determining QOL in Korean epilepsy patients.
Recognition of these factors will lead health professionals to develop different
strategies to improve the QOL of these patients.
PMID: 14616296 [PubMed - indexed for MEDLINE]
196. Health Qual Life Outcomes. 2003 Oct 3;1:48.
Functional status of persons with chronic fatigue syndrome in the Wichita,
Kansas, population.
Solomon L, Nisenbaum R, Reyes M, Papanicolaou DA, Reeves WC.
Division of Viral and Rickettsial Diseases, National Center for Infectious
Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
zfk9@cdc.gov
Comment in:
Health Qual Life Outcomes. 2003;1:52.
BACKGROUND: Scant research has adequately addressed the impact of chronic fatigue
syndrome on patients' daily activities and quality of life. Enumerating specific
problems related to quality of life in chronic fatigue syndrome patients can help
us to better understand and manage this illness. This study addresses issues of
functional status in persons with chronic fatigue syndrome and other fatiguing
illnesses in a population based sample, which can be generalized to all persons
with chronic fatigue. METHODS: We conducted a random telephone survey in Wichita,
Kansas to identify persons with chronic fatigue syndrome and other fatiguing
illnesses. Respondents reporting severe fatigue of at least 1 month's duration
and randomly selected non-fatigued respondents were asked to participate in a
detailed telephone interview. Participants were asked about symptoms, medical and
psychiatric illnesses, and about physical, social, and recreational functioning.
Those meeting the 1994 chronic fatigue syndrome case definition, as determined on
the basis of their telephone responses, were invited for clinical evaluation to
confirm a diagnosis of chronic fatigue syndrome. For this analysis, we evaluated
unemployment due to fatigue, number of hours per week spent on work, chores, and
other activities (currently and prior to the onset of fatigue), and energy level.
RESULTS: There was no difference between persons with chronic fatigue syndrome
and persons with a chronic fatigue syndrome-like illness that could be explained
by a medical or psychiatric condition for any of the outcomes we measured except
for unemployment due to fatigue (15% vs. 40%, P <.01). Persons with chronic
fatigue syndrome and other fatiguing illnesses had substantially less energy and
spent less time on hobbies, schooling, or volunteer work than did non-fatigued
controls (P <.01). CONCLUSIONS: Persons with chronic fatigue syndrome are as
impaired as persons whose fatigue could be explained by a medical or psychiatric
condition, and they have less energy than non-fatigued controls.
PMCID: PMC239865
PMID: 14577835 [PubMed - indexed for MEDLINE]
197. 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]
198. Aust N Z J Psychiatry. 2003 Oct;37(5):577-85.
Quality of life of community-based chronic schizophrenia patients in Penang,
Malaysia.
Mubarak AR, Baba I, Chin LH, Hoe QS.
School of Social Administration and Social Work, Flinders University of South
Australia, Bedford Park, Adelaide. mubarak@flinders.edu.au
OBJECTIVE: This is a study of the quality of life (QOL) of 174 community-based
chronic schizophrenia patients in Penang, Malaysia. METHOD: The study samples
were selected from the Out Patient Department, Department of Psychiatry, Penang
General Hospital, Malaysia. The data was collected through personal interviews
with the respondents. A questionnaire prepared by the research team was used to
collect data on background characteristics. Lehman's (1988) Quality of Life
Interview was used to collect data on patients' QOL. RESULT: Equal number of
males and females participated in the study. The interviews on QOL indicated
problems in the areas of life in general, place of living, daily activities,
social relations, finance, work and general health. The results also revealed
that community-based schizophrenia patients had acute poverty and experienced
social isolation, discrimination and exploitation in the workplace. CONCLUSION:
Implications of these results on the implementation process of National Mental
Health Policy in Malaysia are discussed. The research paper also discusses the
negative impacts of limited rehabilitation facilities available in the community
and its implications on the QOL of severely mentally ill patients. The need for
immediate research attention on QOL of such patients in the South-east Asian
region has been highlighted.
PMID: 14511086 [PubMed - indexed for MEDLINE]
199. Diabetes Care. 2003 Sep;26(9):2562-7.
Association between number of physician visits and influenza vaccination coverage
among diabetic adults with access to care.
Egede LE.
Department of Medicine, Medical University of South Carolina, Charleston, South
Carolina 29401, USA. egedel@musc.edu
OBJECTIVE: The proportion of diabetic adults that receives the influenza vaccine
is less than ideal. This study determined the relationship between the number of
physician visits in the previous 12 months and the likelihood of influenza
vaccination among diabetic adults with access to care. RESEARCH DESIGN AND
METHODS: Data on 1807 diabetic adults with access to care in the 1999 National
Health Interview Survey (NHIS) were analyzed. Prevalence of influenza vaccination
was determined by number of physician visits. Logistic regression was used to
determine the independent association between number of physician visits and
influenza vaccination coverage, controlling for age, sex, race/ethnicity,
education, income, employment census region, and comorbidity. STATA was used for
analyses to account for the complex sampling design of NHIS. RESULTS: Overall,
56% of subjects received the influenza vaccine. Proportions vaccinated by number
of physician visits were as follows: 35% (no visit), 47% (1-3 visits), 58% (4-9
visits), and 61% (>or=10 visits). Compared with people with no physician visit,
people with 4-9 visits (odds ratio [OR] 2.61) and >or=10 visits (2.96) were
significantly more likely to be vaccinated. However, after controlling for
covariates, only people with >or=10 visits (2.34) were significantly more likely
to be vaccinated. CONCLUSIONS: In this nationally representative sample, repeated
physician visits by diabetic adults with access to care were associated with only
modest increases in influenza vaccination coverage. In adjusted analysis, odds of
influenza vaccination were not significantly associated with number of physician
visits, except in people with >or=10 visits.
PMID: 12941719 [PubMed - indexed for MEDLINE]
200. 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]