Introduction Recent studies suggest that female workers face a greater risk of long-term chronic disease than male workers. A 2008 Mexican study indicated that older female workers have an elevated prevalence of arthritis, diabetes, and hypertension compared to men. A recent U.S. study showed that women working long hours have an elevated risk for chronic disease later in life compared to men. South Korean researchers reported that women in nonstandard jobs are more likely to suffer chronic mental disorders. However, little is known about why female workers have a comparatively greater risk of long term chronic disease. Methods This study involves conducting a systematic literature review followed by a meta analysis of studies involving chronic disease among working women, particularly focusing on populations of working women who are aged fifty and older. The review also focuses on identifying distinctive aspects of women’s work in specific occupational groups in an international context. Result Initial results from the analysis suggest several explanations: a) the evidence is relatively strong that working long hours for extended periods of time raises the likelihood for chronic disease, b) the literature suggests that shift work and disruption of circadian rhythms among women can create long-term chronic health problems, c) women are often required to perform multiple roles at home and work which place greater stress on the women’s ability to meet those additional responsibilities, d) because of those obligations, many working women may not have sufficient time to take care of their health, and e) some demanding physical tasks might be difficult to perform because of inherent gender-based biological constraints (e.g., performing heavy materials-handling tasks). Discussion More specific empirical study of the reasons for elevated chronic disease risk among working women is needed. Additionally, workplace-based interventions to screen affected women for chronic disease should be adopted.

The United States has many resources for providing services to workers with disabilities, including state-based workers' compensation insurance and federal programs such as Social Security Disability Insurance. Legislation exists to protect the rights of people with disabilities, provide wage protection in event of disability, supply rehabilitation services, and support return to productive work. However, there is no central authority for coordinating work disability issues, resulting in fragmentation, inefficiency, and redundancy among systems. Of considerable concern is the ambient atmosphere of distrust that too often taints efforts to create a more harmonious social system for addressing work disability needs.

Objectives: This study aims at evaluating the chronic disease risk related to prolonged work in long-hour schedules for eight major chronic diseases: heart disease, non-skin cancer, arthritis, diabetes, chronic lung disease, asthma, chronic depression, and hypertension. Methods: The study used data from the National Longitudinal Survey of Youth, 1979 covering 32 years of job history (1978 to 2009) for 7492 respondents. Logistic regression analyses were performed to test the relationship between average weekly work hours, and the reported prevalence of those conditions for each individual. Results: Regularly working long hours over 32 years was significantly associated with elevated risks of heart disease, non-skin cancer, arthritis, and diabetes. The observed risk was much larger among women than among men. Conclusions: Working long-hour schedules over many years increases the risk for some specific chronic diseases, especially for women.

Appointment wait times are a neglected dimension of children's access to psychiatry. We systematically examined how long an adolescent waits for a new patient appointment with a psychiatrist for routine medication management. From state directories, we identified 578 providers of adolescent psychiatric care in Ohio. Researchers posing as parents telephoned randomly selected offices, seeking care for a hypothetical 14-year-old patient under different scenarios. Overall, we measured 498 wait times at 140 unique offices. The median wait time was 50 days (interquartile range = 29-81 days). In adjusted models, adolescents with Medicaid waited longer than those with private insurance, especially during the spring (geometric mean = 50.9 vs. 41.9 days; p = 0.02). Wait times also varied markedly by region, with geometric means ranging from 22.4 to 75.1 days (p < 0.01). This study demonstrates that adolescents often experience lengthy wait times for routine care. This methodology represents a useful approach to real-time monitoring of psychiatric services.

OBJECTIVE:Regular use of recommended preventive health services can promote good health and prevent disease. However, individuals may forgo obtaining preventive care when they are busy with competing activities and commitments. This study examined whether time pressure related to work obligations creates barriers to obtaining needed preventive health services. METHODS:Data from the 2002-2010 Medical Expenditure Panel Survey (MEPS) were used to measure the work hours of 61,034 employees (including 27,910 females) and their use of five preventive health services (flu vaccinations, routine check-ups, dental check-ups, mammograms and Pap smear). Multivariable logistic regression analyses were performed to test the association between working hours and use of each of those five services. RESULTS:Individuals working long hours (>60 per week) were significantly less likely to obtain dental check-ups (OR=0.81, 95% CI: 0.72-0.91) and mammograms (OR=0.47, 95% CI: 0.31-0.73). Working 51-60 h weekly was associated with less likelihood of receiving Pap smear (OR=0.67, 95% CI: 0.46-0.96). No association was found for flu vaccination. CONCLUSIONS:Time pressure from work might create barriers for people to receive particular preventive health services, such as breast cancer screening, cervical cancer screening and dental check-ups. Health practitioners should be aware of this particular source of barriers to care.

Objective: This study examines the effect of taking a health risk assessment (HRA) on health care costs, utilization, and member health risks over a 3-year period. Methods: This retrospective cohort study examined changes utilization, costs, and health risks among a random sample of 500 employees completing an HRA compared with a matched group of 500 employees who did not complete an HRA. Results: The HRA group accessed services more frequently and at a lower overall cost, was more likely to utilize primary care and preventive services after the HRA, and improved on seven out of eight health risk measures. Conclusions: This study demonstrates that significant and sustained improvement in health risks and lower health care costs may be achievable with efforts such as an HRA that seeks to engage employees in health improvement efforts.

Increasing emphasis is being placed on measuring return on research investment and determining the true impacts of biomedical research for medical practice and population health. This article describes initial progress on development of a new standardized tool for identifying and measuring impacts across research sites. The Translational Research Impact Scale (TRIS) is intended to provide a systematic approach to assessing impact levels using a set of 72 impact indicators organized into three broad research impact domains and nine subdomains. A validation process was conducted with input from a panel of 31 experts in translational research, who met to define and standardize the measurement of research impacts using the TRIS. Testing was performed to estimate the reliability of the experts' ratings. The reliability was found to be high (ranging from .75 to .94) in all of the domains and most of the subdomains. A weighting process was performed assigning item weights to the individual indicators, so that composite scores can be derived.

BACKGROUND:A standardized process using data from the Occupational Information Network (O*NET) is applied to estimate the association between long-term aggregated occupational exposure and the risk of contracting chronic diseases later in life. We demonstrate this process by analyzing relationships between O*NET physical work demand ratings and arthritis onset over a 32-year period.METHODS:The National Longitudinal Survey of Youth provided job histories and chronic disease data. Five O*NET job descriptors were used as surrogate measures of physical work demands. Logistic regression measured the association between those demands and arthritis occurrence.RESULTS:The risk of arthritis was significantly associated with handling and moving objects, kneeling, crouching, and crawling, bending and twisting, working in a cramped or awkward posture, and performing general physical activities.CONCLUSION:This study demonstrates the utility of using O*NET job descriptors to estimate the aggregated long-term risks for osteoarthritis and other chronic diseases when no actual exposure data is available.

Objective: This study uses 32 years of longitudinal job history to analyze the long-term effect of exposure to specific workplace conditions on the risk of contracting asthma or chronic lung disease later in life. Our approach allows for the estimation of occupational respiratory risks even in the absence of direct environmental monitoring. Methods: We employ a novel methodology utilizing data from the National Longitudinal Survey of Youth 1979 (NLSY79), and ratings of job exposures from the Occupational Information Network (O*NET), which are based on 70 years of empirical data compiled by the U. S. Department of Labor. A series of multivariable logistic regression analyses are performed to determine how long-term exposure to a particular occupational O*NET indicator (e.g., working in an extremely hot or cold environment) is related to asthma and COPD risk. Results: The risk of contracting COPD was significantly associated with long-term work in very hot or cold temperatures (OR = 1.50, CI: 1.07-2.10), performing physically demanding activities (OR = 1.65, CI: 1.20-2.28), working outdoors exposed to weather (OR = 1.45, CI: 1.06-1.99), and workplace exposure to contaminants (OR = 1.42, CI: 1.05-1.96). In general, the effects of exposure were greater for COPD than for asthma. With respect to contracting asthma, only exposure to work in very hot or cold temperatures (OR = 1.35, CI: 1.08-1.70) and performing physically demanding activities (OR = 1.23, CI: 1.00-1.52) were statistically significant. Conclusions: Use of O*NET job descriptors as surrogate measures of workplace exposures can provide a useful way of analyzing the risk of occupationally-related respiratory disease in situations where direct exposure measurement is not feasible.

Background Many health care facilities have developed electronic reporting systems for identifying and reporting adverse events (AEs), so that measures can be taken to improve patient safety. Although several studies have examined AEs in surgical settings, there has not previously been a systematic assessment of the variations in adverse event rates among different types of surgery, nor an identification of the particular types of AEs that are most common within each surgical category. Additionally, this study will identify the AE severity level associated with each of the AE category types. Methods This retrospective observational study was conducted at three Midwestern hospitals that are part of a large integrated healthcare system. Data from 2006 through 2009 were analyzed to determine the rates of reported adverse events (per 1,000 hospitalizations involving a surgical procedure) for 96 categories of surgery as classified according to the ICD-9-CM procedural coding system. Univariate and bivariate summary statistics were compiled for AEs by type, severity, and patient age. Results During the four-year study period, there was a total of 82,784 distinct hospitalizations involving at least one surgical procedure at these three hospitals. At least one adverse event was reported at 5,368 (6.5%) of those hospitalizations. The mean rate of AEs among all surgical procedure groups was 82.8 AEs per 1,000 hospitalizations. Adverse event rates varied widely among surgical categories with a high of 556.7 AEs per 1,000 hospitalizations for operations on the heart and pericardium. The most common type of adverse event involved care management, followed by medication events and events related to invasive procedures. Conclusions Detecting variations in AEs among surgical categories can be useful for surgeons and for hospital quality assurance personnel. Documenting the specific AE incidence rates among the most common types of surgical categories, and determining AE severity and age distributions within surgical categories will enable officials to better identify specific patient safety needs and develop appropriately targeted interventions for improvement.

A coalition of employers in the hotel and restaurant industries collaborated with community-based organizations to undertake a unique demonstration project, called the Employed Latino Health Initiative, aimed at improving access to basic health care services for low-wage Latino workers in Columbus, Ohio. With grant funding from the Robert Wood Johnson Foundation, the project developed and tested protocols allowing Latino workers from participating companies to obtain basic health care screenings, referrals to medical providers, health education training, and the services of a qualified community health navigator. Data from the pilot project indicated high screening participation rates, extensive referrals to providers for follow-up care, and a substantial need for facilitation services by community health navigators. The project provides a model for how employers can potentially promote their own interests in boosting work productivity through facilitating expanded access to basic medical services among vulnerable workers, despite the absence of conventional health insurance coverage.

Over the past 20 years, states have increasingly moved away from centrally financed, state-operated facilities to financing models built around community-based service delivery mechanisms. This paper identifies four important broad factors to consider when developing a funding formula to allocate state funding for community mental health services to local boards in an equitable manner, based on local community need: (1) funding factors used by other states; (2) state specific legislative requirements; (3) data availability; and (4) local variation of factors in the funding formula. These considerations are illustrated with the recent experience of Ohio using available evidence and data sources to develop a new community-based allocation formula. We discuss opportunities for implementing changes in formula based mental health funding related to Medicaid expansions for low income adults scheduled to go into effect under the new Patient Protection and Affordable Care Act.

PurposeThis study aims to evaluate whether employees consider employer‐sponsored elder‐care programs to benefit aging family members and whether those programs help employees with caregiving needs, stay productively employed.Design/methodology/approachA nationwide internet‐based survey was conducted between December 2008 and May 2009, eliciting information from 447 users of employer‐sponsored elder‐care services. Survey participants were employed individuals who had requested assistance from one of five national elder‐care service provider organizations (SPOs) during the preceding two years.FindingsA majority of respondents reported that the services helped them to keep working productively (74.0 percent), avoid job absences (65.5 percent), stay employed (58.0 percent), and maintain a good family life at home (72.1 percent). Respondents were generally satisfied with the services provided by SPOs. However, most respondents did not feel that the services help minimize caregiving expenses.Originality/valueTo the best of the authors' knowledge, this is the first US study evaluating the usefulness of employer elder‐care programs, based on the perspectives of employees who have used the programs.

BACKGROUND:This study aims to identify the statistical software applications most commonly employed for data analysis in health services research (HSR) studies in the U.S. The study also examines the extent to which information describing the specific analytical software utilized is provided in published articles reporting on HSR studies.METHODS:Data were extracted from a sample of 1,139 articles (including 877 original research articles) published between 2007 and 2009 in three U.S. HSR journals, that were considered to be representative of the field based upon a set of selection criteria. Descriptive analyses were conducted to categorize patterns in statistical software usage in those articles. The data were stratified by calendar year to detect trends in software use over time.RESULTS:Only 61.0% of original research articles in prominent U.S. HSR journals identified the particular type of statistical software application used for data analysis. Stata and SAS were overwhelmingly the most commonly used software applications employed (in 46.0% and 42.6% of articles respectively). However, SAS use grew considerably during the study period compared to other applications. Stratification of the data revealed that the type of statistical software used varied considerably by whether authors were from the U.S. or from other countries.CONCLUSIONS:The findings highlight a need for HSR investigators to identify more consistently the specific analytical software used in their studies. Knowing that information can be important, because different software packages might produce varying results, owing to differences in the software's underlying estimation methods.

Résumé.En Grande‐Bretagne au XIXe siècle, les premières réglementations sur le temps de travail étaient motivées par des préoccupations humanitaires concernant les femmes et les enfants travaillant dans les usines. Aux Etats‐Unis, les lois sur le temps de travail ont initialement été introduites en réponse aux revendications syndicales et aux conflits sociaux. Durant le XXe siècle, les décideurs politiques ont adopté des lois réduisant le nombre d'heures de travail afin de répartir le travail disponible et résorber ainsi le chômage. Avec l'adoption de la Directive européenne sur le temps de travail, les vingt années écoulées ont reflété un mouvement vers l'intégration sociale et politique, les pressions politiques continues dans la lutte contre le chômage, et l'acceptation croissante de l'ergonomie et des méthodes d'organisation du travail comme composantes de la réglementation internationale sur la sécurité.

This study presents the results of a pilot study of mandatory pre-release testing for sexually transmitted disease (STD) and a behavioral risk survey for male inmates at an Ohio prison. Approximately 4–6 weeks prior to scheduled release, inmates took part in a mandatory blood test and optional genital swab and physical examination to test for STDs. At the time of testing, a voluntary behavioral and knowledge survey was administered to inmates. Pre-release testing identified 53 new cases of STDs among the 916 inmates (5.5%) scheduled for release during the pilot study period. Trichomoniasis and hepatitis C were the most common infections identified through pre-release testing. Nearly all inmates participated in the required blood test. Participation rates for the other testing methods averaged less than 45%. Inmates reported engaging in various risky behaviors during incarceration such as having sex (12.1%), tattooing (36.5%), and drug use (19.5%). Pre-release testing identified several new cases of STDs not identified through existing intake and for-cause testing procedures. Substantial useful information about the prevalence of STD risk behaviors can be obtained through a pre-release survey.

Some U.S. employers sponsor elder care assistance programs to help workers address the care needs of aging family members. Employers hope that by offering these services, workers will be able to maintain productive employment and avoid job absences. This article extends previous research on the effectiveness of these programs by reporting on case studies performed at three employer firms having particularly effective programs, as judged by employees who used the firms' services during the past 2 years. Based on the case studies and a synthesis of previous research, the authors identify best practices and policy recommendations for employer elder care programs nationally.