Pre- and postoperative factors associated with return to work following surgery for lumbar spinal stenosis

Low back disorders are an increasingly common and costly health problem in Western countries. It has been recommended that the return to work of patients should be the most important outcome measure of medical care. The aim of this study was to compare women's and men's working capacity after lumbar spinal stenosis (LSS) operations and to identify the factors related to it. The subjects of this study were 185 women (mean age 54 years, mean follow-up time 4.2 years) and 254 men (mean age 52 years, mean follow-up time 4.3 years). After the operation, 37% of the women and 41% of the men returned to work. None of the patients who had retired before the operation returned to work afterward. The variables that predicted postoperative ability to work for women were: being fit to work at the time of operation, age <50 years at the time of operation, and duration of LSS symptoms <2 years. For men, these variables were: being fit to work at the time of operation, age <50 years at the time of operation, no prior surgery, and the extent of the surgical procedure equal to or less than 1 laminectomy. Women's and men's working capacity do not differ after LSS operation. If the aim is to maximize working capacity, then, when an LSS operation is indicated, it should be performed without delay. In LSS patients who are >50 years old and on sick leave, it is unrealistic to expect that they will return to work. Therefore, after such an extensive surgical procedure, re-education of patients for lighter job could improve the chances of these patients returning to work. © 1996 Wiley-Liss, Inc.     

Factors associated with work ability and intention to leave nursing profession: a nested case-control study

This study aims to identify factors associated with impaired work ability and intention to leave the nursing profession. This is a case-control nested within a cross-sectional study. Samples were randomly selected for work ability (475 controls and 158 cases) and intention to leave profession (454 controls and 151 cases). Data on demographic, lifestyle, occupational features, work environment, work ability and intention to leave profession were collected. Multiple logistic regression analysis was performed. Factors associated with work ability impairment were: risk for moderate (OR=1.28) and high (OR=2.26) job strain, effort-reward imbalance (OR=2.82), high overcommitment (OR=1.77), situations that may contribute to musculoskeletal pain/injury with moderate (OR=1.82) or high (OR=2.58) exposures, degree level (OR=2.13) or elementary/high school level (OR=1.67), and low physical activity (OR=1.74). Age of 31–40 years (OR=0.26) and ≥41 years (OR=0.27) were protective factors. Factors associated with intention to leave profession were: high risk for job strain (OR=1.81), effort-reward imbalance (OR=3.25), situations that may contribute to musculoskeletal pain/injury with high exposure (OR=1.54), and insomnia symptoms (OR=2.72). Age >40 years was a protective factor (OR=0.50). Individual characteristics and occupational conditions were associated with work ability impairment and intention to leave profession. Measures to improve working conditions and individual resources were recommended.     

Factors associated with the willingness of primary caregivers to avail of a dengue vaccine for their 9 to 14-year-olds in an urban community in the Philippines

To help address the need for preventive measures against dengue fever, a leading cause of child mortality in the Philippines, vaccine trials are ongoing and a tetravalent vaccine (Dengvaxia™, Sanofi Pasteur) has been developed. It is hypothesized that while acceptability would be high among primary caregivers (i.e., parents/guardians), the willingness to have one's child immunized against dengue would be associated with socio-demographic variables, attitudes and knowledge regarding dengue and vaccination, and past experience with dengue. This study aimed to assess the aforementioned factors’ association with primary caregivers’ willingness to avail of a dengue vaccine for their 9 to 14-year-old children in an urban community in the Philippines.A cross-sectional study utilizing interviews was conducted to determine which factors were associated with willingness-to-avail assuming a free vaccine, and a case study utilizing a focus group discussion was employed to capture some underlying reasons for their willingness. Data were analyzed using multiple logistic regression and thematic analysis.Among the 202 study participants, 193 (95.54%) were willing to avail of the vaccine. There was a high probability of vaccine acceptance by primary caregivers (95.54%), with good attitude towards vaccination (≥12/15 points) [aOR 10.62, 90% CI (1.73–26.28)] and large household size (>5) [aOR 9.63, 90% CI (2.04–45.58)] being positively associated with willingness-to-avail, and good knowledge regarding dengue fever [aOR 0.10, 90% CI (0.03–0.74)] and older age (>44 years) [aOR 0.14, 90% CI (0.03–0.61)] being negatively associated.Crude analysis showed that household size, knowledge regarding dengue, and attitude towards vaccination were significantly associated with willingness. Multivariate analysis revealed that these factors and the primary caregiver’s age were associated with willingness. Thematic analysis showed various perceptions regarding dengue and vaccination. Knowing these factors are associated with willingness-to-avail of the vaccine may help in understanding the audience of health promotion projects aimed at increasing immunization coverage.